Primary Care Reimagined; The Walk-in Revolution

Authored by: Syed Hasan

For decades, primary care physicians, more commonly referred to as PCPs, have been at the forefront of medicine. Whether it be through annual checkups, an illness or injury, or even for seeking a referral to a specialist, the first stop for most has been a PCP, until now. 

In a study following commercially insured US adults from 2008 to 2016, it was found that visits to PCPs have declined by 24.2% over a total of 142 million primary care visits [1]. This could mean one of two things. Either patients have miraculously found cures to their ailments on their own, or, more plausibly, have found alternative methods to obtain the medical care that they need. The reason for this move away from primary care doctors could be due to a plethora of factors, beginning with the experience itself. A visit to the primary care clinic is often plagued with issues ranging from long wait times to be seen and overworked doctors that have such a tight schedule that they have little time to spend on individual patient interactions. 

In the realm of replacements for primary care physicians, an emerging business, Urgent Care Centers, have begun to establish their prominence in the healthcare scene. Urgent Care centers have created a highway for people of all socioeconomic statuses and varying schedules to see a licensed healthcare professional through a method streamlined in the patient’s favor. In a systematic review aiming to seek why people were choosing emergency care, “Access to and confidence in primary care was a key factor identified by 26 studies… in most studies patients had access to primary healthcare and chose instead to seek more urgent or emergency care, often without contacting a PCP first” [2]. In one study, “44% of patients found their GP ‘inaccessible to their need’ ” [2]. This ties into the notion of patients believing that they are in need of more intensive care than actually required. Searching for specialists and urgent care centers, to bypass the primary care checkpoints in their panic to receive care quickly. 

The convenience of visiting urgent cares is also illustrated by looking at side-by-side utilization of either form of care, with a study finding that “96% of visits occur during weekdays” in primary care offices, while urgent cares have a more equal distribution across the week “with 28%-29% occurring on weekends” [3]. The efficient and cost effective Urgent Cares allow for a shift away from traditional scheduled visits of the past, avoidance of an expensive visit to the emergency room, and are a more convenient way to fit in medical care. With the increase in prevalence of conditions and a decline in the health of the overall US population, the expectations for current primary care doctors continues to increase. As the satisfaction with primary care physicians is overwhelmingly low, medical students hoping to choose future specializations are beginning to opt out of primary care. The grueling hours, long expectations, and number of patients seen per day compound to form a field that many are beginning to stray away from. An article authored by Dr. Bodenheimer and published in The New England Journal of Medicine notes that from 1997 to 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent” [4]. The decrease in residencies is tied directly to the demanding nature of the profession, and with the increase of urgent care visits by people of all insurances. It is clear that primary care is not an attractive specialty for aspiring physicians. 

The utilization of Urgent Cares will continue to increase as more Urgent Care clinics are built, and many patients that originally would have gone to the emergency room may also choose Urgent Care alternatives once they are made more popular across areas and access to these medical clinics increase. A study that focused on reasons for visits to either emergency or primary care found “a total of 27.1 percent of all emergency department visits could be managed at a retail clinic or urgent care center—16.8 percent when hours are restricted” [5]. As knowledge of Urgent Cares increases and the trustworthiness people hold builds a repertoire to the general population, many emergency care visits will become urgent care visits, and the process of visiting an Urgent Care will be further optimized.

References:

1. Ganguli, I., Shi, Z., Orav, E. J., Rao, A., Ray, K. N., & Mehrotra, A. (2020). Declining use of primary care among commercially insured adults in the United States, 2008–2016. Annals of Internal Medicine, 172(4), 240–247. https://doi.org/10.7326/m19-1834 

2. Coster, J. E., Turner, J. K., Bradbury, D., & Cantrell, A. (2017). Why do people choose emergency and Urgent Care Services? A rapid review utilizing a systematic literature search and narrative synthesis. Academic Emergency Medicine, 24(9), 1137–1149. https://doi.org/10.1111/acem.13220 

3. Krause , T. (2018). (PDF) comparison of utilization of urgent care and primary care 2011-2015. Family Medicine and Care. https://www.researchgate.net/publication/325787666_Comparison_of_utilization_of_urgent_care_and_primary_care_2011-2015 

4. Bodenheimer, T. (2006). Primary care — will it survive? New England Journal of Medicine, 355(9), 861–864. https://doi.org/10.1056/nejmp068155 

5. Weinick, R. (2010, September). Many Emergency Department Visits Could Be Managed At Urgent Care Centers And Retail Clinics. Health Affairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2009.0748