The Urgent Care/Primary Care Dilemma

Although most of the Urgent Care “chains” of late provide urgent care and some occupational medicine services, most don’t consider themselves primary care providers.

In my 28 years of owning and operating urgent care centers, however, I’ve found that there is a diverse spectrum of how primary care services are intermingled with urgent care. Many of my urgent care colleagues consider themselves primary care physicians first, then urgent care providers.

I think in the early days, this was part of the pushback of “traditional” primary care physicians against their new urgent care neighbors, thinking that urgent care centers would “steal” their patients.

This may have been the case with FP and IM physicians who started their urgent care centers to offer extended hours, 7-day walk-ins, and expanded capability services to an otherwise general practice base. But ER docs would typically set up the “free-standing ER” model center with the “treat and release” alternative to ER mentality type of care, with no primary care services to speak of.

Not uncommon is the single “mom & pop” urgent care center which serves three audiences:

1. Acute, urgent care patients

2. Occupational medicine patients

3. Primary care for patients who do not have a primary care physician.

It has been a very common occurrence to see a patient for an acute problem, only to identify a previously undiagnosed condition during this visit. If the patient doesn’t have a primary care physician, urgent care centers have to handle it basically in two ways:

1. Accept the patient as primary care if the practice “rolls that way”

2. Refer to a local primary care physician.

It really depends on the type of practice. I used to be of the “take care of all 3 types” of patients persuasion, but now I think urgent care should stick to urgent care unless you are going to completely embrace Accountable Care and take full responsibility for all care and outcomes. Several of my colleagues are taking this route and moving away from services like Occ Med (still do it but not really pursuing it).

If health care reform is going to lead to increased access and utilization of the health care system as a whole, then what primary providers can do best is provide continuity and accountability, urgent care centers can see all the unscheduled acute problems (because primary’s will be too busy) and ERs should see only the more serious cases where life and limb decisions need to be made.

ER or Urgent Care? I like what I heard from one physician — if you can safely drive or walk, go to urgent care, otherwise ER. Of course, we’ve had our share of folks who still needed to be driven in because of an orthopedic injury, vomiting, or what have you, and perfectly appropriate for urgent care!