Lancaster Physician Winter 2018 - 9

winter 2018

Urgent Care

While these activities are necessary, their
complexity fills office hours with additional
responsibilities, frustrations, and less time
to respond to the urgent medical needs that
naturally arise in any physician's patient panel.
When doctors' patients get sick with a mild
illness in this day and age of convenience, how
can they take care of them when their schedules
are already bursting at the seams? In the past
model, patients were referred to the emergency
room for care. But with overwhelming volumes,
long waiting times, protocol-driven care, and the
liberal use of high-tech and high-cost diagnostic
equipment, neither cost efficiency or patient
satisfaction is served.
Enter the urgent care clinician-a provider
focused and adept at providing care in an
efficient, timely, and cost-effective manner to
patients who either do not have a primary care
provider or are not able to access their provider
in a reasonable amount of time. Patients who
use urgent care clinicians not only get fast access
to care, but also the convenience of online
scheduling, quick turnaround times, in-house
radiology and laboratory testing, and EHR
integration for transfer of records. The result:
Happy patients and happy primary care doctors.
Is it any wonder this is the fastest growing branch
of medicine in Lancaster?
For providers in urgent care, there are lots
of benefits with a workday composed of direct
patient care with minimal clerical burden and
additional EHR tasks. Inbox management is
negligible; the workday typically has very defined
endpoints; the patient care is rewarding, while
comforting patients and their families dealing
with acute medical emergencies of low to
moderate acuity.
Although the urgent care specialty has now
engaged many clinicians across the county in
long-term professionally satisfying careers, there
are fortunately many physicians who still choose
longitudinal relationship-based care and caring
for friends and families over decades. The rewards
of both specialties now are complementing
each other with better access to care for all in
Lancaster County and a new professional career
track for providers.

For Dr. Tom Raff, it was about
sustainability. For his wife, it
was about the beepers.

TOM RAFF, MD
Associate Medical Director Urgent Care, LG Health

After doing 27 years of "full
spectrum family medicine,"
including obstetrics, Dr. Raff
needed a change.

Don't get me wrong, I loved the job, but I
had found myself more and more tired with the
call schedule, more irritable with the interns in
the middle of the night, and more focused on
getting back to the call room then spending time
with the laboring patients. Being a bit "north"
of age 50 and with two young kids at home, I
thought, "Can I really do this well for the next
15 years?" And did I mention my wife hated
my beepers? Yes, plural-one for OB and one
for Family Practice call. Night call had to go!
All of this was running through my mind one
night while sitting at my daughter's Irish dance
class when one of the other dads (a fellow family
doctor) mentioned he was thinking of doing
some moonlighting in urgent care because the
hours were good and the pay was tempting.
Having always enjoyed doing ED medicine (I
had almost switched into ED as an intern), I
asked for the contact number to check it out.
After touching up my CV and sending it
off, I received a call from the Director of LG
Health's Urgent Care, who disappointed me
by telling me that they weren't hiring "out of
network" moonlighters, but would I be interested in being the Associate Director? It seems
that 20 years of teaching residents, running
quality improvement and peer review for my
department, and sitting on hospital committees
lined up with teaching PAs, on-boarding new
graduates, and doing peer review for urgent
care. Who would've known? Long shifts but
no beepers! No call nights! I would have to
adjust! After some thought and discussion, I
decided to make the jump. My wife loved the
"no beeper" part. Of course, for me, the hardest part was saying goodbye to my long-term

LANCASTER

PHYSICIAN

patients, some of whose children-and even
grandchildren-I delivered.
When I started the job, I noted that the
providers came from a variety of backgrounds,
all with different reasons for doing urgent care.
Urgent care doesn't have a residency educational
structure like family medicine or emergency
medicine, so providers come from emergency
medicine, family medicine, and occupational
medicine, as well as nursing and physician assistants' school. As I spoke with other providers,
I found the reasons for doing urgent care are
almost as varied as the sources of providers.
For Robin Gish, after 25 years of traditional
office-based family practice, it was the ability
to have more time with family and less of the
relentless pressure to be "productive." The block
scheduling of long shifts was appealing because
it allows equally long blocks of free time without
the need to catch up on charting/phone calls
or chart prep. The pressure to "produce" was
not there-you simply saw the patients who
walked in the door until you were done with
the shift. At the end of the day, you went home,
your work done without having to think about
finishing up charts and dealing with what I like
to call "the medusa of modern medicine"(i.e.,
the inbox. And no night call).
Anne Ambarian, a practitioner at Patient First,
literally stumbled into the position when a friend
suggested it while Anne was disillusioned by
changes in her practice. The hospital that owned
her practice was in the midst of converting it
Continued on page 10

Table of Contents for the Digital Edition of Lancaster Physician Winter 2018