Urgent care without the wait: emergency room alternatives arrived in Alaska in the 1980s and continue strong.

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Have you sliced your finger recently and wondered whether you should go to the emergency room to have it stitched closed? Had a migraine and had your doctor's office tell you they can give you an appointment next week? Have you postponed finding a family doctor only to find that your children's immunization records are due at school? All feasible scenarios, and those people face every day.

Where do you go when these things happen? In the more populated centers of Alaska, such as Anchorage, Fairbanks and Mat-Su, you have choices.

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With general hospitals, there are also emergency rooms, and emergency rooms take all patients. The trade off, though, is that emergency rooms take all patients--which means that everyone can come into the emergency room, whether for major or minor emergencies. That may mean that you, who might be nursing a sprained ankle, may wait while the emergency room medical staff rush someone seriously injured in an automobile accident past you and into immediate care.

No, you wouldn't change the emergency room's priorities. But you might want to eliminate that long stint waiting for treatment for yourself.

ORIGINS

America's original urgent care centers opened their doors in the 1970s, and have been offering unscheduled, walk-in care for routine and non-life-threatening medical injuries and illnesses for more than 30 years. Many of these centers have been opened by physicians who saw the need for convenient access to unscheduled medical care, and others have been opened by hospital systems seeking new access to patients.

At urgent care centers, patients need make no appointment and need no referrals. Urgent care centers take most insurance plans, and deal with both urgent and non-urgent medical issues. Medical staff at these centers sees patients who need to be seen quickly by a physician, but can't get to their family doctor immediately. They see patients after normal office hours and on holidays, and they see patients who don't have family doctors.

In Alaska, urgent care centers began to offer their services in the 1980s--Anchorage's First Care and Wasilla's AIC Urgent Care both opened in 1985. AIC was sold to Mat-Su Regional Medical Center in 1989, and became a department of the hospital, according to Linda Olson, director of Urgent Care and Infusion Therapy.

"The hospital board decided to make the urgent care center a part of the hospital so we could work more closely with the emergency room and be accredited as a hospital department," Olson said. "I really think the hospital was very forward-thinking when they set us up this way. It keeps the waiting time in the emergency room down, and lets them take care of the serious emergencies immediately."

In addition to going through the same accreditation process as any hospital does, Olson said the connection gives a sense of credibility to the center.

'MIDDLE GROUND'

"We say we're a walk-in acute care facility," Olson added. "We will take care of all sorts of mild- to moderately acute illnesses. If we get people who need to be in the emergency room and we judge they can't transport themselves, we arrange for ambulance transport. Our physicians consult with emergency room staff and communicate the entire status of the patients.

"We have a staff of six-three physicians, two physicians' assistants, and a nurse practitioner," Olson said, "and we're open seven days a week from 9 a.m. to 9 p.m.

"My philosophy is that we try to be a middle ground between the doctor's office and an emergency room," Olson added. "We try to be closer to the doctor's office in our pricing."

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Anchorage has several urgent care centers. First Care, which began operations more than 22 years ago, has two locations today--one on Spenard Road and one on Huffman Road.

"We see lacerations, workers' compensation injuries, illnesses, injuries, immunizations, physicals, minor surgical procedures, sprains, and throughout the summer, we see a lot of foreign-body removal--lots of fish-hooks," said Kelley Baker, director of administration for First Care.

Formed by two Anchorage physicians, Dr. Clifford Merchant and Dr. Scott Mackie, First Care is open for walk-in patients from 7 a.m. until midnight every day of the week.

"We understand patients cannot plan illnesses and injuries during their primary physicians' working hours, so we offer extended hours, affordable and convenient walk-in care," Baker said.

Both Merchant, a physician with extensive emergency medical experience, and Mackie, an internal medical physician, work at First Care. Between the two locations, Baker said First Care's clinical staff consists of 10 physicians, five physician assistants, 22 registered nurses, eight laboratory or X-ray technicians, and on-site lab and X-ray facilities.

