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When Is Urgent Care the Right Care?

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Shiny, new signs—usually red and blue with medical-themed logos—announce that another urgent care center has opened in a Main Line-area town. Residents typically receive oversized postcards touting “extended hours,” “flat fees” and the über-appealing “no waiting time.” 

But ask 10 people the difference between urgent care clinics, emergency rooms and primary care, and an equal number of different opinions emerge. It’s clear that urgent care facilities are marketing themselves as a hybrid of the latter two things, but there’s also a big difference between them. “I think it can be difficult for patients to know the appropriate level of care to seek for their symptoms,” says Dr. Steve Gamburg, chairman of the department of emergency medicine for Main Line Health. “The thought process may be: ‘I have pain in my shoulder. Is it because I lifted something heavy? Or am I having a heart attack?’ Or: ‘My kid has a sore throat. Is it a regular sore throat, or could it be something more serious?’”

The concern is that patients will make the wrong decision about where to go, wasting what could be valuable time. And that’s not because urgent care clinics are exaggerating their capabilities. Gamburg makes it clear that they’re not. 

In fact, Main Line Health has its own urgent care center in Exton Square. It houses the state-of-the-art facilities of a number of doctors, many of them specialists. Its Broomall location offers extended hours. But it’s not certified in urgent care. 

Confused yet? That’s the problem: the public’s perception—or misperception—of where to go for what and when. Why drive to an emergency room and wait for hours when an urgent care clinic is available? “There are many things incorrect about that statement,” Gamburg says. “But I agree that many people are thinking that exact thing.” 

To patients, every medical situation is an emergency, and no one wants to wait to receive care. “Our goal is not to confuse or compromise patient care, but to provide an alternative to primary care and ERs when appropriate,” says Jim Raporte, operations director for AFC Doctors Express locations in Narberth, Downing-town and South Philadelphia. “We want patients to be educated about where to go to seek the right level of care.”

Dr. Kate Kirksey is the primary physician at AFC Doctors Express in Narberth. She explains that urgent care facilities are there to treat coughs, colds and flu; provide physicals for schools, camps and workplaces; administer vaccines; conduct drug screenings; screen and treat urinary tract infections; and X-ray and set fractures and sprains. 

There’s nothing remarkably urgent about those situations. Raporte, however, says the “urgent” refers to the speed with which patients see doctors. While primary care physicians can perform many of the above duties, getting appointments with them can take weeks, says Raporte—and office hours are often limited. 

“Our urgent care industry is growing because the primary care field has not evolved to meet patients’ needs,” Raporte says. “I’m not talking about the skills of primary care physicians. I’m talking about the administration of the care —the management end. Primary care doctors are shutting down because they’re inundated with insurance red tape and other such paperwork.”

Meanwhile, primary care offices aren’t open on weekends or most evenings, and that’s when patients have time to see them. “Many people don’t want to take a day off work to see a doctor, so they delay care until their problem is a real  mergency,” Raporte says. “I think primary care should have adapted to the needs of patients and their lives, instead of expecting us to accommodate it.”

Dr. Geoff Winkley built his practice around that premise. In 2010, he opened one of the first urgent care clinics in the area: Doctor’s Best Immediate Medical Care in Berwyn. Winkley is a board-certified emergency medicine physician with 20 years of experience. “But when I worked in the ER, we saw patients coming in for colds because their primary care doctors were too busy to see them,” Winkley says. “That’s not good for the patients or the ERs.”

Gamburg refutes that. “I don’t believe that primary care offices are overbooked and that it takes weeks to get an appointment,” he says. “Yes, they are closed on most weekends and often in the evenings. But most health systems and individual practices have been evolving to meet patients’ needs.”

But Raporte is confident in his belief that patients really do want extended hours and immediate medical attention. Winkley agrees. “The main problem is one of access for patients,” he says. “If you want to schedule an appointment, fine. But if you need help today, that’s tough to accommodate.”

At Doctor’s Best Immediate Medical Care, patients are seen on a walk-in basis; no appointments are needed or accepted. Winkley and his staff receive the most patients on Saturdays, Sundays and weekday evenings. “When primary care offices are closed, our volume goes through the roof,” he says. “We also have a tremendously high rate of returning patients.”

And they often want Doctor’s Best to be their PCP. “But we can’t be, because we don’t do the preventative care that primary care physicians do,” he says. “We also don’t do the long-term management of a case that some patients require.”

As for emergency rooms, Winkley and Raporte state firmly that urgent care centers are not attempting to replace them. “When patients are having medical emergencies that are beyond the scope of what our facilities can treat, we get them to the nearest emergency room as quickly as possible,” Winkley says.

Those emergencies include heart attack, stroke, severe burns, head trauma, loss of consciousness, punctures or lacerations requiring surgery, and women going into labor. “On the other hand,” Raporte says, “urgent care is a good alternative for things that we can treat, because the average ER wait is two to four hours. Our wait time is 20 minutes.”

Wait time is not two to four hours at Main Line Health emergency rooms, says Gamburg. At Lankenau Medical Center and Bryn Mawr, Riddle and Paoli hospitals, the average wait time is 20-25 minutes. The image of emergency rooms as patient holding areas is outdated, he says. “We revised the processes by which we respond to care,” Gamburg explains. “We—and many other ERs around the country—have rapid evaluation units and a fast-track system. We work in parallel systems rather than serial. Serial processes restrict physicians to work in order, one action at a time. That’s been replaced with parallel processing, where we can do many things simultaneously.”

Another fuzzy issue: cost. Word has it that urgent care clinics do not accept insurance. Not true, Winkley contends. “The vast majority of urgent care clinics take the vast majority of health insurances,” he says. “But it is up to the insurance  ompany to decide what it will pay for. That’s true with every kind of medical care. To that end, we have extensive conversations with patients about insurance.”

There is one simple aspect of urgent care, and that’s the ability to self-pay for services. At Doctor’s Best, the fee for an evaluation is $129, which Winkley says is aligned with the cost of visiting a primary care physician. Tests and procedures are charged separately. At Doctors Express, the average cost for a visit is $120-$150, Raporte says. “That is much less expensive than an ER,” he says. “Hospitals have all of that cost—patient care, machines, technology, staff—to absorb. They can’t streamline their costs the way we do.”

Gamburg raises an eyebrow at that claim. “You can’t make a blanket statement like that,” he says. “If you need the full gamut of tests that we will run, then you have to expect a higher fee. If not, then we charge only for what we do, and that can be similar to an urgent care facility.”

He also adds that the bonus of being in an ER is that tests like MRIs and CTs, along with specialist consultations, can be done at the hospital. “Urgent care cannot do any of that,” Gamburg says. 

But Gamburg wants to be clear that he is not anti-urgent care. “Doctors I have met have been highly professional, courteous, and interested in quality care,” he says. “I have nothing negative to say about them.”

There is a place for urgent care within healthcare, he believes. “They can treat very well-recognized issues that are minor in severity,” says Gamburg. “If you scrape your knee, get splinters, or have a cold or earache, going to urgent care is fine. But when people seek treatment, they should err on the side of caution. Don’t discount primary care physicians because you assume they can’t see you. And don’t assume our ERs are too busy to treat you. 

“Even if you have to wait in an emergency room,” Gamburg adds, “the wait is worth it.”

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