- July 28, 2020
- Steve Heisler
- Podcast Episodes
In this episode, Steve and Joe discuss:
1. At what point in your life did you start purchasing urgent care centers?
- When I finished fellowship, I began to practice and realize that infectious disease doctors are at the low end of the pay scale for physicians, and that, combined with student loan debt, made me interested in seeing how I might be able to mitigate the set of circumstances and it happened that urgent cares were up and coming at the time, and there was not one in my hometown.
2. Did you see senior and elderly patients?
- Yes, quite a few.
3. Is it accurate to say that the research showing that the senior and elderly population like to go to their primary care doctor first is correct?
- Absolutely. That’s where the trust lies. That’s where people feel most comfortable is with the physician that they have a relationship with.
4. Did you start seeing some of those seniors and elders either coming over from their primary care doctor or just circumventing the primary care doctor and coming right to urgent care?
- Well, both actually, probably the most common was their primary care sending the patient over to me over to be seen in the urgent care because the primary wanted the patient to be seen and they weren’t available, or they wanted some ancillary service that we provided, such as an X-ray, a chest X-ray, for example. And their office didn’t have that. We could do the X-ray and read it for him.
5. What was the most common issue that seniors and elders were coming in with?
- Upper respiratory, bronchitis or pneumonia even, and urinary tract infection.
6. Do you have to send a lot of them over to the ER, or what would you do when they came in?
- If it was simple and could be treated in urgent care with a dose of IV antibiotics and follow that with discharge them with a prescription for oral antibiotics, that would work fine most of the time. However, if it was more advanced, and the patient was becoming bacteremic, or even septic, you know, their life depends on early intervention, you know, immediate intervention with IV antibiotics so the first task would be to get a dose of IV antibiotics on board and then to ship them to the hospital where their treatment needed for an IV treatment needed to be continued.
7. What is it about the urgent care centers, which I don’t know if it’s often but you’re seeing that maybe they haven’t gotten the best care coming in and these UTIs or upper respiratory infections were not dealt with properly?
- I’ve seen that. Yes.
8. Can you tell our injured senior community a little bit about the problem that you’re finding with urgent care centers?
- Many people recognize that urgent care centers can be profit centers, they can be very profitable. It doesn’t require the investor physician to be doing everything to generate income. In other words, he owns urgent cares and they produce income for him. The issue comes about when the physician that owns tries to run too many centers and what he does is he hires what’s known as physician extenders. Physician extenders are people such as physician’s assistants and nurse practitioners. Now, the law is that as long as the physician is present someplace within the state and available by phone, that the PA or the NP can act autonomously, and when they have an issue or question, they can phone the physician. Most states have statutes that define the scope of practice for physician extenders.
9. In your situation in Rhode Island, the physician extenders could operate as long as the doctor was within the state and was available by phone?
- Correct, and what that often meant was that one set of urgent care centers was owned by one group that owned eight or nine urgent cares had one doctor and maybe 15 or 16, extenders acting at any given time.
10. As a result of that, what did you see occurring?
- As a result, the extender was acting almost completely on its own. If the case came in, that was serious, the extender who was on his own would first have to recognize that he had a serious case, and then after recognizing it would have to phone the physician to get help. That is very unlikely to happen in clinical practice, in reality.
11. How do you know that this is going on in other urgent care centers?
- I know of the centers, I know of the people involved, and I know of the practices involved. I know what I did to keep things safe.
12. Do you have any evidence that this is a national issue? We know that urgent care centers are growing and we know that there are chains of urgent care centers. Are you saying that that is happening across the country?
- I can tell you that in recent years, there’s a good amount of case law that’s come out, which highlights this issue.
13. Do you contend that they’re putting the patient’s safety in jeopardy?
- Yeah, the equation is simple. If I hire a physician assistant, it costs me less money than to hire an M.D. or D.O.
14. Can you give our listeners an example or two of some really bad things that happened to seniors or elders as a result of going to an urgent care center where they didn’t see a doctor or they saw a patient extender or doctor extender who made a mistake?
- A case that comes to mind that’s relatively recent is a case out of Florida a 75 year old male had uncomplicated UTI, went to an urgent care canter and it was missed and not treated by I think nurse practitioner who somehow missed the diagnosis. The patient got worse, went back to the urgent care, and this time they recognized it and what they did and they sent him home on an oral antibiotic that he had resistance to. Now, the problem here is that and the reason it was resistant is that he had previously had a UTI a year prior that was treated and found resistant to this particular drug. Now, the patient extender didn’t look back into the records that she had available to her. She didn’t realize that the patient was organism resistant and the patient ended up dying.
15. Do you believe that in general, urgent care centers are understaffed, on top of the fact that a nurse practitioner or a physician’s assistant is not a doctor? They also might be seeing more patients than they should be seeing?
- Certainly. Steve. I want to be clear, nurse practitioners, PAs, and MDs, we all have our place. We all have legitimacy in the health care system. I’m not putting down extenders, what I’m saying is that they’re being misused.
16. Is it realistic to expect them to tell you that there is or there isn’t a doctor on staff or presently in the facility?
- Well, I think most often people are going, to tell the truth, I would.
17. Does it also make sense to check the Better Business Bureau or go online and see if there have been any problems with that particular franchise or chain or urgent care center?
- Oh, absolutely. It’s very easy to find the reputation of a given place online.
18. Do you have any other tips or advice to our injured senior population listening to this podcast as far as urgent care centers are concerned?
- I think it’s important that any physician that you see is board certified. I think it’s important and I think it’s important that if you are going to go to urgent care, it’s very reasonable to ask if the people that are going to see you are board-certified in either family medicine, internal medicine, or emergency medicine, that’s an additional safeguard.
19. Can you just briefly tell our listeners, how you become board certified or, what exactly board certified means?
- A doctor doesn’t have to be board-certified to practice in any state. On the other hand, after a doctor completes training, for example, internal medicine training, which is a year of internship and two years of residency, after that, they sit for an exam. If they pass that exam that’s when they’re given what we call board certification. The significance of that is that Dr has mastered his craft instead of not taking, preparing for, and being diligent in studies and in going through residency and internship. They’re technically knowledgeable about the particular fields.
20. So the board-certified physicians are the cream of the crop?
- In my view, and most people in my shoes, our view is that being board-certified is kind of a bare-bones requirement.
21. Is there a high percentage of physicians that are board-certified?
- I would say over 50% are board-certified.
To find out more about the National Injured Senior Law Center or to set up a free consultation go to https://www.injuredseniorhotline.com/ or call 855-622-6530
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Show notes by Podcastologist: Kristen Braun
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