Urgent care medicine eyes specialty status

Two new fellowships emerge as demand for urgent care services grows quickly.

By Myrle Croasdale — Posted June 12, 2006

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In August, Shelly Verma, MD, will start a one-year urgent care medicine fellowship in Cleveland, the first of its kind.

"It's a nice medium between family practice and emergency medicine, and there's the opportunity to do procedures," Dr. Verma said. "You get to use a lot of clinical skills and diagnostics skills,"

Leaders within urgent care medicine say public demand for fast access to health care is pushing growth for more urgent care centers. At the same time, they say, there's growing interest among physicians who practice urgent care medicine to win recognition as a specialty. To this end, urgent care professional organizations have begun to set standards for their field, have established an accreditation board and have developed fellowships for new physicians wanting to go directly into the field instead of first practicing in primary care or emergency medicine for several years.

Right now, two urgent care physician organizations are spearheading separate fellowships. The Cleveland fellowship will begin training three physicians this summer, while a similar one-year fellowship in Columbus, Ohio, will likely begin in 2007 with two fellows. Each fellowship is also being done in collaboration with an academic medical center and a for-profit urgent care company.

Lee Resnick, MD, medical director for University Hospitals Urgent Care Centers and director of the fellowship in Cleveland, said there's also a practical reason his company is helping fund a fellowship: It's a way to improve hiring.

There are an estimated 28,000 to 30,000 urgent care physicians today and 15,000 to 18,000 urgent care medical centers. A year ago, the number of these physicians was at 20,000 and centers at 10,000.

"I can't hire someone right out of residency," Dr. Resnick said. "So how do we train them? I learned on the job, and that's not a good way to learn."

The Cleveland fellowship is being developed and funded by University Hospitals of Cleveland, the Case Western Reserve University School of Medicine in Cleveland, the Urgent Care Assn. of America and University Primary & Specialty Care Practices.

The Columbus fellowship is being organized by Ohio State University, the American Academy of Urgent Care Medicine and Ambulatory Care Affiliates Ltd.

Gaining credibility

Though the fellowships are being organized by two different urgent care medicine societies, they are similar in many respects.

Both programs will cover areas such as radiology, because these physicians won't have access to a hospital radiologist for consultation. Orthopedics is also among the core competencies in both programs, as is occupational medicine.

However, the programs differ in who they'll accept. The Cleveland program is open to family medicine and internal medicine/pediatric graduates, while the one at OSU plans to draw from internal medicine, family medicine, pediatrics and emergency medicine.

Ultimately, members of the AAUCM would like to see urgent care medicine recognized by the American Board of Medical Specialties and have a three-year residency. The AAUCM, which says it's the largest urgent care organization with 5,000 members, is in the American Medical Association's Specialty and Service Society.

While urgent care groups may be united in their desire for specialty recognition, some physicians are skeptical this is needed.

Michael D. Bishop, MD, is chair of Bloomington, Ind.-based Unity Physician Group, which operates six urgent care centers in Indiana and staffs 10 emergency departments in Indiana and Kentucky. He said most family and emergency medicine physicians are adequately trained to handle urgent care medicine.

"The more training one can get in general, the better," Dr. Bishop said of the fellowships. "But, I don't think it's necessary for everybody."

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External links

American Academy of Urgent Care Medicine (link)

Urgent Care Assn. of America (link)

National Assn. for Ambulatory Care (link)

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