I read your article “Is There a Doctor in the House? Urgent Care Centers and the Debate Over Advanced Practice Providers” with interest [June 15, Xpress]. Let me first say that I have been practicing as a physician assistant since graduating from the Duke University PA program in 1995. To be honest, I was not aware that there was much debate over “advanced practice providers” as the subhead suggests.
The reader might be interested to know a little background and philosophy of APPs (namely physician assistants and nurse practitioners). In the late 1960s, Dr. Eugene Stead of Duke University foresaw the need for more medical providers. He envisioned a provider with less training, who could work in collaboration with a physician to help meet that need. To this day, PAs always work in collaboration with a physician as envisioned. The nurse practitioner profession was born soon after, and in North Carolina, NPs also always have a collaborating physician.
The quote in bold, “Misaligned incentives and cutting corners on training can result in catastrophe” by Dr. Mitch Li sounds pretty scary. In reality, patients receive the same quality of care by APPs as they would if they were seeing the physician face to face. That is not to say APPs are interchangeable with MDs. Like any competent health care provider, APPs recognize their limitations and either consult a physician when the problem is beyond their skill set or transfer the patient to a higher level of care.
Another quote by Dr. Li caught my attention. “Urgent cares wouldn’t be necessary if we had a functioning primary care system” sounds good on the surface, but what really constitutes a “functioning” primary care system? First of all, the reader might be a bit confused about what primary care really is given the article’s sidebar titled “Asheville area primary care clinics” that actually lists acute care practices. While primary care practices do treat acute problems, they also manage ongoing, chronic problems like diabetes and hypertension, while urgent cares do not.
Early in my career, I practiced in a family practice (primary care) in a nearby rural county. There were no urgent cares in that area at that time. We saw pretty much everything. I found my niche in that practice seeing primarily acute problems. Having my schedule open to see “walk-ins” and “work-ins” allowed the physicians to see their scheduled patients without getting bogged down. There were times when I was idle and times when I was extremely busy, but that was the nature of that primary care practice, and it worked. I now work in an urgent care in a different nearby county. The primary care practices in this county often direct their sick and injured patients to us. We always fax our office note to the patient’s primary care provider. This system also works pretty well.
— Dennis Seely, PA-C (Physician Assistant – Certified)
Editor’s note: Thank you for your feedback. We have updated the headline of the sidebar in the online version of the article to “Asheville area acute care clinics.”