Want to make Duke physician Kevin Broyles, MD, wince? Just say that unpleasant phrase: doc in a box.

When Broyles joined Duke’s urgent care service 10 years ago, the field was still struggling to earn respect and acceptance from academic health centers. That’s because urgent care centers were born in the late 1970s of an entrepreneurial spirit that some people believe can compromise patient care. Overhead costs in such centers are low; patients enjoy rapid access to health care, but the quality of that care is sometimes in question.

Everyone agrees that urgent care medicine meets a real need for rapid-access and after-hours health care in our communities, and academic health centers such as Duke have embraced the phenomenon. Broyles says this helps make sure patients who need urgent care have timely access that is backed by proper medical expertise.

“Not all urgent care centers are equal,” Broyles cautions. “Duke Urgent Care centers have at least one board-certified, Duke-credentialed physician on duty with every physician assistant [PA] or nurse practitioner [NP],” he says. “And our urgent care doctors have extensive experience in both emergency and primary care medicine. So when you come here, you know you’re getting the rapid access to care that well-seasoned PA and NP professionals can provide, plus the assurance that your care that is backed by a physician’s depth of knowledge and training.”

Know When to Go

Broyles says it’s important for people to know when urgent care is right for them, as well as what its limits are. “What an urgent care center can do is similar to what a doctor’s office can do,” says Broyles. “Our scope of care is more limited, however, because we do not try to provide ongoing care. Sometimes people think that we’re part of the emergency medicine service, but we’re not. Urgent care is a unique service.”

Because it’s less expensive to go to an urgent care center than an emergency room, many people are motivated by cost to try urgent care first. “What should drive folks is not cost, but the most appropriate place for you to get your care,” says Broyles. “When patients come to Urgent Care for true health emergencies, they have to be transferred to an emergency room -- this not only delays their own treatment, but also hinders the care to other patients.”

Other people use urgent care as they would a primary care physician -- though some urgent care centers welcome these “frequent flyers,” Duke Urgent Care’s policy is to recommend them to a primary care doctor for needs such as routine physicals, Pap smears, and regular care for chronic illness. “Because we work hard to get patients in and out within an hour, and because we rotate our staff continuously, urgent care is just not a good way to get long-term health care,” says Broyles.

Test your triage power

What about the “minute clinic”? A new kind of health care is on the scene: little retail clinics, in stores such as CVS and Wal-Mart, that are tied to store pharmacies and offer a short menu of health services. “These clinics don’t have the support of a doctor on site,” Broyles says. “But to some people with very straightforward, two-minute needs,” such as a flu shot or a strep test, “they can be helpful.”

The physician assistant: a Duke original Duke is the birthplace of the physician assistant (PA) -- its program, the nation’s first, celebrated its 40th anniversary last year. A PA’s training qualifies him or her to handle a wide range of diagnostic and therapeutic care; they are qualified to do all of the procedures and clinical work that falls under the scope of a primary-care doctor’s office or urgent care center. PAs in Duke’s urgent care clinics always consult with a Dukecredentialed physician about patient treatment.