Top Challenges That Physicians of Urgent Care Centers Face
Even though the urgent care center (UCC) market is rapidly expanding, physicians and physician owners of UCCs have faced many challenges throughout the year.
“One of the biggest challenges I’ve faced is finding providers that have the skills needed to work in urgent care,” Richard Wallace, a physician at Bayside Urgent Care in Clearwater, FL., says. “Most applicants come in very qualified and can do all of the procedures, but they don’t have the best work ethic and bedside manner. It’s been hard for us to find good quality providers.”
“A lot of doctors want to become specialists and make more money, many go from full-time to part-time because of life changes like getting married and starting a family, and the younger doctors aren’t willing to put in the effort like the more senior physicians were,” Peter Lamelas, a physician at MD Now Urgent Care in Palm Beach and Miami-Dade, FL., says. “Older doctors also want to retire, and younger doctors want a more flexible schedule; they want a social life outside of being a doctor.”
Larry Earl, the chief medical officer of ASAP Urgent Care in Connecticut, agrees that staffing problems are a major issue in the UCC market.
“It’s hard to find good staff, keep them motivated and stimulate them to stay with you for the long term,” Earl says.
In addition to a provider staffing shortage, Lamelas says that there is a lack of training for physicians entering into the UCC market.
“Typically, UCCs are going to find themselves using internal medicine doctors that may lack experience and need to be trained in-house, or retired emergency physicians that will need additional training,” Lamelas says. “Or you will have some that may not have completed their residency, or completed a residency in non-traditional care like OB-GYN, and transitioned to urgent care medicine.”
“One of the challenges I’ve faced this past year has been finding, and putting in, some sort of support and training mechanism for the guys here to feel comfortable,” Wallace says.
To combat this problem, Lamelas says that the American Board of Physician Specialties (ABPS) has created an urgent care board certification examination.
“This examination will help screen out those who have a basic knowledge of urgent care medicine, and shed some light on who is qualified to work in these centers,” Lamelas says.
While there is a lack of qualified physicians and adequate training, there is no shortage to the number of patients coming through the doors every day.
“The volume of problems grows as the industry expands,” Wallace says. “There was a time when I was seeing 60 patients a day. The more patients you see, the more likely you are to make errors.”
Treating patients is also a challenge that physicians of UCCs face, according to Earl. He says that most urgent care treatments are fairly standard, and physicians are frustrated with patients that continue to demand medications that they don’t need.
“We are retail-meets-medicine,” Earl says. “We have that retail mindset where we’re treating patients as customers, but we also have to balance that with medically correct care. There’s always the ongoing challenge of balancing overuse of resources and giving patients what they really need.”
Wallace also says that depending upon a center’s location, language and communication barriers between patients can also prove to be a challenge.
“My center has a very diverse patient population,” Wallace says. “Sometimes, we need interpreters and translators.”
In addition to staff and patient challenges, Lamelas says that pressure from insurance companies is also a battle.
“Insurance costs go up every year, and some of the insurance companies do not have escalators or increases on urgent care reimbursement,” Lamelas says. “UCCs will also have to learn to control their costs better due to flat fees.” Lamelas also explains that as costs shift from patients to insurance companies, patients are more responsible for co-pays and deductibles. This creates more challenges with collecting payment upfront, as patients do not want to pay more money.
“The UCC actually isn’t getting any more money from the patient,” Lamelas says. “The patient is just more responsible for the payment.”
However, there is a silver lining. Lamelas says that since insurance companies are doing the same thing to emergency rooms, UCCs can benefit from that. Patients that don’t want to incur a larger cost from emergency rooms will choose to pay the costs at UCCs instead.
Lamelas says that a combination of staffing and insurance challenges will lead to another problem for physicians: competition and consolidation.
“Consolidation regionally, nationally and in certain markets will squeeze out the smaller urgent care centers,” Lamelas says. “The days of the mom-and-pop center are over. The centers with a strong presence will just get stronger, and the single center will die out.”
The challenges that physicians faced in 2014 will likely continue to occur in 2015. Physicians will also start to see new challenges arise.
“An emerging challenge will be figuring out an effective way for a UCC to work with another medical group or entity, like a hospital health system,” Earl says. “We need to come up with a reasonable plan to keep patients that don’t need to be in the ER out of there, and when to make the right call to send a patient from a UCC to the ER.”
Earl also says he hopes to tackle the challenge of reducing long wait times for patients.
“Our goal is get a patient in and out within 20 minutes,” Earl says.
In 2015, Earl also hopes to establish relationships among other groups to be the preferred choice in after-hours care, and the alternative to emergency room care, when appropriate.
Wallace says that he will likely continue to face pace challenges in 2015, as well as challenges with communication and rapport with patients.
“How many patients you have at given time varies,” Wallace says. “One minute the waiting room is completely empty, and the next minute, all seven rooms in the clinic are full.”
While physicians must deal with many challenges each year, there are solutions that can help.
The urgent care board certification examination by the ABPS can help UCCs hire the right people, as well as show what additional training will be necessary. Lamelas adds that the use of mid levels and extenders such as nurse practitioners and physician assistants will also aid the staffing crisis.
Of all the challenges that he has been through, Wallace stresses that the most important one he has faced, and will continue to face, is job integrity.
“Do your job, do it well and be aware; know how to treat injuries appropriately,” Wallace says. “As a provider, you’re the jack-of-all-trades, and you must know what to do in certain situations.”
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