Need a doctor now? You have options

The options are growing for patients who need to see a doctor right away but theirs is booked up.

Doctors' offices and hospitals are getting into the urgent-care business or adjusting their practice hours to better accommodate patients.

Commonwealth Primary Care, which last year opened a walk-in clinic in Westbury Pharmacy, recently opened an Immediate Care Center with evening and weekend hours in western Henrico County.

In the first month, it had approximately 700 patient visits, double what was expected, said Beth Billett, executive director of Commonwealth Primary Care, a group of primary-care practices. We thought it would take longer ramping up, Billett said.

HCA Inc., whose properties include CJW Medical Center and Henrico Doctors' Hospital, in August opened an urgent-care center on Stony Point Road in South Richmond and has plans to open two more by year's end.

It's another access point, said Charlie Domalik, spokesman for HCA Richmond Health System. These might be people who are putting off going in or they are too busy to go to their primary-care physician and not sick enough to go to the emergency room . This is a third option for them.

Some doctors in private practice are changing how they practice to take care of people who need to see a doctor the same day they call.

The market is demanding the shift, said Dr. Joseph Leming, a physician with Prime Care Family Practice in Colonial Heights.

Physicians who run primary-care practices, some of us have been thinking about . . . access for a long time, Leming said. In our practice, 10 years ago we were all appointmented-out for four to six weeks. So if a patient called us with an urgent problem, it would take a long time to get to see one of us. Today, in my practice, each one of us has an afternoon where we start with no appointments. So patients with an urgent problem can be seen that day, he said.

The shift is being driven by competition -- much of it from the growing number of retail health clinics such as the RediClinics in some Wal-Mart stores. There is also the MinuteClinic chain in some CVS stores. There aren't any MinuteClinics in the Richmond area yet, but the company Web site has a job ad seeking a nurse practitioner for the Richmond area.

Another chain, Take Care Health Centers, which are in Walgreen's stores, plans to expand to 400 clinics by the end of next year. A company official would not say if the Richmond area was in those plans.

Target has clinics in its Minnesota and Maryland stores, and consumers can go online and check for the next walk-in appointment time.

Overall, according to the Convenient Care Association, the number of retail health clinics in the U.S. could grow to 700 or more by the end of the year.

As those numbers grow, doctors who have resisted the walk-in model of care offered by such places as Patient First are jumping on the bandwagon.

In many respects, we are the pioneers, said Jim Schulenberg, Patient First spokesman. We have been around 26 years. Our chief executive officer and founder is a physician, and he started with one location in Midlothian. . . . He had come out of emergency care and realized that many of the things treated in an emergency room could be treated elsewhere.

Patient First has 20 locations, 15 in Virginia. Hours are 8 a.m. to 10 p.m. seven days a week, Schulenberg said.

Like Patient First, the Immediate Care Center on Independence Park Drive in western Henrico takes walk-ins. The center stays open until 8 p.m. and has Saturday and Sunday hours. It is staffed by a full-time physician, with evening and weekend coverage provided by the other physicians in the Commonwealth Primary Care network. Another full-time doctor is being added in November, Billett said.

We see sore throats, a lot of strep throat, people who need stitches. People who need stitches removed. Colds. . . . I think we will definitely do more immediate care in the future, Billett said.

In contrast, retail health clinics are typically staffed by physician assistants or nurse practitioners. Prices for typical treatments are often posted and can run less than an insurance co-pay at a doctor's office.

The American Medical Association has responded to the growth of retail clinics by urging tighter health and safety standards.

Leming believes patients can get good care at retail clinics and that they can be a source of referrals to doctors like himself for ongoing care.

When you see someone roll out RediClinics and they are an instant success and the numbers are staggering, you would be a fool to say the market wasn't demanding that, Leming said. I am not sure the physician community has completely embraced the demand.

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