2018 has been filled with many new “firsts” for me. Many of them were fantastic; however, some of them were not. This is just called ‘life’ and you have to figure out how to deal with the ups and downs. Today, I need to emphasize the extreme importance of calling urgent care centers before going to be seen.
My goal with blogging is to provide education. Of course, the information is interpreted by me and supported by personal experience. Having worked as a physician for over 25 years, I have unique insights into the healthcare system that many non-medical people do not.
Clearing up recent controversy from a previous post
I caused extreme controversy when I published my post entitled: Why You MUST Immediately Ask for the Credentials of Healthcare Providers. The post was intended to bring up a subject that I personally know that people are unaware of.
I have repeatedly stated that Nurse Practitioners (NP) and Physician Assistants (PA) provide valuable healthcare services. These providers also have the option to obtain further education to earn a doctorate.
However, in the clinical setting, it is confusing to patients when non-physician providers introduce themselves as “Dr”. Patients assume that the provider is a physician with the training and experience of a physician. It is important for patients to understand the true credentials.
I also fully understand that many non-physician providers always clearly identify themselves and clearly let patients know their credentials. But I submit to you that right now, on the internet, there are countless examples of non-physician providers who wear scrubs and white coats with their name marked “Dr” and allow patients to assume that they are physicians.
Patients should be aware of this confusion and just ask about credentials.
How do we categorize healthcare providers?
Many NP and PA providers became extremely angry when I described them as midlevel providers in my previous post. This was the name commonly used that apparently is not appreciated. I was sent emails and comments where I was called an “uneducated idiot” and they questioned my own credentials.
Having a difference of opinion should not lead to name calling. I am nowhere close to an uneducated idiot, and my credentials are a source of great pride that I share daily with my patients.
It is important for us to have a dialogue and to have both sides educate our patients without becoming ugly online in a way we would never speak face to face!
Their anger stemmed from the fact they did not want anyone to think that they were providing midlevel care. In every company, there are CEOs, presidents and a variety of midlevel managers. There are different experience and training factors associated with this term.
A post by an emergency room physician discusses the controversial naming system and the differences between NP and PA. Bottom line, there is no controversy in the training differences between these providers and physicians. Physicians have more.
Another less popular term that has been used is the physician extender because these non-physician providers initially were intended to allow physicians to extend their abilities to see more patients. Oversight and review by physicians was the goal before NPs started seeking independent work.
Another reason for the increasing number of non-physician providers is an increasing shortage of physicians. This is not because fewer people are choosing to become physicians, but because there is less funding available to provide the extensive residency training.
In 2018, over 5,000 US citizens were unsuccessful at obtaining a training position. There needs to be a movement to increase the number of residency positions to allow medical students to gain the outstanding training needed to provide unsupervised healthcare.
To summarize, please note that I am now calling both NP and PA non-physician providers.
Nurse practitioners have voiced the desire to be called APRN, which is fine if we are only discussing them, but we need to discuss both groups of non-physician providers.
Just as we lump medical doctors (MD) and osteopathic doctors (DO) into the same category called physicians, PA and NP can also be lumped into the same category of non-physician providers despite their training differences.
I have NOT said it was bad to see non-physician providers. I have NOT said they were all incompetent. Nor did I say that simply knowing someone’s credentials tells you how good of a provider they are. Our credentials are just one fact that the public needs to know about us.
No healthcare provider is perfect
Physicians are not perfect, and non-physician providers do not make mistakes all the time. Every provider is unique.
I still believe that credentials should be checked, just like we do for anyone else we hire and pay for services. We should all be proud of our credentials and not have an issue with sharing them when asked.
The purpose of the previous post is to say that all healthcare providers are not equal. This is true in any industry. I wanted to empower patients to ask and not to assume anything.
In the old days (Yes, I was there!), most providers were physicians, and most of the non-physician providers had extensive healthcare experience while being supervised by a physician.
Now, there is a real possibility that the provider seeing your family has not been through a rigorous medical school education, nor the extensive residency programs to gain knowledge, nor has decades of experience as a healthcare practitioner.
In many states, NPs are allowed to go directly from an online master’s degree (without any clinical practice as a nurse) and work in an independent practice with NO physician oversight.
Experience matters. By asking providers about their personal credentials and years in the field, patients are better able to determine if their needs are being met.
It is acceptable to have a preference for providers
I recently participated in a Facebook group where most of the participants were not only anti-vaxxers, but in general, anti-traditional medicine. They avoided medications, vitamins or anything that has chemicals, including foods, that can harm their bodies.
I asked what they do when their families get sick and need to go to the hospital.
This group of people said they seek healthcare providers who are naturopaths or functional medicine doctors who have alternative treatment options available. Although I am a traditional physician, I appreciate that it is their right to not choose to see me but to select a provider in line with their desires.
