Urgent care centers seeing explosion in growth

By BILL HENDRICK
http://www.ajc.com

Elba Ramos is lying on a cot, nervously inhaling laughing gas through a clear plastic nasal mask, but she’s definitely not laughing. Instead, she’s grimacing as Dr. Sam Lorenzo talks to her in a soothing voice while pricking the end of an infected finger with an anesthetic needle.

Though feeling no pain, she flinches, but he’s finished within minutes. She soon plunks down her $30 co-pay and leaves Georgia Urgent Care in Roswell.

And she learned not to do her own cuticles any more.

She’s one of several dozen patients Lorenzo will see this day in his urgent care clinic — one of thousands of minor emergency centers staffed by doctors that are popping up around the country.

“This is great,” said Ramos, 49, of Roswell. “You don’t have to wait and you get out fast.”

Though urgent care centers have existed in small numbers for more than two decades, they’re experiencing an explosion in growth now, especially in busy metro areas such as Atlanta.

Their growth is out-pacing that of retail walk-in medical clinics staffed by registered nurses or physician assistants, which also are expanding rapidly, with an estimated 1,000 operating around the country. Atlanta is one of their hottest markets.

But it’s even hotter for urgent care clinics, often dubbed “doc in the box” facilities. Estimates for the number of physician-staffed urgent clinics vary widely, but the Chicago-based Urgent Care Association of America, the largest trade group, puts the number at 8,000.

“We see two to three new opening announcements every week,” said Lou Ellen Horwitz, the group’s executive director. “It’s very difficult to know how many there are because definitions vary, and there is no national registry.”

The group has commissioned a Harvard Medical School study to investigate the operations, staffing, volume and wait times of urgent care clinics.

 

Different relationships

Some physicians caution that urgent care centers can’t offer the doctor-patient relationships they say most people should have with family doctors. But the American Medical Association said it has no qualms about the facilities if they are staffed by board certified physicians.

Most clinics accept insurance, but turn away those who can’t pay. Dr. Franz Ritucci, president of the Orlando-based American Academy of Urgent Care Medicine, said states don’t regulate such centers and contends 8,000 may be a low estimate.

Horwitz said urgent care facilities are almost always staffed by and usually owned by the physicians who practice in them, many of whom have left emergency rooms or primary care offices to take more control over quality of life. She said at least 1,200 are hospital owned. Others are owned by operators like Concentra Urgent Care, which runs 324 in 40 states, including 11 in metro Atlanta, said spokesman Alan Ayers.

 

Speed advantage

Prices generally are less or on par with what patients would pay their own doctors, Ritucci said. The centers save money by seeing lots of patients. They save as well by “cross-training” technicians so that they can take X-rays, draw blood and handle other medical chores. Most operate 12 hours a day, seven days a week.

“The reason these centers are growing is, our health care system is imploding and has failed,” Ritucci said. “If you have an ear infection and call your family doctor, you probably wouldn’t be seen the same day.”

Lorenzo, 49, the CEO of Georgia Urgent Care who has 20 years experience in emergency medicine, started the practice last November with six other ER doctors who together invested $1 million.

It’s staffed from 11 a.m. to 9 p.m. seven days a week by one of the owners or doctors working on contract, plus a medical assistant or nurse and a receptionist.

Lorenzo’s “day job” is in the ER at the Henry Medical Center, where he works 12 shifts a month, 12 hours a day.

“I work here on weekends on my days off, three days a month,” he said. “The other partners work at other times. And we plan to expand.”

But so far, the business is operating on a shoestring, he said, and the owners aren’t getting paid.

“It’s just sweat equity now, but it looks like we’re getting close to paying our bills,” he said.

So what drives him and the tens of thousands of other docs going into urgent care?

“I love it because we love emergency medicine, but there’s also a need to slow down a bit,” he said. “But also, I get to spend more time with patients, which I love.”

Ramos loves it, too.

“It’s like a no-brainer,” she said. “Who wants to spend five hours in the ER?”

Lorenzo said patients usually are in and out within 45 minutes. The doctors treat such problems as strep throat, small lacerations and infections. Patients with serious problems are sent to emergency rooms. Most patients pay — although a few can’t, Lorenzo said.

Emily Leeder, 33, of Roswell, was in another room as Lorenzo worked on Ramos. She’d come in for “a severe reaction to poison ivy.”

“I have been to the ER for things like this, and they take longer,” she said. “All I needed was a steroid shot.”

Bruce Harrison, a senior vice president for WellStar Health System, one of the few hospital companies in the area that operate urgent care centers, said they provide “everything from stitches, sinusitis [treatment], lab work, sports physicals and X-rays.”

But it’s tough for urgent care centers to turn a profit, Harrison said.

“Our goal is to break even, and we do,” he said. “We operate the centers to provide a level of service for nonserious problems” and to familiarize the community with the WellStar brand.

There are several Northside urgent clinics. They are owned by doctors affiliated with Northside, but not by the hospital, said Northside Hospital spokesman Russ Davis.

“Urgent care centers can make money, but you have to run them lean and mean,” said Bill Wenmark, president of the National Association for Ambulatory Care, a group that advocates industry standards. The secret to success is high volume.

 

Not regulated

Walk-in clinics staffed by non-physicians also provide care for minor illnesses, but doctors’ lobbying groups stress that nurses shouldn’t be substitutes for doctors.

The American Academy of Pediatrics opposes all retail clinics, contending they interfere with long-term doctor-patient relationships. The American Academy of Family Physicians said it has no problems with clinics staffed by doctors.

Dr. Sandra A. Fryhofer, an Atlanta internist, said urgent care clinics “are not a substitute for having a personal primary care physician who knows you and your medical history. Continuity of care and follow-up are major concerns.”

Georgia state health agencies don’t regulate urgent care centers or walk-in nurse clinics, but that’s not why the Medical Association of Georgia is wary of both types of facilities, said spokesman Tom Kornegay.

“We believe the nurse- staffed urgent care facilities play an applicable role in terms of services they provide, but the key is, they don’t replace the need for primary care physicians,” he said. “To the extent urgent care clinics are owned by for-profit corporate entities and driven by traditional business models, we are concerned about the potential for physicians being subjected to undue or inappropriate influence by those entities that might not have the best interests of the patients in mind.”

Urgent care physicians such as Dr. Vicky Schuh, owner of Peachtree Immediate Care and Occupational Medicine in Fayetteville, say that’s a bum rap.

“I worked in an ER for seven years and decided to do this,” she said. “I had worked day shifts, night shifts, but when I had kids I thought I could tighten up the formula. I have two little boys, 8 and 10, and now I don’t miss a beat with them.”

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