Dr. James Gore, an old friend and an urgent care pioneer, shared those words of wisdom with me during a recent conversation. We were discussing the current state of health care and the challenges we face in urgent care with the rabid market activity we are seeing. We chatted a bit about the new faces and the outside interests entering the industry, and we laughed about all the mistakes being made by people looking for a quick buck. Those of us who have been in the business long enough know how much time and attention urgent care practices require in order to function properly and effectively meet the sometimes fickle needs of our patients. We know how complex and layered this business is. We know how regional and local the dynamics are. And we have the scars to show that we have learned from our mistakes and survived against the odds.
Yet it seems like many think that the urgent care model can be deconstructed into its individual parts, and that these can be mass-produced at scale and still achieve the same results. The flaw in this approach is that its success requires rapid growth and taking advantage of efficiencies. The problem with that is the lost opportunity to learn and pivot, one step at a time. There are no shortcuts to experience, and experience is the ultimate determinant of success for any business with a complex model with thin margins.
In response to this problem, I have seen large operators take two approaches: the “smarter than thou” approach and the “talent acquisition” approach. In the first approach, investors with strong track records in operating other businesses apply methods from those businesses to scale up an urgent care company. The risk is that they grow the company too fast and make too many assumptions, tantalized by their success with other business models. Many will end up putting on the brakes and reorganizing the business in response to underperformance. Ultimately, these investors have to slow down and learn the business just like the rest of us.
In the “talent acquisition” approach, a skilled and charismatic operator (usually a physician) who has successfully built a regional network of 2 to 10 centers is hired to be the operative and leadership model for scaling up. The problem here is twofold: First, the transaction has made the seller financially comfortable and unmotivated. When your entire life savings is no longer at stake, it is human nature to slow down a bit. Second, what works for 2 to 10 centers is often not a good template for scale. A charismatic leader depends on personal interaction to influence others. Once that influence is diluted, this approach becomes much less effective. Unfortunately, for many it’s the only leadership tool they have developed. Entrepreneurs can be quite ineffective in an organizational structure where communication and management require discipline, patience, and collaboration.
This brings me back to the opening quote: “People don’t care how much you know until they know how much you care.” I can’t help but think that Dr. Gore has succinctly and eloquently summed up the secret sauce for success in urgent care. Big or small, independent or integrated, investor-owned or entrepreneurial venture, urgent care centers all have to answer to the same customer. And the core driver of consumer behavior in health care, more than any other variable, is whether the patient feels cared for. In fact, every other layer of this business is a commodity except for the care experience. You can find revenue-cycle expertise and financial and real estate know how. Health-care operators and managers are ubiquitous, and the supply chain is full of options. But although all of these are critical functions, none of them matter to the patient. Unless you are focused relentlessly on the who and how of the care experience, you will not have sustained success in this competitive environment. Discovering how to deliver this experience, the elements that contribute to it, and the talent profiles of the people who execute it is the key to solving the urgent care riddle, regardless of how much you know.
Lee A. Resnick, MD, FAAFP
Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine
