Urgent Care Answers From Stern's Inbox

My e-mail inbox receives frequent e-mail questions about the business of urgent care. I thought that readers might benefit from a few of my recent replies.

Q: I am currently a first-year family medicine resident and will get my license next year and have some questions about urgent care centers. I’d like to know what are the requirements for opening an urgent care center? I will be licensed in my second year of residency; does that mean I can open an urgent care in my name? I know Arizona requires a specific license.

— Name withheld, Arizona

A: I do love your energy and forward thinking. There are serious obstacles, however, to a second-year resident opening an urgent care center. In most cases, you will need at least $400,000 (or even significantly more) to capitalize a startup urgent care center. Not many second-year residents have already built up this kind of capital.

Urgent care medicine is unique, so becoming an expert at laceration repairs, worker compensation cases, and musculoskeletal radiology, for instance, often takes time. From our experience, very few residency programs fully prepare a physician for the variety and rigor of urgent care medicine.

To accelerate your learning curve, you might consider applying for an urgent care fellowship through the Urgent Care Association of America. Of course, this will take an additional year of training after your residency. On the bright side, however, graduates of urgent care fellowships are in great demand and seem to receive significantly higher salary offers than physicians right out of residency.

Payors in Arizona reimburse on lower fee schedules than in most of the rest of the country. This means that you will have to see more patients more efficiently just to pay your bills.

In Arizona, licensing the urgent care center cannot begin until after you open your doors. You will not be able to begin contracting with payors until after you get a license. This will delay your contracting and credentialing by ~4-6 months, and it will significantly harm your bottom line for even longer. Thus, being in Arizona can result in an even bigger required investment.

Most payers will not credential a physician until the physician is board eligible, so you will have to bill out of plan for most major payors. This will cause even more losses.

The biggest obstacle is your time. Starting an urgent care requires more work than anything most people attempt in their lifetimes. It is not a part-time job (rather it is more like two full-time jobs), so any physician in residency would do well to focus on learning clinical medicine while in residency and save the adventure of opening an urgent care until later. As I have said elsewhere, “Starting an urgent care is the hardest job you will ever love.”

If you understand and have accounted for these issues, however, I don’t see any legal obstacle to your concept. It is humbling, but I’m sure that I would have given Bill Gates the terrible advice to skip his dreams of selling software that he did not even own and finish his degree at Harvard, but he would have been too smart to listen to me.

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines

Read Comments [0]