Convenient care: Medical services become more accessible in Southeast Missouri

Urgent care clinics are becoming more common, making it less likely that you'll wait for hours in the emergency room or hear that your doctor is unavailable -- when you need him now.

"We want to be the in-between," says Pete DeLuca, regional director of operations and marketing of Doctors Express, which opened an immediate care clinic in Cape Girardeau in July. "We're definitely not trying to compete with primary care providers, and we're not trying to take from their patient base. We're working with the primary care physicians to take their overflow and their weekends, treat patients quickly and efficiently, and send them back to their primary care doctor."

Doctors Express, open every day from 8 a.m. to 8 p.m., handles broken bones, colds and coughs, school physicals, X-rays, medications and nearly every other basic health care need. The clinic employs three doctors, a nurse administrator, a full-time and part-time nurse, and several PRNs and X-ray technicians. At least one doctor, nurse and X-ray technician are on-site at all times, says DeLuca. If a patient's situation is traumatic or life-threatening, the clinic stabilizes the patient and sends him or her to a hospital.

Southeast Missouri Hospital's ER Express clinic is adjacent to the emergency department and open 9 a.m. to 9 p.m., 365 days a year. Angela Selzer, lead nurse practitioner in the emergency room, explains that patients must first check into the emergency department; from there, a registered nurse sorts patients between the ER and ER Express based on complaint, vital signs and previous history.

"There is a need for ER Express to treat patients who cannot get into their primary care office for acute care illnesses, but the patients do not require the resources of the main ER. Then the main ER can focus on patients who are sicker," says Selzer. ER Express handles about 25 percent of the total ER volume, she adds, and patients are usually treated in less than 90 minutes from check-in to check-out. ER Express is staffed by nurse practitioners who collaborate with the ER physicians.

According to Selzer, ER Express patient volume is up 12 percent from last year.

"I believe this trend will continue due to a nationwide shortage of primary care providers and increasing consumer demand," she notes.

Dr. Bernie Ranchero of Doctors Express expects to see the same trend at his new clinic.

"There is a primary care shortage in America and it's huge," says Ranchero. By 2025, number of older adults in America will rise by 73 percent because people are living longer and the baby boomer generation is getting older, he notes.

"A patient who is in the older population, age 65 and up, sees his physician three times as much as a younger adult," says Ranchero. "They're living longer and they have more complex needs, so we need more physicians." But despite the current shortage of primary care physicians, most students entering medical school are not going into primary or family care, says Ranchero. That means the shortage will only get bigger, and all those patients will need to go somewhere -- that's where urgent care clinics come in to fill the gaps.

"Along with the consumer demand, the changes in the health care delivery system will likely increase the trend in convenient care clinics," says Alex Ogburn, director of occupational health services and physician recruitment at Saint Francis Medical Center. "As access to care increases, more patients will flood the system, making the primary care physician shortage more acute."

Saint Francis has two walk-in medical clinics offering extended evening and weekend hours: Convenient Care, adjacent to the Gene E. Huckstep Emergency and Trauma Center, opened in 1989, while Immediate Convenient Care, located at 1702 N. Kingshighway in Cape Girardeau, was acquired by Saint Francis in January 2010. According to Ogburn, the acquisition of Immediate Convenient Care is one step Saint Francis has taken to address primary care shortages and improve access to health care.

"The trend toward convenient care clinics is health care's response to the consumer demand for quality care that is convenient, efficient and a cost-effective alternative," says Ogburn. "Because of the increasing call for value and convenience, these clinics will become more prevalent."