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Rebirth of Urgent Care Medicine

Some of you who’ve been reading my stuff know that this website was first called I loved urgent care medicine so much that I dedicated most of my writing to spread awareness of the joy of working in this field. And I find that there is this rebirth of urgent care medicine – so many great reasons to consider venturing into or getting back into urgent care medicine.

As crazy as you might think an urgent care clinic is, the majority of the cases are straightforward and the patients are quite grateful. In a way, it’s one of the corners of medicine that’s still untainted.

Urgent Care Medicine

You don’t have to be a family medicine doctor but it helps a lot. You can be an internal medicine physician or pediatrician and still take advantage of what an urgent care career can offer.

Unlike primary care medicine, you won’t be stuck with the chronic management of your patient’s illnesses. They might have some new condition going on which you’ll need to investigate and manage; that can be tiring.

In primary care medicine, you also have to fight for insurance contracts. You’ll have to renegotiate them and may have to choose between taking Medicaid/Medicare or not.

Urgent care medicine is much simpler. You won’t get tangled up with the chronic care or the chronic expectations your patients might have. It’s not like there isn’t continuity of care but it’s more interspersed.

Why Now?

Patients are getting far more access to virtual medicine so you would think that we’d need fewer in-person urgent care clinics. But at the same time patients are getting sicker, older, living longer, and want more western medical interventions.

Telemedicine is taking all the simple cases off the top. So you are left with primary care patients who’ll have their own PCP’s whom they see. And you have the high acuity patients who are going to the ER’s.

ER’s are becoming much less profitable and though there are standalone ER’s I don’t think there will ever be enough of them to compete with standalone urgent cares.

Patients want high-impact care and they want it fast. They want competent physicians whom they can turn to without a long wait. And many will want to have this access despite insurance changes. That’s where the urgent care model shines.

Why Private Urgent Care?

A private urgent care allows you to run your practice the way you see fit. If you don’t want to see certain patients or want to hire a specific MA, you can do that.

If you don’t like seeing high acuity patients then you can structure your urgent care that way. You can discharge a patient from your practice or offer free sports physicals on Sundays.

When you’re running your own private urgent care you can choose to accept insurance or just take cash. Both models can work and have been done successfully in all kinds of markets.

A malpractice claim or a medical board investigation is much less likely in your own private practice. The reason is that you can follow-up any way necessary or end a potentially bad patient interaction as soon as you deem necessary.

You can set your own hours and have control over your staff. These are all factors that can improve one’s career satisfaction and hopefully decrease the chance of eventual burnout.

Private Practice vs Employed

I’ve done the employee thing for a decade and a half. It was great. I learned a lot. But I have very little faith in large medical groups to do the right things for patients. That’s why I prefer a private practice model.

Not that I’ve ever had my own private practice. But I own and have owned my own businesses over the years. I know the value of being your own boss and having some control over what you do and how you do it.

The private practice urgent care model is all but dead. I see many group practices or chains but a good old, standalone, local urgent care clinic – where are they at?

Urgent Care Models

As I mentioned, ER’s are slammed and patients are tired of waiting. Many can’t get much out of a virtual visit if they have something that needs a more thorough analysis.

Think of the most common urgent care cases:

  • UTI
  • URI
  • Asthma exacerbation
  • Pneumonia
  • STD
  • Cellulitis
  • Ear pain
  • Pinkeye
  • Dental pain
  • Vertigo
  • Dehydration
  • Chest pain
  • Abscess
  • Lacerations
  • Fractures

The last 6 on the list is probably what most physicians prefer to not deal with. I get it. I would argue that they are rather easy to manage if you know how to triage the right subset out to the ER.

One urgent care model is higher volume, lower acuity clinic. You basically do rapid flu, rapid strep, COVID-19, pregnancy tests, and deal with UTI’s and coughs and colds. Maybe the occasional aches and pains and off-work notes. This might be called a walk-in clinic.

Another urgent care model might be one where you are doing IV fluids, getting X-rays, repairing lacs, and draining abscesses, and working patients up.

It isn’t hard to start a lower acuity practice and increase your acuity based on your comfort level and patient demands.

What Services to Offer

There isn’t a lot that you need to offer. And once you have been open for 1 year you’ll quickly recognize which services are in highest demand and which services aren’t making you a whole lot of money.

EKG’s and drug testing and basic point-of-care testing will already be an incredible service and save your patients a lot of money from not having to go to the ER.

Your MA can do splinting and ear wax removal and wound care and nail care.

Finding Support

It doesn’t feel good to work in a clinic alone and have to deal with potentially high acuity cases. But you don’t have to go at it alone. Here are some options to consider to feel like you have more support.

Remember that specialists in the neighborhood will want your referrals. They’ll be more than happy to hop on the phone with you to offer you some guidance in care.

You can also work with a part-time PA or NP. These will often be clinicians who have worked in the ER with plenty of higher-acuity experience.

Finally, if you have a really good MA or LVP/LPN you will feel rather well-supported because they can manage a lot of the work without much guidance from you. And if a case needs to be escalated they will step in and be helpful.

Franchising an Urgent Care

The urgent care model is easily replicated. Some of the biggest obstacles are finding the right suppliers for equipment and furnishing the place. Maybe you don’t want to track down a radiologist and negotiate those prices. This is where a franchise model might make the most sense.

You’ll pay a certain amount from your gross income but in return, you’ll have a lot of support from the franchising agency. Imagine all of the time you would spend on administrative work, that will free up but in return, you’ll pay for that.

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