Some years ago, my husband cut his finger on a too-sharp knife while peeling a cucumber, and no matter what he tried, he couldn't stop the bleeding. Because it was a Sunday night, there was no use calling our doctor. So, off he went to the over-crowded emergency room, returning many hours later.
Fast forward to today, when he would have been able to go to a local walk-in clinic, and be seen almost immediately by a nurse practitioner or an M.D., saving hours of waiting and discomfort.
Walk-in clinics are just one of many alternative health care options these days.
#1: Retail Clinics
Best for: As a back-up when your own doctor is unavailable and for simple ailments like bronchitis, inner ear infections, conjunctivitis, and sinusitis. Plus, these clinics provide some level of preventive care, from immunizations to screening blood tests.
Want to treat a sore throat in a hurry? You might try a retail clinic. Typically found in pharmacies, groceries and “big box” stores, retail clinics are staffed by nurse practitioners and doctors, and as a whole they received almost six million visits in 2009, according to the Rand Corporation.
No appointment is necessary, and the convenience of weekend and evening hours is a solid draw for many. Pricing is transparent – you know what you’re paying before you pay for it, and most accept health insurance; in fact, costs at retail clinics are substantially lower than similar treatment at doctor’s offices and emergency departments.
Limitations: They cannot treat sprains, strains, or fractures, or monitor chronic illnesses.
#2: Urgent Care Centers
Best for: Illnesses or injuries that are not life-threatening, but need immediate treatment, including accidents and falls, sprains and strains, moderate back problems, bleeding/cuts, fever or flu, etc.
Also known as Immediate Care, Walk-in Care or Convenient Care, these centers have been around for decades, yet they’re still seeing an upswing in growth. (Some popular names in the game are NextCare, MedExpress, Doctors Express.)
Urgent care centers are staffed by trained and licensed physicians and medical assistants, x-ray technicians and registered nurses, with nearly one-third of them owned and operated by hospitals. They can perform x-rays and some on-site lab tests, plus procedures like suturing and casting. In some communities, these centers can function as primary-care practices, and may handle ongoing care for some chronic conditions.
Limitations: These centers do not provide emergency medical care, or treat conditions that could threaten or impair your life, such as poisoning, moderate to severe burns, severe chest pain or difficulty breathing, seizures, serious head, neck or back injury, etc.
#3: Nurse-led Practices
Best for: Diagnosing, treating and working with patients to manage their care. Their training emphasizes wellness and overall health, and they can be a source of excellent overall care.
Advanced practice registered nurses, or APRNS, are nationally certified registered nurses who have completed master’s or doctoral programs. APRNs order and interpret diagnostic tests and make diagnoses; initiate and manage treatment plans and can prescribe medication.
Tay Kopanos, vice president, state government affairs for the American Association of Nurse Practitioners (AANP) says, “The healthcare system is now seeing the benefits of patient access to nurse practitioner-provided health services, and many patients are now choosing NPs as their primary-care providers.”
One study in the British Journal of General Practice noted that nurses “tended to provide more information to patients,” as well as give longer consultations than doctors. The study also found no significant difference in patient health outcomes between doctors and nurses in terms of emergency care.
Limitations: Some states don't allow them to see primary care patients without supervision by a physician, and some deny admitting privileges to nurse practitioners.
#4: Physician's Assistants (PAs)
Best for: When you can’t get in to see your doctor, a PA can take a comprehensive health history, conduct a thorough physical examination, make a diagnosis, and set up a treatment plan. If the case is complicated, they have immediate access to a physician.
PAs have extensive medical training and may provide many of the same services as physicians themselves; numerous independent studies find the quality of the medical care to be equivalent to that of physicians. They take patient medical histories, order and perform tests, develop treatment plans, counsel on preventive healthcare and may prescribe medication and even assist in surgery. Rather than waiting months to see a physician specialist, PAs can streamline your care and carry out tasks like X-rays, CAT scans and some small procedures like suturing or casting a broken limb.
Limitations: Their scope of practice may be limited by their supervising physician and state laws. In some states, they cannot prescribe controlled substances.
#5: Group Visits
Best for: People with chronic illnesses like diabetes, hypertension or asthma. You get more time than with an individual appointment (90 minutes vs. 15), plus the opportunity to share ideas and create a bond with other patients.
For patients with similar medical conditions, group visits (a.k.a. Shared Medical Appointments, or SMAs) can take the place of a one-on-one visit with a physician. Depending on the condition being addressed, they may be staffed by nurses, nurse practitioners, Certified Diabetes Educators, trained psychotherapists, or social workers, and can include family members and help with education, teaching skills for self-management and strategies for lifestyle and behavioral changes.
Group visits also give you access to both your physician and other members of a health care team like nutritionists, behaviorists or health educators. According to the American Academy of Family Physicians (AAFP), group visits “are a proven, effective method for enhancing a patient’s self-care of chronic conditions, increasing patient satisfaction, and improving outcomes.”
Limitations: Some people prefer the privacy of a one-on-one visit with their doctor, rather than a group setting.
What’s fueling the alternative healthcare boom?
Why so many new options? For one, it’s becoming tougher to find a primary care physician, because demand is outpacing supply: Due to a lack of prestige and relatively lower pay, the number of medical students and residents going into primary care is declining. At the same time, the 65-and-older population is expected to grow 46 percent between 2014 and 2025, and 30 million Americans have become newly insured thanks to 2010's Affordable Care Act. The Association of American Medical Colleges projects a shortage of 12,000-31,000 primary care doctors by 2025.
On the practical side, “patients may not be willing to disrupt their entire lives or miss work to see their own doctor,” says Don Goldman, M.D., chief medical and scientific officer of the Institute for Healthcare Improvement in Cambridge, Massachusetts. People rightly sense that there are now other ways to receive basic medical care, he adds.
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