Until just a few years ago, people in the Eugene-Springfield area had only a few choices for where to get help if injury or illness struck when regular doctors' offices were shut tight.
They either headed to the metro area's sole urgent care clinic, or to the emergency departments at Sacred Heart Medical Center, or McKenzie-Willamette Medical Center.
Today, people in the area needing care for immediate, but not life-threatening, conditions have more choices than ever: three ERs, four urgent care clinics, and a retail clinic in the south Eugene Market of Choice store for minor complaints in patients age 4 and older.
The proliferation of choices locally mirrors the surge in urgent care nationwide.
National urgent care experts expect that growth to continue, fueled by patients' desire for convenience.
"I call it the 'McDonald's Society,' " said Franz Ritucci, director of the American Academy of Urgent Care Medicine, which is based in Orlando, Fla. "We want what we want when we want it."
What effect the new clinics will have in the Eugene-Springfield market remains to be seen.
"I think a lot of it depends on what happens with Obamacare (national health care reform)," said Dr. Alex Morley, one of the owners of Eugene Urgent Care, which operates two urgent care clinics in Eugene.
"I don't think anybody knows what's going to happen with that," he said. "It may help us, or it may not help. I guess we'll all find out."
PeaceHealth, the nonprofit parent of Sacred Heart Medical Center and of the medical group that operates two urgent care facilities and a retail clinic in this market, is trying to offer patients many ways to access health care when they need it, and at whatever level they need, spokeswoman Andrea Ash said.
Some of these approaches, such as the Check-up Clinic in the south Eugene Market of Choice, which serves market employees as well as the general public, are admittedly experimental, PeaceHealth Medical Group officials said.
The retail clinic - the first in PeaceHealth's three-state system, opened in late 2009 and isn't yet profitable, PeaceHealth officials said.
It's "a model, among several, we're exploring to look at different access points in the PeaceHealth System," said Henry Veldman, vice president for PeaceHealth Medical Group.
"We don't anticipate that it will revolutionize the world, so to speak, but I think we can learn a lot from it," he said. "The jury is still out whether this model is successful in this part of the country."
Nationally the increase in demand for urgent care is clear.
About 700 to 800 urgent care clinics have been opening in the United States each year, for a current total of 8,700, according to the American Academy of Urgent Care Medicine.
In many places, patients feel they don't have access to care when and where they want to receive it, and they're frustrated with long waits at the ER, academy director Franz Ritucci said.
He predicts that use of urgent care is likely to grow with national health care reforms.
"You'll find now there are even more people that have coverage, and they will expect to feel entitled, that they, too, now should receive care at any point in time," Ritucci said.
"We know there are not enough physicians in the pipeline to take care of the millions of new people coming into the pipeline," he said.
So urgent care centers, which focus on treating a specific ailment quickly, are able to process a larger number of patients than family practitioners, who are assessing and managing a patient's overall health, he said.
Urgent care also presents a significant cost savings - emergency room services generally cost three times what primary care or urgent care services do, according to the Urgent Care Association of America, which is based near Chicago.
That is because of the expense of staffing and equipping ERs, which are set up to treat conditions as serious as strokes, heart attacks, gun-shot wounds and injuries from car wrecks.
A 2009 RAND Corp. study concluded that 14 to 27 percent of emergency room visits could be handled by urgent care centers or retail clinics, saving up to $4.4 billion a year in health costs.
However, not everyone is aware of these new clinics, or when it makes sense to use them.
Most of the people using the local urgent cares have a regular doctor and health insurance, clinic officials said. But they show up at urgent care when their doctor's office is closed, when they can't be seen by their doctor as quickly as they'd like to, or if they need a quick, specialized service, such as stitches.
A smaller group of the patients has no regular doctor, the urgent care operators said, for example a senior with Medicare coverage who can't find a physician accepting new Medicare patients, or a college student who has a doctor in their hometown and doesn't want to bother finding another in Eugene.
The recent proliferation of urgent care choices in Eugene-Springfield has propelled the market into a new era of health care competition. And it raises the question of whether the local market is big enough to sustain so many urgent care clinics.
"Everything has the possibility of changing over time," PeaceHealth spokesman Jim Godbold said. "It depends on what happens with national health care reform and the downturn in the economy, but I think the answer right now is yes."
Morley, an owner and the medical director of Eugene Urgent Care also answers in the affirmative.
"I think that there's room for everybody," he said.
Ritucci, the national urgent care official, said having four urgent care clinics to serve the combined Eugene-Springfield population of about 350,000 people is "very typical."
"In fact, you're a little bit behind the curve," he noted.
The general rule used to be that it took about 40,000 people to support an urgent care center, said Lou Ellen Horwitz, executive director of the Urgent Care Association of America.
But with the burgeoning number of urgent care clinics and the rise in visits per center, she said that number is probably smaller, depending on the patient mix and what other forms of care are available in an area.
Filling the void
For many years PeaceHealth Medical Group had the only urgent care in town.
When PeaceHealth built RiverBend, its new medical center in Springfield, it opened the urgent care at RiverBend, and closed its urgent care clinic downtown.
Morley and his Eugene Urgent Care associates, who formerly worked together at McKenzie-Willamette Medical Center's emergency department, saw the void and stepped in to fill it.
They opened their first center at 13th Avenue and Patterson Street near the UO in December 2008; a second at 1800 Coburg Road in Eugene followed in October 2009.
"We thought there was a good opportunity," Morley said. "We felt we were providing a good service that people were ready for and needed."
Eugene Urgent Care's owners declined to disclose whether their clinics are profitable.
"We're a new company still, and we've got a lot of overhead," Morley said.
To help defray those costs, especially because walk-in traffic fluctuates, Eugene Urgent Care is subleasing some of its space to companies offering other medical services, such as labs, physical and occupational therapy, and orthotics.
PeaceHealth officials didn't directly answer when asked whether their decision to reinstate urgent care services in Eugene was prompted by the emergence of a new competitor.
Morley, of Eugene Urgent Care, said he and his partners were surprised when PeaceHealth announced in September 2008, amidst shutting down its downtown Eugene urgent care clinic and opening the one at RiverBend, that it was seeking a site for an urgent care in west Eugene.
That center, located in the former Volunteers in Medicine clinic on West 11th, opened just this year on Jan. 15.
PeaceHealth spokeswoman Andrea Ash said the recession delayed plans to open this clinic earlier.
But the west Eugene urgent care clinic has been busy from Day 1, and "it just keeps getting busier," said Dr. Tom Ewing, PeaceHealth Medical Group medical director.
PeaceHealth's urgent care at RiverBend saw about 95 patients a day, he said. With the opening of the west Eugene clinic, the two clinics combined now see 120 to 125 patients a day, Ewing said.
The two Eugene Urgent Cares each see about 30 to 40 patients a day, Morley said. PeaceHealth's retail clinic in the south Eugene Market of Choice store, which also serves Market of Choice employees, sees an average of 10 patients a day, Ash said.