Thirty years ago, hospitals opened up free-standing "urgent care" centers to siphon patients from their competition ["A Wait at the ER Measured in Minutes, Not Hours," September 29-October 6]. Ten years later, many closed after losing money. I don't think the new "concierge" ERs will succeed in doing any more than exacerbating the gap between the well-heeled and the rest of us. ERs are overcrowded because, for many, they are the only source of care. A more efficient approach would have primary-care physicians' offices running two shifts, staying open 12 to 16 hours a day and weekends. Nurse practitioners can handle the mundane after-hours problems, freeing traditional ERs to handle life-threatening emergencies.
David A. Rivera, M.D. Lombard , Ill.
Back in the 1950s in my hometown in Virginia's Piedmont, we had clinics with a doctor on duty 24 hours a day. During the day, several handled the normal cases. Visits were covered by our insurance. Unless the problem was a broken bone or major blood loss, you went there first. Now, when there's any kind of medical problem, you end up at the emergency room at the local hospital. The new free-standing emergency rooms sound a lot like the old clinics. I'd like to see something like this in both wealthy and poor communities. They would take a lot of pressure off hospital emergency rooms.
Walter G. Staples Jr. Pittsburgh