Will Urgent Care end Primary Care ?

[EMEDPA]

Did you guys also use blood letting, leaches, frontal lobotomy and jugum's? :)

nope, but we did frequent large volume gastric lavage for ODs which has gone out of favor. I always thought it was a good motivational tool to prevent future ODs....

[GetMeOuttaThisMess]

^^ Amen. I do miss chymopapain for contained disc herniations. Another good tool when used APPROPRIATELY (which it wasn't in many cases resulting in transverse myelitis cases) that had to go away. Miss the prescriptions for pedi ibuprofen (wasn't OTC) resulting in parents trying to find open pharmacies over holidays, NOT.

[medic25]

yup, we did procardia puncture and swallow as well....apparently that was a bad idea.....

 

Good old procardia; I remember it well...

Personally my favorite blast from the past is MAST pants. You knew you had a hot trauma when you heard the Velcro crackle as the pants inflated...

[EMEDPA]

Good old procardia; I remember it well...

Personally my favorite blast from the past is MAST pants. You knew you had a hot trauma when you heard the Velcro crackle as the pants inflated...

my class in medic school was the last one taught mast pants. I have only ever used them to stabilize pelvic fractures.

[fakingpatience]

my class in medic school was the last one taught mast pants. I have only ever used them to stabilize pelvic fractures.

 

We had to pass a state test on MAST pants for my paramedic... 2.5 years ago...  Some places still are in the stoneages  (other fun tidbits, EOAs as the only backup rescue airways, handcrank IOs, and verapmil ).  Oh and don't forget the high flow 02 and backboard for every patient! 

[EMEDPA]

haven't used an EOA since 1992. King LTs are the bomb.

[ToppDog]

Ha, I remember using the suction cups on an EKG, & the mounting.  I wonder how many know what mounting an EKG means.  And, no, it's not that.  Get your mind out of the gutter :)

[Acebecker]

Not changing the subject, but I do wonder if urgent cares aren't possibly the worst thing to happen to medicine in a long time.  Here's my thinking on this.

 

1. People will go to urgent care for anything. 

2. If they don't get the result they want, they'll go to another one.  This often results in excess antibiotic use - "he's been seen by two other providers and is not better, so he must need antibiotics now." 

3. Often they will come to urgent care without having tried any home remedies or tincture of time - there's no self-reliance or attempt to problem solve on the part of the patient. 

4. Insurance will almost always pay for these visits as they are 'acute care' visits; as a result, practices are opening up urgent cares as cash cows for the rest of the practice. And as a majority of the patients visits become urgent care visits, insurance rates will continue to rise as they have higher outlay to cover these patients. 

5. Patient expectations of their medical providers are altered - they get seen quickly and pretty much whenever they want to be seen.  They think their PCPs should be the same way - "I walk in and I get to be seen...  If I'm not going to be seen, the first question I'll ask is, 'Who do I complain to?  Let me talk to your manager!'"

 

UC alleviates, or used to, the overburdening of our ERs.  But it is basically pandering to the demands of the masses much like the Queen song - "I want it all, and I want it now."  It's a sign of the millenial generation I think.  And now the ERs are getting overburdened again because the UCs close at 8pm or they get overrun and instead of waiting it out or calling the PCP the Pts go to the ER because they want to be seen NOW. 

 

As much as I enjoy working in UC, I think it may be a horrible invention. 

[EMEDPA]

Ha, I remember using the suction cups on an EKG, & the mounting.  I wonder how many know what mounting an EKG means.  And, no, it's not that.  Get your mind out of the gutter :)

yup, did that. cut up the strips and mounted in proper order on a sheet of paper with spaces for each lead.

[EMEDPA]

 

As much as I enjoy working in UC, I think it may be a horrible invention. 

if used appropriately for minor ambulatory issues and procedural and ortho stuff thay are great. they don't take the place of a pcp or a hospital.

my least favorite abuse of the UC system is this: " I have already seen my pcp, 3 specialists and had 2 surgeries for this problem and I think they are all wrong. it is 2 am on a saturday and I want you to find the real problem.....". UC is NOT a 3rd/4th/5th opinion after your pcp and/or a specialist to get what you want. I ALWAYS send these folks back to their pcp without any new tx.

[Acebecker]

I agree - will never take the place of a PCP. 

[GetMeOuttaThisMess]

Not changing the subject, but I do wonder if urgent cares aren't possibly the worst thing to happen to medicine in a long time.  Here's my thinking on this.

 

1. People will go to urgent care for anything. 

2. If they don't get the result they want, they'll go to another one.  This often results in excess antibiotic use - "he's been seen by two other providers and is not better, so he must need antibiotics now." 

3. Often they will come to urgent care without having tried any home remedies or tincture of time - there's no self-reliance or attempt to problem solve on the part of the patient. 

