This was mentioned in another current thread and I wanted to start a discussion about this topic.
I don't know much about freestanding ER's or how common they are (I assume not very). Cost was brought up as a reason why more doc's don't do this. I imagine that demographic/location play a big role in the viability of something like this. I found this article on the topic which gives a little bit of an overview.
www.ucaoa.org/docs/Article_Freestanding.pdf‎
Anyone have any experience with freestanding ER's? What are pro's/con's? Limitations? Viability of something like this expanding? Is this something that we may see more of in the future?
Any thoughts or ideas on the subject are appreciated.
You obviously spun this off from my comments in this thread:
http://forums.studentdoctor.net/showpost.php?p=14434378&postcount=17
To answer you questions:
Cost was brought up as a reason why more doc's don't do this.
Really? Doctors don't hesitate to buy a $600,000 house when they don't have a penny in their bank account to put down. It's not unlike starting any other business or physician practice. You don't need 3/4 million in
cash to do it. You certainly would need assistance, a business loan or other investors. It always
costs money to make money.
I imagine that demographic/location play a big role in the viability of something like this.
This definitely does. Note the linked article which points out that some states have their own "EMTALA-like" laws. Your state may or may not. If you state doesn't, it might be time to get grandfathered in. Or, falling under the "urgent care" classification circumvents this altogether, regardless of state. I don't know of any state that applies EMTALA to urgent cares under state law. If they did, all urgent cares in such states would immediately be rendered bankrupt and have to close.
Is this something that we may see more of in the future?
Of course you'll see more free standing ECCs. That's not a question. The question is who will own and operate them. Will you work at one and be an employee or be owner, operator and pilot of one. Hospitals build their own, to cast a wider net and scoop patients and revenue from a wider area. Now is the time physicians can still own and operate UCCs and ECCs.
Someday it may be illegal for a physician to own an urgent care or free standing emergency center. "How could that be you ask? This is America, we live in a 'free country'!" Well, Obamacare banned physician ownership of hospitals in 2010.
http://www.forbes.com/sites/science...t-victim-physician-owned-specialty-hospitals/
Urgent Cares and free standing ECCs may be next.
Are you so free?
Now, why don't more EPs get the entrepreneurial spirit and take on a challenge and investment such as starting an ECC?
-Many know nothing of business, and are overwhelmed and intimidated by the idea.
-Many are attracted to EM for the ability to be an "hourly worker" with little other "after hours" responsibility. Then there is dismay when one is treated like replaceable hourly help.
-Many think being part of a "Democratic group" is the same as being your own boss. It's not. It makes you a "vendor" which is not exactly the same as being an employee and is better in many ways, but you are still a de facto employee of the hospital. It reminds me of the "Respect for physicians thread" and my own, Ruminations On Hot Dogs and Emergency Medicine
http://forums.studentdoctor.net/showpost.php?p=14037516&postcount=75
-There is risk in taking a leap and starting your own "practice" or "business" which is what such a venture is, but there is risk in taking
no risk, too. Any doctor who starts a solo or group practice has this same risk, it doesn't need to seem so overwhelming. With help, ie, an accountant, healthcare attorney, and maybe a consultant it's very doable.
**Disclaimer- I've never owned or operated an Urgent Care or ECC. It's something I've strongly considered and still would consider. However, I do think it's an opportunity that's been overlooked by too many EPs to their loss. Surgeons have owned and operated ASCs and this is the EP equivalent, yet compared to surgeons, so few have gone on their own, and become independent and free.