Many people have a preference for traditional providers, such as a female OB-Gyn. This does not mean that male OB-Gyn physicians are not excellent. It is a personal choice.
It is just as acceptable to request a female physician as it is to request a physician instead of a PA or NP. In fact, it is your right to choose your provider.
Today’s Topic: Why You MUST call Urgent Care Centers Before Visiting.
All urgent care centers are not created equal. Imagine that. Who is surprised?
With the blossoming number of competing healthcare systems, community urgent care and retail care centers have sprung up on every corner. I have repeatedly emphasized to my patients that these facilities are NOT to be used in place of your pediatrician or family practitioner. I absolutely LOVE this post by pediatrician Dr. Kristen Stuppy who provides examples of problems and situations that can occur when you take your child to urgent care centers because it is “convenient care”!
You have gone through a lot of work to select the primary care physician (PCP) of your choice. If you are not satisfied with your PCP, find a new one! Here and here are excellent posts that suggest ways to choose a provider that you love.
In cases where urgent care is needed, patients must understand the level of care that is offered at each center. And I highly recommend that you call in advance and ask for what you need in order to avoid being surprised upon your arrival.
If you do not have time to call because the problem is severe or worsening, you might consider this to be an indication for an emergency room (ER) visit. Emergency rooms are equipped to handle the smallest to the largest healthcare problems.
I perform tonsillectomies and, if my patients get dehydrated, one complication that may occur is bleeding from the mouth. I have provided extensive instructions about what steps they should do at home and when to go to the ER. However, patients have started to consider these urgent care centers as equal to an ER. Nope.
Yes, I have had bleeding patients show up to urgent care centers which cannot manage the problem nor start IV fluids. Yes, that is right. All centers do not insert IVs. Choosing the wrong urgent care center may delay your care and ultimately cost you more money.
Take some time NOW to find several urgent care or retail care centers near you. Call them and ask what services they provide. Based on your needs, you may need to choose one over another for different problems. A basic idea of problems to be seen in urgent care vs. emergency rooms is listed here.
Sample questions you might ask urgent care centers:
- Are IV fluids available?
- Is there a physician available to see?
- Do you have casts or boots for fractures?
- Are xrays available?
- Is there an age restriction? (Some do not see young children!)
Obviously, if your concern is a bad cough, possible ear infection or a sore throat, any of the centers will be able to handle your needs. However, I have seen patients with delayed care because of choosing the wrong facility.
So, why am I writing about this today? Well on my list of “firsts” this year, I experienced an urgent care visit.
Dr. Burton’s list of FIRSTS over the past 2 weeks:
- Traveled to London to witness my daughter graduate from the London School of Hygiene
- Rode on the Eurostar train
- Visited Paris, France and saw the Eiffel Tower and the Lourve
- Visited Barcelona and learned to love Gaudi, the architecture, and the food (Can you say PAELLA?)
- Rolled my foot during the security check prior to boarding a plane to come home. Hopped on one foot to my seat. Who has hopped down an aisle on an airplane? Yeah, pretty sure that is just me.
- Tried to hop from my seat off the plane, but that was a fail! Needed to use a wheelchair in the airport.
- Experienced all the inconveniences of wheelchair life with finding elevators and having separate access lines.
- Examined foot at home and knew it was fractured (Perks of Doctor life). Then like any “good” patient, I consulted Dr. Google. Realized I would need to go to an urgent care center for the first time.
- Because of the location of the fracture on my foot, Dr. Google taught me that there are several levels and one may need surgery. I called a friend who happens to be an orthopedic surgeon. He informed me that all centers do not have boots or shoes. Why would I go to a center that did not have a shoe or a boot? Learned a new question to ask urgent care centers.
- Called a beautiful shiny urgent care center that I see every day driving to work. I asked if there was a physician available, if they could do xrays and if they had a boot or shoe. Because I needed these things, there was no need to go if my needs were not going to be met. I needed to talk to an experienced provider to learn more about my fracture. This is not an injury I wanted to discuss with an NP or PA fresh out of school. This was my preference because I would not know in advance if the urgent care center was staffed with a highly experienced non-physician or one right out of school.
What I learned from calling urgent care centers
Long story short, the fancy facility had a physician and xrays, but I was told my foot would be splinted. What? No shoe or boot? I found this hard to believe, but you need to use the information that is provided.
So, I called the “not as glitzy” urgent care center up the street and they offered me the 3 things I needed. Boom.
If you want to know if you have the flu, or need to be checked for some other infection, then most urgent care centers will fit your needs. Just make sure that if you have other needs, the center you are choosing has them available. Never assume! Always ask.
Followup: I am fine. I am gimpy but fine. Also, leave Dr. Google alone until you have been seen by a physician and THEN use it as a way to better understand what you have been told! It provided me with unnecessary worry that led me to ask unnecessary questions to my physicians. The same way my patients question me about unrelated information. Let’s agree that Dr. Google should not be the first line of healthcare!
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