Doctors Express Wants To Be Where You Are
At his Doctors Express center in Towson, Md., Dr. Scott Burger has spent the last three years tending to the community's night-time fevers and weekend hurts.
Now, the former emergency room physician wants to take the center's model nationwide, doing for urgent health care what, say, Papa John's did for pizza - making sure the public can find it anywhere and always knows what it's going to get.
"In every community, at least one," Burger, 36, says of his ultimate goal, "so when people think of where they need to go for their health care needs, the first thing they think . . . is 'Where's the Doctors Express?'
At a time President Obama is pressing Congress to radically overhaul the nation's health care system with an eye to affordable insurance for everyone, Burger and his partners are trying to launch the nation's first urgent-care franchise, applying a model often associated with fast food and car repair to centers that would deliver affordable, non-emergency treatment to almost anyone who walks in.
They're hoping to open 3,000 centers around the country, at which members of the public can come in without an appointment, in the evening or on weekends when their own doctors' offices are closed, and get stitches, something for a sore throat or even a broken bone treated for a fraction of what they'd pay for a trip to an emergency room, and without the wait.
They say they'll differ from the roughly 8,000 other urgent-care centers, as well as smaller retail clinics that have sprung up in shopping centers in the last decade, by offering a consistent, broad range of treatment and service on the spot. Every Doctors Express will have a physician on duty at all times, unlike some centers that leave patient care to the supervision of a nurse practitioner or other professional. All will have digital X-ray equipment, a lab and a pharmacy to dispense drugs, which other urgent-care centers may not have.
And unlike most other centers, many Doctors Express franchises can be owned by corporate managers who don't have a medical background. The company says it will guide them in everything from what credentials to look for when hiring staff to how to pick the best location.
"It is novel since it's the first one," says Lou Ellen Horwitz, executive director of the Urgent Care Association of America. "We've seen a variety of different ways of setting up (urgent-care centers) and managing them on both a regional and a national level, just not this particular franchise model."
Burger is close to seeing whether his center, which has been open three years, can be replicated elsewhere and if his idea takes off.
The first franchise is scheduled to open July 30, in Temple, Texas. The private company says it has sold roughly two dozen more in Texas, Georgia, New Jersey, South Carolina, North Carolina, Colorado and Virginia, but there's no schedule yet for them to open, and they cannot be independently confirmed.
'Committed to this idea'
In the beginning, Burger says his dreams were more modest than delivering health care across the country.
As an emergency medicine resident in New York City during the late 1990s, Burger says he grew frustrated seeing the long waits endured by patients who came to the emergency room with less critical injuries or illnesses.
"People would come in with sore throats, lacerations, possible broken bones, and they had no other place to go," he recalls. "We wanted to take care of them, but we couldn't do it in an expeditious fashion. I felt there was a better way to do this."
He and his wife, Kathleen, scrimped and saved to open a single center that could tend to sprains, infections and myriad other aches and injuries that too often pop up when a primary care doctor's office is closed.
"We only recently purchased a home because we didn't commit any of our finances to anything other than this business," he says. "Financially, we put all our eggs in this basket because we were committed to this idea."
Burger also teamed with two partners, his former college roommate Tony Bonacuse and Peter Ross. Together, they co-founded Doctors Express in 2005, opening the Towson center a year later. Bonacuse serves as the company's president, and Ross is CEO. Burger is chief medical officer.
"There is no way I would've ventured out on my own, being an emergency room doctor without having the support of intelligent people with business sense," Burger says. "Our skill sets blended."
About two years ago, after Ross and Bonacuse found franchising success with a separate venture, an in-home medical assistance company called Senior Helpers, Burger began to see the potential in doing something similar with Doctors Express.
"The emergency room crisis and lack of primary-care physicians is not a problem isolated to New York City, where I used to work, or Maryland. This is a national problem," Burger says. "We felt it was something we wanted to bring across this country, and (franchising) has proven to be the most effective way to grow a brand in a quick fashion."
The Towson center is a test site of sorts. Burger figured out the best equipment and strategies to expedite patient care - such as taking X-rays next to the exam room - that could be replicated throughout the country.
