Younger Patients Prefer Urgent Care Clinics To Primary Doctors

Oct. 22--Sarah Davis is not looking for a primary care doctor anytime soon.

The 33-year-old Nuuanu resident said she doesn't have any medical problems and is in good health.

"I don't need any follow-up. If I have some problem, if I just come (to an urgent care clinic), it's easier because I'm still healthy," said Davis, who was at Island Urgent Care in Kakaako, where her husband was being treated for dehydration.

Davis is part of the millennial generation -- those born between 1981 and 1996 -- many of whom are ditching primary care doctors in favor of walk-in clinics and urgent care facilities.

Almost half -- 45 percent -- of 18- to 29-year-olds nationwide do not have a primary care provider, according to a recent survey by the Kaiser Family Foundation. That compares with 28 percent of 30- to 49-year-olds, 18 percent of 50- to 64-year-olds and 12 percent of seniors 65 years and older.

A number of stand-alone clinics have sprouted up as the generational shift toward faster service and immediate access to care becomes the priority for younger people.

"I only came here today because I wanted to be seen right away. Normally I can get in pretty fast to my primary care, but I didn't want to wait at all, basically," said Davis' husband, Scott, 34. "Kind of like someone would go to the ER to be seen right away, the walk-in clinics are similar in that sense. Anecdotally, the fact that more and more of these are sprouting up means that more people are using them."

Dr. Robert Ruggieri, who owns four Island Urgent Care clinics on Oahu, where as many as 40 percent of patients do not have regular doctors, said he's "amazed at the number of people who don't have primary care providers."

People with significant illnesses or those on Medicare and Medicaid, the government health insurance programs for seniors and low-income residents, have a difficult time securing a primary care doctor, he said. In addition, changes to health insurance payments are also driving more doctors out of the market, thereby increasing the shortage in primary care doctors.

"The younger generation traditionally does not have a primary care physician because they feel invincible. The last doctor they've seen is their pediatrician," he said. "When they want something the first place they're going to go is to their phone to use some kind of app to find out what can be done to help them, where they can be seen for service, where they can get in today. In the past it's only been the emergency room, but now urgent care makes it more available. With a shortage of primary care physicians and overcrowded ERs, urgent care is a natural option."

Hawaii Pacific Health, owner of Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Medical Center, and Wilcox Health on Kauai, is investing millions of dollars in new primary care clinics partly to meet the needs of the younger generation.

The company is opening at least three new clinics and expanding services at more than a dozen existing facilities within the next couple of years. Clinics in Kapolei and Kakaako are expected to be completed in July, while another in Kahala is slated for May 2020.

Marie Flannery, Straub's vice president for clinic operations, said that HPH is "leveraging things really attractive to millennials," including online e-visits as an alternative to going to the doctor's office.

Dr. Monica Price, HPH's physician overseeing the walk-in clinics, added, "We do see our fair share of those young millennials who feel so healthy and sort of invincible at this point, but when they do have a little something ... they do seek medical care and that's what we're there for. They want to acutely treat what might come up without necessarily thinking about the big picture of all of us getting older."

The HPH clinics will take care of urgent medical concerns but also try to connect patients with long-term doctors, she said.

"We'll definitely take advantage and get them permanently placed with primary care providers," Price said. "As things come up they know your history; it makes for better care if doctors have a relationship with patients. Unfortunately, it's not going to get any easier (finding a primary care doctor) moving forward. Our population isn't getting any younger or smaller, so the earlier the better."

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