Brenda Brush Wakes up with a sore throat and pain under her eyes and thinks, Ugh, another sinus infection. But the 39-year-old assistant elementary school principal heads to work anyway, hoping her symptoms go away. They don't. So at 4:15 P.M., she swings by the doctor's office on her way home, and the receptionist calls her before she's even picked up a magazine. The doctor examines her, asks her what she's feeling, takes her temperature, and writes a prescription for an antibiotic to treat, yes, her sinus infection. She's home and taking her first dose within an hour.
No appointment. No wait. No working around a doctor's schedule. This isn't your usual sick visit because Brush went to her local urgent care center. "I love my primary care physician and have been seeing her for the past 15 years, but she has limited office hours that don't always jive with my workday," says Brush. "It's much easier for me to head to the urgent care clinic after work or on the weekend. Plus, they accept my insurance."
Brush is just one of thousands of patients fueling the boom in urgent care centers—also called walk-in clinics. Of the 9,400 current clinics, 88% report that they'll open new centers or expand existing ones this year. By 2017, there will be more than 12,000 clinics across the country—about the same as the number of Starbucks in the United States. Add to that the surge in retail clinics, nested in chains like Target, CVS, and Walmart, and you have an almost overwhelming range of choices available to you.
"It's a convenience revolution," says Ateev Mehrotra, M.D., M.P.H., associate professor of health care policy and medicine at Harvard Medical School. But is the clinic next to the burger joint as good for your health as it is for your schedule? Only if you use it intelligently. Right now, there are no special regulations guiding these clinics or studies on how they stack up against traditional care, so you shouldn't take anything for granted when you walk in (starting with the fact that you may not see an M.D.). But with a little digging and some clear guidelines, you can tap into high-quality walk-in care for life's minor emergencies. Relax: We make it easy with this guide.
The Mass Appeal of Urgent Care
Research shows that if patients called all the shots, most of us would always choose to visit our regular, steady-Eddie doctors, says Mehrotra—"if we could do that in a convenient and timely way." Problem is, seeing a primary care physician (PCP, also called a family doctor or internist) is becoming tougher, thanks in part to the flood of 34 million newly insured Americans, explains Ann O'Malley, M.D., a senior fellow at Mathematica, a health policy research firm in Washington, D.C. Plenty of primary care practices are too full to take on new patients and offer only limited availability for sick visits.
At the same time, people look for ease and speed in their medical care just as they do in any service. The new clinics tend to deliver on that, with a much shorter wait than you'd find in an emergency room. Urgent-care-industry estimates state that people usually get seen in 30 minutes or less—and some patients say they've spent as little as 5 or 10 minutes in a waiting room. Service without the wait is enough to prompt some people, like 40-year-old Christine Schomberg, to rely solely on urgent care centers. "I don't even use my primary care physician anymore because the receptionist always tells me she's totally booked," says the Rocky Point, NY, mom of two. "My local urgent care center is so convenient, and the level of care is excellent."
Why You Still Need Your Regular Doc
It's great that Schomberg gives rave reviews of her local urgent care clinic, and not so surprising. Many well-respected doctors are switching to the field as it gets tougher and tougher to sustain the costs and paperwork of a private medical practice. But O'Malley and other experts—even the clinic physicians themselves—say this isn't how urgent care should be used, and warn against swapping your PCP for one of these centers.
"I know my patients are going to go to urgent care when they can't see me, and that's OK," says Julia Jenkins, M.D., a primary care physician in Palm Harbor, FL, and member of the Florida Academy of Family Physicians. "I can't work 24/7. However, I do worry that if patients stop coming to me when they've got a minor illness, I'm missing an opportunity to talk to them about their overall health."
That's because Jenkins, like most PCPs, uses sick visits to talk to patients about vital preventive care. Even though you're at the doctor's office for a sore throat, she may go further, checking in with you about your exercise regimen or reminding you that you're overdue for a cholesterol screening.
