Future of Urgent Care

[tealeafexplorer]

It seems like the trend is putting NP’s or PA’s into urgent care spots as the main provider.

What does the future look like for physicians in the role of urgent care?

I would love to do urgent care part time or maybe full time 3 days a week while I dabble in other avenues that aren’t medicine.

Don’t these NPs or PA’s have to be overseen by a physician though?

@cabinbuilder have any insight on the future of urgent care for a physician part time and full time? Do you think the field will ever be completely taken over by mid levels?

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[MatchGod]

Would like to know this too!

 

[Leukocyte]

In a growing number of States, NPs can practice independently and do not need to be overseen by a physician (they just need a physician to "collaborate" with). So it depends on the State and its laws around midlevels. Unfortunately, more and more State lawmakers are buying the strong midlevel lobbyists argument that midlevels need to practice independently and should have a scope similar to physicians because it helps improve access to care. Unfortunately, most Urgent Care centers are money focused establishments, and in States were NPs can practice independently, they will preferentially hire NPs because it is cheaper to hire a NP as opposed to a MD/DO. As for PAs, they will simply have one of their MDs/DOs "oversee" an all PA urgent care practice. I mean, just look at what is happening in Emergency Medicine. In general:
-Profit-driven urgent care centers (which is the majority) will preferentially hire a NP/PA whenever they can
-Very very few urgent care centers only hire MDs/DOs. These tend to be owned by the physicians who strongly believe in the physician model of care delivery.

It looks like the urgent care practice model is following the path of anesthesia and emergency medicine. And if this trend continues, midlevels might even creep and dominate primary care/family medicine (not just urgent care). However, the same can be said for almost all non-surgical specialties.

NPs/PAs/Nurse Midwifes use the argument of "access to care" and "physician shortage" to lobby for greater scope of practice. But if that is the case, why not focus on strategies to increase the number of physicians in high-need areas.

 

[Splenda88]

@Leukocyte Increase the # of physicians or even NP/PA in these underserved areas is difficult. Everyone wants to live where there is some entertainment, schools etc...

The owner of these urgent care want to make the $$$ like everyone else. Urgent care is mostly low acuity medicine so it makes sense to pay an NP/PA 100-120k/yr instead of paying a physician 230k+

I think FM/IM docs who want to work part time so they can "dabble in other avenues that aren’t medicine" would be better off getting a hospital medicine job 1week on and 3 weeks off making 120-150k/yr.

 

[bronx43]

It seems like the trend is putting NP’s or PA’s into urgent care spots as the main provider.

What does the future look like for physicians in the role of urgent care?

I would love to do urgent care part time or maybe full time 3 days a week while I dabble in other avenues that aren’t medicine.

Don’t these NPs or PA’s have to be overseen by a physician though?

@cabinbuilder have any insight on the future of urgent care for a physician part time and full time? Do you think the field will ever be completely taken over by mid levels?

I honestly can't remember the last time I saw a physician in an urgent care. For all intents and purposes, it's already taken over by midlevels.

 

[bronx43]

In a growing number of States, NPs can practice independently and do not need to be overseen by a physician (they just need a physician to "collaborate" with). So it depends on the State and its laws around midlevels. Unfortunately, more and more State lawmakers are buying the strong midlevel lobbyists argument that midlevels need to practice independently and should have a scope similar to physicians because it helps improve access to care. Unfortunately, most Urgent Care centers are money focused establishments, and in States were NPs can practice independently, they will preferentially hire NPs because it is cheaper to hire a NP as opposed to a MD/DO. As for PAs, they will simply have one of their MDs/DOs "oversee" an all PA urgent care practice. I mean, just look at what is happening in Emergency Medicine. In general:
-Profit-driven urgent care centers (which is the majority) will preferentially hire a NP/PA whenever they can
-Very very few urgent care centers only hire MDs/DOs. These tend to be owned by the physicians who strongly believe in the physician model of care delivery.

