Healthcare System

When you are sick and need urgent medical care, do you know where you should go to be evaluated and treated? Should you try your primary care doctor? Sorry, they may not be able to see you until next week. How about the ER at the local hospital? Their website says the average wait to see a doctor is 4 hours. Perhaps an urgent care or the “clinic” at your pharmacy? Confused?
These different settings can provide vastly different levels of care. And they can leave you on the hook for a substantial amount of money, even if you have medical insurance. Time to get educated so you can make better decisions for yourself and your family, and save time and money in the process.

Emergency Department (ER)
Hospital-based emergency departments can handle nearly any type of medical condition, from the mundane to the life threatening; and they are open around the clock. ERs are equipped to perform emergency medical procedures, run labs, XRays, and advanced imaging such as ultrasound and CT scans. But this level of medical care comes at a price. When you visit an ED, you will be billed not only by the treating physician, you will also get a “facility fee” from the hospital itself. This is a bill for the use of the hospital’s space, equipment, nursing services, medications, etc. These fees are significantly higher than the physician bill and can easily run over a thousand dollars if you are getting blood work, CT scans, and treatments. You will also be billed separately by a radiologist if you have any Xray or other imaging studies done. Even if you have insurance, co-pays for an ER usually run between $100-$200; and if you have a high-deductible policy you will pay substantially more out of pocket. The ER is the place to go if you’re worried about any kind of serious problem (heart attack, stroke, etc), but probably not the most cost effective option for a cold or stubbed toe.

Urgent Care Center (UCC)
Urgent Care Centers are a hybrid between the ER, your PCP office, and a retail clinic. They are more accessible than your PCP and you can usually be seen the same day. Most UCCs offer both appointments and drop-in options. They can usually treat many more conditions than a retail clinic, and are equipped to do labwork and Xrays. UCCs are usually staffed with a physician as well as a mid-level provider (nurse practitioner or physician assistant). Unlike retail clinics, UCCs can also treat lacerations, broken bones, and abscesses. They are also considerably less expensive than going to the ER, even when you have insurance. The main drawback for UCCs is that they are not open 24/7 like ERs, although most offer evening and weekend hours. They are also not equipped to handle major medical emergencies such as heart attacks, strokes, or major traumatic injuries.

Retail Clinics
Retail Clinics, like the ones found in some pharmacies, are convenient and generally affordable. You can usually be seen quickly without an appointment. Their main drawback is that they are very limited in the services that they offer. Most retail clinics have a short list of conditions they can diagnose and treat such as a UTI or Strep throat. They can only do very simple lab tests, don’t run blood tests, and don’t have XRay capability. Retail clinics also can’t repair lacerations or drain abscesses. And don’t expect to see a doctor as these clinics are staffed exclusively by mid-level providers

Primary Care Office (PCP)
If you have a primary care physician, their office may be a good starting point if you have a minor problem such as a cold or flu. The main benefits of your PCP are that they know your medical history, your insurance will cover the visit, and your copay (if any) will usually be quite low. If, however, you have an injury or more significant problem, or if you need labs or XRays, your PCP will likely need to send you elsewhere for your care. It is also often difficult to get same day, evening, or weekend appointments with most primary care physicians.

Benefits: Full-scale medical services. Can treat most medical conditions. Available 24/7/365.
Drawbacks: Not equipped to treat serious medical or trauma problems. No advanced imaging such as ultrasound or CT.
Who Should Go: Most individuals between 6 months – 80 years without multiple medical problems. Straightforward medical problems such as cold, flu, sinus and ear infections, asthma, bronchitis, pneumonia, UTIs, lacerations, abscess, sprains, broken bones, STDs. Patients without insurance.

Retail Clinic
Benefits: Low waiting time. Low cost.
Drawbacks: No physician. Can only treat a limited number of conditions such as Strep throat and UTI. No XRays or blood tests. Cannot perform procedures such as laceration repair or abscess drainage.
Who Should Go: Individuals who have a very minor condition and need minimal testing. Patients without insurance.

PCP Office:
Benefits: Your doctor. Familiar with your medical history. Generally least expensive option for insured patients.
Drawbacks: Limited hours. Limited appointments. Cannot do XRays or procedures. Anything complicated will need to be sent to another facility such as an ER or UCC.
Who Should Go: Individuals who have a very minor condition and need minimal testing. Patients without insurance.