4. Insurance will almost always pay for these visits as they are 'acute care' visits; as a result, practices are opening up urgent cares as cash cows for the rest of the practice. And as a majority of the patients visits become urgent care visits, insurance rates will continue to rise as they have higher outlay to cover these patients. 

5. Patient expectations of their medical providers are altered - they get seen quickly and pretty much whenever they want to be seen.  They think their PCPs should be the same way - "I walk in and I get to be seen...  If I'm not going to be seen, the first question I'll ask is, 'Who do I complain to?  Let me talk to your manager!'"

 

UC alleviates, or used to, the overburdening of our ERs.  But it is basically pandering to the demands of the masses much like the Queen song - "I want it all, and I want it now."  It's a sign of the millenial generation I think.  And now the ERs are getting overburdened again because the UCs close at 8pm or they get overrun and instead of waiting it out or calling the PCP the Pts go to the ER because they want to be seen NOW. 

 

As much as I enjoy working in UC, I think it may be a horrible invention. 

 

Man, I hate it when common sense enters the picture...  I thought about this several years ago and wondered why PCP's/small groups don't combine together and open an UC clinic for their clientele within one of the offices.  They get the revenue, the patient gets seen same day, records can be saved to the provider's EMR, and they can split the costs of the sole advanced provider.

[SocialMedicine]

This message board is a bit biased. The very fact that you are on here posting shows you take yourself and your profession seriously, and are interested in health care. In my opinion a decent number of UC providers and facilities are commercialized and eager to make a profit and cut into primary care business. I respect innovation and people who want to work hard and take chances, however UC is not always set up to provide the same level as a PCP. One example. In New York City there was an outbreak of bacterial meningitis last year. The urgent care center took out ads in papers and bus depots they will administer vaccine at a walk in basis. When you walked in you learned about the facility and many of those individuals now f/u their for vaccinations, urgent care, and other issues outside the typical UC scope. This is not necessarily a bad thing, but it is one way in which the commercialized UC can push into primary care territory unopposed. I do not see many large primary care groups forming with a similar commercial and innovate mind set , and I see an urgent care on every street corner with one.

[sk732]

Ha, I remember using the suction cups on an EKG, & the mounting.  I wonder how many know what mounting an EKG means.  And, no, it's not that.  Get your mind out of the gutter :)

I remember vividly doing that, staying in school several hours trying to get the perfect strips and mounts...

 

The only good thing I have to say about the UC near where I work is it's tapped into the same EMR, so can be looked at, and we all talk to each other around here.  Amazed at how many people hate the wait time in there, yet don't want to wait in the ER...ironically, they are the ones that usually get turfed to the ER.  Can't win sometimes. 

 

Of course, I work in Canada, so people seem to think that because it's "free", they can go where ever, when ever, for stuff that they should have just talked to their mommies about...and continue to do so until they hear what they want to hear.  These are also the same people that complain about wait times, why they can't get what they want, when they want it, but yet snivel when their taxes go up to pay for all of this.  I'm a firm believer in user fees for non-emergent conditions going to ER's here, and for doctor shopping because someone was told what they needed to hear, not what they wanted to hear.  I've actually had people in my office, looking for a second opinion from me, because a specialist told them they wouldn't operate on them for a condition that it was contraindicated...and I'm not their primary care provider, nor am I a specialist, much less an MD.  When that starts happening here, I think our health dollars will be able to be spent better.

 

Oh, and fire half of the multi-gazillion dollar salaried health care administrators sucking up money that should be spent on people at the pointy end of care delivery...but that's another rant.

 

SK

[Guest Paula]

Are you sure you work in Canada?  Sounds like the good 'ol U S of A urgent care/EM setting to me. 

[sk732]

Are you sure you work in Canada?  Sounds like the good 'ol U S of A urgent care/EM setting to me. 

 

Yup to both - just they don't have to pay here...well don't pay directly in most provinces.  Some (my old stomping grounds for instance), you pay monthly direct or out of salary; in the others, it comes out of your taxes.  You do pay for ambulance rides here - pretty expensive in the rural area I work in, even worse if it's deemed a trauma or stroke bypass to the major centres.  I made sure I got the rider on my Blue Cross for that :).

 

SK

[KMD16]

Will urgent care ends primary care?

 

It's becoming a reality. Maybe not. I tell you. I'm seeing a trend: PCP are becoming the new medical specialist in town. Lately, it's taking anywhere from two months to six month for my patient to schedule an actual visit to see a PCP as new patient or existing patient.

 

We are overworked. The continue low reimbursement, the continue increasing overhead, paperwork etc had resulted to medicine today more about increasing patient volumes. Given this trend. Where do you think patients would turn to? Urgentcare or the ED.

