December 11, 2012

Paging Dr. Marcus Welby: why private practice doctors switch to urgent care

“My time was spent fighting insurance companies and doing paperwork instead of caring for patients.”

“My time is spent fighting insurance companies and doing paperwork instead of caring for patients.”

My father was a family medicine doctor for more than 40 years. Running a single-doctor practice, he wore many hats. Not only did he need to be a healthcare expert, he was also a small-business owner, accountant, HR director and IT person—roles he was never trained for. All while facing the challenges of practicing medicine: malpractice insurance costs, low reimbursements, government regulations and the uncertainty of healthcare reform.

So I shouldn’t have been surprised by what I heard from doctors who left private practice to work in urgent care. As part of a recruitment branding project for a large regional urgent care provider, I interviewed these doctors about their experiences. What shocked me was that the traditional model of the PCP private practice has been failing for a long time.

Here were some of the sentiments I heard repeatedly:

  • “Being responsible for every aspect of a patient’s health was a burden.”
  • “I was always on call; work followed me wherever I went.”
  • “I get punished for taking time off; the work doesn’t go away, it just piles up.”
  • “I was tired of managing chronic diseases. I didn’t feel like I was actually healing people.”
  • “My time was spent fighting insurance companies and doing paperwork instead of caring for patients.”
  • “In urgent care, I get paid more and work less.”

A 2012 physician survey commissioned by The Physician Foundation and conducted by Merritt Hawkins found that:

  • 77.4 percent of physicians are somewhat or very pessimistic about the future of the medical profession.
  • Physicians spend more than 22 percent of their time on nonclinical paperwork.
  • In the next one to three years, more than 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
  • 57.9 percent of physicians would not recommend medicine as a career to their children or other young people.

Is urgent care the answer?

I found that the doctors working for our urgent care client were genuinely happy. With standardized facilities and processes, and a strong support staff, they rediscovered why they chose to practice medicine in the first place. They performed hands-on medicine, some of which they never did in private practice. They saw instant results and grateful patients. And they had long stretches of time off with no call, to spend with family or to explore other interests.

What does this mean for hospitals and healthcare systems?

Urgent care is only one part of the equation, but it’s likely that these large urgent care providers will become a force in the healthcare community. As a hospital or healthcare system, you need to realize that the best urgent care providers are not “fly-by-night” organizations staffed by nurse practitioners who treat cuts and scrapes. Increasingly, you will have to compete with these urgent care providers for PCP physicians, ED physicians and patients. It’s important to understand the value proposition that they offer, and to be able to effectively communicate the differences and limitations to your audience.


This blog post first appeared in Ragan’s Health Care Communication News.