Urgent Care

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NRAI2001

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Seems like FM is perfect for urgent care. Also seems like urgent cares are popping up everywhere nowadays?

Are many new grads going into private practice working for or being owner/part owners of urgent cares? Any experiences joining an urgent care group or starting one?

Obviously it would take time and hard work to start up a new urgent care but does it make financial sense to do so? Would their be huge hurdles to overcome, which should you anticipate? What would the success rate of doing so in your guys opinion?

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Seems like FM is perfect for urgent care. Also seems like urgent cares are popping up everywhere nowadays?

Are many new grads going into private practice working for or being owner/part owners of urgent cares? Any experiences joining an urgent care group or starting one?

Obviously it would take time and hard work to start up a new urgent care but does it make financial sense to do so? Would their be huge hurdles to overcome, which should you anticipate? What would the success rate of doing so in your guys opinion?

Urgent care is where FM skills go to die

I'm a FM/SM trained, and I work a bit at a busy UC. What VA Hopeful Dr said, is true.

The volume is too high, the pay not that great, and basically people come in for "antibiotics for my sinus infection, because it turned into a pneumonia last time". Royal PITA.
 
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Is it true that an urgent care visit is billed higher than a normal clinic visit?

Also what is the average collection/bill for a simple cough and cold type of visit to an urgent care?
 
Is it true that an urgent care visit is billed higher than a normal clinic visit?

Nope. They do tend to jack the bill up with (frequently unnecessary) ancillaries, however. That's why they're typically more expensive than going to your primary care doctor.

Also what is the average collection/bill for a simple cough and cold type of visit to an urgent care?

Depends on how creative you get with the ancillaries, I suppose.

Typical urgent care visit:
S: "Normally healthy 30 y/o WM presents c/o cough x1 day. Requests Zithromax. Denies fever, CP, SOB, N/V/D/C. Sick contacts at home."
O: Normal VS. PE: ("blah, blah, blah..."). Rapid strep: Negative. Throat C&S sent. Rapid flu: Negative. Respiratory viral PCR sent. Monospot negative. CBC, CMP, UA normal. Urine C&S sent. CXR: Negative. Albuterol HHN (with pre- and post-administration PEF) x2 administered w/improvement.
A: URI
P: Zithromax. F/up w/PCP.

You get the picture. If they had a CT scanner, you can bet they'd use it.
 
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Seems like FM is perfect for urgent care. Also seems like urgent cares are popping up everywhere nowadays?

Are many new grads going into private practice working for or being owner/part owners of urgent cares? Any experiences joining an urgent care group or starting one?

Obviously it would take time and hard work to start up a new urgent care but does it make financial sense to do so? Would their be huge hurdles to overcome, which should you anticipate? What would the success rate of doing so in your guys opinion?

If your goal is profit>taking care of patients, them urgent care might be for you, if you can find a place not already saturated with them. As above posters have said, it's typically not good medicine. It's defensive-medicine and profit driven. Volume over quality, no continuity, everything gets an xray/labs. The culture is very customer service driven, so there is a push to keep patients happy.

It's good money as a side gig in fellowship, but working full- time at this would wear me down. Money isn't bad, but I'd rather make less and enjoy my job.
 
If your goal is profit>taking care of patients, them urgent care might be for you, if you can find a place not already saturated with them. As above posters have said, it's typically not good medicine. It's defensive-medicine and profit driven. Volume over quality, no continuity, everything gets an xray/labs. The culture is very customer service driven, so there is a push to keep patients happy.

It's good money as a side gig in fellowship, but working full- time at this would wear me down. Money isn't bad, but I'd rather make less and enjoy my job.

Not to disagree with this sentiment, but, isn't this how the ED works, potentially higher acuity = more defensive?

Granted, only about 25% of the stuff that I see actually requires a true urgent care visit, most of the stuff we see can be managed via the PCP.

The issue becomes the PCP not having any options for getting patients in the same day, therefore, when little sally has a cold, the mother thinks she's got a double pneumonia and is seen in the UC, and ofcourse, the midlevel agrees and treats them with azithromycin.

I've had to supervise mid levels, and they literally tell me, their full time supervising docs usually know their limits, so if they have patients that are concerning, they get seen over. Lol. I guess that's what 200 hours of clinical gets ya, granted sometimes 20k hours that docs have doesn't fair better to little sally's mother.
 
I'm a FM/SM trained, and I work a bit at a busy UC. What VA Hopeful Dr said, is true.

The volume is too high, the pay not that great, and basically people come in for "antibiotics for my sinus infection, because it turned into a pneumonia last time". Royal PITA.
I did a year of full time UC and it truly sucked.

