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Let’s not rush in urgent care centers at the expense of primary care

October 18th, 2018

Did you hear my heart go thud? As I write this, I just read of Beaumont’s plan to open 30 urgent care centers in Metro Detroit with an out-of-state urgent care clinic operator by the end of 2019. It’s not a new concept, just more of the same; yet I fear the proliferation of urgent care clinics may lead to the demise of the Patient Centered Medical Home and its focus on patent-centric, whole person care.

We want everything fast: our information, our food, our relationships… but should we slow down just a bit here and think about the patient/physician bond that is formed through the years, through primary care physicians who sometimes take care of entire families, even multi-generations of families? What’s the likelihood of replicating the health benefits of a primary care physician/patient relationship in an urgent care setting?  How about the multi-disciplinary team efforts offered by many PCP practices as an effective means of controlling and or preventing chronic conditions? That’s not on the urgent care menu. (Or should I say “Immediate Care?” I see signs (literally) that this segment of the industry is morphing into a drive-through type healthcare approach.)

Interoperability, one of my crusading initiatives, (Yes, I have many), will prove extremely difficult if not impossible in an urgent care setting, with patients the losers when their PCPs or specialists are not able to access EHR data from the urgent care provider.  Another challenge is the ability for PCPs to maintain solid financial footing relative to their urgent care physician peers. PCPs can’t charge a facility fee – but urgent care clinics can. Even when providing the same exact service. Not only isn’t it fair, it’s not the appropriate use of our precious health care dollars. Did Beaumont or other health systems ask local PCPs if they wanted to be part of an urgent care type network? That could be an innovative and prudent approach to what is apparently a pressing need for the type of services/hours/care rendered by urgent care clinics.

This is not to say that urgent care clinics don’t have a place in keeping us healthy, especially over the weekend when a trip to the Emergency Department seems unnecessary, (not to mention costly and time consuming) yet our strep throat, sliced finger, eye infection or flu-like symptoms do merit medical attention. But they are complementary to our existing medical relationships, not replacements. Their focus is on episodic care, not forging relationships with patients. I’ve been to urgent care clinics many times over the years for myself and immediate family members. I’ll be darned if I can remember the name of any of the treating physicians, as kind and capable as they may have been. Such encounters simply don’t tend to produce relationships, unlike the physician/patient relationships that develop in primary care. On that note, I want to redirect the conversation to a group of physicians that are trying to rescue primary care in Michigan: D.O. physicians

A September 2018 JAMA article highlights the impact that D.O.s play in driving primary care, noting that among the osteopathic physicians in residency training programs in 2017, 50% were training in internal medicine, family medicine, pediatrics and ob/gyn, compared to 40% of MDs, with an additional 25% of family medicine residency programs filled by osteopathic physicians. In my own experience, I repeatedly witness D.O.s in action, steeped in community, stepping up to participate in new primary care initiatives and reaching out to the disadvantaged. As a child, I recall my immigrant father turned away from a Detroit hospital on Christmas Eve when he had no insurance to treat the open wound on his foot.  He hobbled a mile away in the snow to a Detroit osteopathic hospital, where he was not only treated but given cab fare by the attending physician to ensure his safe travels home.  That’s primary care at its finest.

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