Walk-in clinics tap market for quick, convenient service
When Gina McDonough’s 15-year-old daughter woke up on a Monday with a sinus infection, she figured she might as well pull her other daughter, whose arm was tender from a puck hit during a hockey game, out of school to get them both treated at the same time.
But her first choice was not their pediatrician’s office, where they would have to wait to be squeezed in, nor the emergency room, where the wait time would be too unpredictable.
Instead, McDonough took Nicole and her little sister Ciara, 13, to Health Express in Weymouth, a walk-in urgent care clinic just five minutes from their Hingham home. She estimates she’s been to this clinic or its Pembroke location at least 10 times.
“It’s almost getting to the point that the only reason I go see my traditional physician is for the annual physical,” McDonough said as she waited for Ciara to have her arm X-rayed.
Urgent care centers have quickly become the first choice for many Greater Boston residents, attracted to the convenient locations, evening and weekend hours, and affordability compared with emergency room costs. The demand for care in cases that are not medical emergencies, yet are serious enough that they should be attended to quickly or outside regular office hours, has led to a recent wave of free-standing urgent care facilities opening up throughout the region.
Since 2012, Health Express, started by two board-certified emergency room doctors, has grown to seven locations in communities south of Boston, the latest opening Oct. 1 in Quincy, and has plans for a West Roxbury location next year.
Doctors Express, formerly a Baltimore-based franchise, was launched in Massachusetts in 2010 by entrepreneur Richard Crews and a business partner in Springfield. It quickly expanded to Greater Boston, including Saugus and Dedham. In 2012, Doctors Express was purchased by Alabama-based urgent care company American Family Care and renamed AFC Doctors Express. The individually owned clinics see an average of 35 to 40 patients a day, with an average visit lasting about 49 minutes, Crews said.
More recently, hospitals have entered the fray and launched their own facilities, such as Beth Israel Deaconess Urgent Care at Chestnut Hill, in an effort to expand relationships with existing patients in their networks, as well as entice new patients who may be attracted by the reputation that comes with the hospital’s name.
The concept of urgent care in Massachusetts is not new, but the proliferation of facilities is, said Dr. Dennis Dimitri, president of the Massachusetts Medical Society. The number one factor driving the growth in urgent care is patient convenience, which some believe is being influenced by a generational shift in priorities, Dimitri said.
“The older generation, the so-called baby boomer generation, may put more stock in the importance of continuity of care, and be willing to go more out of their way to see their primary care physician to care for their problems, whereas the younger millennial generation puts more stock in convenience and easy access, doing what I need to do now, as opposed to waiting,” Dimitri said.
The Urgent Care Association of America states on its website that there are more than 6,900 urgent care centers nationwide and growing as more private equity investors pour money into the industry. From 2008 to 2010, the association estimates, the industry grew by about 300 urgent care centers per year, a rate that it said appeared to double in 2011. A recent market report forecasts urgent care will grow to a $30.5 billion global business by 2020.
While urgent care facilities may fill the niche between emergency room visits and doctors’ appointments, Dimitri cautions that they should not replace primary care. Urgent care centers, he said, are not familiar with a patient’s medical and social history, which could lead to an unsafe mixing of prescriptions, or duplicate tests and treatments.
“The flip side of urgent care centers is this breakdown of continuity. There’s been this push for years to develop attributes of continuity of care where one sees the same physician,” Dimitri said. “Urgent care interrupts that continuity, and that may be detrimental in the quality of care the patients are seeing.”
Owners and managers at AFC Doctors Express and Health Express said they maintain electronic records of patient visits and readily share those with primary care doctors when requested. Their goal, they stressed, is to provide urgent care when needed, not to replace a patient’s regular doctor.
In 2012, Dr. Chris Whelan and the late Dr. Michael Hughes, who worked as emergency room physicians at South Shore Hospital in Weymouth and Cape Cod Hospital in Hyannis, opened the first Health Express facility in Weymouth, spurred by a report from a major health insurance company that it would no longer require patients to get doctor referrals for urgent care.
Most of the time each Health Express is staffed by an emergency room board-certified doctor, but at times by ER-experienced nurse practitioners and physician assistants, Whelan said.
“We’re trying to be an outlet to the ER,” he said. If patients want to go see their primary care physician, “that’s fine with me; I’m there to help their PCP after hours, I don’t want to steal their patients,” Whelan said. “The ER is overwhelmed, they’re always busy, and if we can unload some of that volume, they can take care of the sicker patients and we can take care of those in-between ones.”
The speed of care offered by urgent care centers has also become attractive to private and municipal employers that require preemployment physicals and drug screenings. Health Express has annual occupational health service contracts with a dozen communities south of Boston, providing physicals for municipal employees including police and fire.
It was a preemployment physical to get her school bus driver’s license that brought Samantha Famolare, 22, of Peabody, to AFC Doctors Express in Saugus earlier this month. This was her second time at an urgent care facility, having gone to another one a couple of weeks earlier for swelling in her feet after she couldn’t get an appointment with her primary care physician. Famolare said she was impressed by the level of care, the low cost, and the speed at both facilities.
“I was in and out. I would go here [over] an emergency room,” Famolare said. “These guys have the same degrees that anyone in a hospital is going to have. A doctor in a white jacket is a doctor in a white jacket.”
A Baltimore-based franchise business, Doctors Express (since renamed AFC Doctors Express) was launched in Massachusetts in 2010 by entrepreneur Richard Crews and a business partner in Springfield. It quickly expanded to Greater Boston, including Saugus and Dedham. The individually owned clinics see an average of 35 to 40 patients a day, with an average visit lasting about 49 minutes, Crews said.
“There was a huge need for this,” Crews said. “I really felt that health care was an industry where people expected great medical care but they didn’t necessarily expect a great experience. . . My thought was I can provide high quality care and, at the same time, a great patient experience.”
Hospitals are also capitalizing on the demand. Last year, Beth Israel Deaconess opened its urgent care facilities in Newton’s Chestnut Hill section and in Norwood to provide a lower-cost alternative to the emergency room, but offer more services than a walk-in retail clinic like those in CVS pharmacies and Walmart, said Jayne Carvelli-Sheehan, senior vice president for ambulatory and emergency services and system clinical integration.
“Retail minute clinics are run by what we call physicians extenders, such as nurse practitioners, physician assistants,” Carvelli-Sheehan said. “We do advanced urgent care — lab services with blood results on site and urinalysis, CT scans, general radiology, and ultrasound . . . with board-certified emergency department physicians.”
Unlike the hospital’s primary care offices, the urgent care facilities remain open until 9 p.m. on weekdays and 7 p.m. on weekends.
As the competition heats up and investor money pours in to create more urgent care locations and larger chains, more physicians with their own practices are extending their hours into the evening and weekends to accommodate patients with urgent needs, said Dimitri, with the Massachusetts Medical Society.
Asked whether there is a saturation point that would stem the increase in urgent care facilities in the state, Dimitri said he wasn’t certain.
“It is a consumer-driven process,” he said. “It’s like asking when do we have enough Starbucks locations.”