Robert L. Broghammer, M.D., M.B.A., M.P.H., of Allen Occupational Health in Waterloo Iowa and Jeffrey A. Westpheling, M.D., M.P.H., of St. Luke’s Work Well Clinic, Cedar Rapids, Iowa, are among those who do not favor the mixed-used model, as outlined in the following letters to RYAN Associates/NAOHP:
From Dr. Broghammer:
“It was with some dismay that I saw the announcement of the Ryan Associates’ seminar regarding mixing occupational medicine with urgent care. I realize this is a ‘trend’ currently, especially with Concentra, but I must vehemently disagree that the two are complementary let alone easily integrated.
“While it is true that much of what we do has an ‘urgent’ basis (i.e. lacerations, traumas, chemical exposures, etc.), occupational medicine is a distinct and separate discipline with its own Accreditation Council for Graduate Medical Education-approved post-graduate medical training programs and separate board certification process. As you know, occupational medicine training focuses on toxicology, epidemiology, statistical analysis, orthopedics, surveillance screening, impairment and disability, wellness, and a host of other specific areas dedicated to the care of workers and their companies.
“Urgent care is nothing more than a descriptor for a clinic that will see you ASAP for a perceived medical problem. There is no specific knowledge base, even rudimentary, for urgent care providers who may provide services for injured workers covered by the workers’ compensation system or for the myriad of other occupational-specific issues that need to be addressed and taken care of.
“Urgent care providers may have extremely diverse backgrounds and there is no formal standardization of training to practice in an urgent care setting one simply needs a license and a pulse. Family practitioners, internists, pediatricians, physician assistants, nurse practitioners, general surgeons, and obstetricians are just a few of the disciplines that I know of personally that have/do practice in urgent care settings.
“Likewise, occupational medicine providers, such as myself, have very little or no training in the variety of medical problems that may present to an urgent care center which have no relationship to work. Imagine an infant presenting with a fever versus a normally healthy worker. The differential diagnosis for the two is vastly different. For instance, the worker may have metal fume fever but it is highly unlikely the infant does.
“No, the integration of the two separate and distinct services will only serve to confuse the clients and dilute the value of providing specific occupational medicine services. The trend is nothing more than attempting to squeeze a couple of extra bucks out of clinics by short-sighted administrators.
“Not one of my colleagues who I trained with and who are board certified in occupational and environmental medicine would consider working in such a clinic long-term.”
From Dr. Westpheling:
“I completely agree with the above statements and would add the following comments:
“An advantage of a stand-alone occupational medicine clinic is avoiding the patient wait times typically associated with urgent care centers and emergency departments. Companies and their employees look to have issues addressed in a timely and efficient manner to reduce time away from work.
“I have always emphasized that urgent care centers are meant to see minor emergencies/urgencies as a backup to primary care providers and overcrowded emergency rooms. They are not intended, nor should they be, to provide long-term follow-up or primary care. When this occurs, the worker ends up seeing multiple providers over several visits resulting in poor continuity of care.
“The mixing of patient types also raises several concerns including well or injured workers sitting in waiting rooms with coughing/sneezing sick patients and continually having to shift thought processes from work injury to personal care.”
