Robert L Broghammer M.D., M.B.A., M.P.H., of Allen Occupational Health, a hospital-affiliated program in Waterloo, IA, writes us to express dismay about RYAN Associates' plans for an April seminar on Integrating Urgent Care and Occupational Health Services:
"I realize this is a ‘trend’ currently, especially with Concentra, but I must vehemently disagree that the two are complementary let alone easily integrated. While it is true that much of what we do has an ‘urgent’ basis (i.e. lacerations, traumas, chemical exposures, etc.), Occupational Medicine is a distinct and separate discipline with its own ACGME-approved post-graduate medical training programs and separate board certification process.
"As you know, occupational medicine training focuses on toxicology, epidemiology, statistical analysis, orthopedics, surveillance screening, impairment and disability, wellness, and a host of other specific areas dedicated to the care of workers and their companies. Urgent care is nothing more than a descriptor for a clinic that will see you ASAP for a perceived medical problem. There is no specific knowledge base, even rudimentary, for urgent care providers who may provide services for injured workers covered by the worker’s compensation system or for the myriad of other occupational specific issues that need to be addressed and taken care of.
"Urgent care providers may have extremely diverse backgrounds and there is no formal standardization of training to practice in an urgent care setting – one simply needs a license and a pulse. Family practitioners, internists, pediatricians, physician’s assistants, nurse practitioners, general surgeons, and obstetricians are just a few of the disciplines that I know of personally that have/do practice in urgent care settings. Likewise, occupational medicine providers, such as myself, have very little or no training in the variety of medical problems that may present to an urgent care center which have no relationship to work. Imagine an infant presenting with a fever versus a normally healthy worker. The differential diagnosis for the two is vastly different. For instance, the worker may have metal fume fever but it is highly unlikely the infant does.
"The integration of the two separate and distinct services will only serve to confuse the clients and dilute the value of providing specific occupational medicine services. The trend, in my opinion, is nothing more than attempting to squeeze a couple extra bucks out of clinics by short-sighted administrators. Not one of my colleagues who I trained with and who are board certified in Occupational and Environmental Medicine would consider working in such a clinic long-term."
RYAN Associates' President and CEO Frank Leone responds:
"I don't think anyone is saying that it is a wise idea for a clinician to do both occupational medicine and urgent care. Yet they are not that different. The larger issue is economic; blended clinics offer a vast array of economies of scale (staffing, operations, shared equipment and diagnostic tools, sales and marketing, etc.) which not only makes them advisable in the economic climate, but often essential."
Donna Lee Gardner, a senior principal and consultant with RYAN Associates, adds:
"In my opinion, the economy has driven the need for a Total Health Management focus for employers and their employees.
"We are not saying the occupational medicine model should be one with urgent care. We are saying that episodic care in a customer friendly environment that is available to employers and their employees helps reduce emergency department visits, decreases the overall cost of care and provides one-stop shopping.
"The American College of Occupational and Environmental Medicine has long defined the role of occupational medicine as improving the safety and work environment for employers and their employees. What more expeditious way but to improve the health of the workforce AND provide appropriate access to care for all health concerns? Having the occupational medicine provider there can then provide meaningful return to work for all workers for work-related and non-work-related illness and injury."
What do you think? Please comment here or send email to Kohara@noahp.com.
I frequently end up helping in Urgent Care, despite my certification in OccMed. I am thankful that I had first completed a residency in Family Practice and practiced it in a small town, 'do-it-all', setting. Even then, I remain uncomfortable.
ReplyDeleteI cannot see how someone from solely an OccMed residency has any business doing Urgent Care, seeing after an newborn with a fever, a senior with complex multi-system disease or a twenty-one year old female with abdominal pain.
These two specialties have been conjoined solely for economic survival, not because it makes any sense whatsoever from a clinical standpoint.
Frankly, I think it's dangerous.
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