 

There's primary care shortage. And, it has been and it will continue to be according to the AAFP unless there's increase in residency spot by > 25%. Then, there's the issues of funding. The issues of US medical school graduate with less desire going into primary care. The prediction that primary care training slots will go unfilled in the near future. Maybe mere speculation that should be ignore. Maybe not!

 

The ACA just added or will add 32 millions patients. Oh sh!t. The ACA...We just realized the terrible reimbursement rate. And, we will all opt out. Things are not looking good.

[JohnnyM2]

yup, accessibility is key. if your pcp accepts your insurance and can see you on a same day basis, pts will go there. if you schedule a week out they will go elsewhere for urgent issues.

 

 

Primary care needs to change. 8:00 or 9:00 am to 5:00 PM, half day on Wednesday and no weekends just doesn't cut it for many people. Scheduling appointments a week or more out also doesn't cut it. We live in an immediate gratification society. Primary care practices need to extend their hours. They can do this with PAs and NPs. My son, who is in college, typically goes to an urgent care in Dallas (same co-pay as PCP here at home). They typically see him same day with appointments just two to three hours out and call him 20 mins before his appointment so he can be doing other things til its time to drive over there. Delayed appointments and short hours are what force patients into ERs. I had an internal medecine doc working in a group private practice and could only get an appointment with him 4 or more weeks out. I asked the scheduler what I was supposed to do if I was really feeling sick and she told me to go to the ER ($400 co-pay). I dumped him in a heartbeat and went to another doc who can always see me in a day or two, at most, because they reserve an early morning block for patients who need to be seen urgently.

[andersenpa]

I'm not in the PCP/UC world, but is there a problem with a growth in UC?

As long as patients have access to a PCP that they can schedule elective annuals with or things of that nature, then let UC be the solution that it is.

Just like obs units are avoiding certain admissions, UC can avoid clogging up a PCP's schedule with quick fixes.

[surgblumm]

Urgent Care , as it had ts genesis, was to relieve the volume in the ER. We all are aware that it has become big business and when businesses become big, big brother starts to look closely at how charts are constructed, particularly the EMR. Not all primary care practices are involved to this extent. I have some insider information that tells me that their will be a massive crack down that ends the proliferation of these much needed clinics because of the simple concept of GREED. Can one of you folks tell me how I can post new posts? I am returning as a full time user of the forum and was a contributor and will again join your ranks. thanks to Mike and his creative idea, we have a place to meet as PAs and to share our thoughts. bob

[Guest Paula]

Bob, when you enter one of the discussion sections, for example, Professional PA General discussion forum, you will see a black box that says 'start new discussion".

 

Just click it, enter the title of your topic, and then enter the body of your text, hit post when you are done. 

 

Does this make sense?

[CByersPAC]

I agree with earlier statements that primary care needs to change its model if it wants to provide care to people who are sick today and have busy schedules. There's a whole set of rules and behaviors patients need to comply with to get their primary care needs met, generally involving fitting into a schedule designed for the provider or facility's convenience. Add to this the difficulty of scheduling a same-day appointment when one is sick, and it's not surprising patients vote with their feet and choose an episodic care facility. I don't necessarily see this as a problem, just a change.

[surgblumm]

Thanks Paula, perfect sense. Bob

[winterallsummer]

I don't personally take issue with UC because most the pts they see are for acute things, med refills, etc.  The problem is when pts with multiple, chronic health issues that needs to be followed, have someone the hospitalist can call, to coordinate between specialists, etc - those pts will suffer if their UC is their PCP.  I would think most busy PCP offices are happy to send simple lacs, runny noses and allergies to UC centers.

[gbrothers98]

UC is all about money. Provide the access, in comes the money. 

If a PCP is incentivized, they will incorporate UC into the mix.

Otherwise, they will see what is scheduled. In most practices, there is a disconnect between who answers the phone and the provider with no directive or incentive concerning access. The common retort when no appointments at my place is the ED is available, damn the copay. Most UC are staffed lean to take advantage of volume and leverage that. They also have an efficient process because of the business model vs many PCP offices that are able to stay in business because patients wont go anywhere else even when confronted with poor service.

And I would have to say this is not a millennial thing. This is a boomer on through the generations thing, very much an American (and maybe Canadian) perspective. We have defined healthcare as a commodity that can be purchased rather than a service to the general population. So it will be viewed similarly as going to Walmart or switching cell carriers. Fast, convenient, buyer beware concerning quality.

In the end, everyone may complain about the cost of healthcare but this is about job creation. With such a contribution to the economy and GDP, no one wants to mess with it, it needs to continue to generate the cash flow. While PCP offices may get replaced with UC and everyone bemoans the fact, it is a reality based upon our way of doing business. Until that paradigm shifts, unlikely, it will continue to be the trend.

G Brothers PA-C