Expanding Practice Scope with Urgent Care Services

We live in an era of immediate gratification where everything is available at our fingertips. We expect services to be available early, late, and on the weekends, as evidenced by the rapid growth of urgent care centers around the country. I have noticed this trend firsthand while working as a PA in urgent care, obstetrics and gynecology, and emergency medicine.

I often ask patients with non-emergent complaints why they came to the emergency department. I've heard "My primary provider doesn't have an opening for two days" or "I can't make appointments with my hectic schedule." Just yesterday I was doing a sports physical on a teenager and the mother told me, "I usually bring him to his pediatrician for this, but I just forgot to make an appointment this year and tryouts are tomorrow." Patients expect access to care when they want it and where they want it.

Adding urgent care hours to your existing practice isn't just about patient convenience and practice revenue: It is actually a patient safety issue. Consider how the quality and safety of care are improved when providers have access to patients' entire electronic health records. Providers can perform medication reconciliation and have access to the past medical history. In addition, there is built-in follow up as the primary-care physician is copied on every note, and a follow-up appointment can be scheduled if needed.

One group of primary-care practices in Connecticut has addressed this demand by opening their practices on evenings and weekends for "extended hours." Patients can make an appointment, call ahead, or just walk-in for care. They can be an established patient of the practice or a new patient looking for a medical home. These extended hours are mainly staffed by PAs.

Why PAs? PAs are well-suited to help practices extend into the urgent care arena because of their education, certification, and experience. For example, PAs:

• Are educated as medical generalists and therefore able to provide a full range of care as they have training in all areas of practice, including pediatrics, internal medicine, and surgery.

• Work autonomously and have a collaborative relationship with physicians. They know when to seek another opinion and are comfortable working on a clinical team.

• Are cost-effective - PAs provide most of what a physician can at about 50 percent of the cost.

• Maintain certification through a rigorous process that includes completing substantive CME every two years and passing a secure, proctored certification exam every 10 years.

• Transition easily among different specialties. In fact, over half of PAs change specialties during their career. Our wide range of clinical experience from multiple fields enriches the urgent care experience for our patients.

Urgent care is an emerging discipline that is here to stay. Primary-care providers should re-evaluate their practice and establish ways to provide extended hours and urgent care walk-in access to their patients. Certified PAs will help physicians meet this demand.

Jessie Dorne, PA-C,is president of the Association of Family Practice Physician Assistants. She is certified by the National Commission on Certification of Physician Assistants (NCCPA) and works for PhysicianOne Urgent Care, ProHealth Physicians Inc., and Norwalk Hospital.

This blog was developed in partnership with NCCPA.