The data are hard to refute in the article, “Urgent Care Centers Offer Access—at a Cost,” but the researchers' conclusions are questionable. (EMN. 2021;43:1; https://bit.ly/3fn8oan.)
The study purports to show that urgent care may decrease potentially unnecessary ED visits, but that this comes at a high cost, with about 37 urgent care visits needed to decrease one low-acuity ED visit. The underlying assumption is that the only purpose for urgent care is as a stand-in for the ED. That is sometimes the case, but patients also come to urgent care to fill in the gaps of primary care when it is not readily available. Lack of easy access to primary care is endemic in a country where, despite the ACA, many people have inadequate insurance or none at all and where overworked primary care physicians cannot see patients in a timely fashion.
The authors of the study looked at diagnoses such as a rash, urinary tract infection, and muscle strain. All of these are conditions that warrant timely medical care, and the assumption that patients can see their PCP the next day is, in many cases, simply wrong.
Comparison with other countries is instructive. Americans on average go to the doctor about five times per year. This puts them toward the bottom of the Organisation for Economic Co-operation and Development average, with South Koreans seeing their doctors a whopping 16.6 times per year and Germans at a respectable 10. Rather than see urgent care visits as simple stand-ins for ED visits, they should be seen as a mix of “true” urgent visits, along with a form of misplaced primary care.
In most other countries, patients see their PCP for urgent care, and PCPs make slots in their schedule and have rotating after-hours openings available. Low reimbursement for primary care visits in the United States leads to overbooking, making urgent care visits unavailable. Furthermore, high malpractice rates for minor office-based surgical procedures, such as laceration repair and abscess drainage, make these procedures unprofitable to PCPs, who send those patients to urgent care or the ED.
The current state of affairs for medical access is less than optimal for doctors and patients. We would all be better served by paying attention to what patients need, which is easy access to the right level and type of care.
Eric Lubliner, MD