A doc! Stat! People want their appointments now, at their convenience, and new Web sites and programs are making it so.

Posted: March 08, 2010

Struggling with a hacking cough that kept getting worse, Paul Spelman needed to see a doctor in January - and fast. His wife was just weeks away from giving birth to their first child.

But Spelman, 30, a graduate student at the Wharton School, didn't have a family doctor in Philadelphia. So when his cough woke him up early one morning, he searched online for a quick appointment in the city.

Spelman landed on the DocAsap.com Web site, a start-up founded last summer by Wharton graduates that promises users same-day appointments. He scheduled a doctor visit for about six hours later. After mild bronchitis was diagnosed, Spelman began a course of antibiotics and his cough quickly improved. "The reason that I was happy with the service was just the fact that it was so immediate," he said.

DocAsap.com is part of a growing number of initiatives across the region that often send sick, or healthy, patients to doctors on the same day. From doctor practices to retail clinics to hospital systems, the quick-appointment trend is growing, said physician Lori Heim, president of the American Academy of Family Physicians.

"It's definitely part of our society now," she said. A 2009 academy survey found that 62 percent of practices nationally use same-day or open-access scheduling.

The reason? "Patients want to be seen when they want to be seen," Heim said. "Convenience has become a very dominant force in every marketplace."

And as patients' lives have grown busier, so have physicians' practices. Last year, the average wait time for five specialties in Philadelphia was 27 days - the second-longest, after Boston - of 15 cities surveyed by the firm Merritt Hawkins & Associates.

Dermatologists and obstetrician-gynecologists made patients wait the longest, 47 and 46 days respectively, in the Philadelphia region.

On top of that, South Jersey is facing a potential doctor deficit. Every county in South Jersey except Camden has fewer primary-care doctors than the national average, according to the New Jersey Council of Teaching Hospitals.

Faced with those factors, the creators of DocAsap.com focused on increasing access. "It's not just a painkiller kind of a situation," said founder Puneet Maheshwari. "We are being used for convenience as well."

The Web site has signed up more than two dozen primary-care doctors, dentists, and psychiatrists in Philadelphia, Atlantic City, and Washington. By plugging in an address, insurer, and scheduling preference, users can book quick appointments with a few keystrokes. So far, about 200 patients, mostly young people seeking evening or weekend visits, have gotten seen through the Web site, Maheshwari said.

DocAsap.com will add dozens more doctors in the next few months, said Anuja Rathi, the site's chief executive. Physicians pay up to $400 a month to be listed while the site is free for users. Before a doctor's profile is added, DocAsap.com researches the physician online and visits the practice, Maheshwari said, but investigating whether a doctor has faced legal issues, such as malpractice suits, isn't part of the vetting process.

Patients who prefer to use a specific office can find quick options in at least two of Philadelphia's biggest health systems.

The teaching practice run by the Department of Family and Community Medicine at Thomas Jefferson University started an internal program about two years ago to give patients rapid access to doctors, said Richard Wender, chair of the department. The practice already enables patients to call the day before to book appointments. And it added the Care Now program to make sure people with health problems, even new patients, could be seen expeditiously, he said.

Nurse practitioners are the linchpin of Care Now, which treats more than 100 people a day, Wender said, but medical professors and residents take turns seeing patients through the program.

Besides dealing with immediate medical problems, Care Now visits are meant to treat long-term issues. For instance, if a woman hasn't had a recent mammogram, one would be scheduled. "It's doing the things that make a difference, the things that are really going to save your life," Wender said.

Similarly, the Drexel University College of Medicine last month opened a retail clinic in Center City. Nurse practitioners are the primary providers for walk-in patients. Doctors will be available on site or by phone, said Thomas McAndrew, medical director of the Drexel Convenient Care Center.

For $65 a visit, patients can have problems treated and also be prescribed medication, get a physical, and receive diabetes or cholesterol screenings, McAndrew said. Staff will follow up with a patient's primary-care doctor. "We're not going to be adjusting any chronic medications," he said. "We're kind of an adjunct to a primary-care office. We're really not a substitute for it."

Like the Jefferson program, patients seeking quick care will be connected with specialists for long-term issues. "It's going to be very easy to get a person to see a doctor," he said.

Plenty more options exist. Each of the three major types of quick appointments - convenient care or retail clinics, urgent-care centers, and programs within physician practices - are active in the Philadelphia area, said Tine Hansen-Turton, executive director of the Philadelphia-based Convenient Care Association.

The trouble sometimes is finding them. Hansen-Turton said she wasn't aware of any centralized database though her trade group's Web site offers state-specific maps of retail clinic locations. About a dozen sites are listed in and around Philadelphia, including one each in Mount Laurel and Bryn Mawr.

The movement will keep growing "both on the Jersey side and the Pennsylvania side," Hansen-Turton said. And in what might be an effort to compete, more doctors are expanding their hours, she said.

Quick care isn't without risks. "It's very important that we don't do this in such a way that further fragments or leads to duplicated care, drug interactions, [and] all of those things that really do not improve quality," said Heim, of the Academy of Family Physicians. "When you start talking about complex problems, a quick appointment may not be in the patient's best interest."

Patients with one place for care, such as a regular primary doctor, have better disease control, higher vaccination rates, and lower hospitalization and ER use, Heim said.

So it's important for the providers of quick appointments to connect with a patient's primary doctor and relay what was done, including any medications prescribed. For safety, Heim said, it's also wise to share details of the patient's electronic health records with any doctor the patient sees.

As for Spelman, now bronchitis-free and the father of a baby girl, he was so happy with the doctor he found on DocAsap.com that he said he'd gladly visit her again before he graduates in May and leaves town.

"If I were staying, I would certainly have joined that practice," he said.

Contact Christina Hernandez at christinamh@gmail.com.

Web Sites for Immediate Visits

www.DocAsap.com

American Academy of Family Physicians

http://www.aafp.org

Jefferson Family and Community Medicine

http://www.jeffersonhospital.org/fammed/

Drexel center

Go.philly.com/drexelclinic

Convenient Care Association map

Go.philly.com/clinicmap

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