Long wait times in emergency departments have led to a resurgence of urgent care centers.
The LA Times has a piece on the phenomenon, and notes that many of these facilities have opened up in suburbs, where patients with insurance tend to live.
By skimming off the profitable and straight-forward cases, emergency departments have generally taken a disparaging view of their urgent care brethren. Sandra Schneider, vice president of the American College of Emergency Physicians, says that, “As it is now, anybody who has an MD or license to practice could put up a sign and say ‘I’m an urgent-care doctor.’ If you’re having a heart attack, you really want an emergency physician there, because that’s what they’re trained to do.”
Sounds like a turf war is brewing.
An urgent care physician shot back with an interesting argument, saying that emergency doctors are, in fact, not the best trained to treat urgent care problems. He found that, “emergency physicians, who tended to rely heavily on expensive and time-consuming labs and tests, were not always as fast at diagnosing and treating as internal medicine or family practitioners.”
That’s sure to raise some eyebrows within the emergency physician community.
As for my take, I’ve met both internists and ED physicians who order a lot of tests, and doctors in both fields who don’t. If anything, defensive medicine may be more prevalent in the ER, which gives the impression that doctors there order more studies.
But that’s no reason why they can’t staff an urgent care clinic.
Related posts:
- Why more emergency departments are shutting down and becoming urgent care centers
- Should emergency departments handle more urgent care cases?
- Building health centers is useless if you can’t staff them
- Emergency care
- Are family physicians better suited to practice primary care?
- Saving emergency care with primary care
- Unable to provide proper patient care, emergency doctors are suing the state of California
{ 11 comments }
I wondered if anyone else noticed that.
Without any disrespect, I think that the outlined policy is rationalization based on physician-staffing price points and not on a proclivity toward speed or testing-use.
But I’m a cynic.
GruntDoc
i thought there was a shortage of emergency docs. why wouldn’t we want those docs to work in the er?
conversely, why do they want to work in the urgent care centers?
As a Dad of 4 young, active and injury prone kiddos, our mantra when things go mildly wrong is “anything but the ED, please”. Local Urgent Care fits that bill when stuff happens after our Peds office is closed. Relatively short waits, decent care for the minor stuff we bring there…Key word here is “mild”. If I think for a moment that there’s something more significant or sinister than “mild”, I go to the ER. Far more resources there if the doo doo hits the fan.
Of course New Hampshire is a small “market” compared to say, Los Angeles. Not sure I’d have any clue how to manage this in a gignormous population.
I think it is an interesting argument, similar to the problem of ER docs treating primary care problems in the ED and how if a patient presents to an office and ED with the same complaint, will likely get different workups. As an ED doc, I understand the problem. We are taught to always rule out the emergencies, and I am constantly worrying about the worst case scenario, and likely will order more tests since they are at my disposal, which is not necessarily a bad thing for emergencies but is probably too expensive for less emergency conditions. This mind set, however, might not be the best for urgent care. However, we are used to doing minor procedures, suturing, fracture care, etc, which can benefit an urgent care.
I think there is enough business to go around for all right now.
In addition to testing the ER doc has a bevy of specialists to ask their opinions, since there is no specialty coverage at the urgent care.
There are going to be high utilizers in any specialty.
Real determination is what services can be provided. Most internists I know won’t touch little kids or gyne problems. Many FPs I know aren’t comfortable with suturing or setting broken bones. I see very few other primary care physicians reading their own x-rays. If you can find someone in another specialty that performs all the tasks needed in an acute care clinic, hire them.
In response to Anon 9:15 – why do ED physicians want to work in an acute care clinic? Hmmmm. Minor cut in pay to deal with 90% less hassles, patients who are thank you for treating them, and a much more relaxed atmosphere. Tough choice.
I am a family practitioner who occasionally moonlights at an urgicare, which is usually staffed by er docs.
It is ridiculous. The great majority of visits are not urgent at all. All shift, I am thinking, “why couldn’t they wait for their doctors office to open?”
The need for urgicare is a myth. There is no such thing as urgent care, things are either emergencies or they can wait. And I do not think urgicare saves the system any money by keeping people “out of the er”; in fact,it porbably increases cost by increasing utilization.
Urgi care is a lie, a disingenious attempt to further undermine primary care.
“Why would an ER doc want to work Urgent Care?”:
1. No hospital admin. pinhead hassles
2. No medicare core measure BS
3. Insured, or cash paying patients.
4. no freeloading, medicaid entitled losers.
5. no unsolvable social problems
6. no EMTALA
7. less liability. If it is tough send to the ER
8. No futile G-tube, foley, daiper, dementia nursing home care.
9. No spitting, urinating, puking, cussing drunks.
10. No bipolar, dilauded seeking dope heads
11. No hospital admit boarding
12. No nurse call offs
13. Close at 10pm
just to name a few
An urgent care physician shot back with an interesting argument, saying that emergency doctors are, in fact, not the best trained to treat urgent care problems. He found that, “emergency physicians, who tended to rely heavily on expensive and time-consuming labs and tests, were not always as fast at diagnosing and treating as internal medicine or family practitioners.” Is there some research comparing similar patients? Is there outcomes research showing that emergency physicians are worse at treating patients?
And the big question – if these are the patients, who do not belong in the ED, is the comparison with ED patients anything but misleading?
There are many ED problems, but is promoting animosity the solution?
When I’ve worked in Urgent Care clinics, what I would find is the majority……the VAST majority…..of patients have problems that sould have been addressed in a primary care office.
The patients called. Not at 3-AM. Not on a Sunday afternoon. They called on, say, a Tuesday. At 9-AM when the office started answering the phone.
The patient gets told they cannot fit in the patient for the urgent problem. No time in the entire day. They can see the patient the following week.
Then they go to an Urgent Care, for a problem I could see in my office for half the price.
“It is ridiculous. The great majority of visits are not urgent at all. All shift, I am thinking, “why couldn’t they wait for their doctors office to open?”
In a perfect world, everyone would be somewhat calm and collected when it came to smaller medical issues. However, this is far from a perfect world. I get a cut on my hand, I clean it, apply pressure if needed, slap on a bandage and I’m done with it. Someone else with the same cut might freak and need to see a doctor ASAP. if they can’t get in to see their regular doctor (or don’t have a regular doctor) going to an UC Center is more appealing than going to an ER. Suck it up, Suzie! it’s one of the many joys of being a doctor.
Comments on this entry are closed.