Ideally, you want to develop a relationship with one doctor over time who gets to know you and can spot telling changes in your health—some of which you may not even notice yourself. "Good health doesn't mean putting bandages on problems; it means taking steps to stay well, which your primary doctor is best suited to help you do," says Robert Wergin, M.D., president of the American Academy of Family Physicians. So the trouble with an over-reliance on convenient care may be the loss of consistent care. And continuity contributes to good health: Patients with PCPs have lower mortality rates, fewer hospitalizations, and more satisfaction with the health care system, research at Johns Hopkins University shows.
A doctor familiar with your history could even pick up on a detail that saves your life. Wergin remembers a male patient who came in with what he thought was a bad sinus infection. "He mentioned that it was causing a shortness of breath when he walked, but I knew this patient well enough to wonder if he needed more than an antibiotic." He ordered a cardiac stress test, and it turned out the arteries around his heart were severely blocked. The patient had quadruple bypass surgery that very week.
The Trade-offs of Speedy Service
The traditional physician's office has an edge when it comes to a crucial tool in getting the care you need: your medical records. "Having a complete history is essential to avoid things like drug interactions or know when a problem may be more serious than it seems," says Wergin. It'll also help a doctor see trends—say, that it might be time for an MRI for your on-and-off back pain, or that your persistent laryngitis may be due to undiagnosed allergies.
If the urgent care center you visit is affiliated with your go-to medical practice, the staff should be able to access your records and update them. But with just 35% of urgent care facilities owned by physicians or physician groups, there's a good chance the doctor there will be flying a little blind, diagnosing based on your answers to a series of questions. And it will be your job to update your PCP on what happened at a clinic so that your records remain current.
Urgent care has its place in a healthy life, especially if it means you'll deal with quick, routine matters instead of putting off a call to your doc. You just need to do some homework before you wake up on a Sunday morning with an earache. Checking out the local clinic isn't anyone's idea of fun, especially when you're feeling fine. Get it done anyway.
The new reality is that you don't have just one doctor, you have a growing portfolio of them. Staying in great health means knowing which jobs are best handled by clinics, primary care doctors, and emergency rooms. Like most of life, it's a combo of freedom and responsibility. You're in charge. You get to make the call about where you're most comfortable going. So step up and take your place at the center of this revolution.
Research Local Clinics Now (Before You Need One)
Ask your PCP which urgent care clinic she recommends.
"You don't have to feel like you're cheating on your primary care doctor if you see someone else," says Florida primary care physician Jenkins. "Your doctor understands the need for urgent care and may be able to recommend a well-respected clinic." There may even be a center affiliated with her practice—a bonus that means clinic staff can access and update your records. Also, double-check your doctor's hours; she could be more available than you think. A recent survey of PCPs by the American Academy of Family Physicians found that 81% offer their patients same-day appointments for urgent conditions, and 45% have extended and even weekend hours.
Find out what services your local clinic provides.
Some clinics are huge facilities with multiple doctors, nurses, and radiology technicians who can handle everything from X-rays and stitches to treating dehydration or the common cold. Others are much smaller and may lack the resources to handle broken bones or extensive lab work. With no regulating body requiring that urgent care centers provide a set array of services, the only way to know for sure which treatments are available is to call and ask.
Check out the urgent care clinic's website.
Look at where the doctors on staff went to medical school, how long they've been in practice, and whether or not they're board certified (meaning they have expertise in a specialty, such as emergency medicine, family medicine, or pediatrics). Not finding more than the doctors' names? Use the "DoctorFinder" tool on the American Medical Association's website (ama-assn.org) for info on the certifications and training of virtually every licensed physician in the U.S. To find out about malpractice suits or disciplinary actions, check your state medical board's website. (It's worth doing this for all of your doctors, not just those who work at urgent care clinics.)
Know that you may not see an M.D.
