Urgent care industry grows as need, business opportunity meet
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When you think of a last-minute doctor’s visit, you probably don’t think of a pleasant experience. But the waiting room at Northwell Health’s urgent care center on Manhattan’s Upper West Side feels a bit spalike, with leather chairs and a beige stone backsplash.
“You’ll see lots of rounded edges,” said Dr. Neal Shipley, the system’s New York medical director. “It’s supposed to be warm and inviting and welcoming.”
Maybe more important to the experience is what patients don’t see, including the center’s in-house lab. During this visit, 10 machines were busy running COVID tests. They were so compact — the size of a brick — they almost looked like toys.
“This kind of thing only used to be able to be done in an analyzer that would, like, take up the space of, like, a classroom, and now it’s literally the size of a handheld device,” Shipley said.
Urgent care centers became a critical piece of the health care system during the pandemic, partly because of COVID testing and treatment, and also because at one point — besides overstretched emergency rooms — urgent care was one of the few places people could go for sprained wrists or urinary tract infections.
“We did our best to sort of protect the rest of the health care system and keep people out of the emergency departments, and when primary care offices were closed at the time and emergency departments were overwhelmed, we did stay open,” Shipley said.
There are more than 11,000 urgent care facilities in the U.S., compared to 4,000 emergency rooms. And urgent care is expanding. The industry grows around 10% each year, according to Lou Ellen Horwitz, CEO of the Urgent Care Association — with big-name chains like Concentra, MedExpress and CityMD expanding.
“The megacompanies, if you want to call them that, is a relatively new phenomenon. And really what made all of that possible was private equity interest in the space,” she said.
Private equity, and big companies like Amazon, which recently acquired One Medical, realized that urgent care is a gap filler. That’s true for the uninsured, who pay on average a tenth of what they would at the ER, and for the growing number of people who have no primary care physician.
“There’s also a time access that we fulfill: ‘I’m sick and I need to get in to see my primary care doctor, but I can’t get an appointment for three weeks,'” Horwitz said.
That happens there aren’t enough of them. Experts say the country will face a shortage of up to 55,000 primary care physicians in the next decade.
Ari Friedman, an ER doctor and health economist at the University of Pennsylvania, worries that people have become too reliant on urgent care and are skipping preventive care.
“There’s this idea of the longitudinal relationship with your primary care doctor, where you don’t just see somebody once. You see them kind of over and over and over again, and that builds a relationship,” he said.
That relationship gives a doctor the opportunity to notice whether a patient has been complaining about their back for a year or is overdue for a colonoscopy.
Urgent cares associated with hospital systems shrug off this criticism. They say patients are more likely to stay within the system and urgent care doctors can refer them to their own specialists, which is also how they make money — via a pyramid of referrals. Independent practices rely on churn, a large volume of flu shots and strep tests, Friedman said.
The problem with this is that to make money, clinics tend to open in wealthier communities.
“The model has a huge amount of potential. But we need to put urgent care in places where they’re increasing access,” Friedman said.
That’s lower-income neighborhoods and rural areas — which already suffer from health care shortages.
CORRECTION (Dec. 16, 2022): An earlier version of this story misspelled Lou Ellen Horwitz’s name.
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