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About 'family care doctors'|The Family Doctor, Minus the M.D.







About 'family care doctors'|The Family Doctor, Minus the M.D.








You've               sprained               your               ankle,               or               have               a               severe               case               of               poison               oak,               or               your               child               has               an               earache.

Where               do               you               go               to               get               it               taken               care               of?

Years               ago,               the               answer               was               easy:               to               your               family               doctor.

But               these               days,               the               question               isn't               so               easily               answered.
               A               variety               of               economic               and               societal               shifts               are               now               sending               people               increasingly               to               hospital               emergency               rooms               and               urgent               care               facilities               to               handle               non-life-threatening,               yet               pressing,               health               problems.
               "There               is               a               shortage               of               primary               care               physicians               in               this               area,"               said               Michael               McMillan,               CEO               of               Doctors               On               Duty               and               Cypress               Healthcare               Partners               in               Monterey,               California.

"Some               people               don't               even               have               a               primary               care               physician               anymore."
               Because               fewer               people               have               health               insurance,               they're               handling               their               health               concerns               on               a               case-by-case               basis,               rather               than               seeing               a               regular               doctor.

And               they're               increasingly               relying               on               either               emergency               care               at               local               hospitals               or               urgent               care               centers               like               Doctors               on               Duty.
               In               addition,               because               the               numbers               of               primary               care               doctors               are               on               the               decline,               those               that               remain               can't               accommodate               everyone.

Many               patients               are               frustrated               when               they               have               a               problem               and               can't               get               an               appointment               right               away.

And               again,               they               turn               to               the               ER               or               urgent               care.
               This               pattern               isn't               unique               to               Monterey               County,               but               is               part               of               a               nationwide               trend.

Emergency               rooms               are               being               impacted               like               never               before,               with               longer               wait               times               and               more               people               coming               through,               and               the               alternative               for               simple               complaints               -               urgent               care               centers               -               are               also               doing               a               brisk               business.
               Urgent               care               centers               are               also               making               headway               because               the               price               is               more               reasonable,               in               general.

The               average               cost               for               a               visit               to               Doctors               on               Duty               is               around               $105,               McMillan               said;               to               go               to               the               ER               may               cost               $300               or               more.
               The               average               wait               time               at               ERs               across               the               country               is               about               4               hours,               but               local               hospitals               representatives               say               their               track               record               is               better               than               that.

Even               so,               a               typical               visit               to               the               ER               at               Community               Hospital               of               the               Monterey               Peninsula               is               a               little               under               3               hours.
               "There's               been               a               slight               decrease               in               volume               in               the               past               four               years,"               said               Jodi               Schaffer,               RN,               director               of               the               emergency               department               at               CHOMP.

ER               visits               are               down               from               49,000               to               45,000               in               2008,               she               said,               noting               that               that               decrease               has               made               waiting               times               a               bit               shorter               than               in               previous               years.
               An               average               of               125               patients               pass               through               the               CHOMP               emergency               room               daily,               although               it               can               be               as               few               as               90               and               as               many               as               170.

And               Monday               is               typically               the               busiest               day               of               the               week.
               What               local               emergency               rooms               have               done               to               respond               to               the               increasing               volume               is               to               set               up               a               sort               of               urgent               care               center               within               the               ER.

Patients               with               minor               injuries               or               illness               -               what               Schaffer               calls               "a               single               simple               problem"               -               are               seen               in               CHOMP's               "express               care"               rooms,               which               are               located               within               the               emergency               department.
               Recent               remodeling               at               the               hospital               helped               open               10               rooms               just               for               express               care,               which               Schaffer               said               should               lower               the               overall               wait               time               in               the               ER.
               "(The               wait               time)               is               one               of               the               things               we're               always               looking               at               and               working               on,"               said               Schaffer.
               A               similar               system               is               in               place               at               Salinas               Valley               Memorial               Hospital,               in               Salinas,               California,               which               saw               43,000               ER               visits               in               2008,               according               to               Dr.

Andrew               Kaminski,               medical               director               of               the               SVMH               emergency               department.

