The Norwood News, WFUV Radio, and BronxNet Television present a five-part series on health-related struggles affecting residents of the Bronx.

Urgent Care Offers Lower Costs and Wait Times, But at a Price

As urgent care centers pop up across the Bronx, Dr. Barry Baker, a private practitioner, prefers the traditional physician-patient model. But it doesn’t mean he doesn’t keep one foot in the urgent care trend.

Dr. Baker, who has an office in Throggs Neck, always knew he wanted to go into private practice. “I saw an ad in The New York Times ‘Practice for Sale’–I contacted the husband and wife who owned the practice and they were on Castle Hill Avenue. They were practicing for 49 years and we got to have a nice relationship, and that’s how I ended up in the Bronx,” said Dr. Baker.

“What makes my situation ideal is I’m the only doctor in this office. It’s always best to stay with the same provider so that the provider knows you and he understands your problems and your family situation so he can follow through and make things a lot easier and understand your situation,” said Dr. Baker.

Dr. Baker is something of a rarity. About 15 years ago, he wanted to start offering patients care whenever they needed it. He began accepting walk- ins, formalizing it in 2012 when he put a sign outside his office reading, “Urgent Care Walk-ins Welcome.” He is not an urgent care doctor, but unlike regular physicians, he will see patients that same day if they need it urgently.

According to Dr. Baker, it is very uncommon for doctors to see patients on the same day they need care. “They like to keep to a schedule and sometimes it makes other patients who have an appointment unhappy that walk-ins go in before them,” said Dr. Baker, who also manages his current load of regular patients.

For Julius Chen, an assistant professor at Columbia University Mailman School of Public Health, urban area residents value convenience, low wait times, and the option to get care wherever and whenever they want. Given the ubiquitous times they are open, urgent care appeals to patients afflicted with basic illnesses, such as a cold, which can be treated quickly. It also helps lower wait times at emergency rooms.

The flipside, according to Chen, lies in the inherent short-term relationship between urgent care doctors and patients. “You basically walk into the urgent care clinic and see whatever doctor happens to be in that day. They treat you and you leave. But there’s no guarantee that that information will be provided to your primary care physician, or to other specialists,” said Chen, referring to test results, diagnosis, prognosis, or other pertinent information.

According to Chen, this poses a problem for diagnosing and treating chronic illnesses. “Primary care physicians are the ones who are able to deliver continuity of care,” Chen said, opening up the potential for being misdiagnosed or not receiving accurate treatment.

Urgent care, however, has so far worked for Theresa, a patient at City MD Urgent Care in Fordham who declined to give her last name, and fits into this category. Theresa came down with the flu and opted for urgent care instead of going to her primary doctor’s office. She said she went to urgent care because “it’s quicker.” Her primary care doctor “takes too long to give me an appointment,” she said. “So, urgent care is the best thing they ever made, honestly.”

Lontrina Kinsey is another Bronx resident who goes to urgent care for its convenience. She has gone “more than seven times because I have an asthmatic baby and another bouncy baby boy. And sometimes if he is coughing or something like that, then I feel my parenting nervousness. So I’ll just go there, checkup and clear them of anything. It’s very good.”

Data collected by The Urgent Care Association shows “a median of 35 percent of patients seeking care at urgent care centers are unaffiliated with a primary care provider or medical home” nationwide.

Dr. Baker said when he gets a call from an urgent care facility regarding one of his patients he provides the information they need on the spot. “But the patient’s medical record, X-rays and laboratory results are not usually available to the urgent care facility. “So, if they do go to an urgent care facility I usually recommend that the urgent care facility send the patient back to me where I have access to many laboratory tests and information, so there can be continuity of care,” said Dr. Baker.

The US Census Bureau estimates 11.1 percent of Bronx residents are uninsured, lowering their chance of having a primary care doctor. That number has been steadily decreasing since 2013 as more Bronx residents become insured.

What’s increasing is a greater push for a so-called “patient-centered medical home,” where one provider is “at the center of your treatment and can kind of direct your course of care,” said Chen.

“Urgent care clinics don’t really fall into that model. They’re more like a one off. You just happen to have some sort of injury or some type of immediate health need and you go there and get treatment and you don’t really interact with that urgent care clinic again,” said Chen, adding there’s very little follow-up and no developing relationship.

According to Dr. Baker, patients prefer speed of care over quality of care. “I think that the neighborhood has become younger and they’re not family-based as much as they use to be. And patients want to be treated very quickly and appropriately,” he said.