Medicine to Go

Clinics for impatient patients

When a flying metal shard gashed his left wrist, Nick Diaz, 33, an inspector at a Houston toolmaking firm, wondered where to go for help. His plant was too small to have a medical department, his own doctor was way across town and he did not want the hassle of checking in at a hospital. So he went to a neat, one-story building with a 40-ft.-high sign bearing a distinctive logo: an upraised hand with a bandage wrapped around its fingers and a first-aid cross on its palm. Once inside the MedStop clinic, Diaz quickly got his cut cleaned, X-rayed and closed up with two stitches. He was able to pay his $67 bill and leave within an hour.

The clinic is part of a rising phenomenon in health care: quick-service, walk-in establishments that critics deride as "medical McDonald's." Now numbering about 150, most of them run for profit by private physicians, these places are known as freestanding emergency clinics, or FECs, because they are physically separate from hospital facilities. FECs appeared in Delaware and Rhode Island in the early and mid-1970s, but now the big growth area is the Sunbelt, particularly Texas.

Usually the centers are open seven days a week, but only during fixed hours and mainly to cater to people needing routine tests or treatment of simple ailments such as cuts, sprains, colds and sore throats. Though many clinics can and do provide first aid for auto-accident and heart-attack victims, they do not keep patients overnight. Says Dr. David Carlyle, medical director for MedStop's three clinics (one in Dallas, two in Houston): "We are basically geared to take care of one-shot problems." MedStop, one of the FEC pioneers, was started three years ago by Henry Harper Jr., 34, a Houston physician who decided while working in a hospital emergency room that there should be a low-cost alternative for people with simple medical needs. His clinics are open between 8 a.m. and 10 p.m. and staffed by four people: a receptionist, an X-ray technician, a nurse and an M.D., who may be an experienced physician or, on weekends, a young doctor completing training at a hospital.

Typically the clinics handle 60 patients a day. A customer simply walks in, fills out a registration form, then sits down in a large, well-lit room until the nurse ushers him into one of several treatment areas: a "crash room" equipped with cardiac defibrillators and respirators for the rare patients who arrive with serious problems, an orthopedic room equipped to deal with fractures and sprains, a "suture bay" for minor lacerations, or an X-ray room.

There is also a laboratory to do blood and urine tests and bacterial cultures. About half of MedStop's business comes from doing pre-employment physicals for companies or dealing with minor on-the-job injuries. Employers like MedStop, says Carlyle, "because time is money. We can get people in and out faster than an emergency room or doctor's office and do just as good a job."

MedStop charges slightly more than private physicians, but it undercuts hospital fees by 40% to 45% or more. A routine chest X ray may cost $80 at a hospital emergency room, vs. only $30 at MedStop. Aside from workmen's compensation, the clinics accept no insurance, claiming that the paper work would raise their costs by 10%. Payment is strictly by cash, check or credit card.

Some hospital officials are aghast at such clinics. Dr. James Cross, director of emergency medicine for Houston's Memorial Hospital system, points out that FEC cannot offer patients the "emotional rapport" they expect from a family doctor. Moreover, FECs take needed business away from traditional emergency rooms, which are open 24 hours and must accept all patients whether they can pay or not. "It is hard to imagine good medicine as a franchise on a national level," says Cross. "You cannot standardize medicine. You cannot package and deliver consistency the way McDonald's does hamburgers." MedStop's CarIlyle counters that his clinics, at least, maintain high standards. With nearly 135,000 patients treated so far, he points out, MedStop has never been sued for malpractice.

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