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Urgent Care And Primary Care: Which Model Is Right For You?

Who's your doctor? Depending on the age of the person you ask, the answer could vary greatly.

Ask a baby boomer who their primary care physician is, and they may proudly name the doctor and tell you how long they've been a patient.

Ask a millennial that same question, and they might say, "Primary care who?"

Going to the doctor is not what it used to be. As the VP of franchise sales and development at an urgent care franchise, I've found that the value of long-standing patient-doctor relationships that once were the building blocks of this nation's healthcare system is changing as the line between primary care and urgent care blurs.

Under the traditional primary care model, patients usually choose a doctor through their health insurance provider's website based on who is in-network, accepting new patients and located close to their home or office. Many patients only visit a physician when they have an illness or injury that demands attention.

Traditionally, urgent care has served as an intermediary between primary care and the emergency room. Patients would seek it out for nonemergency situations such as coughs, colds, strains and sprains if they couldn't get into their PCP due to scheduling or because they needed care during off-hours or weekends.

Thanks to a shift in cultural values and demographics, traditional primary care is struggling in the United States. According to the Healthcare Cost Institute, visits to primary care doctors declined 18% between 2012 and 2016. In the 2019 report "Healthcare: Who Survives?" WD Partners found that the top three reasons given by surveyed patients for not visiting a PCP were that it took too long to get an appointment, there was an unbearable wait time at the doctor's office, and no walk-in appointments were available.

The number of urgent care clinics jumped 8% between 2017 and 2018, according to Urgent Care Association data reported by Business Insider. (Full disclosure: My company is mentioned in the article.) They suggest 89 million patients visit urgent care clinics each year, which account for more than 29% of all primary care visits in the country to nearly 15% of all outpatient physician visits.

The idea of these healthcare entities as two separate things seems to be going away. Urgent care now often crosses over in the primary care space, with a more comprehensive scope of services beyond the convenience and ease of access it became known for.

Many urgent care centers are able provide X-rays, lab work and prescriptions all in one visit and under one roof. Consumers may prefer convenience over credentials and provider continuity, and when urgent care is the only medical care administered to a patient, urgent care turns into primary care.

Health insurance companies are also at play in the shift away from primary care. Patients sometimes see less benefits and higher premiums while doctors see a reduction in pay. In order for physicians to make a profit, they might increase the volume of patients they see, which increases wait times and decreases face-to-face time during visits. Insurance companies might also interfere with the best course of treatment because they don't cover certain procedures.

A recent poll from the Kaiser Family Foundation found that 45% of adults between 18 and 29 did not have a primary care physician (compared to 12% of those aged 65 and older). It is a stark contrast to the 82% of adults between 50 and 64 who did claim to have a primary care physician.

While 80% of participants in the poll from WD Partners stated they had visited a primary care clinic for care in the last six months, they named urgent care clinics as the second choice for care over an emergency room.

Given the small number of urgent cares available to millions of healthcare consumers, I believe this number shows a growing interest in urgent care as a serious primary care physician alternative.

If you are considering a primary care or an urgent care as a long-term business model, there is one main point to take into account: How does the area you want to do business in perceive primary and urgent care? The first point to consider is that some regions perceive urgent care and primary care as two separate things. In some areas, for example, I've found that the view of urgent care is very specific. "I broke something." "I cut something." It is basically considered a replacement for an emergency room. In others, urgent care and primary care are viewed as one and the same, with the only difference being one facility does not require an appointment (urgent care) while the other often does (primary care).

The idea would be to choose the option that best suits your area. If that option happens to be primary care, begin the education process early for your patients to let them know that there is a gray area where the urgent care and the primary care overlap. That way, you have the ability to expand into urgent care when your market softens to the idea. I believe living in the overlap is where you can have the most flexibility for your patients, provide the highest value to your patients and have the highest chance for business success.

Once you know what patients think about each concept, you know what hurdles you will have to overcome. Knowing what your competition does allows you to offer a point of differentiation. If the competition follows a basic urgent care concept of "treat 'em and street 'em," a primary care provider can beat them on service. If the competition is typical primary care, an expanded urgent care model could beat them on service and convenience.

It is possible to strike a balance and achieve "the best of both worlds" when it comes to healthcare. You can expand your services so that prior to the point where patients need a specialist, you can handle all their healthcare needs. Ultimately, the need for terms like urgent care and primary care becomes obsolete -- you just provide medical care.

Newton Child Care Center's $1M Expansion Means More Jobs, More Kids

Jun. 22—Peck Child Development Center is planning a $1 million expansion of its child care center in Newton, which is not only an unprecedented move for the 52-year-old organization but it is also addressing a need in the community by increasing the volume of children served from 54 to 95.

Ashton McPherson, the child development director of Peck, said the new addition would be built on the playground area just north of the existing building. Much of the playground equipment would then be moved to a southwest corner of the property, which is currently made up of green space and an alleyway.

In addition to the renovation work, designs show that staff and visitors will have access to a new parking lot with 15 stalls. Currently, cars are able to park along a sidewalk on the south side of the building, but it is next to an alleyway commonly known for fast traffic. It is likely to be abated when the project is complete.

Peck will also be able to provide up to three more full-time positions and five part-time or summer positions. There are currently 11 staff members working in three classrooms with students ages 2 to 10. Apart from small remodeling work, the facility has not seen structural upgrades this significant in its entire lifetime.

As long as Peck can get the funding it needs, McPherson estimated the project could begin as soon as fall 2023, with a completion date of around spring 2024.

"I'm really excited about it," she said. "...Our goal is to raise the $1 million. We do have some matching funds that we can get, and we've applied for some grants. If we can't get the funding — which I'm hoping we can — we are going to take out a loan just because it's definitely something our community needs."

As of June, Peck has 47 kids on its waitlist. Other child care facilities in Newton are experiencing similar situations. The demand is high for child care, but every place is at capacity. McPherson said the expansion is something Peck's board members have been working on for some time to address the issue.

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"We've got a lot of people wanting to come to Newton. I get calls all the time from Des Moines and they're like, 'I'm moving and I need a daycare.' They're moving from big towns to small towns and can't find daycare. That's not normal to them," she said. "If we open 70 percent more spots, we can get in a lot of these kids."

Children who are enrolled in Peck are going on field trips to the library, to Living History Farms and to splash pads and pools. But they are also learning and using a curriculum shared by the Newton Community School District and Newton YMCA, which also offer preschool services.

The partnership with the school district using the same curriculum has proven to be very successful in preparing children for primary school. McPherson said she's received positive feedback from families whose kids are learning the necessary skills needed to start kindergarten.

"We know it works," she said. "The kids are prepared and they enjoy coming here. They want to come back for the summer and can't wait to go on these field trips. They do get a little sad when they're 10 and have to go find somewhere else. We just don't have the room for that."

At this moment, Peck is uncertain if it will change its age limit when the new addition is constructed.

McPherson stressed that the expansion will not have a detrimental financial effect on Peck families, but they can expect a small increase. At most, she said tuition would be raised by no more than $5 to $10. On average, McPherson said a family pays $110 to $140 a week to enroll their child at Peck.

"I'm very excited to get these kids off the waitlist and get them into a good quality and affordable child care ... And show them our Peck experience."

To donate to the Peck expansion, please visit https://secure.Qgiv.Com/for/peckchilddevelopmentcenter.

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