Relieving ER backlogs
Urgent care centers touted
Dr. Susan Lohre remembers thinking many times while working
in the emergency room of a St. Louis hospital that they should start an
urgent care center.
"When I was at Barnes (Hospital) in St. Louis, we would
frequently laugh that we could go across the street and open up one because
we would be inundated," said Lohre, who grew up in Cincinnati but
now lives in Northern Kentucky.
"I was an ER doc for 24 years, and I just got tired
of the way people were being treated as a result of circumstances that
were out of my control. Once I got them in a room and in a stretcher,
I could take really good care of them. But in the waiting room, there
was nothing I could do.
"There would be up to 12-hour waits for serious problems.
Once they got into the ER, the waits for laboratory and X-ray were long.
If you had to admit them, the waits were long. No beds.
"It's the same thing here; it's the same thing everywhere."
So having returned to the Cincinnati area in 2003, Lohre
and her brother Steve started MedPlus on Montgomery Road in Montgomery
For a myriad of reasons, people are using the emergency
room for primary care, she said.
People can't get in to see their doctors, or doctors' hours
and patients' work hours conflict.
A lot don't have insurance. The Greater Cincinnati Health
Council reports that the greatest percentage of hospitals' uncompensated
care is for emergency room patients.
Emergency rooms are filled with people who aren't really
experiencing emergencies, said Dr. Franz Ritucci, director of the American
Academy of Urgent Care Medicine, an arm of the American Medical Association.
"They are not really emergencies, they are urgencies
perceived by the public, and it's better that they be seen by urgent care
physician," Ritucci said.
A report on 2003 nationwide emergency room usage, released
last month by the Centers for Disease Control and Prevention, said "on
average, patients spent 3.2 hours in the emergency department, of which
46.5 minutes were spent waiting to see a physician."
The report also noted, "The primary role of the (emergency
department) is the treatment of seriously ill and injured patients. However,
the ED provides a significant amount of unscheduled urgent care, often
because there is inadequate capacity for this care in other parts of the
health care system."
The report said 35.2 percent of visits to emergency departments
were for urgent situations rather than emergencies. Emergencies accounted
for 15.2 percent of visits.
The report said patients with urgent conditions should be
seen within 15 to 60 minutes while people with emergency conditions should
be seen in less than 15 minutes.
Certainly, conditions such as sprained ankles, ear infections
and rashes need to be treated, but emergency medical doctors who are trained
to treat serious trauma, heart attacks and the like are overqualified,
Because patients typically can get X-rays and lab work at
urgent care centers, because the centers are open more convenient hours,
and because patients don't need appointments, it only makes sense that
urgent care has begun evolving as its own specialty, said Ritucci.
"It's the specialty of tomorrow," he said. "It's
a reflection of what our society wants."
The centers had a bad reputation within the medical community
when they started springing up about 20 years ago, Lohre said.
"Namely, they were (staffed by) doctors who couldn't
do anything else ... Initially, they had no experience, and they weren't
the caliber of medicine that I want to practice," she said.
To practice medicine, a doctor doesn't need to complete
a residency, which can take several years, depending on the doctor's medical
specialty. To practice, a doctor technically only a needs to complete
a one-year internship, Lohre said.
Lohre said she believes a disproportionate number of doctors
who hadn't completed residencies ended up at urgent care centers 15 years
or 20 years ago.
The medical community pushed for urgent care doctors to
become better qualified, she said, and the medicine being practiced has
For example, the North American Association for Ambulatory
Urgent Care, which was founded in 1973 and of which Lohre is a member,
has prepared the self-administered Urgent Care Accreditation Practice
Another organization, the American Academy of Urgent Care
Medicine, was founded in 1997 and, after a mandatory five-year wait, was
allowed to become an American Medical Association member.
One of its goals was to raise the level and standard of
care that urgent care centers deliver.
Since its inception, the AAUCM has helped define what urgent
care doctors do, and the association now offers a board certification.
It also has worked with the AMA to create a specialty code
that insurance companies can use for billing purposes.
In 2004, leaders in urgent care founded the Urgent Care
Association of America, a national voting body for the specialty. The
organization drew 250 members to its first convention in Orlando in April.
Leaders in the specialty are working toward creating urgent-care-specific
residencies for doctors in training and fellowships for doctors who want
to specialize in urgent care, said Dr. David Stern, communications director
for the UCOA.
Lohre, who has one other full-time doctor on staff and three
part time, said she only will hire board certified doctors, meaning they
must complete a residency.
Lohre said has certification in emergency medicine, which
surpasses what is required for the urgent care certification. Her nurses
all have many years of emergency room experience as well, she said.
According to Stern, there's little question Lohre is "riding
the crest of a wave" that's surging into the future.
About 700 to 800 urgent care centers open every year, Stern
said, and there are still many communities that he considers underserved.
Urgent care center chains serve some areas, such as Columbus,
and some chains have become multi-state operations, he said.
Years ago, hospitals and family doctors viewed urgent care
centers as threats, he said. Now they see them as important players in
a continuum of care, he said.