A Sense of Urgency
Cover Story
Written by Jill Rose   
Sunday, 01 November 2009
A Sense of Urgency
Would a national niche for urgent care help overcrowded EDs and primary care practices? Dr. Scott Burger and his partners are banking on it.

A Sense of Urgency
What do you get when you cross a savvy ED doc with two businessmen experienced with franchising? A healthcare model with the potential to take the country by storm.

Dr. Scott Burger began his career as an emergency medical resident at Beth Israel Medical Center in Manhattan and was later an attending physician at Harlem Hospital. He noticed a fatal flaw in the fast track/urgent care programs both organizations used to reduce ED wait times: many staff members were involved with both types of patients.

“If a person comes in with an ankle injury and needs an X-ray, that case will have to wait for the person who rolled in with respiratory distress,” he said. “It doesn’t matter that the ankle injury has been there for four or five hours and the respiratory distress arrived 10 minutes ago.” The same holds true for labs, where strep tests wait behind those needed for ICU patients.

“I felt that urgent care was a needed type of medical delivery system, but I thought it would be best done outside the hospital,” said Burger. In February 2006, he and business partners Tony Bonacuse and Peter Ross opened the first Doctors Express, located in Towson, Md.

The plan was to open a number of urgent care centers in the area with a strong brand and clearly defined market. The centers are staffed by a physician during all hours of operation, differentiating them from retail clinics and some competing urgent care facilities. Digital X-ray equipment, a lab, and a pharmacy are on site, so a wide variety of illnesses and injuries can be treated.

Doctors Express customers are too ill for a primary care visit (most practices don’t have X-ray machines or stitch wounds) and not ill enough for the ED. One or two patients per week have underestimated the significance of their illness and are sent to the ED from the center, said Burger; everyone else is treated.

A few years into the business, with the financials looking healthy, the partners began to look at replicating the successful model in other areas of the country. “We did our due diligence and spent a lot of hours putting together a strong team to bring this to the market,” said Burger, chief medical officer. “We thought this would be a great way for people to own their own business in a field that is recession resistant.”

Defining urgent care
The main draw behind having a national brand of urgent care centers is consistency. “We want people to know that if they have an injured ankle, regardless of where they are, they can look up the nearest Doctors Express and know there will be an X-ray machine and a physician onsite to diagnose the problem,” explained Burger.

Every Doctors Express site will have digital radiology and laboratory services, and most will dispense medication on site (a few states prohibit dispensing from a doctor’s office). “We want to define what urgent care is,” said Burger. “We want people to know what types of services we provide and that we provide them across the board.”

The first franchised center opened in Temple, Texas in mid-August, and Burger is pleased with its growth thus far. “The response from the community there has been exceptional. The owners [who are not clinicians] have executed on everything we talked about during training, and the center is seeing a lot of need and keeping people out of the ED.”

That training consists of a week-long course on the business aspects of running an urgent care center. Topics include the computer system, marketing, billing, and the use of collection agencies when needed.

After that, franchisees (who pay $55,000 for a single franchise license or $250,000 to develop multiple franchises in a particular area) are assigned a business consultant. “That’s a specialist here at corporate who walks them through a structured pre-opening timeline and task list to make sure they’re getting everything done in a timely fashion,” explained Burger.

New franchisees are also given guidelines on what to look for when hiring physicians. Each center employs two or three physicians, usually one full-time and one or two part-time. Centers are open 8:00 a.m. to 8:00 p.m. weekdays and 8:00 a.m. to 5:00 p.m. on weekends (longer hours are possible if the market supports it).

Once physicians are hired, they travel to the Maryland headquarters for two days of training on systems and software. “We aren’t teaching them how to take care of patients, just showing them our systems,” said Burger, noting that ED and family practice physicians are best suited for the position.

Room for both?
Although the thought of packaging a healthcare model the same way you would a fast-food concept is distasteful to some, Burger said the overall response has been positive. In general, hospitals are glad to have non-critically-ill patients treated somewhere other than the ED. When waits are long in the ED, partially due to patients who do not have a life-or-death issue but have nowhere else to go, the hospital’s reputation in the community suffers, noted Burger.

“Progressive administrators see the value. We’re not trying to do what they do. We’re trying to pull out of the ED the people for whom they created urgent care units in their institutions to try to expedite care—something they have a lot of difficulty with,” Burger said.

In the same vein, Burger and his team are careful not to compete with area physicians. “We do not do primary care; we have a relationship with the internists in the area so that they are taking care of people with hypertension, high cholesterol, etc. Those patients need a primary care physician to manage them.”

Although there is some overlap between Doctors Express and retail clinics, Burger seems to feel there is room for both. “I hear stories almost daily about people not being able to get in to see their doctor or that their doctor left his practice to develop a concierge practice with 500 patients instead of 5,000,” he said. “There’s a lot of room out there because a lot of people need to be taken care of.”

To that end, Burger and his team are actively working to sell more centers. “We have a dedicated sales force working on franchise development, teaching people about what we’re doing to see if they’re interested in developing this model,” he said. The group is also looking at converting some existing urgent care centers into Doctors Express centers.

Urgent care centers are one of the fastest growing areas of healthcare in the country, noted Burger. “We’re committed to developing a national brand to help define the market for urgent care. We think we can have a strong, positive impact on the delivery of healthcare in this country.”
 
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