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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