How did you get interested in urgent care medicine,  and in pediatric urgent care medicine?

Well, for me it was time for a career change.  I think from the time I was pre-med, I was thinking I would do primary care in a small town,   and that’s kind of where I landed,  and had my own pediatric practice for about 20 years in a little town in  Tennessee  A rural  practice, that’s what I wanted to do, and I really was very pleased with that and really felt like you’re making a difference in a community like that.  It was just my pleasure, I guess, to watch over these kids and provide local pediatric care in a rural area that otherwise wouldn’t have access to it. You know, at some point along the way, and I think I got that way the last couple of years, where the joy was going out and there was kind of a resentment for all the hassles of running your own practice and all that.  And I felt like it was probably time for a change. I definitely. . .for me it’s kind of getting out from under the load of running my own practice and all that goes into primary care.  So that’s the initial draw, I guess.  I love the lifestyle it presents, in terms of shift work and being able to walk away when you’re done. I guess, it was more personal, I think, how I ended up in this You know too, I think getting kind of immersed in running your own practice — and I love that and I love that aspect of things —  but every once in a while my head would come up,  and I would go to a CME, or exposed to the medicine again, and I realized how much I loved it.  Getting into urgent care for me, it’s just kind of a return to the medicine part of it.  I think so much of primary care is more than that — it’s a bit of social work involved in that,  and of course the business aspect of running your own practice.  It’s good just to be practicing medicine; I guess that’s my long answer.

Did you join an existing urgent care or did you open your own?

I was fortunate to find a position here in Evansville, Indiana; it was brand new. It just kind of came along at just the right time, when I was ready to make a transition. This is a large hospital-owned system with about 15 pediatricians and I think I counted 65 family physicians. They wanted to start  —  they have five other general urgent cares within their system and they wanted to start a pediatric urgent care and they recruited me to be their medical director. We launched last November, so really we kind of had a built-in patient population with this kind of scenario, with so many, I guess “feeder” physicians. We basically took over the after-hours clinic the pediatricians were doing and have been off and running ever since.

What kind of problems are you seeing that you didn’t see before; what kind of illnesses — or are they pretty much consistent no matter which practice you’re in.

I don’t know that I’ve seen. . . again, coming from a rural  practice setting I pretty much saw it all and really operated urgent care within my practice. I always did but at some point I actually started marketing it as such.  So just more of it,  just more more higher acuity things that you would  typically see in general practice. Just more of it I guess.

Do you see different kinds of urgent care situations where you are, compared to what you hear from other members of SPUC?

I don’t think so. Just talking to people at the conference this fall, I think one thing that stood out to me is that every everybody’s circumstance and situation is unique and really this is something that has to be tailored to the community and the resources that you have. For us, I’m on the bottom floor of the medical office building that most of the pediatricians work out of, and we’re attached to the hospital and we have a pediatric hospitalist and we have an ER nearby and we have a strong orthopedic support. So we see the same things. And how we get things done is a little bit different, but we see the ortho and we see the acute abdomen and you know the closed head injuries and all that kind of stuff.  And then it’s just a matter of trying to figure out the best way to get them taken care of and that’s what’s different, I think,  from situation to situation.

Has your time in private practice helped support your urgent care work?  Are there things that you do differently or that you react to differently than maybe your younger colleagues?

Yeah that’s a good question; I think when you’re in practice on your own you kind of develop your own style and have your own way of doing things and it might not always be according to guidelines or whatever — it just might work better for your situation.  I think coming in to this situation I realized, you know, I’m not just practicing for myself now, I’m actually representing these other pediatricians and really the only way to do that well is to really practice as close to guidelines as you can. And so, I think coming in to the urgent care setting I have a renewed interest in ..  when I’m trying to refine how I do things, and different types of visits. I find myself going back to guidelines and just trying to,  you know, kind of reorder my workflow and the workflow of those that work here in such a way that we’re really practicing as close to guidelines as we can. It’s not just my style or my way of doing things and I realize dealing with the other pediatricians that they all do things a little differently — the typical general practice things, everybody still using Albuterol for bronchiolitis and all that those kinds of things change slowly and individuals practicing — but for us we try to stay as close to guidelines as we can because it’s the only frame of reference. We can’t practice like everybody else or figure out what everybody else would have us do, so we just practice as close to guidelines as we can.

How has being a part of SPUC helped with that?

First of all, I think it’s just kind of really refreshing to be around everybody else dealing with the same stuff we’re dealing with. I’m looking forward to more guidelines — not guidelines, guidance, I guess — or more collaboration about guidelines amongst ourselves and transposing, meeting ER guidelines into urgent care settings, again taking into consideration the various environments we find ourselves in. I’m looking forward to more of that. That’s good. I find a lot of urgent care issues that we face are flow issues and workflow, and I see a lot of the stuff on the message board about those types of things. How to staff, all that kind of stuff. I think it’s very helpful to get ideas.  I did get a few ideas from just talking to people at the conference, you know, about what they do with their hours — what’s good about it;  what’s bad about it, and how they’re staffing. All those kinds of things are really helpful; no one wants to reinvent the wheel if someone’s done it before it’s good to learn from them.

What hours does your urgent care operate and what is the staffing?

We’re open 8:00 to 8:00, seven days a week. And that was just an attempt to keep the hours consistent among all the urgent cares in our system. So we staff a single provider all day and then we add a second provider from 2:00 to 8:00. And then on weekends we staff two providers all day long — that’s kind of evolved over time but I think that’s probably where will be for a while unless we have significant unanticipated growth.

And support staff?

Support staff: usually just one receptionist up front and then we have two nurses all day long.

Is there anything else that you’ve noticed or learned or anything that maybe we should point out here?

I can’t think of anything off the top of my head here.   I appreciate what you guys are doing in SPUC;  I think it’s a needed thing.  Any ideas for getting qualified staff. . . I guess, really, our biggest struggle is finding providers that have the skill set that go beyond just the primary care aspect — procedural skills, primarily,  more resources for that, we really definitely need some more training opportunities.

Did you do any additional training upon leaving general practice pediatrics to go into urgent care?

No, I think everything I’m doing now I’ve always done. That’s maybe a lot different than maybe my urban practice colleagues. I definitely spent some more  time boning up on orthopedics. In fact that was one of the things my other providers were kind of clamoring for, some guidance on that.  So I put quite a bit of time into developing some guidelines on what type  of splints for what kind of problems and follow-up.  I kind of did that on my own, but nothing formal, I guess, no.