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Urgent Care Medicine on the Rise

In 2009 I got hired on by Kaiser Permanente in SoCal as an urgentologist. Since then most medical groups have been expanding their urgent care departments. This wasn’t always the case. When I got hired on in 2009, urgent care was supposed to be a stop-gap measure until enough primary care doctors could be hired on to avoid leakage to the urgent care.

It’s 2018 and urgent care or same-day or walk-in, whatever you want to call it, is as mainstream as is primary care. Patients won’t wait weeks for their primary care doctor and refuse to wait 4-6 hours in the ER and pay those outrageous fees.

Urgent Care Medicine

Urgent cares are profitable businesses, just ask my friends who own them. Quite a few ER doctors and family medicine doctors have opened their own.

For larger medical groups, especially HMO’s, urgent cares save a ton of money by taking the burden off of their emergency rooms which are loss leaders.

Previously, we weren’t able to bill for telemedicine services through private insurers or CMS. Now, it’s possible for urgent cares, whether private or medical group affiliated, to bill for telemedicine services through their own telemedicine platform.

Telemedicine Services

In the past only large medical groups could afford their own telemedicine platforms which they designed from the ground up. The laws were hard to decipher for meeting HIPAA guidelines, and FTC requirements.

Now there are companies such as Vsee which market to the solo physician practice as well as larger medical groups. Chiron and Doxy are good examples as well.

For around $150/month per clinician, you can have your own telehealth platform as robust and capable as Vsee. It allows you to do telephone, video, and text visits with your patients.

It can integrate into your own EMR or you can use the EMR built into Vsee. I met with the CEO of Vsee and I am quite impressed with everything he is doing and the plans he has for Vsee. I would highly recommend this platform to my readers.

ER Visits are Down

The number of ER visits have decreased quite a bit over the past several years. This is in part due to appointment availabilities at urgent cares and because of virtual visit options for patients.

Patients choose these options not just because of convenience but also due to the high cost of an ER visit.

Outpatient Radiology

A patient can go to the urgent care and be ruled out for a heart attack, for a pulmonary embolism, or for a DVT. This is because of all the private, outpatient radiology centers scattered over the US.

When I work in a private urgent care I can call up the radiologist at a nearby radiology center and have him/her get my patient in for an urgent CTA to rule out a PE. The report will be available to me 15 minutes after the study is completed.

Stat Point-of-care Testing

With a point-of-care in-office machine you can check all sorts of acute blood panels in your private practice. These stat machines can check all sorts of labs and provide you with a result within minutes.

  • adenovirus for acute conjunctivitis
  • lyme disease
  • chlamydia
  • H. pylori
  • legionnella
  • mono
  • RSV
  • troponin
  • D-Dimer

Access to Specialists

This American Doc is a rapidly growing company which is expanding its list of telehealth specialists. This is fantastic for a private clinic which needs immediate or convenient access to a specialist on behalf of a patient.

It might be needing an EKG review or an evaluation of a rash to rule out Steven Johnson. Maybe you need to talk to a psychiatrist to adjust a patient’s medication or determine the proper protocol for post-exposure prophylaxis.

Private Practice Opportunity

Many of you whom I’ve consulted with have your own private practice in dermatology, ENT, rheumatology, and integrative medicine. For the most part you guys love what you do and don’t see yourself retiring anytime soon. So what the fuck was I thinking signing up with KP at the start of my career??

The work isn’t easy but you have learned over the years how to ask for help and build more workflows to take the pressure off of yourself.

With this level of technology penetration in medicine, there is an option for many of us to start our own private practices. Because of technology it’s possible to do it on a small enough scale which curbs overhead and doesn’t create a ton of work for us.

And if Urgent Care seems too scary, the retail clinic model, specifically the low-acuity Walk-in Clinic, is gaining popularity as well.

Business Models

There are many urgent care business models you can follow. Urgent cares now can partner up with all sorts of other companies to deliver the services patients are asking for but not getting from their primary care or ER visits.

You can send patients home and get them IV treatment in their homes. This decreases your liability of complications inside your urgent care. It also decreases your need for space.

I’ve never seen so many happy faces getting IV’s.

You can even contract with a private ambulance company to send their EMT’s to the patient’s home for an evaluation. They can get all sorts of lab tests and offer interventions at lower costs than if the patient were to go to the ER or call 911.

You can even hire independent contractor RN’s to visit patients regularly for:

  • in-home wound care
  • colostomy management
  • foley catheter care
  • disimpaction
  • bed sore management

You won’t need your own RN and can use other companies which have the entire infrastructure in place. They will even bill the person’s insurance company and you won’t have to handle any of the headache.

You’ll come out looking like a star because you have curated all these services for patients.

Urgent Care as a Career

If you’re a Primary Care doctor or ER doctor and have been eying Urgent Care medicine, I would highly recommend it.

Now that I’m retired from medicine, I genuinely miss the fast pace but simplicity of the cases in the Urgent Care. No follow-up, no complex relationship, capable nurses, and a limited number of conditions to worry about.

The colleagues you have are also worth mentioning. There is a lot you can learn from another doctor who actually gets some downtime to look something up. Running cases by each other builds camaraderie and makes the work more enjoyable.

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