While most urgent care clinics have a doctor on staff, you may walk in and find that the only professionals in the clinic at the time are physician assistants or nurse practitioners. If it's important, call ahead and ask, "What's the likelihood I'll see a doctor when I come to this clinic?"
When to Go Where
Retail clinics are fine for…
- Immunizations and routine lab tests for diabetes, cholesterol, and blood pressure
- Illnesses that can be easily diagnosed, such as strep throat, upper respiratory infections, conjunctivitis, ear infections, or urinary tract infections (clinics generally have the same diagnostic equipment your doctor has)
- Minor concerns that merit advice or a prescription, such as rashes, bug bites, cuts, and bruises
Should You Try a Retail Clinic?
It depends on your problem. Right now, the clinics in chain stores such as CVS and Walmart tend to be staffed by nurse practitioners who can deal with things like common family illnesses, camp physicals, and routine lab tests (though you'll still need a doctor to manage changes in care based on the results). But they are rapidly expanding their services, so it pays to know what the ones closest to you offer. The next time you're shopping, pop in and find out who's on staff and what they can and can't treat. And while you're there, check out the prices: A basic health screening, for instance, costs $59–$69 at CVS, and $40 at Walmart.
Urgent care centers are fine for…
The same issues and concerns retail clinics handle, plus the following:
- Treating a cut or animal bite—as long as it's not on your face or in another visible location. If you're worried about how it will look later, you may want to go to a hospital that can call on a plastic surgeon
- Managing non-severe allergic reactions (hives, say, but not difficulty breathing)
- Treating you when you're away from home and can't see your primary care doc
- A sprain or potential fracture that doesn't seem severe, as long as your urgent care center has basic X-ray machines (most of them do)
Primary care physicians are best if…
- You have a chronic condition, such as diabetes, high blood pressure, or chronic pain, and/or you're on a lot of prescription medications
- You're experiencing the same health issue for the second or third time in a short period (i.e., a third urinary tract infection in three months or a second sinus infection soon after the first)
- You're not responding to a doctor-prescribed treatment within a set time period, or your condition is getting worse
- It's time for your annual checkup, including routine tests and referrals for preventive procedures, such as a colonoscopy or a mammogram
Go to a hospital E.R. right away if…
- You have any possible symptoms of heart attack, which can be very subtle in women, including upper back pressure that feels like squeezing; pressure in your chest; pain in your arm, back, or jaw; sudden nausea and/or vomiting; unusual fatigue
- You're wheezing or have shortness of breath
- You have severe pain—for example, a sudden and severe headache—or extreme flu symptoms
- You have a head or eye injury. Even if a cut on your face is minor, you may want access to a plastic surgeon, which you'll find at a hospital
- You have a fever over 103; 102 for kids 6–24 months, 104 for older kids. Also go if you have a fever along with other symptoms, such as a rash, nausea, confusion, or a stiff neck, which could indicate a serious problem, such as meningitis or tetanus
- You feel sudden, severe abdominal pain
- You've been seriously burned (you have a blister more than three inches long and there's severe pain and swelling, or if the burn is deep enough to affect all layers of the skin, or the skin is attached to clothing)
- You are showing the symptoms of a possible stroke, including numbness or weakness in the face, arm, or leg, trouble speaking and/or seeing with one or both eyes, or have sudden dizziness and trouble walking or staying balanced or coordinated
What You'll Pay: A typical co-pay costs $50–$150 at an emergency room or $25–$50 at an urgent care center. Cost of a visit for three common illnesses: $570 at an E.R. or $155 at an urgent care center. Urgent care centers typically charge up to 80% less for stitches, X-rays, and the like if you pay out of pocket (be aware that not every clinic accepts uninsured people). Along with being cheaper than the ER, most urgent care centers show and explain their prices before you're examined. That means no exorbitant hospital bills arriving months after an E.R. trip from docs you didn't even realize you had seen.
This story originally appeared in the January/February 2015 issue of Dr. Oz The Good Life.