"In about 35 minutes, we can see the patients, take the X-ray, diagnose the problem, splint the broken bone," Burger says. "It's about efficiencies."
Seeking 80 locations in Texas
As lawmakers, consumers and the health care industry debate how best to deliver affordable care to all Americans, Burger sees the urgent-care industry as one that's growing and profitable.
"We've yet to find a market where there are enough providers for the care that people need," he says, adding that the Towson center turned a profit in less than a year.
As at most urgent-care centers, Doctors Express patients without insurance will have to pay for services at the time they're given, Burger says. While prices will vary slightly from state to state, the average patient at the Towson center pays about $125.
In addition to treating walk-in patients, Doctors Express centers will conduct drug screens, do pre-employment physicals and give vaccinations.
Looking like a cross between a private doctor's office and a medical center, the facilities will have four to six rooms and an on-duty team consisting of a physician, an X-ray technician, a nurse or medical assistant and a receptionist.
Because they'll be open year-round,@ except major holidays, on weekends and until 8 p.m. during the week, there will be multiple doctors and other professionals on staff to rotate through the schedule. Burger has additional staff to meet that promise in Towson.
It costs roughly $500,000 to get a franchise up and running, and part of the sales pitch is that you don't have to be in the medical field to own one.
"We're looking to bring people that don't have medical experience into it, that may have been in Corporate America, who were downsized or who have always dreamed about being in their own business and want something very recession-resistant," says Doug Schadle, the company's head of franchise development, who says Doctors Express will also start targeting the physician community.
On a recent day at the Towson center, Burger - also known as "Dr. Scott" - examined a teen who slammed her finger in a car door and reassured a man who feared he might have swine flu. Burger says the franchise model will allow local owners to form a bond with the community.
"Although this is going to be a national company with centers all over the country, we still want the personal touch of individual people having ownership of their centers and personal relationships with the patients," he says.
Vicki Langan, 51, and her husband, Pat, are opening the first Doctors Express franchise in Temple, Texas.
Having worked in franchise development for other companies, most recently as senior vice president of operations for Curves, Langan says she thought Doctors Express had a solid plan and wanted to be part of its initial wave of franchisees.
"We wanted something that would give back to the community," says Langan, who left Curves in October. "We didn't want retail or fast food," she says. "We wanted a service industry to be involved with. And right now, with the health care crisis going on, this was a great way to provide affordable health care to people."
She and her husband are master franchisees, paying $250,000 for the rights to develop Doctors Express centers throughout Southwest and Central Texas. Langan anticipates that the area can support nearly 80 locations.
"I think there's a huge need," she says. "My projections show I need about 28 patients a day to break even, and I anticipate we hit that in the first month."
A need for primary care
Some medical experts agree that urgent-care centers fill a void.
"To the extent that patients have access to places where they can have their immediate needs met outside a hospital, that can be a positive," says Caroline Steinberg, vice president for trends analysis for the American Hospital Association.
While some hospitals own urgent-care centers or have urgent-care tracks within their emergency departments, Steinberg says hospitals increasingly see primary care as a bigger community need.
"More often than not, people are understanding that the problem is not lack of access to urgent care, it's lack of access to primary care," she says, "They're saying, 'Let's put a clinic in school so those kids with asthma never need urgent care.' "
An increase in the number of urgent-care centers won't necessarily ease the crowding in emergency rooms by siphoning off less critical cases, medical experts say.
Only 12.1% of emergency room visits in 2006, the most recent year available, were considered non-urgent, meaning the patients needed to be seen within two to 24 hours of arrival, according to the National Center for Health Statistics.
Medical professionals caution that the public needs to understand when an urgent-care center won't do. A person suffering chest pain, symptoms of a stroke, or any kind of life-threatening trauma needs to head to an emergency room, says Dr. Angela Gardner, president-elect of the American College of Emergency Physicians.
Yet Gardner says an urgent-care franchise could be positive, providing a consistency of service that is currently missing.
"It's an interesting idea," Gardner, who is also an assistant professor at the University of Texas-Southwestern, says of Doctors Express. "I look forward to seeing how they perform."