Demystifying Medicine One Month at a Time


The trend-spotting New York Times published a front-pager about the growth of urgent care clinics nationwide.

These are the places that are often referred to as “minor emergency rooms,” or “doc-in-a-box” outfits. Their value proposition is simple: You don’t need an appointment. The costs are “reasonable,” and much more transparent than usual medical care at a doctor’s office, emergency room, or hospital. Best of all: they can treat a majority of acute conditions and have you in and out in under an hour. No ER can make that claim. Heck, not many doctors’ offices can make that claim.First-Aid-Kit

As the article makes clear, urgent care centers have one tremendous advantage over emergency departments: they can cherry pick patients. ERs are required by a federal law called EMTALA (1986) to see and stabilize every patient, regardless of their ability to pay. Urgent cares have no such obligation. And they don’t take Medicaid. To be seen, you must have either private insurance or pay cash.

Seeing a money-making opportunity, big money (i.e. Wall Street, health insurers, hospital chains) are investing big in urgent care centers.

Naturally, skimming the straightforward acute cases out of the medical morass makes some unhappy. The article quotes one physician:

“The relationship I have with my patients and the comprehensiveness of care I provide to them is important,” said Dr. Robert L. Wergin, a family physician in Milford, Neb., and the president-elect of the American Academy of Family Physicians. “While there is a role for these centers, if I were sick I’d rather see my regular doctor, and I hope my patients feel that way.”

As a doctor, I very much see Dr. Wergin’s point of view. I believe in the importance of a relationship with a doctor (or, heck, a ‘Medical Home‘) over the long term. But as a patient and ‘consumer,’ I can certainly see the value in a place that can handle acute stuff on a walk-in, cash basis. My own patients who try to see me for minor maladies are often disappointed to find I’m not available for same day appointments much of the time.

I think the article gets it right. Urgent care is a trend likely to grow at least until the market is saturated. What will keep them afloat is the value they provide, until doctors’ offices (‘medical homes’) can offer truly expanded hours and availability, and come up with more transparent pricing and same day efficiencies.

Doctors and traditionalists will continue to wring their hands over this upstart economic/delivery model, but as the industry moves from cottage to corporate, this is just one more stream in a raging river.


  1. It isn’t necessarily that patients opt for urgent care over their doctors. Doctors may push patients to urgent care. Last weekend I called my doctor’s answering service for a follow up to an appointment I’d had the week before. The prescription she had written wasn’t helping my back pain, and I wanted to discuss an alternative. I hoped to talk to my doctor, or someone in her practice, on the phone. The answering service told me to go to an urgent care center, because the doctor would not adjust medication based on a phone call.

  2. glasshospital

    July 10, 2014 at 2:28 pm

    Funny coincidence about you having back pain. Certainly hope it’s on the mend. Next (next) post is on that very topic.

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