Why the trend toward quick and easy appointments may not be making us healthier

Is convenience, affordability, and accessibility of urgent care clinics good for our health?

I have been thinking a lot lately about the impact “drive-through” medicine has on the health of patients after a frustrating day during which I saw a “broken” finger that was not broken, a “severe” ear infection that disappeared in two days, and a 4-year-old that was treated for a bladder infection they did not have. By the time the third patient showed up with the wrong diagnosis, I began to question whether urgent care centers were more helpful or more harmful.

Urgent care clinics attempt to bridge the gap between primary care and emergency care. These clinics are one of the fastest growing niches in healthcare. In 2019, there were 11,481 urgent care centers in this country. By 2022, there were more than 14,000, representative of an increase of more than 71 million patient visits per year. Lately, urgent care feels a bit like ordering fast food at a drive-through. While it is fast and cheap, the real question should be: Is it good for our health?

No one knows for sure. For now, know that it is easy, a quality preferred by Gen Z and Millennials. Research shows they prefer the convenience of urgent care over the care provided by a primary care physician. They also like conducting their doctor visits by cellphone.

You know what else is easy? Ordering fast food. While a Whopper can be customized to "Have it Your Way,” no matter how you dress up it up a high-calorie meal loaded with saturated fat does nothing to improve your health. Even worse, when you trade convenience for home-cooking, you might end up sicker.

It is no different when you trade expertise and a longer wait time at the doctor’s office for convenience. Lately, I am seeing more children than ever who follow up after being seen at an urgent care for fever. Parents are told the child has an “ear infection,” a condition which is treated with an antibiotic. The urgent cares love to prescribe Augmentin, a strong antibiotic more likely to cause side effects like stomach upset, diarrhea, and yeast infections. A few days after visiting the urgent care, a patient or two will come in because of a complication from the antibiotic. I end up explaining the ears are clear but the diarrhea was caused by an antibiotic their child did not need in the first place.

If the child is not diagnosed with an ear infection, inevitably, they are treated for a bladder infection (known as urinary tract infection or UTI.) Proper diagnosis involves performing a urine culture to see if bacteria are present. After 48 hours, this test is either positive (with bacterial growth) or negative (no growth.) In my experience, urgent cares call only when the test is positive, but not when it is negative. Parents give their children antibiotics for 10 days, and when a complication arises, they are frustrated to learn the whole thing has been an exercise in futility.

Just as the drive-through attendant is not responsible if you have a heart attack after finishing your Whopper; the provider at your urgent care is not responsible for your long-term health. Slim profit margins mean urgent cares must focus on their bottom line. In years past, urgent cares were owned and operated by physicians; today, however, over 50% are hospital-owned and operated. The fastest growing ownership sector is private equity, making up 15% of the market, but rapidly expanding their footprint. It is akin to asking a banker about what to do about a sore throat.

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Fewer physicians are working in urgent cares than ever before. Merely 0.3% of these clinics are staffed by physicians only. More than three-quarters do not require a physician to be on-site, staffing with a mixture of physicians and non-physician providers. When private equity groups take over an urgent care, they lay off physicians and hire non-physicians to lower labor costs, boosting profits significantly for the corporation.

Does convenience, affordability, and accessibility come at a price? It seems so. Research shows that once a zip code is served by an urgent care, Medicare spending increases significantly — by $6,335 per patient annually — with no improvement in longevity. Worse than that, opening an urgent care in a community is associated with increased emergency room visits, lengthier hospital stays, and higher prescription costs for the Medicare crowd. As one owner of an urgent care said: “The benefit to patients is getting them out of the ER…And on the flip side, it’s provided us with some more feet through the door.”

The child who “broke” their finger had a second set of x-rays, which showed no fracture. He returned to baseball practice and played in the weekend game. The child diagnosed with the ear infection really had bacterial pneumonia, so they got a different antibiotic. The 4-year-old without the bladder infection had a virus known as “fifths disease.” They needed chicken soup, extra rest, and lots of snuggles from mom and dad. All three ended up paying twice the price, for half the knowledge and it certainly did not save anyone time.

While not valued by everyone, receiving regular checkups at your doctor’s office is the best healthcare money can buy. When it comes to service, including healthcare, it can be good, fast, or cheap. You can never have all three, so pick two. Being good and fast tends to be expensive, like concierge medicine, great for those who can afford it but out of reach for most Americans. As a primary care physician, I can be cheap and good, but admit that I am anything but fast. Urgent cares have cornered the market on fast and cheap — akin to the fast-food drive-through — but quality is questionable.

In healthcare, convenience, affordability, and accessibility come at a hefty price — the choice is up to you.

Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.

This article originally appeared on Kitsap Sun: Waiting at the doctor may be inconvenient, but expertise matters