Clinics like ZoomCare are popping up everywhere. Nationwide, the number of similar walk-in care facilities has grown 20 percent in the last four years. That trend is expected to continue as more people get health insurance under the Affordable Care Act.
The clinics are run by doctors, but what are the chances a doctor is the person you'll see when you go in for an appointment? And how exactly do these clinics operate? As the popularity grows, we wanted to see how they operate.
I recently used Skype to make a video call for a ZoomCare appointment about a lingering cold.
The woman on the other end in the white lab coat asked me how many days I've had my symptoms. I told her I initially got sick about two weeks prior but I still have an annoying cough. She asked me if I'm coughing things out or if it's dry. I explained there is phlegm but it's clear. She then prescribed me cough syrup with codeine to help me sleep at night.
We then hung up. Welcome to next-generation medicine.
My Skype visit makes Elizabeth Martin's trip to the ZoomCare in Downtown Portland for a travel vaccine feel so traditional. She's headed to Panama for a backpacking vacation and picked the downtown location because it is close to her work.
"It's convenient and same-day appointments are pretty efficient," said Martin.
Since moving to Portland two and a half years ago, she hasn't bothered finding a primary care physician yet. She told me she just uses ZoomCare as her primary care and she's thought very little about the person in the white coat - whether he or she is a doctor of something else.
"I haven't worried about it. I feel I'm in good hands, like it's a reliable company," she said.
On this day, Elizabeth is told prior to her appointment that the person seeing her is not a doctor; rather, she will see a physician assistant.
A physician assistant is someone who has obtained an undergraduate degree then completed a two-year master's program.
On a different day, Elizabeth might be seen by a nurse practitioner at ZoomCare. That's someone who received a four-year undergraduate degree in the nursing field, then completed anywhere from two to four years of additional schooling for the practioner's license.
As ZoomCare CEO Dr. Dave Sanders told me, the company is expanding rapidly. It's on track to have 35 locations up and running in the Portland area by June of next year. And it's already expanded to Seattle and Boise.
I asked Sanders how likely it is that I'll actually see a doctor versus a nurse practitioner in my ZoomCare appointment.
"At ZoomCare it's a team so you might see a doctor or a physician assistant or a nurse practitioner any given day. It's a team based model," he explained.
Changing the law
ZoomCare helped rewrite the rules of that model. Oregon law used to require a five-to-one ratio of physician assistants being overseen by actual doctors. In 2010, the company lobbied and got lawmakers to increase that to an eight-to-one ratio.
The company also convinced lawmakers to give physician assistants the authority to dispense certain medications. And earlier this year, Oregon governor John Kitzhaber signed into law a bill that allows nurse practitioners to dispense medications in metro areas.
"I'm just convinced that a physician assistant, a nurse practitioner in our system, are phenomenal. I mean there is no difference. There isn't," said Sanders.
Critics say nothing can replace a doctor
Dr. Kara Kassay owns her own practice in Lake Oswego. She won't even discuss physician assistants as a comparison. She does say nurse practitioners can deal with certain illnesses as well as she can, but she believes aspects of disease can be missed by those who simply aren't doctors.
"We're not equivalent. Our education is not equivalent. The way we think is not equivalent," says Kassay.
Kassay says clinics like ZoomCare, Doctors Express and Portland Urgent Care aren't ideal for treating chronic conditions, but they're helpful if you've got a sore throat, a bladder infection, or something relatively minor.
"Anybody who repeatedly goes back to one of these facilities for regular care gets what I call bits and pieces medicine and that's bad medicine," Kassay said.
Dr. John Braddock, a former emergency room doctor now working as a medical director at a Concentra urgent care, offers a macro view. He observes two forces at work: millions more people flooding the national health care system under the Affordable Care Act and the current shortage of primary care doctors -- estimated at 15,000 nationwide.
Doctors are coming out of medical school with roughly $150,000 in student loans to pay back. They make a lot more money right now going into specialties like cardiology, surgery or urology - those specialties can generate salaries of half a million dollars a year. A family practice doctor often earns half of that - $200,000.
"I think it's inevitable that nurse practitioners and physician assistants are going to be the primary care physician of the future," foresees Braddock. "If you have a supply curve that's just going up a teeny bit and a demand curve that's going vertical on you, someone's got to fill that gap."
ZoomCare is busy filling its locations with more specialty services like dermatology, psychiatry, and physical therapy. It even has an orthopedic surgeon on staff now.
I asked Sanders if a ZoomCare is like an emergency room. If I come in with an open gash on my arm because a tree fell on me, can someone here stitch me up?
"Yes, absolutely," he said. "Our argument is this is the best place to start for almost anything except for major injuries and trauma."
ZoomCare and similar clinics are inspected and regulated by the same state agencies that check up on your doctor's office, like the Oregon Medical Board, Pharmacy Board, the X-ray Imaging Board and OSHA. But they are not subject to the same level of scrutiny as the emergency room of a larger certified hospital.
ZoomCare is one of the only stand-alone clinics in our area that has received that same level of recognition with the state that urgent care clinics connected to hospitals systems like Providence or Legacy receive. That recognition means ZoomCare has demonstrated an effort to help its patients prevent disease and treat chronic illness.
Wall Street loves the business model. A Reuters report says at least a dozen private equity firms have plowed millions of dollars into clinics like ZoomCare over the last few years.
It's the new world of health care on demand.
Strategies on being a smarter patient at a clinic:
- Call ahead
- Find out if the person you're seeing is a doctor, nurse practitioner or physician assistant.
- Ask if the staff is only on contract, or if they're full time.
- Realize most of these clinics do not accept Medicaid and Medicare as payment.