Doc out of the Box

REVIEW SUMMARY
Company. Doctor's Walk-In Clinic
Industry. Urgent health care centers
Key. Affordability and efficiency, without appointments or long waits

Three decades of running urgent care centers give Dr. Stephen Dickey a keen ability to predict patient behavior.

Even though the Doctor's Walk-In Clinic he founded in Tampa in 1980 is open evenings and weekends, he says it's difficult to change people's mindset whenever they get injured or need to see a physician right away.

“Monday is still our busiest day of the week,” says Dickey, 65, who with his white hair and mustache looks like the classic family doctor. “Most people don't realize we're open Saturdays and Sundays. It's just an education process.”

Just as the traditional doctor's office has changed over the years, so has the public's perception of urgent care, which is positioned squarely between primary care physicians and hospital emergency rooms. There are currently eight Doctor's Walk-In Clinic locations in the Tampa Bay market, though demand for services will likely increase in years to come along with the area's population and availability of healthcare insurance.

Both ERs and urgent care clinics, sometimes nicknamed doc-in-a-box, are expected to become flooded with new patients as the health insurance reform law President Obama signed March 23 goes into effect over the next few years. However, Dickey points out that three out of every four patients in a typical ER waiting room aren't necessarily in a life-or-death situation.

“The ERs are so over-utilized by people who don't even need to be there,” says Dickey, who established Doctor's Walk-In Clinic after roughly 10 years working in the ER at St. Joseph's Hospital in Tampa. He points out that a visit to one of his current clinics is comparable to that for a doctor's office, which may require making an appointment weeks in advance, yet a trip to the ER may cost triple and involve hours of waiting to be examined.

No substitute for primary care
Doctor's Walk-In Clinics are equipped to handle fairly minor illnesses and injuries, such as sprains or fractures, cuts and other common ailments. They can also conduct physical exams for work or school, administer flu shots, take X-rays, and handle workers' compensation claims.

Dickey, who earned his medical degree from Indiana University, says the clinics refer serious cases to a nearby ER and will also recommend that patients with chronic conditions, such as hypertension, see a primary care physician. They are not meant to compete with those types of facilities, he says.

They may not have to anyway. With an estimated 32 million Americans getting new coverage under Obamacare, some of whom might have relied on homeopathic remedies to balance a lack of health insurance, Dickey believes both urgent care and ERs will see dramatic increases in patient numbers.

It may also impact the way new doctors enter the field, he adds, leading them to work at hospitals or urgent care clinics rather than starting their own private practice straight out of medical school. That's actually good news for places like Doctor's Walk-In Clinic, which have at least two doctors on staff at each center during its business hours — 8 a.m. to 8 p.m. throughout the week, closing only on Thanksgiving and Christmas.

Besides doctors, each clinic has nurses, X-ray technicians and laboratory personnel on site. “It's one thing to have bricks and mortar, but it's another thing to build a team that works together well,” Dickey says.

Instead of scattering throughout the Bay area, Doctor's Walk-In Clinic operates in a controlled-growth mode, according to Dickey. Locations are targeted near hospitals and medical office buildings, or in high-traffic and highly visible areas such as shopping malls and banks.

Potential for growth
With six locations in Hillsborough County and one each in Pinellas and Pasco counties, Dickey says the potential for growth is hardly limited. For the time being, his chain is concentrating on upgrading current facilities, including the recent expansion of its Clearwater clinic along U.S. 19 near Countryside Boulevard.

“I still get in my car and drive around to get a feel for the community,” Dickey says, noting that his definition of the greater Tampa Bay market for growth purposes extends to New Port Richey, Lakeland and Sarasota. Population trends are an important factor in deciding where future clinics would go, along with gaining a better understanding of how Obamacare will affect demand for services, he says.

“We're very optimistic about this area and want to be part of its growth,” he says. “You have to find the need, but you also have to find a facility where you can work out a lease and make it economically feasible.”

Doctor's Walk-In Clinic is getting new help in that regard, having been acquired in November 2008 by MedExpress Urgent Care, a chain of similar clinics based in Morgantown, W.Va. The privately owned company was launched in 2001 by a group of former ER doctors and now has roughly 40 locations in West Virginia, Pennsylvania, Colorado and South Florida.

Dickey, who now retains the title of vice president of operations with the chain he established, says the philosophy of MedExpress matches the one he has always held, especially regarding customer service. The local clinics can now concentrate more on patient care, while back-office functions are handled at the Morgantown headquarters, he says.

“It has turned out to be a good fit,” says Dickey, whose local corporate office in Westshore overlooks Interstate 275 and Tampa International Airport. Being part of a larger organization provides greater leverage in negotiating with suppliers and insurance companies, and also provides access to capital and expertise in marketing and advertising, he says.

Another positive aspect of joining MedExpress is that it allows its employees around the country to transfer to clinics in different states. “We had two people from West Virginia to relocate to Florida, and it has worked out very well,” Dickey says.

Over 100,000 served
Volume at Doctor's Walk-In Clinics, which have been allowed to retain their original brand, has held steady in recent years at just more than 100,000 patients annually. MedExpress continues to maintain a business model that focuses on access and affordability.

“We believe patients are evolving,” says Erich Lipphardt, MedExpress' vice president of development in Morgantown. “Awareness of urgent care value in the U.S. and Florida still has a long way to go.”

One key difference in the Florida clinics, versus other MedExpress centers around the country, is that the number of patients coming in changes throughout the year, Lipphardt says. Winter visitors add greatly to the numbers, but as they return north the volume slows through spring and summer, he says.

Dickey says he tries to stabilize employment at Doctor's Walk-In Clinic through those fluctuations in local population in order to avoid layoffs, moving staff between centers as needed based on patient traffic. One means of doing that is through the introduction of electronic medical records, a concept advanced by various technology providers in recent years that continues to elicit debate.

Besides allowing doctors to quickly look up a patient's medical history or past and current prescriptions, Dickey's clinics use EMR to track wait times for patients and determine an average. An oversized computer monitor at the Westshore office can track each patient by name and display the amount of time patients must spend in the waiting room at that moment or by the time a doctor sees them.

“It was a challenge the first six months,” Dickey says about the electronic conversion, which has eliminated the need to courier paper files between doctor's offices. “We had some staffers who didn't know what a mouse was.”

Even so, he says, the conversion is necessary to be able to compete in the healthcare field going forward, especially for clinics like his. “Convenience is what we sell,” he says — even on Thursday afternoons, which tend to be the clinics' slowest time.