Where to Go for Care: Primary Care vs. Urgent Care vs. Emergency Care

Health care jargon explained
Healthcare industry

Feeling bad is bad enough. We all get sick or injured sometimes and need to seek medical care. Yet, not knowing where to go can add to the stress of the situation not to mention wasted time and money.  

Let’s look at which type of care is ideal in different scenarios: Emergency room (ER), urgent care center, or primary care provider (PCP).

Keep in mind these are general guidelines. It’s important to have a plan for emergency care agreed upon by your PCP or pediatrician, particularly if you’re in a high-risk category (e.g.baby, elderly, chronic care patient) one of these groups who require special consideration.

When do you need to go to the ER? Emergencies only or expect $$$ bills and long waits

You may find yourself in need of immediate medical care, and in these cases, do not wait! Have someone drive you to the ER or call 911 to take an ambulance. This is for when you need to see someone immediately, and it’s quite often a matter of life or death.

However, a visit to the emergency department is almost always the most expensive type of medical care, even when it’s at an in-network hospital. ER visit copays and coinsurance for the types of scans or treatment are much higher than visiting a primary care provider or urgent care. Still, they exist for a reason, namely, emergencies.

When is a health issue an emergency? Here are 10 situations where a person should seek care in an emergency room, as this could be a life-or-death scenario:

  • Chest pains or a feeling of pressure on the chest, left arm pain, left jaw pain, or other symptoms of a heart attack
  • Symptoms of a stroke, such as slurred speech, confusion, loss of balance or vision, sudden numbness, facial droop
  • Severe allergic reaction with symptoms such as swelling lip or increasing difficulty breathing (sometimes called anaphylactic shock or anaphylaxis)
  • Choking or difficulty breathing
  • Uncontrolled bleeding
  • Head injury
  • Neck or spine injury, especially if it's causing a loss of feeling or inability to do something
  • Pregnant and experiencing vaginal bleeding or abdominal pain
  • Certain pre-identified (with primary care doctor or specialist) symptoms related to patient’s chronic condition
  • Major or multiple broken bones, such as legs or ribs

As you can see, any of these situations can be life-threatening and must be treated ASAP. Because ERs are set up in hospitals, they have all of the necessary equipment and medicine to treat almost any illness or injury. (Note: Best to seek care at an ER and not a Freestanding ER.)

When is urgent care clinic your best bet? When your PCP isn’t available.

While urgent care is a fairly new model in our healthcare landscape, you now find a clinic on almost every corner of the neighborhood. Created with the intention of filling the gap in care between primary care and emergency room care, urgent care is more appropriate for those conditions that are not life-threatening...but that you need help for when your doctor isn’t available. An urgent care clinic is less expensive than emergency care, and you should be able to see the doctor, nurse practitioner, or physician assistant more quickly than at an ER. (The average wait in an ER in Texas is 139 minutes — even longer during flu season.)

Some of the maladies that send you to urgent care are often similar to the maladies that would send you to see your primary care physician. The difference is that in these cases, the health issues or injuries need to be taken care of sooner rather than later — and your doctors may not be available (because it’s the weekend, after hours, or the office is simply busy!) — so urgent care may be your best bet.

Keep in mind that urgent care visits usually cost more than primary care doctor’s visits, even in-network, though they will cost less (often significantly less) than an ER. It’s very important to verify that the urgent care center you go to is in network for your health insurance plan, to avoid any unpleasant, unexpected charges.

Some of the 8 most common conditions treated at urgent care include:

  • Sore throat
  • Colds or flu
  • Eye and ear infections
  • Dehydration
  • Non life-threatening injuries, such as sprains, fractures, cuts that may require stitches (Note: Young kids may not be able to get stitches in a standard urgent care clinic. Best to call in advance.)
  • Abdominal pain
  • Mild to moderate difficulty breathing
  • Urinary Tract Infections

If the medical team at the urgent care decides your issue is more serious, they will send you to the ER. Of course, in an ideal world, you would be able to see your PCP for any of these concerns, but it’s all a matter of timeliness.

When to go to your Primary Care Physician? For most everything not an emergency.

A Primary Care Physician (family medicine doctors, internists, or pediatrician) should be your first line of defense when it comes to medical care. They can treat and diagnose just about any medical condition that you would go to an urgent care center for.

Because your PCP is the hub for all first-contact medical care and has your medical history, your best bet for your health is to visit your primary care doc, even for urgent conditions. (Your wallet will thank you, too.)

Direct Primary Care vs. Traditional Primary Care

The best primary care is one that is easy to access when you need it. Unfortunately, healthcare in the U.S. today is muddled by a complicated coding system that physicians must complete to get paid. This model incentives doctors toward volume (the number of visits with a patient) and not value (helping the patient get better, so they don’t have to go to the doctor).

Along the way, the experience has eroded too. Waiting to get an appointment, waiting in the waiting room, waiting in the exam room, lots of waiting. Is it a wonder that so many avoid seeing the doctor?

With Direct Primary Care, doctors are paid monthly not based on how many visits or calls a patient has. And the experience for patients is that they get to have:

  • Unlimited appointments at no additional cost
  • Built-in telemedicine, including phone, text, and video visits
  • Same-day and next-day appointments
  • Help with coordinating health needs outside of primary care like imaging, specialists, etc.
  • Longer appointments (basically more time and attention)

When appropriate, a visit to the PCP should take care of most non-emergency visits. All in all, it is important to know when to go to the ER, when it’s time to head to urgent care, and when a PCP visit should do the trick.

For more information about Decent’s health plans or DPC email support@decent.com.

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