Should I Go to Urgent Care?

Ruben Castaneda

Adriana Vélez-León's symptoms -- a sore throat, body aches, headache and congestion -- suggested to her that she might be coming down with the flu. Vélez-León, an attorney in the District of Columbia, didn't want to take the chance of infecting co-workers, and she wanted to get checked out. She has health insurance but doesn't have a primary care doctor, and she didn't need to go to an emergency room.

So on a bright, cold day, Vélez-León walked less than two blocks to an urgent care clinic located downtown, near her office. Swabs to her nose and throat determined she didn't have the flu, but was probably just suffering from a bad cold. Vélez-León was seen, diagnosed and out the door in less than an hour. "This is my third time here," Vélez-León, 29, said of her visit to GW Immediate & Primary Care - McPherson Square, part of the George Washington University Medical Faculty Associates network. The clinic has a spacious waiting area, a front desk that on this weekday was staffed by two receptionists, and nine waiting rooms. "It's convenient, it's fast and it's really close to my office."

Vélez-León is part of a meteoric rise in the number of consumers who have been turning to urgent care clinics for health care in recent years, according to research published in October in JAMA Internal Medicine. The cohort study of a large commercial health plan from 2008 to 2015 found utilization of nonemergency acute care centers for the treatment of low-acuity conditions (like sprains, upper respiratory infections and the flu) increased by 140 percent during that time. Meanwhile, emergency department visits for treatment of such conditions decreased during by 36 percent during the same period, researchers found.

[See: 14 Myths and Misconceptions About the Flu Vaccine.]

Increasing demand is spurring a dramatic expansion in the number of urgent care centers in the U.S. There are about 8,250 urgent care clinics throughout the country, according to the most recent estimate by the Urgent Care Association. From 2014 to 2017, about 400 to 500 new urgent care clinics opened each year, according to an industry analysis, "The Essential Role of the Urgent Care Center in Population Health," released by the UCA in January 2018. The surge in demand for urgent care centers is being driven by millennials like Vélez-León and members of Generation X, according to the white paper. "While all age groups are more likely to visit a primary care facility in a nonemergency situation, consumers aged 45 and older are more likely than older adults to rely on primary care, whereas millennials (ages 18 to 34) and younger Gen Xers (ages 35 to 44) are significantly more likely than their older counterparts to visit an urgent care center," according to the analysis.

Urgent care centers provide a higher level of care than what's available at retail clinics located at some pharmacies, but aren't set up to care for patients who need the services of an emergency room, says Dr. Bruce Irwin, founder and chief executive officer of American Family Care, which has 201 urgent care clinics across the country, primarily in southeastern, northeastern and western states. Pharmacy clinics, typically staffed by nurses, provide basic first aid and preventative services like flu shots and physical exams. Emergency rooms are staffed by doctors, nurses and other health professionals trained save the lives of people suffering severe trauma, like victims of gun violence and car crashes and patients experiencing heart attacks and strokes, for example. These facilities are staffed and equipped to conduct surgery. Emergency departments are typically equipped with a wide array of diagnostic tools that allow medical professionals to do blood work, urine exams, X-rays and CAT scans.

In between the health care spaces those facilities occupy are urgent care clinics, which are typically staffed by at least one doctor as well as nurse practitioners and/or physician assistants. These facilities are also usually equipped to do X-ray and urine exams, and some can do blood work. "We're in the middle (between pharmacy clinics and emergency rooms)," Irwin says. "We're an on-demand care solution for people who need health care."

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Irwin and other experts cite easy accessibility as one of the key reasons urgent care clinics are growing in popularity among consumers. Here are some key factors driving the increase in the use of urgent care clinics:

-- Accessibility and convenience. If you call a traditional primary care doctor for an appointment, you may not get one for a week or more. By contrast, urgent care clinics are very accessible. Many are open seven days a week, with extended hours on weekdays, often from 8 a.m. to 8 p.m. You don't need an appointment. You can simply walk in; most urgent care centers will see a you in 20 minutes or less, and most patients will be diagnosed, treated and out the door in an hour or less, according to a 2017 UCA survey. Some clinics allow you to make a same-day appointment online. The same week that Vélez-León went to an urgent care clinic in the District of Columbia, Gina Garcia, 38, went to an urgent care clinic a few miles south in her Alexandria, Virginia, neighborhood -- a facility that's part of the MedStar PromptCare network. Garcia, who's used urgent care clinics for 15 years, went to get checked for symptoms of a cold and an ear infection. A doctor checked her ear, diagnosed an ear infection, provided her over-the-counter medication for her ear pain and gave her a prescription for antibiotics less than 30 minutes after she walked in the door, Garcia says. "The reason I see doctors at urgent care clinics is I want to see someone when I'm sick, not two weeks later when my illness is gone, or when I'm worse," Garcia says.

-- Cost savings. Urgent care centers provide a convenient, lower-cost option for patients, says Laurel Stoimenoff, chief executive officer of UCA. "Nearly half of all visits to urgent care centers result in an average charge of less than $150 -- compared to the average cost of an ER visit at $2,250," Stoimenoff says, citing figures from 2016 Cigna claims data included in the UCA analysis. Many patients only have to pay a copay, which is often less than $100. Garcia's recent visit cost her $20, she says. "A lot of people don't realize how expensive an emergency room visit is," says Leonard Henzke, a principal at ECG Management Consultants in Seattle, which provides consulting services to health care providers. "You can go to an urgent care clinic and get the treatment you need for a fraction of the cost of an emergency room visit." Most urgent care clinics accept Medicare and Medicaid, according to the UCA report.

-- A wide range of services. Patients go to urgent care clinics to get diagnosed and treated for a broad array of conditions and injuries. The facility Vélez-León went to, for instance, can treat such maladies as bronchitis; ear aches; upper respiratory infections; diverticulitis; food intolerance, from poisoning or a virus; high blood pressure; a urinary tract infection; and sprains, minor fractures and lacerations as well as many other conditions, says Dr. Michael Stout, a physician at the clinic.

[See: 10 Reasons to See a Physician Assistant.]

While urgent care clinics provide a wide array of services, patients shouldn't use them as a substitute for a primary care physician, says Matthew Kippenhan, medical director at the Northwestern Medicine Immediate Care Center in Chicago. A primary care physician can help you ward off and, if necessary, manage chronic conditions like cancer, diabetes, heart disease and obesity, he says. "People with chronic medical issues should have a primary care doctor," he says.

The use of urgent care clinics is likely to continue to grow as more consumers learn about the advantages of using these facilities, says Dr. Benjamin Barlow, chief medical officer of AFC. "Urgent care centers are a convenient, lower-cost option for patients who want to be seen promptly," Barlow says. The trend toward greater use by consumers of urgent care clinics is also helpful to the staffs of emergency rooms, many of which are stretched to their limits treating patients for life-threatening trauma and conditions, like heart attacks and strokes. "We as a society need this alternative for patients so they don't bog down emergency departments," Barlow says.