I come from a family of physicians; a 300-year tradition, at that. When my ancestors practiced medicine, the patient-provider relationship was sacrosanct. My grandfather would visit patients in their home, knew the entire family, was often paid in kind, and also offered free treatment days for people throughout the community who could not afford it.
Today's fragmented, specialized healthcare experience is unrecognizable compared to the practice of my forefathers. One of the more recent and rapid disruptions has been the growth of the urgent care segment. From 2013 to 2019, there was a nearly 60% increase in the number of urgent care facilities across the U.S., with a corresponding rapid adoption among patients. One study shows that urgent care facilities handle nearly 90 million visits each year.
As a former practicing physician who was raised to preserve the patient-provider relationship, I initially viewed urgent care as a threat and was among its biggest skeptics. Even though I stopped practicing medicine more than 2 decades ago, I told anyone who would listen that patients didn't really want to go to an urgent care facility. What they really wanted was to be able to see their established providers quickly when they had an issue. And healthcare providers didn't really want their patients going to an urgent care facility for care issues; they wanted to be the ones to treat those cases.
As I have watched the urgent care segment continue to grow and have reflected on my position, I must admit: I got it wrong. Here is why.
An Efficient Pressure Release Valve for the System
Physicians are in short supply. The Association of American Medical Colleges (AAMC) estimates a shortage of up to 48,000 primary care physicians by 2034. It's no wonder that patients are waiting nearly a month, on average, to get in to see their healthcare provider.
With an urgent health issue, there is no time to wait. As a result, many people unnecessarily turn to a hospital's emergency department (ED), which is on average 10 to 12 times more expensive than being treated in an ambulatory care setting. Some studies show that ED overutilization amounts to nearly $50 billion in unnecessary medical spending each year.
But when it comes to ambulatory care, wouldn't it be best for patients to see their physician for urgent health needs? Not necessarily. In looking at the top visit reasons booked with an urgent care facility on Zocdoc, we see issues like urinary tract infection, sexually transmitted disease testing, sore throat, vaginal discharge/infection, sinus problems/sinusitis, and ear infections. More often than not, these issues are easily diagnosed and treated in a more transactional setting.
Imagine if you got a flat tire, that instead of calling AAA to meet you at the roadside to get you on your way, you insisted on being towed to your mechanic to change your tire -- regardless of how far away they were or how long you'd have to wait. While fixing bodies and fixing cars certainly have their differences, one shared truth is that some issues need continuity and others don't.
Urgent care facilities are well suited to resolve more discontinuous issues. In doing so, they free up primary care physicians' scarce time. This enables PCPs to practice at the top of their license and dedicate their time and talent to helping their patients manage chronic or complex issues.
Of course, patients may not know if they have a discontinuous issue or need more specialized care -- but urgent care providers do. As such, they serve an important triaging function within our healthcare system. If they are faced with a more uncommon, complex, or severe health issue, they will not hesitate to refer the patient to their physician, a specialist, or if needed, the ED. In this function, they help ensure the patient is seen by the appropriate provider in the appropriate setting.
An Inevitable Part of a Patient's Medical Team
In medical school, you're taught about adherence: the degree to which a patient follows a physician's recommendations -- from diet and exercise, to completing a course of prescribed medications. But in medical practice, you learn that oftentimes, to get the best outcomes, you need to meet the patients where they are. And today's patients, undeniably, are at urgent care.
Patients are consumers, and they have been conditioned by all other areas of their life to expect instant, on-demand services. Patients have been waiting for a care modality that's ubiquitous, fast, and gives them access to care at atypical times. Many hoped and believed this would be telehealth, but it has turned out that telehealth is a supplement, not a substitute, for in-person care. For most urgent ailments, people will need to be physically seen by a physician: to get their blood pressure taken, their bellies poked, their throats and ears examined, their injuries cleaned up, and more.
I've come to believe that, right under our noses, urgent care is fulfilling the over-promise of telehealth: people can be seen nearly instantly, close to home, and walk away with peace of mind, a course of treatment, or clear next steps. Because of this, I expect urgent care to further cement its place as a core part of a patient's holistic medical team right alongside their primary care physician, dentist, dermatologist, eye doctor, ENT, and more.
And when that happens I believe that patients, providers, and the system on the whole will be better off for it -- and I will be glad to have been so wrong before.
Oliver Kharraz, MD, is founder and CEO of Zocdoc, which recently launched urgent care on its platform.