Over Thanksgiving last year, my husband sliced the tip of his finger while chopping vegetables, drenching our kitchen walls in blood. I immediately rushed into action, applying pressure to the wound while searching on my phone for the nearest urgent care center in Denver. A mix of free-standing emergency rooms and urgent care centers popped up on the map. Knowing the fees associated with free-standing emergency rooms, I rushed us to the nearest urgent care, intent on arriving before it closed.
It was a relatively easy interaction with the health care system. We were in and out quickly and still made it home in time to eat our Thanksgiving dinner. In fact, it was so easy, I found myself thinking about how much more convenient it was than primary care. My husband had to make a follow-up appointment with his primary care provider to get his stitches removed, and that meant missing work to go during normal business hours when his provider was available.
I’ve been reflecting on the mixed messages we’re sending patients about where and how they should access health care. Recent policy conversations are heavy on moving away from the reliance on emergency department usage and moving toward a more regular reliance on primary care—and for good reason. Research shows the obvious advantages of primary care, such as prevention and early intervention, as well as continuity of care. It also has the potential to greatly reduce health care costs, while improving health outcomes. But it’s not primary care offices you see popping up all over the city, advertising their short wait times and shiny, new buildings.
Urgent and emergency care is a booming business. It’s a huge driver of cost to patients and insurance providers, including Medicaid and Medicare, but it’s also a huge source of income for some hospitals and hospital systems—especially those with a large percentage of privately-insured patients. These urgent care centers and free-standing emergency rooms are often more convenient and take less time than going to a regular doctor. The prompt attention in urgent and emergency-type settings is especially tempting when you consider wait times for primary care appointments are getting increasingly longer. Shortages in primary care have remained a massive barrier to patients accessing care and the US will continue to face shortages with estimates of shortfalls as high as 43,100 physicians by 2030.
The message we’re sending is that urgent and emergency care is faster, more convenient, and higher quality than primary care. In fact, many Coloradans don’t have any sort of established relationship with a primary care provider; 20-30% of people on state Medicaid coverage don’t, and that group alone is hundreds of thousands of people. If we believe primary care is as important as we say it is, it needs to be a more accessible and attractive option for patients. This is especially important for health equity, given that those most hurt by the financial costs and costs to a patient’s health outcomes incurred by relying on emergent care are those who have already been marginalized by our health care system.
Sometimes urgent care or the emergency room are exactly the right place to get the care you need, when you need it. It was there for my husband and me last Thanksgiving, and I’m grateful for that. However, if our health care system is working for all Coloradans, it won’t be anyone’s first or only choice, like it is now.