Urgent care saved my butt, but it may cost society more | Patient Perspective

There are many ways to celebrate the advent of your 30s. I chose something distinct: lying face down in a flimsy blue paper gown with an aching butt in an urgent care center at 35th and Market Streets.

It was Memorial Day weekend, and I was returning home from visiting family. I suddenly developed a familiar, but dreaded sensation: a tenderness just above my buttocks so painful it hurt to sit and walk. It’s called a pilonidal cyst, a common skin infection, often due to a congenital defect.

These cysts are most prevalent among men in their 20s and were once known as “Jeep disease” during World War II because soldiers got them while driving over bumpy terrain.

If a cyst becomes infected, one can develop an abscess. And if untreated, it can, in rare cases, lead to sepsis, a potentially fatal blood infection.

Last time, I stupidly waited three weeks to get the cyst drained in the ER, ultimately spending 2.5 hours getting my ailment treated.

This time, I knew not to wait, but also knew I didn’t want to go to the ER again. Instead, I turned to an urgent care clinic. Urgent care is one of the fastest growing clinical spaces, set to bring in about $48 billion in revenue this year. Many systems and private equity firms are muscling into the market because it serves as a bridge over a major failure of our health-care system: the often-long wait to see a doctor.

Urgent care is a subway stop between the ER and the primary doctor’s office, where patients can get their acute and minor problems treated. Typically, patients walk in without an appointment and are seen quickly, often by a nurse practitioner or physician assistant.

These centers began as a 1970s experiment and now top 14,000 nationwide, according to the Urgent Care Association.

The model’s advocates argue urgent care centers improve access to treatment in underserved communities and can divert patients from crowded ERs, which can save time and money.

But it’s unclear whether urgent care’s savings are materializing. One article found that total spending in ERs increased as urgent care became more available. Other studies have found urgent care centers are less likely to open up in rural areas or low-income communities, where people are more likely to be uninsured or covered by Medicaid.

These centers are not “legally obligated to treat everyone,” the way a hospital emergency department is. They can refuse Medicaid patients, as well as the uninsured.

Researchers at Pew found quality shortcomings at urgent care centers that overprescribed antibiotics for respiratory illnesses. And a 2023 study found that urgent care visits were associated with a significant increase in hospital stays.

In my case, urgent care was a good option. A physician assistant applied lidocaine to the region and drained the cyst. With an antibiotics prescription and a general surgery referral, I gingerly stepped outside. The whole visit took 80 minutes.

I was lucky to be seen so quickly. I have a high-deductible Aetna plan through work, so the visit cost $150. But my experience underscores some of the problems confronting our health system. Patients should not be trapped in care purgatory, without being able to afford and access excellent care.

Sam Schotland is a historian and health journalist working in Philadelphia. You can reach him at samuel.schotland@gmail.com.