Teaming with urgent care clinic has its drawbacks
Teaming with urgent care clinic has its drawbacks
Unhappy clients are most likely result
Question: Our hospital has proposed combining the occupational health clinic with the urgent care clinic on the hospital campus. There seem to be a couple of obvious advantages: sharing overhead expenses and providing 24-hour occupational health coverage for second- and third-shift workers. What are the disadvantages?
Answer: There are many disadvantages. This idea would be a major step back for an occupational health program, warns Robert Goldberg, MD, FACOEM, president and medical director of Valley Occupational Medical Group in Modesto, CA, and De La Cruz Occupational Health Care in Sunnyvale, CA. He also is first vice president of the American College of Occupational and Environmental Medicine in Arlington Heights, IL.
While there may be some apparent pluses, Goldberg says those advantages may not be as valuable as you expect, and there are a number of much more significant disadvantages. Combining your occupational health clinic with an urgent care facility would be a return to the time when many occupational health programs were relegated to a corner of the emergency department, or when a failing urgent care center tried to prop up its business by offering some occupational health services.
Don't let economics regress OH medicine
Many successful freestanding occupational health programs started that way, and Goldberg says going back to that situation would be the exact opposite of what has proven to be the best strategy for success.
"The urgent care models have not done well," Goldberg says. "The model that has done well at this point is the freestanding occupational health center totally dedicated to occupational medicine. That's what works."
Providing 24-hour coverage to clients is probably the only positive aspect of a combined occupational and urgent care center, but Goldberg says even that benefit isn't a certainty. Unless you have an occupational medicine physician staffing the clinic 24 hours a day - which is unlikely - the second- and third-shift workers probably will be seen by an internist or emergency medicine specialist.
If that happens, what have you achieved by keeping that worker out of the emergency department?
There is no benefit to having the doors open 24 hours unless the worker can access the entire occupational medicine program at any time.
There may be cost savings from combining the two clinics under one roof, but Goldberg cautions that the savings could be offset by decreased occupational health business if your clients don't like the arrangement.
Here are some other disadvantages that Goldberg would expect to see in a combined clinic:
· Staffing difficulty.
An urgent care clinic usually is staffed by family practice physicians, general internists, or emergency care physicians. An occupational health program needs occupational health specialists.
Should an OH specialist treat the flu?
Will the parent hospital allow the clinic to be, in effect, staffed with twice the number of physicians necessary for the number of patients? Not likely. So you may end up with occupational health patients being treated by the urgent care doctors, or the occupational medicine specialist devoting part of his or her time to treating scraped knees and ear infections.
"It's not good when you have doctors in urgent care clinics trying to do the more specialized occupational health services such as medical surveillance," Goldberg explains. "The physician might be able to do a good physical exam, but when it comes to things like occupational toxicology, they're just filling in the boxes but not really assessing the exposure quantitatively or qualitatively."
· Management problems.
It will be virtually impossible to operate the urgent care and occupational health programs as two separate entities sharing one roof. Someone will be responsible for both programs, and there will be pressure to cut corners by minimizing staff and requiring them to cover both programs at once, for instance.
· Employer dissatisfaction.
A combined clinic will not project the image of a program dedicated to occupational health, and that will be detrimental to marketing. Employers may be turned off by the idea of an urgent care center, seeing it as too similar to sending their injured workers to the emergency department - a concept most employers do not view as a cost-effective way to manage injuries.
"Many employers, not to mention their injured employees, are not thrilled by the idea of sending employees to a clinic where they have to sit in a waiting room next to people with coughs and colds," he says.
"Since we're in an era of specialization, people like to know they are going to a place where there are specialists in occupational medicine."
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