Now that said, I got lots of practice with suturing (including way more 2 layer closures than you'd think you'd see) and since I over-ordered CT scans I got better and telling worrisome abdominal pain from not worrisome. But in exchange I damned near forgot how to treat diabetes and blood pressure.
 
Not to disagree with this sentiment, but, isn't this how the ED works, potentially higher acuity = more defensive?

Granted, only about 25% of the stuff that I see actually requires a true urgent care visit, most of the stuff we see can be managed via the PCP.

The issue becomes the PCP not having any options for getting patients in the same day, therefore, when little sally has a cold, the mother thinks she's got a double pneumonia and is seen in the UC, and ofcourse, the midlevel agrees and treats them with azithromycin.

I've had to supervise mid levels, and they literally tell me, their full time supervising docs usually know their limits, so if they have patients that are concerning, they get seen over. Lol. I guess that's what 200 hours of clinical gets ya, granted sometimes 20k hours that docs have doesn't fair better to little sally's mother.

In true urgent/emergent care, sure. But as just primary care overflow/after hours primary care its overkill. The place I work says we get an xray for every twisted ankle, jammed finger, acute lumbar strain.
 
sounds like they bought a top of the line x ray machine.. 😀😀
Nah, its purely a time saving measure (well I mean maybe - I didn't get paid more to order x-rays but I ordered a bunch of them). If the x-ray shows no fracture even before you go into the room, you do a 30 second history, 30 second "just for show" physical, 60 second talk about taking it easy for a couple days, then out the door.
 
Nah, its purely a time saving measure (well I mean maybe - I didn't get paid more to order x-rays but I ordered a bunch of them). If the x-ray shows no fracture even before you go into the room, you do a 30 second history, 30 second "just for show" physical, 60 second talk about taking it easy for a couple days, then out the door.
And this is what i dont like about urgent care. Sounds like a good way to miss a serious problem early on...especially one that can be fixed.
 
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And this is what i dont like about urgent care. Sounds like a good way to miss a serious problem early on...especially one that can be fixed.
That's why I ended literally every non-go to the ER encounter with "if no better in 48 hours f/u with PCP"
 
And this is what i dont like about urgent care. Sounds like a good way to miss a serious problem early on...especially one that can be fixed.

I think he might have been exaggerating having orders in before seeing a patient..

That's why I ended literally every non-go to the ER encounter with "if no better in 48 hours f/u with PCP"

Same, I don't know if that really means much though. All our charting has that by default at the bottom.
 
The time when you get burned is the 50-something that “bad allx this time of year and zpak always clears me up” that’s had nausea for for the past wk and comes in with sinus congestion...and ends up the ED with having a cardiac event.
 
That's why I ended literally every non-go to the ER encounter with "if no better in 48 hours f/u with PCP"
Sorry, it hit a nerve. I see this stuff in sports clinic and it's frustrating.
21 yo who twisted her knee...urgent care did xray but no exam, said no fracture, reassured, swelling goes down but pain persists, I see them months later and history/exam screams meniscus...MRI shows a bucket handle tear she's been walking on for months.

I get imaging before history and exam when you're slammed but negative stay is just the start
 
I think he might have been exaggerating having orders in before seeing a patient..



Same, I don't know if that really means much though. All our charting has that by default at the bottom.
The urgent care I used to moonlight in during residency had standing orders for tests that got ordered based on the chief complaint.
 
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I think he might have been exaggerating having orders in before seeing a patient..



Same, I don't know if that really means much though. All our charting has that by default at the bottom.
Nope, I was not exaggerating. I was seeing 60-70 patients/day solo in 12 hours. Anything I could do to speed things up, I did.
 
Sorry, it hit a nerve. I see this stuff in sports clinic and it's frustrating.
21 yo who twisted her knee...urgent care did xray but no exam, said no fracture, reassured, swelling goes down but pain persists, I see them months later and history/exam screams meniscus...MRI shows a bucket handle tear she's been walking on for months.

I get imaging before history and exam when you're slammed but negative stay is just the start
Knees are different for exactly that reason. All knees got a decent exam from me... unless the patient is old, no/mild trauma, and xray shows significant arthritis. Then they got Mobic and told to f/u with PCP in 1 week for recheck. I might have still missed a meniscal tear, but we're not supposed to operate on those these days anyway.
 
ON a HAPPY NOTE: I personally love urgent care. I have done it for 7 years. I hated primary care and never wanted to do continuity. I see urgent care as a safety net for a lot of folks who can't get into their PCP and don't want to go to the ER. Have had a lot of acute abdomen's and MI's who were saved because they came through the door.

