This is a post for any physician interested in opening an Urgent Care clinic. I’ve written a lot about urgent care medicine and have given various business models a lot thought. I am going to share some urgent care clinic ideas with you guys and hope that someone can benefit from this information.
I’ve worked in many different urgent cares over the years and have seen it in numerous ways, from after-hour clinics to walk-in clinics, to mini-ER’s, and concierge models.
With telemedicine taking off, demand for quick access is going up. US health customers have voted that they prefer fast access and good bedside manners over conservative, scientific management.
1. Pediatric Urgent Care Clinic
Pediatric medicine, despite how little it pays, has gotten more specialized. There are pediatric emergency rooms, pediatric specialty clinics, and a few pediatric walk-in clinics.
I haven’t yet seen a standalone pediatric urgent care clinic but I have definitely noticed the need for one as parents are reluctant to take their kids to any old urgent care. The reason might be that their child is a little more brittle, prone to UTI’s, or being managed for a chronic condition by their pediatrician.
Urgent cares who see a lot of adults can miss a UTI in an infant and often over-manage ear pain or otitis media. This pisses off the pediatrician and they ask that any future pediatric issues be addressed only with them.
I am a Family Medicine doctor and I can open a pediatric urgent care clinic anywhere in the US. I can staff it with PA’s or NP’s or even bring on an associate pediatrician.
Unique qualities of a pediatric urgent care would be having an optimized waiting room. Having a bunch of kids crying in the same area isn’t ideal. It would be best to have more exam rooms and take patients back right away.
Immunization is another thing that pediatric urgent care clinics should stock. This isn’t a big issue with traditional urgent care clinics.
Protocols will be incredibly helpful in a pediatric urgent care clinic. Pertussis, measles, RSV, UTI’s, sepsis, foreign body aspiration, septic arthritis, and child abuse can easily be missed. Having some protocols in place to look for and manage such conditions is easy to do.
Networking with Pediatricians
Plenty of pediatricians would be more than happy to give up some of their acute appointments to a good pediatric urgent care. It would be worthwhile to develop a network of pediatricians with whom you can refer back and forth.
Try to find the good, local pediatricians. These are caring individuals and don’t want their patients mismanaged. Get together with them and ask about their patients, their preferences, and create a way to share with them what you did with their patient.
I am generally not a fan of having an x-ray in the urgent care clinic but it might make sense for pediatric patients since they will have more trauma. Then again, if you can farm it out to a nearby radiology center, it might give you a little less headache.
2. Efficient Walk-In Clinic
When people see urgent care they associate it with a high acuity clinic and that’s when you start having to deal with more complex patients. This is fine if you have other providers but it will ruin the concept of an urgent care if it slows down the flow of the clinic.
I wouldn’t call this a concierge model but it would have some characteristics in common. I’ll discuss in another post why a concierge clinic model might be a bad idea.
The point of an urgent care is for the patient to be urgently seen – this is rarely the case in most clinics. It’s essentially about convenience for the customer. The patient doesn’t want to pay the high copays of the ER and they don’t want to wait 9.5 months for their primary care doctor.
The important characteristics of a walk-in clinic are speed, efficiency, convenience, ease of access.
Ease of Access
Patients don’t associate fast care with shitty care. Sure, some do. Likely that’s going to be the patient who wants to handle their chronic care at your clinic – that’s not the kind of patient you want to attract.
Patients mostly care about bedside manner and efficiency of the clinic. You could be the best doctor in the world, it doesn’t mean much because the patient has no way of gauging that.
Be nice to the patient without being a pushover, make sure your staff is accommodating, don’t waste the patient’s time, and get them in and out of your clinic quickly. They will love you.
In order to attract low-acuity patients it’s helpful to send the right message to the patient. A simple clinic design without a ton of lettering on the windows, simple exam rooms, and a list of common conditions listed on your website should be helpful.
Patients are great at self-selection. Your website can list some common symptoms or conditions which you won’t manage in your clinic. You want to turn away complex cases and patients who are getting wheeled in with their oxygen tank and bypass machine in tow.
The design of a clinic sends an important message to the patient. One style attracts the geriatric, another the healthier patients. I’m not talking about the $1M-design clinics opening up in SF – that kind of interior design is just excessive. Keep it simple with the design – 2 colors.
Automate everything possible. Have patients sign digitally. Have them fill out forms online. And provide them their visit summaries digitally. They should be able to make their appointment, pay for their visits, and schedule follow-up all online.
Get rid of price confusions, it’s just more work for you. Charge 1 price for everything. Patients will appreciate the simplicity and you won’t have to figure out the payment upon discharge.
From the minute they enter your clinic to the time they exit, it should take no more than 20 minutes. This is very doable when you follow the 80/20 rule. Focus on the easy 80% and turn away the complicated 20%.
Be ready to refund patient’s money to them for the visit if they have an issue that you cannot address. This will make for a very happy customer who will surely use your walk-in services in the future when they have something simpler.
Have multiple MA’s running the show. You shouldn’t need a front-desk person. That’s one more hurdle for the customer to overcome.
You can pay an MA $20/hour and have 3 for the price you’ll pay for an RN.
Skip the vitals! For god’s sake, please skip the vitals. This vitaling business of every single patient is embarrassing for our profession. I’m here to refill my scopolamine, why the fuck do you need to know my weight?
UTI’s, back pains, URI’s, headaches, and VGI’s should all have protocols in place. A scribe can help you fill in everything you need. Most physicians will use one of their MA’s as scribes.
Skip the Fluff
No x-ray. No blood draws. No IV fluids. No complex lacerations.
You can to partner up with those IV companies that go to people’s homes to IV them. See the patient, determine that all they need is an IV, and then tell them to go home and send the IV company to their house.
Adjust to Your Population
You have no idea which group of patients will seek you out. It might be all the active retirees, it might be millennials, or it might be busy soccer moms.
Adjust your workflow and business methods to serve those who come to see the most. If you rarely see peds, then don’t see peds. If you rarely see geriatric patients then advertise and gear more towards younger clients.
If you are seeing a mostly sexually promiscuous crowd, get down PEP and PrEP. Have rapid STD testing available. Pass out condoms instead of lollipops.
3. Virtual & Physical Clinic
I wouldn’t advise anyone to start an online-only telemedicine practice because the market is highly saturated when it comes to advertising. It might make sense in the future but these pieces-of-shit medical boards would love nothing more than to go after physicians doing that.
Instead, you could have a physical office that’s mostly telemedicine based as I’ll explain below. Or you could build a super-niche telemedicine
You do this by having a single exam room, no front desk. You would handle everything yourself without an MA.
The point here is to get the people in the door and get them used to the concept of doing telemedicine only. But if they need an exam or need a test or procedure then you can bring them into the office.
It would be slightly concierge based and the point is to accumulate a patient base.
Consider a pricing model of $20 for the telemedicine visit and add $50 if they need to come in. The point is you want the easy patients to come in for maybe an in-person evaluation of vitals, a simple procedure, or point-of-care test.
You could staff your clinic with an RN or PA and have the patients be seen on the spot or book them for a telemedicine visit with you when they arrive. If a point-of-care test is needed, either the RN or PA can perform the work.
A virtual room might be ideal for this and quite easy to build. The patient can check their own temp or take their own blood pressure or be assisted by the RN or PA.
Consider focusing on a niche population for their acute needs. The reason I say this is because it’s much cheaper to advertise to these patients than have to compete with Teladoc, Doctor on Demand, MDLive, American Well, Oscar, and all the other big players.
The following niche practices come to mind:
- pregnancy related