Waiting a week to see your primary doctor with a sore throat or ear infection? Visiting the emergency room on Saturday evening to see if your child has a broken collarbone from that soccer injury? That was so yesterday. Today you can have those minor ailments and injuries attended to almost as quickly as you can order a latte in the drive-thru.
Walk-in clinics have been around since the 1980’s, but the industry declined and just recently started to flourish again with clinics opening in strip malls and retail stores. Two different business models have emerged: the urgent care clinic and the retail clinic. Recent studies estimate there are currently 8,000 urgent care clinics and 1,000 in-store retail clinics nationwide.
Why the Need?
One big reason is a scarcity of doctors. According to a recent survey of medical students at 11 U.S. medical schools, only two percent planned to pursue careers in general internal medicine. More physicians are choosing to specialize rather than go into primary care, which usually pays significantly less than other fields.
“There’s a huge shortage of primary care physicians nationally and urgent care is able to provide needed access to quality health care,” said Steve Sellars, CEO of Convenient Care LLC, which operates Lake After Hours in Hammond. Convenient Care LLC currently operates 12 locations with plans to open 8-10 additional sites over the next 12 months.
Illnesses and injuries also don’t happen on a schedule. Most primary care physicians have standard Monday through Friday office hours. So even if you have a primary care doctor and don’t have to wait a week for an appointment, it’s still not always that convenient. With multiple locations, extended hours (even on weekends and holidays), and no appointment necessary, clinics are filling a niche. “Families today want convenience. It comes down to convenience. Our growth is primarily because it’s a convenience-oriented model,” said Sellars.
The other big reason is affordability. Clinics are thriving in part because they serve as a cheaper alternative to a hospital or doctor’s visit, especially for the uninsured or those with high-deductible insurance coverage. “We can save people a lot of money. The cost is usually much less than a visit to the ER,” said Tim Haley, Director of Fairway Medical Urgent Care in Covington, who said the average cost of urgent care was five times less expensive than the ER for those with insurance and 10 times less expensive for those without insurance.
The northshore has a few clinics that have been around for years and some newcomers to the landscape, each with their own strengths and menu of services. To make sure you get the right level of care for your situation, make sure you know the services offered before you go.
What is Urgent Care?
According to the Urgent Care Association of America (UCAOA), in order to be counted as an urgent care center you must offer the following at a minimum:
· Provide care primarily on a walk-in basis
· Have evening office hours Monday through Friday
· Have weekend office hours
· Provide on-site x-rays
· Provide suturing for minor lacerations
“We’re for the simple, everyday bumps and bruises, coughs, and colds,” said Haley. “Urgent care clinics are a great place to go when you can’t get in to see your doctor or when your illness or injury isn’t severe enough for the emergency room”. “Our level of service is somewhere between that of a primary care practice and an ER,” said Sellars. Prices can range from $80 - $135 (with some tests extra), comparable to a standard office visit.
The majority of urgent care clinics are independently physician-owned (54%), either by one or a group of doctors. Clinics also can be owned by a larger hospital or medical center, or be corporately-owned. In some clinics you always see a doctor (maybe the same one or different ones), in others a nurse practitioner. Some emphasize fast service, quick referrals, continuity from visit to visit, or patient satisfaction. The business focus can be vastly different for each.
Fairway Medical Urgent Care has been open since January 2009 and is owned by Fairway Medical, which in turn is owned by a group of 33 physicians. “The owners recognized there was a real need in the community because they received so many after hours calls in their own practices,” said Haley. “We think urgent care is a great concept and can act as an extension of their offices and refer people back to their practices”. To this end, Fairway offers their “Fast Track Service”. If you visit the urgent care and need a referral to an orthopedist, for example, you can usually be seen the next day since they have so many doctors in their pool.
Redi-Med in Mandeville has been serving the northshore for more than 25 years and owned by Dr. Mohammed Yousuf since 2001. His emphasis is on expediency and continuity. If you go to Redi-Med, there’s a 90 percent chance you will be seen, and seen quickly, by Dr. Yousuf. “People want to be seen right away, not wait an hour or two. And they come here to see the doctor – me,” he said. “People like to see the same doctor each time – it’s like having a primary doctor, but with more convenience”.
Pelican Urgent Care in Slidell has been open 10 years and is owned by Dr. Kumar Amaraneni, who is board-certified in emergency medicine. “At the time we opened there was only one other clinic in Slidell,” said Andrea Picou, Office Manager. Pelican Urgent Care is open seven days a week and you are always seen by one of the four or five doctors staffing the clinic. Every patient also receives a follow-up call the day after their visit. “Patient care is the most important thing. You want people to come back. It takes time but it’s worth it in the long run,” said Bruce Kiger, Diagnostics Manager.
