Sorry for the hiatus, folks. I’m wearing the new hat of COO/CMO of ASAP Urgent Care, a start up with plans to open new UCCs in the northeast, so my blogging and article writing has been on a bit of a standby.
So here at 5 AM on a rainy Chicago Dec 7 I’ll share some thoughts before the final session of the Ryan OccMed Marketing and Sales conference I’m attending.
As I was writing up job descriptions for our new center positions, I came across this article in KevinMD.
Are emergency physicians best served to staff urgent care centers?
I’m asked about this all the time and the debate rages on about who to hire, FP, IM, IM/Peds, ER or even OccMed.
I’ve worked with dozens, maybe hundreds of physicians in the urgent care setting, I’ve hired, fired, trained, mentored, and counseled all these specialties in the ways and idiosyncrasies of urgent care and occ med practice. There are “good” doctors and “bad” doctors in any specialty, depending on what your definition of good and bad is.
Here are my thoughts and observations, specific to physician staffing in urgent care centers:
1. ER docs can be great assets by virtue of the experience they have with the severely acutely ill patient who shows up at your urgent care–the wrong venue, the ones that should have called 911 or gone directly to the ED. So they come here and the ER doc can handle it. Or can he/she? Do you have chest tubes and a full crash cart, a stat lab, and an MRI right in your center? UCCs are not, and shouldn’t be equipped like an ED–we’re designed for the less acutely ill patient, trying to keep costs down while delivering great care. When the wrong patient comes in, any provider can deliver basic supportive care while calling 911 for transport to the more appropriate venue.
2. ER docs generally have the “treat and release” mentality, which of course works fine in the ED, but they need to adopt more of a continuity-based mindset in urgent care. Not that we are following patients for all their chronic conditions, but for follow-ups of the acute presenting problem, particularly if there is no primary, and certainly for worker’s comp patients. I’ve found this to be a real challenge for some ER docs.
3. The ED treatment of non-emergent workers comp cases makes an easy sell for our urgent care / occmed services. They tend to keep workers out of work, prescribe more intense medications that may be necessary and referrals to specialists take too long. So when ER docs come in to urgent care we need to understand basic occ med concepts of early return to work strategies and OSHA recordability.
4. ER docs are expensive! They generally command a much higher salary in the ER, and it can strain the UC budget if they are not brought in at an urgent care salary.
5. So I’d love to have ER docs in my center if they can actually work as an urgent care doc, not an ER doc. Take a “retail Nordstrom-like attitude” for patient satisfaction, learn how to handle occmed patients, make the patient want to come back to the center for other problems, follow up on labs, referrals, other diagnostics that come back after the visit, and who will work for an urgent care salary.
6.IM docs generally are not comfortable seeing kids nor handling even basic gyn conditions, and sometimes the orthopedics throws them, so these are areas to address and provide training for them to function well in the urgent care.
7.OccMed docs obviously have to also address the same issues, kids, women health, and avoid the “company doctor” mentality that the patient is forced to see you so you don’t have to have a great bedside manner,
8. So who’s left? FPs and Med/Peds, in my experience, have overall worked out the best. Yes, they still need the OccMed training, but they all do. They generally possess the mindset we need, are comfortable with most patient types we cater to, and make salaries consistent with urgent care budgets.
So if you’re an ER or IM doc, don’t come down too hard on me, I’m not saying I wouldn’t hire you, I’m just sharing real challenges I’ve faced over and over again these 20+ years with physician staffing in urgent care centers. If you want to work in urgent care, keep some of these issues in mind. If there are other points and comments you’d like to share, I welcome your contributions to the discussion.
