Putting Immediate (Urgent) Care and Primary Care Under One Roof: A Promising Model

Primary care is the most underfunded and undervalued part of our health care system.¹ To provide truly comprehensive primary care, physicians would require a 27-hour workday.² With the ideal team-based approach, the number shrinks to about nine hours per day,² but unfortunately current billing mechanisms are inadequate to support the required dietitians, counselors, nurses, and care managers.

Over the last few years, 71,000 physicians have left the workforce, with primary care and mental health hit hardest.^3,4 The result is that more than 100 million Americans now lack access to primary care⁵ — meanwhile, health care costs and the prevalence of chronic disease continue to rise.

Despite these headwinds, we will describe in this article a model that can stabilize primary care within our current health care system. By co-locating primary care and “immediate” care — essentially urgent care without urgent care certification — under the same operational umbrella, we improved fiscal solvency, patient access, and clinician satisfaction. While our specific model is no longer in effect due to changing institutional priorities, we still believe it holds promise.

From 2015 through 2022, we operated three clinics, each offering immediate and primary care. Immediate care took walk-ins, with the ability for patients to make “on-my-way” appointments, while primary care required advance appointments. The clinics were open for 12 hours on weekdays and 10 hours on Saturdays and Sundays, with the exception of one clinic located in our city's business district, which was open eight hours on Saturdays and closed on Sundays. Here's how we ran our operations and paid our employees.

Operations. Our clinics were staffed each day by at least one primary care physician (usually a family medicine physician) and one immediate care non-physician clinician (NPC), such as a physician assistant or nurse practitioner. Each clinician was based at one “home” clinic, but we could rotate them between the three clinics based on staffing needs. If we had open shifts, we made them available for physicians or NPCs at a predetermined hourly rate we had negotiated, and we paid out for them quarterly. We split weekend duties, with no physician or NPC asked to work more than two weekend days per month. We limited full holidays — when all of the clinics were closed for the day — to Thanksgiving, Christmas, and New Year's Day. On Memorial Day, July Fourth, and Labor Day we had abridged hours.