In               fact,               an               entire               urgent               care               wing               is               planned               at               the               hospital.
               ER               visits               are               growing               by               9               percent               a               year               at               SVMH,               which               uses               its               urgent               care               rooms               to               handle               less               serious               complaints.
               "Like               any               system,               once               it               gets               saturated,               there               is               an               increase               in               wait               times,"               Kaminski               said.

By               fast-tracking               the               urgent               care               cases,               the               ER's               resources               are               preserved               for               the               patients               who               truly               need               the               advanced               diagnostic               testing               and               care               that               the               ER               can               provide.
               Doctors               on               Duty               and               other               urgent               care               facilities               in               Monterey               County               can               actually               help               ease               the               burden               on               the               hospitals,               and               Kaminski               said               that's               a               good               thing.
               "It's               helpful               for               urgent               care               centers               to               take               the               pressure               off,"               he               said.
               Doctors               on               Duty,               with               12               clinics               from               Greenfield               to               San               Jose,               is               part               of               the               Salinas               Valley               Memorial               Hospital               system.

The               hospital               owns               85               percent               of               Doctors               on               Duty,               with               the               remainder               owned               by               Cypress               Healthcare               Partners,               which               manages               the               day-to-day               operation               of               the               urgent               care               centers.
               Doctors               on               Duty               was               founded               in               Santa               Cruz               by               an               ER               doctor,               Robert               Morris,               who               decided               there               had               to               be               another               way               to               handle               urgent               care.

The               clinics               were               an               immediate               success,               and               in               1996,               Morris               sold               them               to               SVMH.
               SVMH               president/CEO               Sam               Downing               said               the               hospital               started               planning               for               more               urgent               care               in               the               community               25               years               ago,               seeing               it               as               a               more               efficient               way               to               manage               health               care.
               "It's               a               great               concept               ...

our               goal               is               get               more               people               using               urgent               care,"               said               Downing.
               Under               the               hospital's               direction,               more               urgent               care               clinics               have               since               been               opened,               including               the               campus               health               center               at               CSU-Monterey               Bay.
               Several               other               urgent               care               centers               can               also               be               found               in               the               area,               including               Harden               Ranch               Urgent               Care               in               Salinas               (also               managed               by               Cypress               Healthcare               Partners)               and               Monterey               Bay               Urgent               Care               in               Monterey,               but               Doctors               on               Duty               takes               the               lion's               share               of               patients,               with               up               to               160,000               visits               a               year,               McMillan               said.
               Many               urgent               care               centers               can               provide               basic               testing               and               lab               work               that's               sufficient               to               aid               the               resolution               of               basic               concerns.

McMillan               said               the               majority               of               patients               are               seen               within               an               hour               of               walking               in.
               However,               McMillan               said,               the               best               plan               for               consistent               health               care               is               to               have               a               primary               care               physician               that               you               would               see               regularly               and               who               knows               your               history.

Although               urgent               care               centers               are               great               for               minor               complaints,               they               don't               monitor               patients               and               handle               ongoing               concerns               the               way               a               family               doctor               can.
               "Primary               care               physicians               still               play               an               important               role,"               said               McMillan.

"Urgent               care               is               not               a               substitute."
               Schaffer               echoes               this,               calling               primary               care               "the               gold               standard               ...

the               primary               care               doctor               knows               you               best."
               To               that               end,               CHOMP               is               now               in               the               process               of               opening               two               new               primary               care               centers,               one               in               Carmel               and               the               other               in               Marina,               to               help               close               the               health-care               gap.

They               are               under               the               auspices               of               the               Community               Hospital               Foundation               and               will               be               called               Peninsula               Primary               Care.
               Downing               said               that               Salinas               Valley               Memorial               Hospital               is               hoping               to               network               more               with               local               doctors               to               provide               a               better               "continuum               of               care,"               and               also               wants               to               provide               education               to               combat               diabetes               and               obesity               through               its               Doctors               on               Duty               clinics.
               Sources:               Personal               interviews               with               Michael               McMillan,               Sam               Downing,               Jodi               Schaffer               and               Dr.

Andrew               Kaminski,               June               2009;               also               www.doctorsonduty.com






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