Dr. William Gluckman likes a challenge.
It’s what drew him to work in a hospital emergency department in the first place—the fast pace, the variety of ailments he’d treat, the potential to help a lot of people in a short amount of time. It suited his Type-A personality, he said.
But he noticed he couldn’t keep up, no matter how fast he worked. There were just too many patients—many of them waiting hours to be seen—and not enough time to treat them all.
“I felt very frustrated,” he said. “I couldn’t move the people through the hospital fast enough.”
So, Gluckman quit.
He went back to school, received a master’s degree in business administration and, six years ago, tied his two interests together by opening an urgent care center, FastER Urgent Care in Morris Plains. At his clinic, he treats urgent or emergent conditions that are not severe enough for the emergency room, but demand immediate attention—things like minor burns, the flu, a sprained ankle. He sees patients on a walk-in basis, striving to complete care in less than an hour and referring patients back to their primary doctor for follow-up.
Whether Gluckman knew it or not, he wasn’t alone in discovering this brand of medicine. It just so happened the opening of his facility coincided with a national urgent care boom, an expansion that continues to accelerate.
While organizations like the American Medical Association and some physicians have concerns about urgent care, they haven’t slowed its rise. According to the Urgent Care Association of America, the industry grew by about 300 centers a year between 2008-2010. The rate doubled to 600 centers in 2011, although reliable data is hard to come by since there is no national database of urgent care centers, and federal registration is not required.
The New Jersey Department of Health does not track the number of urgent care centers, either, with facilities falling under one of several DOH licensing categories, depending on how the center filed. A University of Nebraska Medical Center study kept track in its state, though, and found there was a 40-percent increase in urgent care clinics in Nebraska between 2008 and last year.
At the local level, Mercer County has seen similar growth in a similar time period. The area has had walk-in clinics for decades, but the first franchised facility didn’t spring up until June 2010 when AfterOurs opened an evening clinic at One Washington Boulevard in Robbinsville. A few months later, Doctors Express followed, hatching a center of its own in November 2010 a half-mile down Route 33 in Hamilton Square.
In the coming months, two more urgent care facilities will join the fray in Hamilton. MedExpress will open this autumn—as soon as next month—in Block Plaza on Route 33 in Hamilton, at the former site of Chapala Mexican restaurant. Patient First will open in 2015 at the former location of Savoy’s restaurant on U.S. 130 in Hamilton. The three centers along Route 33 will be within two miles of each other, with Patient First only a few miles away itself.
The urgent care boom has reached West Windsor, where a new facility just opened, as well as Ewing and Lawrence, which each have multiple centers.
The local expansion serves as a microcosm of a nationwide trend, the economy’s response to an opportunity. The UCAOA attributes recent industry growth to a confluence of events: difficulty in finding primary care, emergency room overcrowding and the influx of private equity into urgent care as the business model proves itself.
It’s the macro version of Gluckman’s experience. National statistics show emergency rooms are overburdened, in part because people who don’t have health insurance have been using the hospital for primary care. Nearly half—49.7 percent—of emergency room visits lasted between two and six hours, according to the Centers for Disease Control’s 2010 National Hospital Ambulatory Medical Care Survey. (The same survey said two-thirds of patients had their first contact with a doctor or nurse practitioner within an hour of arriving at the ER.)
At the same time, fewer doctors are choosing to go into primary care—think the family doctor—for lifestyle reasons. Primary care doctors have lower salaries, often with worse hours, than specialists, Gluckman said. Even Gluckman, like most urgent care doctors, doesn’t work late nights or long hours on weekends, and isn’t on-call.
When comparing, there isn’t much incentive for a new doctor to enter into primary care, Gluckman said. Yet, more and more people need primary doctors, as the population grows and more people gain health insurance coverage. This has become especially true in the last year, as the Affordable Care Act opened coverage to more people.
“We’re not going to be able to churn out enough primary care doctors,” Gluckman said. “They’re being overwhelmed. The demand [for primary care] has always been there. It’s a supply-side issue. The supply is not there.”
The pinch at both ends of the medical spectrum has created a need for something in the middle. The marketplace has responded with urgent care, which Gluckman calls the “safety net.”
“Urgent care really fills that gap,” said Gluckman, a member of the UCAOA board of directors. “It helps to take the weight off the primary care doctors who can’t do same day or next day services.”
