This recent article in the NY Times, about urgent care centers, is really interesting. It’s called The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care and it is full of irritating stuff. Let me explain.
I did a transition year in an urgent care center before I did my DPC practice. It was in a massive chain now owned by an insurance company. I will give my opinions about it in a second, but here are what some of the “experts” said in this NYT piece:
- Dr. Mark J. Werner, a consultant for the Chartis Group, which advises medical practices, emphasized that convenience of care didn’t equal quality or, for that matter, less expensive care. “None of the research has shown any of these approaches to delivering care has meaningfully addressed cost,” Dr. Werner said.
- “The quality of care that you see at a retail clinic is equal or superior to what we see in a doctor’s office or emergency department,” said Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School, who has researched the retail clinics. “And while there is a worry that they will prescribe antibiotics to everybody, we see equal rates occurring between the clinics and doctor’s offices.”
Let’s go to the first point. I agree it is not cheaper. Why? Each visit at the urgent care I worked at came was automatically billed with an E/M code level of 4 or 5. These were way too expensive and over-billed and there was nothing I could do to override the computer to make them lower. The computer EMR gamed the billing system for optimization. Second, I would see full families coming in and say that little “Jimmy has a cough but why don’t you see all of us just in case?”. Now, why would they do that? Because they had Medicaid and didn’t pay a dime! In conclusion, there is no way urgent cares are saving anyone money. They over-bill and up charge and see an endless amount of people without any triage.
Now the second point, which is the most distorted. The ivory tower professor, who is NOT a primary care doctor, talks about equal or superior care? I call absolute bullsh%t on this. Show me those studies! Were they on reading strep tests? A 9 year-old can do that? Or reading a urinalysis? A monkey can do that. In my year at that urgent care chain I saw physicians working there who had a litany of board complaints against them. I saw a pathologist (yes, a pathologist!) there seeing patients all the while doing a side hustle of answering online requests for antibiotics. I saw another doctor who was so bad that I cringed when I heard he was in our local facility because I knew the fallout would be horrible. This guy would work anytime or anywhere so he became their shining star. He later was found to be having multiple affairs with staff and performing girl sports physicals “alone”. In my opinion, 50% of the doctors were atrocious. The midlevels? About the same. Some were really good and some were literally seeing 40 patients a day a week after graduating. One PA was doing so much malpractice that I threatened to leave and go home if she was on my schedule. She once told me that she will do whatever she wants with patients and just have some other doctor at corporate sign her notes. This including endless antibiotics and narcotics. She was a walking disaster but was never fired. In fact, she was later promoted.
Oh, let’s not forget the prices. The place I worked at had a sign that a visit costs around $120. A little more with procedures but never more than $199. That’s even with stitches or x-rays. Impressive, right? It was a lie. That was if you paid cash. If you gave your insurance card then the insurance was billed at those codes mentioned above. My nurse’s daughter-in-law got a bill for over $300 for a UTI.
How about consistency of doctors? I left this clinic after a little over a year. It truly scarred me and gave me PTSD. The two other doctors, who I had started with and were very good, left before me. The turnover was massive but nothing like the other urgent care clinic they owned across town. I was later told by a nurse who worked there that their clinic had 80 doctors and midlevels cycle through in 3 years.
And lastly, about the idiot stating urgent cares don’t give more antibiotics. Who are you kidding? Everyone with a URI gets an antibiotic at these places. Every….last….one. Sometimes the doctor may be honest and say that it is viral but he will still give them an antibiotic to fill in 3 days only if it gets worse. You have to please the patient, you know. How many patients you think waited those 3 days? I once refused to give an abusive patient an antibiotic because it was an obvious virus. She went ballistic and reported me to the board of medicine. It took months but the case was eventually thrown out but not without work and worry on my part.
The NY Times’ authors of this piece don’t know enough to call out bullsh%t. They also didn’t mention direct primary care, which is changing the game. They appropriately expose the concerns about insurance companies owning these chains and that’s good. If my experience is any example (and that was 14 months of seeing up to 70 patients a day) then these places are NOT the answer to our broken system. They are just money-making slot machines for the corporate bad guys who are already raking it in.