The number of urgent care clinics in New Hampshire has almost doubled since 2012. And in the next year, three such clinics will open their doors in the City of Keene. That will mean more choices for patients in the Monadnock Region - and stiff competition for the clinics.
Urgent care clinics are often called retail healthcare. You’ll see the clinics in strip malls. The idea is you can walk in without an appointment, be treated by a doctor for anything from a bad cut to a broken finger to a sore throat, and get out -- quickly.
Max Puyanic, CEO and co-founder of ConvenientMD, shows off his company's Concord clinic. The one he’ll open in Keene next year will be identical.
"We had a little boy come in a few weeks ago who had had his hand stuck in a blender," says Puyanic. "He needed 20 stitches in his fingers. A lot of those types of procedures would be $2,000 to $6,000 visits in emergency room settings. In our environment [they] are going be $200 to $300."
ConvenientMD also has clinics in Exeter and Windham. In addition to these, they’re opening others in Nashua, Bedford, Dover and Merrimack.
"They do best in areas that have very high populations," says Puyanic. "So New Hampshire doesn’t have a high population anywhere really relative to other cities in the country."
The target audience for these clinics is patients who want to avoid a costly trip to the ER, or who lack or don’t want to wait see a primary care doctor. John Martin manages licensing for the Department of Health and Human Services. He says the clinics are starting to show up in areas without so many people.
"Eventually you’re going to see more and more of them up in the North Country," says Martin.
In a shopping area in Keene, a crew of workers spackle the walls of the newest location of Clear Choice MD, slated to open this fall. This is another chain of urgent care clinics that’s expanding from Vermont to New Hampshire and Maine. Dr. Marcus Hampers, the founder and CEO, says in the 20 years he has spent as an ER doctor in New England, he has watched ERs become overburdened with patients who don’t have emergencies.
"The broader issue is they have trouble accessing their primary care provider or they don’t have a primary care provider," says Hampers. "But the end result is the hospitals become plugged up with non-emergency patients. And tragically the sickest patients aren’t being seen as quickly as they should be."
Some research indicates retail clinics may disrupt the relationship between patients and their primary doctors. But the clinics also provide inexpensive care. It’s a tradeoff.
Dr. Andy says patients in the Monadnock region will benefit if the clinics communicate with the local hospital when caring for the same patients. Tremblay is Chair of Primary Care at Cheshire Medical Center/Dartmouth-Hitchcock Keene.
And, by the way, Tremblay is overseeing Cheshire’s foray into urgent care. The hospital is opening its own retail clinic this fall.
"Some of the other organizations that have done this have become extraordinarily adept at doing this and providing good care," says Tremblay. "For us this is a new step in a different direction."
That’s right: in this small city, there will be three urgent care clinics in the next year.
"We’re seeing the urgent care industry in some areas its really becoming over built," says Alan Ayers, Board Director of the Urgent Care Association of America. He says you need a population of about 40,000 to support one urgent care clinic. If he’s right, that means the Monadnock area can really only support one clinic.
The three clinics acknowledge Keene may be oversaturated, and all are confident they will be the one to survive. But, really, who has the advantage?
"The hospital has a little bit of a competitive advantage," says Ayers, "in that if it can realize benefits elsewhere in the hospital system, it doesn’t necessarily have to turn a profit at the point of service for the urgent care."
Then again, the independent shops are nimble and are simply cloning a business that’s worked for them elsewhere. Cheshire, meanwhile, will have to work out some kinks.
All three clinics agree this will be a competitive situation. And they think that competition will mean good things for patients.