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I observed something today that caused me to stop and think. Sign makers were replacing a clinic sig nwith one for a laundromat and there is a story behind that. This space is in a good location in the center of our town. About ten years ago, it came open when the previous optometrist office built a new building. I had been contemplating opening an urgent care clinic in our city and that space caught my eye. Our local medical groups had wait times for weeks and most did not offer same day service. We have a level III ED at the hospital that had a very low satisfaction score for minor ailments. So it seemed like a good niche. While I was in the midst of doing my ground work and research for my business plan, to my total surprise, a NP friend, who apparently had the same vision, opened an urgent care clinic in that space. I supported her in any way I could including giving her all the materials I had accumulated. She started out doing as well as I had predicted. However, the hospital fought back. They quickly created their own urgent care clinic and expanded it to seven days per week 12, hours per day (which she could not do). Being part of the hospital they had stat labs, x-ray and the whole nine yards. They also operated it as a loss for several years with the intent of running her out of business. They succeeded after five years. By the time she moved out, I had established my own headache clinic. I considered moving to her space (mine was better but more $$$) but I passed. I closed after five years as I grew tired of fighting with insurance companies. But a friend of mine, DO, and internist, who was very forward looking in his approach to medicine, took the space and started a very progressive clinic. It was integrated with dietary, exercise, and natural medicine. He had a heavy virtual medicine aspect, home visits, and many other patient-friendly perks. It was a concierge practice (cash and or membership) and we live on a very wealthy island with lots of millionaires (Paul Allen was one for a while). However, after four years, his clinic has bitten the dust and thus the laundromat is moving in. I know in the year of COVID medical has become less rigid. However, it appears to me that there is a message about trying to adapt medical care into a patient-centered or atypical model. It is also a testament of the rough and tumble world of medical business. What do you think?