With a siren wailing in the distance and lights flashing in our rearview mirror, we pull over to the side of the road and let the ambulance pass. Maybe it’s a patient with stroke, heart attack, trauma from an auto accident, burns and smoke inhalation, multiple fractures or worse. But the destination is clear: the hospital emergency department for life-saving care.
On the other side of the street is the more orderly world of the physician’s office, where illness is managed and health is maintained. Appointments are scheduled, office hours are well-defined, and the flow of patients is relatively predictable.
Medical need, however, doesn’t always fall cleanly onto one side of the street or the other. Even if not life-threatening, many injuries and illnesses still require immediate medical attention, before complications set in. Animal and insect bites, sprains and fractures, eye injuries, lacerations, migraine headaches, minor burns, cold and flu symptoms, pneumonia, bronchitis, asthma, urinary tract and other infections, abdominal pain and head injury are just a few examples. So what route should people with these problems take?
Go to the ED? A recent Excellus BlueCross BlueShield study on the use of emergency departments in Upstate New York found 43 percent of the visits to EDs were not necessary. Other studies put the number as high as 70 percent. Whatever the percentage, misuse of the ED accounts for millions of wasted dollars every year and costs us all-the individuals and companies that pay health insurance premiums and the patients themselves in expensive out-of-pocket co-pays. According to the Excellus study, barring the direst circumstances, most people should seek care elsewhere, starting with their primary-care physician.
But when a physician’s office can’t accommodate an unscheduled same-day or next-day visit or is not equipped to suture lacerations, drain abscesses, cast fractures and so on, or it is closed (and telephone advice just won’t suffice), there is another choice.
A new concept in medical care has been emerging for several years, both locally and nationwide: urgent care. Most urgent-care facilities are staffed and supervised by board-certified physicians, physician assistants, nurse practitioners and nurses, plus licensed X-ray and laboratory technicians. Most require their medical staff to be certified in advanced cardiac life support and pediatric advanced life support. In addition to exam and procedure rooms, most urgent-care facilities are equipped with imaging capabilities (such as digital X-ray) and diagnostic laboratories, enabling physicians to accurately and quickly diagnose and treat a patient’s problem. And all of this with no appointment needed-patients just walk in.
A trend the Excellus report glosses over, and one we wish to emphasize, is the decreasing availability of primary-care physicians (internists, pediatricians and family practice physicians). Not only are these doctors busy with scheduled patient appointments, but their numbers are not growing. Studies by the Monroe County Medical Society, the Health Association of New York State and the University of Rochester School of Medicine and Dentistry all indicate a shortage, making a same-day appointment and quick access all the more unlikely.
Hence the need for expanded availability and quicker access to the appropriate level of medical care, which urgent care fulfills as an alternative to overextended primary-care offices and crowded (and expensive) EDs-one that provides high-quality care at considerable cost savings.
A second point we emphasize is that urgent care is not primary care; we see our services augmenting a primary-care physician’s practice, not competing with it. We have no interest in stealing or "poaching" patients. Most urgent-care centers send a report to a patient’s primary-care physician or specialist within 24 hours of a patient visit. And if a patient doesn’t have a primary-care physician for follow-up or needs to see a specialist, we’ll make a referral.
We’re pleased to see Excellus collaborate with the Monroe County Medical Society and the Finger Lakes Health Systems Agency on a campaign to educate the general public on the misuse of emergency departments. We hope this collaboration will formally incorporate urgent care as a part of its process. Give us a seat at the table, and we will do our part. Based on our success to date, we’re already on a street well-traveled.
Janet Williams M.D. and Pam Sullivan M.D. are the medical directors of Rochester Immediate Care in Greece and in Webster, respectively.
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