In replying to a friend’s questions about what to do regarding their mysterious pain, one commenter, intending to be helpful, suggested going to an Urgent Care. I argued against doing so. And then I was accused of being dismissive of every doctor who works in one and, ya know, other things.
In actuality I had also DM’ed my friend advising them on what I thought was the correct course of action, although that course was harder. And for a different post.
Urgent Care Clinics
I’m not sure when the idea for these first appeared. And my first exposure to them was working in an ER that had a separate Urgent Care side. I really liked that model. But I don’t think that’s what most people are thinking of when they recommend an Urgent Care. They are instead thinking of the numerous stand-alone clinics. Frequently in strip malls. And there are some limitations to this model.
Providing easy access to urgent care without the difficulties of an ER is valuable. Those difficulties include long waits and higher bills. Those waits are longer because an urgent patient is not an emergency patient – and they have to tend to the emergency patients first. (This is also why I like the alongside model that I worked at)
Better hours and no need for an appointment certainly solves problems for folks who have limited ability to get a quick appointment otherwise. Like being a member of One Medical, a service that is rich-people-only expensive.
The problem that is solved by what I mentioned above is one that could be solved another way. By providing for better staffing at Primary Care offices. But that’s not the for-profit primary care model. Primary Care wants lean staffing and as many appointments as possible so that the schedule is always crammed tight. Greater use of Advanced Practice Clinicians – NPs and PAs – would help address this, but is also a separate topic.
So, in part, what bothers me about urgent care clinics is that they are a symptom of a dysfunctional healthcare system.
The stand-alone clinics are run by for-profit companies as well. But with a model built from the ground up to achieve that profit in a different way. And that’s also a way that stand-alone clinics are different from ER ones.
The Urgent Care just charges more. Which usually translates to a higher co-pay for the patient and the only benefit they get from that greater cost is convenience. I’m okay with paying more at a convenience store – for the convenience – but not with medical care.
The Urgent Care structure is also one that incentivizes more testing regardless of utility. Although, of course, that’s a problem across the whole U.S. healthcare system. I suspect it’s worse there.
The trigger for my conversation on the friends’ wall was my guess that they’d have an ankle x-ray ordered even though it wasn’t useful. Which is unnecessary exposure to radiation. And contrary to the American College of Radiologists guidelines.
*Personal experience warning* – the only place I’ve been to that was supposed to have an x-ray but it wasn’t working was an Urgent Care. I’ve had that happen multiple times. Which is consistent with my cheap before good expectation of their model.
Just like an ER, and every possible other specialty in medicine, the folks who work in an Urgent Care are good in their domain and not everything else. So what are they good for? Simple orthopedic injuries and simple infectious diseases. These are the two kinds of things that are low enough grade to not require an ER but still require care faster than you can get at a primary care office.
My friend who was suggested to go to an Urgent Care had a weird neuro problem. They weren’t going to be able to do anything for her or have the expertise to address it usefully.
An Urgent Care also has limited treatment options available. Infectious diseases usually require supportive care and sometimes antibiotics or antivirals. And they can handle that well.
Simple orthopedic injuries may require imaging, splints and/or sutures. They can handle that well also.
My friend was only going to be able to get powerful painkillers that provide only temporary relief. That’s not nothing. Sometimes it’s critically important. But it’s very limited.
All of these treatments are things the Primary Care could take care of if they had appropriate staffing.
I want our healthcare system to be better. I really do. And a lot of that is structural changes. And I see Urgent Care clinics as a symptom of what’s wrong. Which biases my view of them.
But they are definitely useful. And I’d rather have a bad solution that helps address our flaws than leaving a hole in our system.