"We also have an orthopedic technician on call, and train our staff for casting and splinting care. These are only for the less serious fractures," she added. "For the more serious injuries, we provide the initial care and then refer the patients to an orthopedic specialist."

At First Care, Baker said, they try to keep waiting time to a minimum.

"We let patients know an estimated waiting time and communicate any unexpected events that could extend their wait. Patients appreciate being informed," she added.

Most of the urgent care centers also see workers' compensation injuries, do drug and alcohol testing and pre-employment physicals.

"We have a board-certified occupational medicine physician," Baker said, "and we do our best to communicate directly with the employer after the initial injury."

THE NP ADVANTAGE

Across town, Bennett Jackson owns Patient's First Medical Clinic, on DeBarr Road. Jackson is a nurse practitioner with advanced training to diagnose and treat most common ailments and diseases.

"Nurse practitioners in Alaska are trained to be independent," Jackson said, "and people can feel comfortable going to an urgent care center knowing they'll probably save time and money.

"You can feel safe in both worlds," Jackson added. "If you need to be in an emergency room, we'll make sure you get there and we'll even expedite getting you there."

Jackson said he has worked in urgent care for many years and thinks it has a definite place in the medical world, and offers a valuable service to people. "From everyone I've talked to," Jackson added, "we're much less expensive than an emergency room."

Jackson went on to say that emergency rooms, by nature, have to be very aggressive in ruling out diseases and making sure their diagnoses are as complete and comprehensive as they can.

"They end up doing more testing than is usually done in a family practice clinic," he said. "I believe emergency rooms are sued more often, so they tend to practice legal prevention medicine.

"For people with life-threatening injuries or illnesses, though, there's really no substitute," Jackson added.

In Fairbanks, the Fairbanks Urgent Care Center opened in 1998 as a partnership between doctors Leonie Deramus and Larry Harikian. The two, who had worked at Bassett Army Hospital, were nearing the contract's end and wanted to continue to live and practice in Fairbanks. Deramus said her specialty is emergency medicine (she has completed a residency in emergency medicine, is board-certified in that specialty and is a fellow in the American College of Emergency Physicians), and Harikian's specialty is occupational medicine.

"There was a tremendous need for this type of clinic," Deramus said. "The only place available for any type of emergency care was the hospital. If a tourist left his blood pressure medicine at home and needed a new prescription, he'd have to go to the emergency room or make an appointment to see a doctor. The urgent care center changed that.

"We don't ever want to encourage someone who should be in the hospital to come here, but if they have a minor emergency--such as a cut or the flu--generally, we can handle it faster than an emergency room can," Deramus said. "For the tourist, it's a fast new prescription."

WAIT LESS

The shorter waiting time in urgent care centers is one of the primary benefits cited by national surveys and by the centers themselves. A second benefit is the longer hours the centers stay open.

Like First Care, Fairbanks Urgent Care Center is open longer than the normal doctor's office--7 a.m. to 9 p.m. on weekdays and 10 a.m. to 7 p.m. on weekends and holidays.

"We do close Thanksgiving, Christmas and New Year's days," said Deramus.

Deramus added she believes the best example of a reason for an urgent care center visit would be a bladder infection.

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"You don't need an emergency room, but you surely can't wait to see a doctor," she said.

Those who work in urgent care centers said they're proud to offer the services they offer with the shorter waiting periods and lower costs than emergency rooms can.

"We like to think our clinic is well respected by our colleagues," Deramus said, "and we fill a niche that has needed filling.

"I believe we're an asset to Alaska," she added.

With the changing seasons, Alaskans tend to move from imbedded fishing hooks and plant allergies to ankle sprains from icy driveways and the annual outbreak of flu and children's earaches. Next time you're facing one of these minor emergencies and can't see your regular doctor right away or can't take time from work to take your child to the doctor, consider an urgent care center as an alternative.