The Injury Revolution

I came out of ER residency in 1986 and started my urgent care center in 1987. It was second nature back then to treat both illnesses and injuries. Lacerations, eye injuries, smashed fingertips, shoulder dislocations, and fracture care were standard fare. I hired our first PA in 1995 and the second a few years later.

At first, patients resisted saying “when can I see a real doctor?”. Despite the fact that my PA colleagues were outstanding in every way and treated everything I treated. Fast forward to the last 10 years when there has been nothing short of a sea change in provider hiring driven by the lack of available physicians, their cost, and the relative availability of APP’s. And I would venture to say that a meaningful percentage of UC profitability was derived directly from this process.

Meanwhile, APP training is simply not the same as a 3- or 5-year residency training program. How could it be? I must admit, I should have seen the implications for injury treatment coming long ago.

Lacking initial injury training and how to follow them up has resulted in the expected, many more referrals out to ortho/optho/ER.

To provide a few examples:

• What used to be a “routine tuft fracture” has become an “open and comminuted distal phalanx fracture” and is referred. 

• What used to be a routine fingertip infection with I&D is now a “high risk felon” and referred. 

• What used to be a “routine corneal FB” has become something for an ophthalmologist to remove (remember when plant nurses removed these?).

• What used to be “small avulsion fracture” is now in need of a “pin”, in some cases the fragment is so small, a pin wouldn’t fit through it anyway!

• What used to be a routine “metatarsal fracture” with boot and crutches gets referred so the orthopedic surgeon can do almost nothing and collect the “global fee”.

I can tell you that the lack of training and experience on the part of any provider leads to fear which leads to excessive referrals. In many cases, those referrals are just going to APPs at the ortho office, or worse yet, going to the “Ortho Urgent Care”. What a defeat that is! 

We are now at grave risk of losing injury care altogether! If you think this is not true then why are payers wanting to pay for “triage only” or telling groups that “you don’t treat injuries” you just “refer them”. Then offering low ball case rates that further dis-incentivize injury care and procedures. This is a downward spiral!

OccDocOne is a scalable tool that can almost overnight upgrade injury management at your centers!