Walk-in clinics becoming big business in Southwest Florida

EVAN WILLIAMS/FLORIDA WEEKLY Dr. Dana Killiam examines Cape Coral resident Lance Dunning at the Accident & Urgent Care Center in the Cape Coral Surgery Center. Not long after Lance Dunning moved to Cape Coral from upstate New York in 2006, the 62-year-old RV salesman caught a nasty virus. It was over a weekend and he wanted to be at work Monday morning. He couldn't get an appointment with his primary doctor in time. It seemed the only option might be the emergency room at a hospital, where he might wait hours to be seen and pay a big bill.

But his primary doctor recommended going to an urgent care walk-in clinic — a good one can treat all manner of acute medical problems that are emergencies to the people experiencing them, even if they're not immediately life threatening. It's relatively inexpensive (an office visit may cost about $120, but most major forms of insurance are accepted), and patients get immediate care.

"Many patients are treated over their lunch breaks," said Dr. Avry Bowers, the senior lead physician at Lee Convenient Care, a trio of urgent care clinics in Fort Myers and Cape Coral run by Lee Memorial Health System. "We have it set up so that we are doing everything possible to get these people in and out in an hour and a half max in season."

COURTESY PHOTO Advanced Medical Center in Naples. Soon after Mr. Dunning's arrival at the Accident & Urgent Care Center in the Cape Coral Surgery Center, Mr. Dunning had been diagnosed by Dr. Dana Killam, and ultimately made it back to work on Monday.

"I consider him an angel," Mr. Dunning said. "It's unbelievable the things he does."

Rob McGann, CEO of Naples Urgent Care and Estero Urgent Care, said "Urgentcare clinics are absolutely bridging the gap between ERs and family doctors." His father, cardiovascular surgeon Dr. Bob McGann, founded the family's urgent-care business in 1996. As more clinics open in Southwest Florida, Rob McGann said, the best ones will emerge.

"It's pretty clear that the urgent care market is a flooded market," he said. "Like other businesses (in the down economy), I think you're going to see a shake out. The best ones will continue to be around and provide a valuable service."

Dr. Larry Hobbs, president of the Florida College of Emergency Physicians, said an urgent-care clinic should have physicians, nurses and staff who have been trained in, or continue to work in emergency rooms. They should be run by a doctor with good credentials and a solid reputation, who is able to use his or her experience and connections to refer the patient to emergency care if need be.

"Just because an office puts the words 'urgent care' on their sign doesn't mean they're capable of providing it," said Dr. Hobbs. "There are a few clinics in Collier and Lee County in which they call themselves urgent care, but they have a nurse (practitioner) that sees the patient."

In addition to being medical director at Southwest Florida Regional Medical Center, Dr. Hobbs runs the Urgent Care Clinic of Southwest Florida in Cape Coral and Estero.

Two trends in the urgent care business, he said, include "individuals who are concerned with making money," by setting up walk-in clinics without properly trained staff. Some of these, he said, have appeared in drug stores or discount stores.

Another trend in urgent care is emergency room doctors who decided to switch their careers to urgent-care or do both. Many urgent care clinics are set up like an ER, to treat patients swiftly, although the environment is less intense.

Examples of times to use urgent care include headaches, skin rashes, sore throats, fevers, lacerations that might require stitches, stomach aches and ear aches — some of the top reasons people visit the ER, according to the Florida Hospital Association.

An emerging specialty

Urgent care is an emerging specialty, like emergency room care was 40 years ago, Dr. Hobbs said.

"Forty years ago we were filling a need (with emergency room doctors) and we developed into a specialty," Dr. Hobbs said. "Urgent care is at that same point emergency rooms were at 40 years ago."

Urgent-care or walk-in clinics may have developed a bad reputation in the 1980s and early '90s, Dr. Hobbs said, when some people used to call them "The doc in the box." Medical residents might open up a walk-in clinic in a strip mall to make a few extra bucks.

"They didn't work," he said. "They didn't fit the hospital or primary care model. The first wave of walk-in clinics failed."

In the late 1990s, more urgent care walkin clinics came back into the fold. And in Southwest Florida, as tourist season hits full stride, they're busier than ever.

Dr. Tyrone Median, an ER doctor in Naples who also runs the Naples Medical Center Walk-in Clinic, across from Naples Community Hospital, said, "We see a lot of the seasonal visitors that come to Collier County — the travelers that stay in the hotels that stay in downtown. But we see patients from the outlying area of Collier as well."

His practice helps take the burden off ERs, and off primary care doctors who might be too busy to see patients for their urgent-care needs.

"There's a huge gap in patients that have doctors and don't have access to them," he said. "If you call a doctor who has a full schedule of patients, he may not have the ability to see you and say, 'well come back next week.'"

Like many urgent care doctors, he sees a wide variety of patients. Many urgent care clinics, like his, are set up to do X-Rays, CAT scans, MRIs and blood work, so patients can get a full diagnostic workup on the same day of their visit.

"I do enjoy it because of the variability in terms of what I tend to see and what I tend to treat, which could be almost anything," Dr. Median said. "I see children and I see geriatrics; medical illnesses and surgical illnesses; so it's not limited care."

Dr. Dana Killam, the ER doctor who treated RV salesman Mr. Dunning, started the Accident & Urgent Care Center in the Cape Coral Surgery Center on Del Prado Boulevard in 2005.

He owns the clinic with his wife.

There's no sign outside, and the only indication that it existed last week was yellow sign inside the Surgery Center that read "Free Flu Shots" and directed people to the second floor. Most of his patients are referrals.

"We don't want to be too busy," Dr. Killam said. "Our patients and I, we're more like a family. We know each other; we know what's going on. Patients follow us and we follow the patients. This clinic, for us, is almost recreational."

Dr. Killam works three or four nightshifts in the ER (7 p.m. to 7 a.m.) and comes to his urgent-care clinic during the day because otherwise, he said, "I'd have too much free time. We do this because we think it's fun."