How are Retail Clinics Different?
Nationally Wal-Mart, Target, CVS, and Walgreens are offering in-store clinics, but on the northshore, the only choice is Take Care Clinic inside Walgreens in Mandeville and Slidell. Here you are seen by a nurse practitioner and the services are bare bones, but the prices start at just $65 – half of what a typical doctor’s office visit costs and wait times average just 20 minutes.
Take Care Clinic focuses exclusively on the diagnoses and treatment of common illnesses such as colds, flu, and sinus and ear infections and can write prescriptions when necessary. They provide treatment for other conditions such as pink eye, head lice, swimmer’s ear, and minor bites, cuts, or burns. They also provide select vaccinations, physicals, and wellness screenings. Retail clinics don’t do lab work, x-rays, or sutures, so if you walk in with a more serious or chronic condition you’ll probably be turned away and referred to a physician.
“We’re not trying to be a replacement for primary care physicians. If we can’t give what’s needed, we find them someone who can,” said Shalan Randolph, Lead Nurse Practitioner for area Take Care Clinics.
Retail clinics seem to be serving more uninsured patients than urgent care clinics and are providing care to people that might otherwise fall through the cracks. “More than 40 percent of our patients would either be going to an emergency room or not getting care at all,” said Gabe Weissman, Spokesperson for Take Care Clinic.
In-store clinics certainly make sense from a business perspective. They increase retail traffic, bringing in new customers who are much more likely to fill their needs for prescriptions or over-the-counter medicines on site rather than leave the drugstore to go to a competitor. “There is definitely a synergistic effect between the clinics, pharmacies, and stores. We work as a team to provide the customer with what they need. One way or the other, you’re going to get help from Walgreens,” said Randolph.
What about the Quality?
A recently released study by the RAND Corporation found that retail clinics located in pharmacies and other stores can provide care for routine illnesses at a lower cost and similar quality as offered in physician offices, urgent care centers, or emergency departments.
The study compared the care provided in different settings for patients with middle ear infections, sore throats, and urinary tract infections. Researchers found no difference in the quality offered to patients visiting retail clinics, physician offices, and urgent care centers. Retail clinics did slightly better than hospital emergency rooms.
Physician groups have raised concerns about the quality of care provided at the clinics, including whether they might be likely to overprescribe antibiotics and limit preventive care by disrupting normal doctor-patient interactions. The RAND study found no evidence to support these concerns.
How’s Business?
An early onset of swine flu this year during the traditionally slow months of August and September helped to keep clinics busy. Seasonal flu vaccinations have also been a brisk business, with clinics administering 2,000-3,000 flu shots each so far this fall. At press time, none of the clinics had received any H1N1 vaccines.
Most local clinics indicate they are increasing their marketing efforts as business slows due to economic and competitive pressures and additional clinics continue to jump into the local marketplace. “The economy is affecting our business as people are putting off going to the doctor,” said Haley. “I don’t think there’s much room for more clinics in the area,” said Yousuf, who noted that walk-in business has slowed somewhat due to increased competition.
Since urgent care is typically a seasonal business, one essential component of services offered by many clinics is occupational health or industrial medicine. These services include employer-paid services like pre-employment physicals, drug screening, vision and hearing testing, respirator fit testing, and wellness screening. It also includes worker’s compensation services due to employment-related injuries.
Picou said industrial medicine is 70 percent of Pelican Urgent Care’s business and has been very profitable. Yousuf said 25-30 percent of Redi-Med’s business is industrial medicine and is more profitable than walk-in business because payment is guaranteed and fewer resources are used.
But this business has also taken a hit due to the economic slowdown. Hiring has slowed or stopped for local businesses, which are cutting expenditures wherever possible. Urgent care clinics in the area report industrial medicine business is down 20-35 percent from last year.
“There are a lot of employers getting a cookie-cutter approach. We think there’s a great opportunity to customize our services and finally provide them what they need,” said Haley of Fairway Medical. Bruce Kiger of Pelican Urgent Care concurs. “We cater to whatever needs they may have. We have to be flexible for each client. If you keep them happy you could open 20 places next door and it wouldn’t make a difference”.
It’s All about Choice
“We want people to know they have choices. They can go to an urgent care clinic instead of the ER and pay less and ultimately help the community by not tying up these needed resources,” said Haley.
“Patients are excited that there is another option. We are part of the solution,” said Randolph.
As consumers are increasingly pressed for time and money, growth in urgent care and retail clinics will likely continue because of their convenience and affordability. This gives you more choices as to how you receive health care. And that is a good thing.