I have a salary but I do get RVU bonuses. I will tell you I almost never order labs, and only order xrays when it's necessary, not "just because". Yes, there are a lot of skills that I have lost but I never wanted to manage patients in the first place.

I work 10 days a month, I have great benefits, and I can do other things with my life. I don't have to be on call and I don't have to find coverage if I go out of town.

To the OP: I would never open my own urgent care since you couldn't possibly run it by yourself. Then you get into having to hire staff and what happens if someone calles in sick, etc. Just a huge headache. I like going to work then going home.
 
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Knees are different for exactly that reason. All knees got a decent exam from me... unless the patient is old, no/mild trauma, and xray shows significant arthritis. Then they got Mobic and told to f/u with PCP in 1 week for recheck. I might have still missed a meniscal tear, but we're not supposed to operate on those these days anyway.

Very general statement, older patient with arthritis and no mechanical symptoms yeah, but otherwise.. definitely indicated.

Regardless, we've gone off topic. OP, I agree with the above poster. Not a mess I'd want to get into personally.
 
Very general statement, older patient with arthritis and no mechanical symptoms yeah, but otherwise.. definitely indicated.

Regardless, we've gone off topic. OP, I agree with the above poster. Not a mess I'd want to get into personally.
I meant on that specific patient I hypotheticaled
 
Urgent Care is a reflection of the inability/failure of many primary care business models to support acute visit availability. They wouldn't exist if it was easy to see one's Primary doc.
 
Urgent Care is a reflection of the inability/failure of many primary care business models to support acute visit availability. They wouldn't exist if it was easy to see one's Primary doc.
How true that is. I was at my yearly for refills, etc. at my IM doc in the same system I work for. I asked them how many patient's they see a day. The answer was 14-17. My IM also does her own inpatient at the hospital. But daanngg. Talk about cush life. No wonder I see 45-55 patients in urgent care. No one is seeing their own patients.
 
Also why do people go to UC /ER for cough for 1 day, or everytime they throw up?
part of the problem is public aid ( although a great safety net for people who are TRULY in need) needs to more regulated and "repeat offenders" should face consequences

on the flip side for some people ( young healthy w/o chronic conditions) UC is a great place as they dont need a regular pcp or need ER visit
 
Also why do people go to UC /ER for cough for 1 day, or everytime they throw up?
part of the problem is public aid ( although a great safety net for people who are TRULY in need) needs to more regulated and "repeat offenders" should face consequences

on the flip side for some people ( young healthy w/o chronic conditions) UC is a great place as they dont need a regular pcp or need ER visit

Because we are suffering from a severe crisis of Darwinian de-evolution and no one has been taught to self treat. I've had people come in for chapped lips, dry skin, head cold, hives, bug bites, etc etc etc. I had college kids not know what antibiotics were. People who think a shot of penicillin is the cure all for every ailment. A kid who had never heard of Benadryl. A mom yesterday who didn't know what kilograms were. It's every day. It's job security.
 
How true that is. I was at my yearly for refills, etc. at my IM doc in the same system I work for. I asked them how many patient's they see a day. The answer was 14-17. My IM also does her own inpatient at the hospital. But daanngg. Talk about cush life. No wonder I see 45-55 patients in urgent care. No one is seeing their own patients.

I mean, I don't see this is as cush.

14-17 in lets say half day outpatient, (~5 hours? = 3/4 PPH, and than you spend the other half rounding on 5-10? patients with variable levels of complexity. That sounds plenty busy to me. Unless of course she only takes care of her own admits, which probably means that inpatient census is less.
 
I mean, I don't see this is as cush.

14-17 in lets say half day outpatient, (~5 hours? = 3/4 PPH, and than you spend the other half rounding on 5-10? patients with variable levels of complexity. That sounds plenty busy to me. Unless of course she only takes care of her own admits, which probably means that inpatient census is less.
The groups that I know of who still do their own inpatient only see their patients, but then also at most block out 2 hours/day to do so - clinic starts at 10am so they have to see all of their inpatients by then no matter if their census is 1 or 8.
 
ON a HAPPY NOTE: I personally love urgent care. I have done it for 7 years. I hated primary care and never wanted to do continuity. I see urgent care as a safety net for a lot of folks who can't get into their PCP and don't want to go to the ER. Have had a lot of acute abdomen's and MI's who were saved because they came through the door.

I have a salary but I do get RVU bonuses. I will tell you I almost never order labs, and only order xrays when it's necessary, not "just because". Yes, there are a lot of skills that I have lost but I never wanted to manage patients in the first place.