That gap also creates a business opportunity, one national chains are taking advantage of by opening franchises in potentially lucrative markets. The businesspeople must see something in Hamilton in particular—the centers there belong to three of the six largest urgent care chains in the United States. Each of those chains has dozens of locations, with more planned in the next few years.
Gluckman himself is in the process of opening a second Morris County location this year, and he admitted many other urgent care providers have had similar thoughts, leading to a rapid concentration of care in areas like Hamilton.
“It’s a good time to expand before the others come into the market,” Gluckman said. “But you’re having so many in your one town? That’s amazing. Sometimes competition is a good thing, but it’s hard to come into an area with an established center and compete. A town of 90,000 is a good size, and if there’s a need in surrounding areas and the access roads are convenient, they may be able to all flourish.”
Still, in New Jersey, urgent care centers have faced a bit of a stigma the industry expands. Urgent care first gained popularity in the Midwest and South, and practitioners at the new facilities in the Northeast have been forced to educate potential clients about what they are—and are not.
“In New Jersey, it’s one thing I’ve faced,” Gluckman said. “‘What’s urgent care?’ There’s still education that needs to be done.”
But it hasn’t stopped companies from coming into the state. The U.S. 130 facility in Hamilton will be Virginia-based Patient First’s first center in New Jersey. MedExpress will soon have 17 centers in the state, with one just opening in Cherry Hill and three more—including the one in Hamilton on Route 33—on the way.
MedExpress will be open every day from 8 a.m. to 8 p.m., with a doctor and full medical team always on duty. The center will have about 20 people on staff, vice president of communications Kelly Sorice said. Patient First will be open from 8 a.m. to 10 p.m., 365 days a year. Both facilities will have X-ray and lab capabilities.
With fewer people are working traditional hours, they need care that is quick and convenient, MedExpress vice president of communications Kelly Sorice said. This is the guiding principle that has lead urgent care practitioners to offer evening and weekend hours, along with facilities that can serve as one-stop shops.
“They need access to care when they need it,” Sorice said.
Part of providing that access is deciding where to put a center. When considering an area for a new franchise, MedExpress officials look for an area in need of urgent care facilities but with a strong base of primary care physicians and hospital facilities. Mercer County’s four hospitals make it a good fit.
MedExpress looks for strong medical support system because it doesn’t want to be the solution to every issue. Instead, it wants to partner with area doctors and hospitals to be a piece of a patient’s total care, Sorice said.
“We believe urgent care doesn’t cover everything,” she said.
Patient First, on the other hand, does offer primary care for patients who do not have a regular physician. Often, a patient goes to Patient First when medical care is needed at a time when the patient’s regular doctor’s office is closed, public relations director Ian Slinkman said.
“If the patient agrees, we will forward a copy of the visit record to the patient’s regular doctor, helping ensure continuity of care,” Slinkman said.
Some hospitals and primary care doctors have partnered with urgent care centers, and Gluckman said there’s some comfort in doing this since they know they are referring customers to an “approved” urgent care facility. That makes a lot more sense than the current opposition, he said.
“Right now, most primary care doctors don’t like urgent care out of fear we’re going to take their patients,” Gluckman said. “I do not keep patients. I will refer you back to your primary care physician. Those types of relationships strengthen the model of urgent care.”
But opposition persists. The study done at the University of Nebraska Medical Center cites the American Medical Association as a premier opponent to urgent care, citing the fragmentation of care. In effect, the fear is if patients begin to use urgent care clinics for health issues, it may reduce the likelihood that patients will find a steady primary care provider. The AMA declined to comment for this story.
Regardless of the opposition, urgent care centers have attracted customers. Last year alone, MedExpress treated 2 million patients in its 135 centers. Part of urgent care’s popularity is due to ease of use, but cost may also play a role.
Insurance company CareFirst Blue Cross Blue Shield analyzed patient data from 2012, and found urgent care, on average, offered a better deal monetarily than the alternatives. Compared with patients who sought treatment at an emergency room for a middle ear infection, those who went to urgent care centers for the same condition averaged a savings of 80 percent—a bill of $498 versus one of $100. The same holds true for treatment for acute bronchitis, with urgent care offering care at an 85-percent discount.
“A smart consumer wouldn’t want to go to the ER and pay $2,000 for strep throat [treatment] when you can go to the urgent care center, and pay less than a tenth of that,” Gluckman said.