As an emergency physician with an unconventional background, previously as a Navy SEAL, I’m always looking for new challenges, but I never pictured Urgent Care as part of my career. Now I’m glad I did. While most practicing Emergency Physicians don’t often consider the value of practicing urgent care medicine, there are many benefits to Emergency Physicians spending some time in the Urgent Care setting. Since Urgent Care centers are popping up all over, we need to explore and expand our role in providing care in these environments. Before I practiced in Urgent care, it was hard to imagine that I would learn much in this environment, but I have found that there are many benefits to the emergency physician.
1. Learning and Practicing Multiple Approaches to Each Illness
Many emergency physicians already practice in multiple practice environments which may include single coverage or other autonomous arrangements, but for those of us practicing solely in larger emergency rooms, an urgent care provides a challenge to practice autonomously and with fewer resources. This sort of environment forces us to realize that there is more than one way to treat each condition, and this is only healthy in our approach to each patient, many of whom deserve multiple treatment options. Patients who are comfortable with fewer tests typically self-triage to Urgent Care. For example, patients present not infrequently to our Urgent Care with abdominal pain that is usually subacute and not severe and are usually diagnosed and treated without imaging and usually before most lab test results are available. Only in being comfortable working with less and aware of multiple approaches can we present truly patient-centered options where we involve the patients in the best course of care. We could certainly do this in the Emergency Department as well.
2. Developing a Patient-Centered Approach
We all learned from many attendings in residency, and I’m sure I took at least one lesson from each of the many excellent attendings I worked with at Pitt. There was one attending in particular who was well ahead of the curve in the patient-centered approach to care in the Emergency Department. This particular attending was bright, confident and very insightful in his treatment approach but whenever possible, he used the patient and family’s opinions when deciding on plans for care. He provided several options to the patient and when appropriate, they chose the plan of care that they felt was best for them. Patients appreciated being included in their healthcare and felt that they had control-because they did! I tried to adopt this approach from him. Sometimes we know that life would be simpler if we had more of the “old school” patients who just say – “you’re the doctor, whatever you recommend.” But I appreciate that each decision is different for each patient with each disease, just as each patient is different. Each patient and family has a complicated set of circumstances that involves their ability to pay for treatments, their ability and likelihood to follow-up and their own tolerance and understanding of risk and their medical care.
3. Being Cost Conscious
Another set of challenges for the ER doctor in Urgent Care is helping to make decisions with the patient about the costs of care. Although the Urgent Care patient is typically overall lower stress than the ER patient, these typically well-informed, cost conscious patients are more involved in decisions about their care. Many of our patients in Urgent Care are more likely to ask about the necessity of any tests which may cost money, such as x-rays or labs, since they are already seeking more affordable options for their care and may have more vested interest in their care. Many of these patients have high-deductible insurance plans or no insurance, so they are naturally more involved in spending their own healthcare dollars. It is actually refreshing to discuss different options for diagnosis and treatment, but these situations also require that we as physicians are more aware of the true potential costs to the patients. Learning about patients insurance plans and having people in the practice who are skilled at answering these questions makes us better physicians and more-informed advocates for our patients. Practicing medicine in the Urgent Care environment allows us to provide care that is closer to what may be needed and more value-based in each situation rather than based on what is easiest, more complete or expected.
4. Becoming more familiar with common illnesses
As Emergency Physicians we do our best to keep up on the latest diagnosis and treatment of many uncommon diseases more than being the experts on everyday illnesses such as those seen in Urgent Care. We are typically specialists in the sicker patients, while in many emergency departments mid-level practitioners treat the lower acuity patients in a fast-track type area.
In Urgent Care we see the “everyday” illnesses, such as upper respiratory infections, allergies, UTIs, rashes and minor injuries to name a few. While this is not exciting, it is still important for Emergency Physicians to be experts in the evidence-based care of these lower acuity, very common illnesses. Part of the reason there may be such a wide range of treatment styles for these illnesses is that we may feel that closely studying the evidence is less important for such low acuity maladies. More and better studies would also be beneficial in standardizing our approach to many of these patients. If board-certified Emergency Physicians were more involved in Urgent Care, we could be more involved in developing studies for this population.
5. Leadership opportunities
If leadership for physicians in the hospital was more like most companies or the military, the executive level physicians who serve as directors, assistants and other clinical leaders would have more of a development track and a standard progression for advancement. This may mean that most ED directors as an example would only serve a limited number of years before they were able to move up or sideways to make room for another class of future executive level physicians.
I am certainly biased by my experience with leadership development in the military and as a leader in the Navy SEALs. However, doctors need to be more involved in the evolution of healthcare delivery, and to do that best we need to have good physicians involved in administration. Since opportunities for physician leadership in hospital medicine are few, we should look to the opportunities in small businesses such as Urgent Care for aiding in the development of our future physician leaders.
6. Change of pace and avoiding burnout
Although most of us went into Emergency Medicine for the adrenaline high that comes from diagnosing and treating the sickest of the sick, we know that this level of stress eventually takes it’s toll on our attitude and mental stamina leading to job dissatisfaction and burnout. A change of pace with an occasional shift with lower acuity, lower maintenance patients may help us avoid burnout and help prolong our careers.
Medicine is changing due to changing insurance plans and concerns with overall out-of-control costs in medicine. Urgent Care is one example of how healthcare is moving towards more of a value-based, cost-sharing and patient-centered experience. Emergency Physicians can benefit from occasional involvement in Urgent Care by adapting our practice and learning to thrive in this evolving environment.