Retail healthcare clinics are popping up everywhere, from strip malls, to grocery stores, to big-box retailers. In fact there are now over 1,400 stand-alone clinics across the country, or twice as many as five years ago. The number of urgent care facilities that treat more serious ailments and injuries has also blossomed to over 9,300 – that’s up from 8,000 in 2008 according to a report from the Washington Post.
Often called “Doc-in-a-box medicine,” urgent care is a low-margin, high-volume proposition that has mushroomed into an estimated $14.5 billion business. Why are these alternatives to the doctor’s office so popular? “We expect to do our banking 24 hours a day, seven days a week, and to shop 24/7,” says Dr. Ateev Mehrotra, an associate professor in the Department of Health Care Policy at Harvard Medical School and an adjunct policy analyst at the RAND Corporation, “So now we want our health care to be 24/7.”
Franz Ritucci, president of American Academy of Urgent Care Medicine, calls it the McDonald’s society. “We want what we want when we want it,” he says. That’s particularly true if what we want is a doctor to look at our sick child, so urgent care centers, retail clinics, and even concierge medicine are attracting people who don’t want to wait to see a physician.
But it is also profits that are driving the proliferation of these point-of-care clinics – both in cost savings for patients and dollars earned for investors.
Let’s say you’re suffering with chest congestion and a bad cough. You call your family physician, but can’t get an appointment for days. You’re feeling worse by the minute, so you head to the closest ER. You’re diagnosed with acute bronchitis and the emergency department bill (according to Blue Cross Blue Shield) would be about $812. Alternately, you could have gone to an urgent care facility for the same treatment. You didn’t need an appointment, you likely waited less than 30 minutes to see a doctor, and the treatment cost $122. Even if isn’t an issue, a savings of $690 means most patients would choose an urgent care clinic.
Another reason urgent care centers thrive? In an article for KevinMD, Richard Young, MD, says insurance companies will pay $150 to urgent care facilities, but only $70 to a family medicine center for the same diagnoses and treatment. It’s unclear whether such urgent care centers offer better or worse care than other providers, but some family physicians (who stand to lose business to these clinics) wonder if patients are getting convenience but forsaking quality. Although urgent care clinics have been working hard to keep up communications with primary physicians, some doctors worry that urgent care centers create disjointed care for patients because urgent care clinics tend to focus on fixing a single problem. "Family doctors take a more holistic view of a person," says Glen Stream of the American Academy of Family Physicians.
What’s more, experts say, the difficulty of getting an appointment at a regular doctor’s office could make these clinics the only realistic option for some consumers. An Association of American Medical Colleges report says the U.S. could lose as many as 10,000 doctors by the year 2025 – and primary-care physicians could account for as much as one-third of the shortage – which means it’s only going to get more difficult to see a primary-care physician.
Although proponents say they don’t intend point-of-care clinics to replace conventional doctors, the healthcare system has been steering patients toward them with incentives consumers are finding hard to resist. And for now, at least, many patients seem satisfied visiting urgent care clinics.
However, urgent care centers won’t take on the more difficult issues. The proliferation of the walk-in clinics is largely an effort by the overburdened health system to divert patients with minor ailments to facilities that are less expensive than the emergency room. ERs are also required by law (EMTALA) to see and stabilize every patient, regardless of their ability to pay. Urgent care centers have no such obligation.
Do doctors want to work in urgent care? The answer looks like yes. Healthcare reform and an evolving market are shaping who urgent care doctors are and how they practice medicine. Today the American Academy of Urgent Care Medicine says about 20,000 physicians practice urgent care medicine and that number is growing. They cite that pay is generally better and physicians are offered better hours. As the physician shortage persists, urgent care centers provide a more efficient way for doctors and patients to make use of their time.
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