Annie McKinnon knows better than to walk around barefooted, even at home. She has diabetes and has to be careful of foot injuries, and you never know when you will have one of those freak accidents at home.
Like the one she had on a recent Thursday evening that brought her to the recently opened Patient First medical center in Colonial Heights to get her foot stitched up.
"It was pretty painful for a couple of seconds, then it went numb," McKinnon said.
The injury happened as she lost her balance and bent her toes back when trying to get up from the floor, where she was fixing her computer. To be safe, she got in her car and started for the hospital, calling a relative on the way.
The relative, who knew someone who had been to the Patient First since it opened May 4, suggested she go there. Her foot was throbbing by then.
At Patient First, she got in almost immediately to see Dr. Elizabeth Jenkins.
"I really like it," said McKinnon, her foot cleaned, stitched and bandaged, as she waited for a tetanus shot.
The new facility, at 2160 Temple Ave., is one of six new Patient First medical centers that have either opened or are planned to open this year by the Henrico County-based company.
By year's end, the company expects to operate 37 Patient First centers in three states — Virginia, Maryland and Pennsylvania. It opened its first Pennsylvania center in April.
Adding six centers in a year is an undertaking, said Dr. Richard P. "Pete" Sowers, Patient First's founder and chief executive officer.
"It's a big year," Sowers said from his office in the Innsbrook Corporate Center.
Of Patient First's recent growth, he said "it's more of a geometric progression, a certain percentage growth each year, and if you can do that, the numbers add up over time. There's no real magic to the number.
"We hope to be able to continue our expansion in a very structured and slow and deliberate fashion, as we've been doing for 30 years."
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Thirty years ago, Sowers opened his first urgent-care center, then called Commonwealth Emergicenter, near a 7-Eleven on Midlothian Turnpike and Buford Road in Chesterfield County.
The goal was to provide quick access to medical care at a convenient location.
It was a hot concept in the early 1980s. So-called "doc in a box" facilities proliferated in the Richmond area, opening under names such as MedFirst, Medical Access, Prompt Care Medical Center, Urgent Care Emergicenter and Health Care Treatment Center.
By 1987, the urgent-care market was thinning considerably, with many of the facilities closing or switching format to traditional primary-care medical practices.
By not straying far from a core mission and by standardizing operations, Patient First has outlasted some rivals and continues to attract customers such as McKinnon, who have a regular family doctor but sometimes need episodic urgent care when regular doctor's offices are closed.
For others, Patient First is their so-called medical home. Doctors' schedules are posted online, and patients can time their visits for when their preferred doctors are on duty.
"The only two things we've really changed is when insurance companies wanted us to do primary care, we added that," Sowers said. "That was 20 years or so ago. Then we added dispensing prescriptions on site. We added that over 20 years ago. Those are the only real changes in the services we offer."
There is very little advertising beyond promoting a new center's grand opening, Sowers said. Word of mouth from satisfied customers, such as what happened with McKinnon, drives much of the patient traffic, he said.
"They all operate exactly the same way," said Sowers, explaining the consistency across the Patient First centers. "They have the same hours, the same staffing.
"When the center is new, we have a smaller staff. When it gets bigger, we add accordingly," he said.
There are no appointments. Centers are open 8 a.m. to 10 p.m., 365 days a year.
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Sowers, an emergency-medicine doctor, was well-acquainted with the patient market when he opened the first urgent-care center in 1981.
He saw firsthand that not all emergencies were life-threatening, but sometimes patients didn't have any other options on nights or weekends.
Sprains, minor burns, cuts and many other maladies could be treated as urgent care at a lower cost than in a hospital emergency room, where heart attacks, gun shots and other serious conditions get first attention from emergency-room staff. That can make for long waits.
Urgent care was not a novel idea, Sowers said, identifying a physician in Rhode Island as a pioneer.
Nationally, the number of urgent-care centers is again growing, said Lou Ellen Horwitz, executive director of the Urgent Care Association of America, based in Illinois.
At last count, there were about 8,500 urgent-care centers in the United States, according to the association. That number does not include retail clinics inside stores such as CVS and Walmart.
"It has been growing steadily by about 300 centers a year," Horwitz said. "We are watching existing centers add locations. There is a lot of growth that way."
Also new is the first urgent-care franchise — Doctors Express, Horwitz said. Since 2010, Doctors Express has opened dozens of locations across the country, including centers in Alexandria and Woodbridge and one planned for Roanoke.
Baby boomers are one group fueling the increased demand for urgent-care centers, according to a 2007 report prepared for the California Health Foundation.
But health care is expected to create millions of newly insured people who will need places to get care.
"The anticipation is that urgent-care centers are going to become a lot busier because they don't require an appointment. They're extremely easy access," Horwitz said. "So for patients having a hard time finding a primary-care physician, urgent care is expected to pick up a significant amount of that volume."
* * * * *
Insurance companies like urgent-care centers because the care costs less.
Anthem Blue Cross Blue Shield in Virginia, for instance, launched a campaign in July 2010 urging plan members to consider urgent-care centers and clinics inside stores for problems that could be handled outside of emergency rooms.
That was somewhat in response to aggressive hospital marketing of no-wait emergency-room visits, and of late, even broadcasting emergency department wait time on billboards, in tweets and on blogs.
Hospital emergency departments may stand to lose some patients to urgent-care centers. The 2007 report cautions that patient mix at safety-net hospitals could be affected if they lose insured patients to urgent-care centers, leaving the uninsured patient to emergency-room care.
* * * * *
Patient First medical centers tend to be along busy thoroughfares, and the buildings' signature bright green roofs make them easy to spot.
The Colonial Heights center is within a short drive of the Fort Lee Army post and Virginia State University, both with populations that may be away from their usual sources of medical care. Patient First is a network provider for the Tricare military insurance plan and for most major health plans.
On the Thursday evening McKinnon was there, the center got busier as the day wore on.
Aaron Carpenter, 23, of Colonial Heights, said he waited only about two minutes before being called back to a treatment room. He had hurt his neck. He has a regular doctor he goes to, but he liked the convenience of not having to make an appointment. He was able to register electronically.
Since 1981, Patient First has used electronic medical records, Sowers said.
"I got X-rays and (the doctor) talked to me right after," Carpenter said. He left with muscle relaxants and advice to take it easy, as in no lifting weights, for a few days.
"I'm glad they put one in Colonial Heights," he said. "I don't have to go to Chester anymore."
Timeline
1981: Dr. Richard P. "Pete" Sowers opens an urgent-care center at 8100 Midlothian Turnpike in Chesterfield County. The practice is called Commonwealth Emergicenter. Sowers had been an emergency doctor at Petersburg General Hospital.
1987: Second urgent-care center opens on Parham Road. Name is changed to Patient First.
1988-1997: Ten centers open (five in the Richmond area, four in Hampton Roads and one in Maryland).
1998: Five additional centers open (three in Maryland and two in Hampton Roads).
1999: Centers open in Mechanicsville and in Owings Mills, Md.
2006: Center opens in Newport News
2007: Center opens in Maryland, on the campus of Johns Hopkins Bayview Medical Center.
2008: Four centers open (three in Maryland and one in Hampton Roads).
2009: Waldorf, Md. center opens.
2010: Four centers open in Northern Virginia; one opens in Aberdeen, Md.
2011: Opens its first centers in Pennsylvania (East York and Colonial Park). Center opens in Colonial Heights.
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