Where to Turn for Immediate Medical Care

Going to the emergency room to get a child's ear infection attended to is like using a proverbial shotgun to kill a mosquito. But thousands of people wind up at the ER all the time with such not-necessarily-critical ailments because they can't get an appointment to see their regular doctor in a timely fashion or because an accident or illness strikes outside of regular business hours.

In fact, a new survey found that 73 percent of people said they had difficulty getting access to their doctor when they needed to. Thirty percent reported that it was hard to get a next-day appointment when they were sick; twice that number said it was difficult to get care on weekends or in the evening from their regular doctor. More than 40 percent of respondents said that, even during regular business hours, they had trouble getting advice from their doctor on the telephone. So they end up at the emergency room, where care is much pricier than at the doctor's office. (ER patients often shell out a copayment of $100 or more for a visit that might cost them just $20 elsewhere.)

Those percentages appear in a Commonwealth Fund survey released today, "Public Views on U.S. Health System Organization: A Call for New Directions," that describes problems on many fronts, not just access to care. The telephone survey of 1,004 adults was conducted by Harris Interactive in May.

But as more people than ever visit medical professionals, access problems loom large. The Centers for Disease Control and Prevention reported yesterday that Americans made more than a billion visits to physician offices, hospital outpatient centers, and emergency rooms in 2006, a 26 percent increase from 10 years earlier. (The population grew 11 percent during that time.) ER visitors are waiting longer, too: an average of 56 minutes in 2006, compared with 38 minutes in 1997.

Illness isn't predictable, but physicians have been slow to make themselves available nights and weekends. A Commonwealth Fund survey of primary-care physicians in 2006 found that only 40 percent had any kind of after-hours arrangements, fewer than in the six other countries surveyed. "The majority of physicians still practice in small practices with just a few doctors," says Cathy Schoen, senior vice president for the Commonwealth Fund. If doctors want to make themselves available during evening or weekend hours, "they'd have to be on call all the time."

If you can't get in to see your doctor, you may have other options, notably retail clinics that have sprung up in recent years in drug, discount, and grocery stores. Typically open seven days a week and staffed by nurse practitioners, these clinics offer a limited menu of basic services—vaccines, treatment for strep throat and ear infections, among others—on a walk-in basis for a set fee. Insurance often covers visits to these clinics for a standard copayment. There are currently 988 clinics in 34 states, according to Merchant Medicine, a research and consulting firm. Although it's a challenge to get people to make that first visit, "once they experience it for the first time, they come back," says Tom Charland, CEO of Merchant Medicine. Check out the Convenient Care Association website for clinics in your area.

Urgent-care clinics can handle more serious problems on a walk-in basis, usually more quickly and cheaply than an emergency room. They can treat minor fractures and moderately severe cuts and remove foreign bodies, among other things. There are about 9,000 urgent-care centers in the United States. Staffed by physicians, most are open nights and weekends, though not around-the-clock. You can find a list of centers at the Urgent Care Association website.

Though they're no cheaper than an ER, "freestanding" emergency rooms that aren't located at hospitals are beginning to spring up around the country. They can't treat the most severely injured patients, but most are open 24-7, and if you visit one you might be seen much more quickly than at a regular hospital emergency room.

Wondering whether your injury is ER-worthy? Check out my recent story about the types of injuries and conditions your health insurer is likely to cover if you show up at the emergency room.