I work 10 days a month, I have great benefits, and I can do other things with my life. I don't have to be on call and I don't have to find coverage if I go out of town.

To the OP: I would never open my own urgent care since you couldn't possibly run it by yourself. Then you get into having to hire staff and what happens if someone calles in sick, etc. Just a huge headache. I like going to work then going home.


Urgent care physician here too and love it. I am hourly plus RVU bonus. Required to work 10 12-hour Days a month but currently doing 13-15. The urgent care I work at is owned by the hospital system so we are able to see the past history and pcp notes (phone calls). We can also send our notes and a message to the pcp if we are concerned and need them followed up sooner than later.

We have had MI’s come in to ours too. As well as new cancers, pulmonary embolism, miscarriages, diverticulitis with perforation etc. since it is hospital owned, we are able to admit patients to the hospital from urgent care (or send to surgery for appendectomy or orthopedic surgeries).

Some have been sent by their pcp for their chest pain (which is not appropriate). A lot of our patients have been told by their pcp to go to urgent care to be evaluated. We set up referral if needed because sometimes the pcp cannot get them in for a follow up for months.

We do have people come in for pain medications but they have learned we do not hand out narcotics easily and do not come in as often.

We do have Ultrasound, CT and MRI available, but I don’t order them unless necessary.


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I mean, I don't see this is as cush.

14-17 in lets say half day outpatient, (~5 hours? = 3/4 PPH, and than you spend the other half rounding on 5-10? patients with variable levels of complexity. That sounds plenty busy to me. Unless of course she only takes care of her own admits, which probably means that inpatient census is less.
She only does her own admits.
 
Urgent care physician here too and love it. I am hourly plus RVU bonus. Required to work 10 12-hour Days a month but currently doing 13-15. The urgent care I work at is owned by the hospital system so we are able to see the past history and pcp notes (phone calls). We can also send our notes and a message to the pcp if we are concerned and need them followed up sooner than later.

We have had MI’s come in to ours too. As well as new cancers, pulmonary embolism, miscarriages, diverticulitis with perforation etc. since it is hospital owned, we are able to admit patients to the hospital from urgent care (or send to surgery for appendectomy or orthopedic surgeries).

Some have been sent by their pcp for their chest pain (which is not appropriate). A lot of our patients have been told by their pcp to go to urgent care to be evaluated. We set up referral if needed because sometimes the pcp cannot get them in for a follow up for months.

We do have people come in for pain medications but they have learned we do not hand out narcotics easily and do not come in as often.

We do have Ultrasound, CT and MRI available, but I don’t order them unless necessary.


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Nice!! We only have xray. We don't admit to the hospital. I have to route everyone through the ER which sucks but I have no choice.
 
Urgent Care is a reflection of the inability/failure of many primary care business models to support acute visit availability. They wouldn't exist if it was easy to see one's Primary doc.
That may be, but many offices have same day appointment availability. Our office is usually able to accommodate the majority of our sick patients.
 
That may be, but many offices have same day appointment availability. Our office is usually able to accommodate the majority of our sick patients.

Same here. Most of our patients who end up in urgent care never even called us.

They get this letter:

We received records about your recent visit to the emergency department, urgent care center, or retail health clinic. Thank you for the opportunity to review this information, as it helps us to better meet your needs when you next contact our office. Please don't hesitate to call us if you need specific follow-up care from your recent visit.

We'd like you to know that we have same-day appointments and after hours coverage so that we can be available to you for urgent matters, including:

- A doctor is available after hours for many urgent concerns; you can reach us using the normal office number. Our answering service will contact the physician who is on call. He or she will call you back promptly.

- We have "same day appointments" in our schedules, for unexpected or urgent medical needs.

- We have an after hours clinic available at our _____ office from 6-8pm on weekdays, and 9am-2pm on weekends. No appointment is needed. They are located at _____. Their phone number is (___)___-____.

The advantages of seeking care through your primary care physician include:

- Greater continuity of care. We have a more complete record and understanding of your past history and what medicines you take. This helps you receive medication that will not interfere with other medications you may already be taking.

- Our practice is committed to following nationally accepted guidelines, including when it's appropriate to prescribe antibiotics and other medications.

- Your out-of-pocket expense (e.g., copayment) is generally much less for services at our office than at other locations.

- In many instances, you will avoid lengthy waiting times to be seen in emergency rooms and other settings for non-emergent services.

- Most importantly, we like to see our patients and help them get the best possible care!