It looks like the urgent care practice model is following the path of anesthesia and emergency medicine. And if this trend continues, midlevels might even creep and dominate primary care/family medicine (not just urgent care). However, the same can be said for almost all non-surgical specialties.

NPs/PAs/Nurse Midwifes use the argument of "access to care" and "physician shortage" to lobby for greater scope of practice. But if that is the case, why not focus on strategies to increase the number of physicians in high-need areas.

I think the trend is early, but I'm seeing more and more well-trained young physicians opt to take far suburban/rural jobs instead of abusive metro jobs. Employers in bigger cities have become increasingly more exploitative since COVID, while COL is increasing rapidly. The lower threshold of affording a middle class lifestyle is being threatened for young physicians, who are responding accordingly. At my academic institution, more and more new grads are either moving out to the edges of the city or simply commuting an hour each way. Job postings from big city employers are popping up like weeds - a lot are "academic."

If this trend continues, we may be seeing the great medical diaspora of the 2020s. This is actually a huge boon for rural populations, who have had subpar medical care for decades.

 

[allantois]

I honestly can't remember the last time I saw a physician in an urgent care. For all intents and purposes, it's already taken over by midlevels.

Most urgent cares near me have at least one physician (well they typically have one physician and one PA/NP)

 

[sloh]

Most urgent cares near me have at least one physician (well they typically have one physician and one PA/NP)

“At least one.”

 

[cabinbuilder]

It seems like the trend is putting NP’s or PA’s into urgent care spots as the main provider.

What does the future look like for physicians in the role of urgent care?

I would love to do urgent care part time or maybe full time 3 days a week while I dabble in other avenues that aren’t medicine.

Don’t these NPs or PA’s have to be overseen by a physician though?

@cabinbuilder have any insight on the future of urgent care for a physician part time and full time? Do you think the field will ever be completely taken over by mid levels?

It all comes down to the quality of the admin. If admin wants to cut corners and let people die having untrained folks working urgent care then the doctors will be pushed out. I spend a lot of my time ensuring patient safety since I have these yahoos I have to work with in UC who don't know how to do procedures and give everyone steroids. Where I worked in Oregon the admin came in one day and fired all the docs and replaced them with midlevels. Where I work now they advertise "Physician staffed" but that's really only half true. The urgent director is an MD so he is fighting to save the physician slots.

 

[kelly88]

There is some kind of outrage with medicine in our country.

 

[dr_shark]

There is some kind of outrage with medicine in our country.

I think if we politicize medicine a little more we can finally kill it completely.

 

[cabinbuilder]

It seems like the trend is putting NP’s or PA’s into urgent care spots as the main provider.

What does the future look like for physicians in the role of urgent care?

I would love to do urgent care part time or maybe full time 3 days a week while I dabble in other avenues that aren’t medicine.

Don’t these NPs or PA’s have to be overseen by a physician though?

@cabinbuilder have any insight on the future of urgent care for a physician part time and full time? Do you think the field will ever be completely taken over by mid levels?

I think it depends on which part of the country you live in. Where I am in Texas there just aren't enough doctors to fill the shifts. On the flip side of that, a lot of the NP's they are putting in UC have no procedural skills and my employer is now facing the "oh **** what did we do?" when you have angry patients who can't get their ingrown nails fixed or joints injected because the NP's don't know how. The clinic manager who has no medical knowledge now fields angry calls all day. I am also waiting for a sentinel event where someone dies from lack of knowledge that the person before then is actually very ill. My staff knows to put all procedures on my schedule so at least they are assessed and not just shuttled to the ER. Yes, the PA and NP have to be "supervised" by a physician which means they are attached your your medical license but not much more supervision occurs due to different shifts and working in separate buildings. I have been waging my own war against the incompetence I see every day by refusing to attach any of them to my license. It really has thrown a wrench into the admin's goals which are not my own.