Thanks again for including us in the follow-up notes, and please don't hesitate to call us if you have any questions about this letter or for any of your health concerns. Stay well!
 
Nice!! We only have xray. We don't admit to the hospital. I have to route everyone through the ER which sucks but I have no choice.

It is nice. I do not know how many acute appendicitis I have diagnosed and sent them straight to outpatient surgery and patient was home before my shift was over.

I had a STEMI walk in right before I left today. Door to EMS was 18 minutes. We are 1.5 miles from hospital. Got nitro, ekg, IV and labs going in the 18 minutes along with contacting ED for STEMI activation and getting her entire history in the computer since she was from out of state. It was a good team effort.


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Same here. Most of our patients who end up in urgent care never even called us.

They get this letter:

We received records about your recent visit to the emergency department, urgent care center, or retail health clinic. Thank you for the opportunity to review this information, as it helps us to better meet your needs when you next contact our office. Please don't hesitate to call us if you need specific follow-up care from your recent visit.

We'd like you to know that we have same-day appointments and after hours coverage so that we can be available to you for urgent matters, including:

- A doctor is available after hours for many urgent concerns; you can reach us using the normal office number. Our answering service will contact the physician who is on call. He or she will call you back promptly.

- We have "same day appointments" in our schedules, for unexpected or urgent medical needs.

- We have an after hours clinic available at our _____ office from 6-8pm on weekdays, and 9am-2pm on weekends. No appointment is needed. They are located at _____. Their phone number is (___)___-____.

The advantages of seeking care through your primary care physician include:

- Greater continuity of care. We have a more complete record and understanding of your past history and what medicines you take. This helps you receive medication that will not interfere with other medications you may already be taking.

- Our practice is committed to following nationally accepted guidelines, including when it's appropriate to prescribe antibiotics and other medications.

- Your out-of-pocket expense (e.g., copayment) is generally much less for services at our office than at other locations.

- In many instances, you will avoid lengthy waiting times to be seen in emergency rooms and other settings for non-emergent services.

- Most importantly, we like to see our patients and help them get the best possible care!

Thanks again for including us in the follow-up notes, and please don't hesitate to call us if you have any questions about this letter or for any of your health concerns. Stay well!


We try to get everyone set up with a pcp if they don’t have one. We have options for people who do not have insurance as well. There are some offices that are great at getting their patients appointments but others their default is go to UC. We can see all phone calls to the office and know they have called. There is one office that does walk in hours and we try to make sure their patients know that.

We I was doing primary care I had appointments that were not booked until that day. I was the only one in the office and there were not any UC around. I had some patients that could get bad quick and would work them in if they called. The bad thing is I know most of the phone calls do not reach the doc because some of the things that get sent to us should either been seen in their office (chronic condition or med refill) or ED.


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I agree with all this, which is why I spent a decent amount of time probing about the capacity to keep slots open for acutes. I think that urgent care an be a nice position for some, but as someone who loves continuity it isnt for me. I do look at it as a failure if my people go to an urgent care because of lack of access to me. Calling the office needs to be fast and getting set up for an eval needs to be painless. At my residency, my patients essentially felt like they were calling Verizon customer service. You need a human on the other end who knows the docs and can get people sorted out. Otherwise we loose them to an outside UC.
 
I agree with all this, which is why I spent a decent amount of time probing about the capacity to keep slots open for acutes. I think that urgent care an be a nice position for some, but as someone who loves continuity it isnt for me. I do look at it as a failure if my people go to an urgent care because of lack of access to me. Calling the office needs to be fast and getting set up for an eval needs to be painless. At my residency, my patients essentially felt like they were calling Verizon customer service. You need a human on the other end who knows the docs and can get people sorted out. Otherwise we loose them to an outside UC.
That’s the problem at most clinics, at least employed ones - takes too long to just get to the front desk
 
That’s the problem at most clinics, at least employed ones - takes too long to just get to the front desk

Yea so here are my thoughts on that since I care alot about it. I think that any applicant should CALL the office and pretend to be a patient interested in getting a message to the office. Use that in your process for applying for a job:

“Hi thank you calling Medco, the leader in providing an innovative health treatment product. Our menu options have changed, so please listen to 12 possible selections...” - click/dont work for them!

“Hi thank you for calling healthy system Y. ...Oh you want —— street family practice? Uh well this is actually a call center, if you want I can put you on hold for a transfer or I can send you to a providers voice mail. Did you get this years flu shot?” Dont work for them either!

“Hi thank you for calling ——- medical associates, what can I do for you today?”

That is what you want. Our accessibility is part of our specialty.
 
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