this is more of a rant/discussion than anything. I’ve worked as an urgent care EMT during the summers of ‘23, ‘24, ‘25 and the entire year through ‘26. I work for a somewhat large company that owns many clinics under the same name throughout MA. I work at around 5 of these clinics. A lot has changed, none of it for the better. In fact, this corporatized healthcare model is harming patients. In ‘24 we were short staffed, I worked around 80 hours per week, struggling to serve patients that needed care. This year, we got a new CEO. I’m back to my normal hours but our clinic practices are unethical, and I am slowly being driven out because the practices are so unfair to patients. First, reservation systems. Why should a sick, bleeding, or afraid patient sit in the waiting room as a walk-in while a drug screen who made an appointment walks right in? I can only imagine how these walk-in patients feel when non-urgent occ med or administrative health bullshit gets brought back cuz they KNEW how to make a reservation or simply WERENT URGENT. Urgent cases can’t afford to sit back and wait for their reservation at 7:20 pm. From what I’ve seen, the walk-ins are far more urgent, and are completely disregarded by this insane system. How is this just? It clearly disadvantages those who are unaware of the system, don’t have access to technology, aren’t technologically competent, and those who actually need care urgently. I’ve begun to completely ignore the reservation system if there are more urgent people sitting out there, and when I do, entitled patients who don’t need to be seen urgently feel the need to scream because they made “an appointment.” If you want to make an appointment, go to your primary care (all of the patients who make reservations seemingly have a PCP, all the walk-ins seemingly don’t, big surprise right). One time I got disowned from my manager for taking back a walk-in with chest pain who had been out there for 1.5 hrs over a patient who needed an ear lavage who made an appointment. Turned out after I took him back and got his EKG, he had global ST-depression and coded in the ambulance. If he continued to sit out there, he would have coded in the waiting room.
This brings me to my second issue. If the state of healthcare is the way it is right now, where people can’t afford ER co-pays or wait times, then we have to adapt to this. We are simply ill prepared and ill equipped to care for those who come in. I recently had a patient stumble into our “emergency” exam room coughing up blood. He coded as soon as he got on the bed. We had pads on him in seconds but he was asystolic. 12 minutes of CPR. One of my providers was on top of him because the room is so small and he couldn’t get on the other side of the stretcher as it is right next to the wall. The suction device didn’t have the right tubing. We had 2 people holding it in place. We did everything we could, and our team did a fantastic job with the situation we were dealt, but this is unacceptable. If these cases are gonna show up, we can’t control it, we have to be prepared. There is no reason that stretcher should be against the a wall, we could all barely fit in that room. The suction should not have had the wrong tubing. Luckily I was with a skilled team who had emergency training, but I am often with teams of old nurses who only have primary care experience, and run away when they have a hard stick. They would be so unprepared to handle that, and I pray every day I’m with them that something like that doesn’t come in. We need skilled staff, adequate training, proper resources, and we simply don’t have that. This will continue happening, and I thank the lord that when it did we had the perfect team with plenty of ED experience to handle it. It also brings up an ethical dilemma. When emergent cases come in and we bring them back, we tell them to go to the ER and if they consent, call EMS for them. Still, there are many cases that should be seen in the ER but are required to be brought back to be seen in triage, only to be sent out. My issue with this is that we are stealing from them. If we sent them to the ER as soon as they showed up to our MRs, they wouldn’t be billed. But as soon as they are brought back, they have to be billed, even if they get sent away in triage. I understand that it would be a liability issue if we sent an emergent away at the front desk and they coded or crashed on their way to the ER, but my issue is that the company refuses to let us cancel the visits of those who we send to the ER, even when they aren’t evaluated by a provider. Thus, they are getting billed for me taking their vitals, assessing them, and telling them they need to the ER + risks and benefits of doing so/not doing so. It’s thievery.
This is getting long, but the last thing I’ll end with is the occmed, admin stuff like drug tests, DOT physicals, etc. There is NO REASON THIS SHOULD BE IN URGENT CARE. It takes so much time away from staff who should be seeing patients who actually need care. It’s a cash grab, and it drives me absolutely insane.
I completely understand that I work for a private company, and I signed up for this. I understand they have the power to tell me how to do my job. But I also signed up to care for people when they need it, and I have an ethical code that I simply have to abide by, and the company forces me to go against it. I’m tired of decisions about how we care for our patients being made by executives, managers, and administration who have never laid eyes on a patient in their lives. I’m attending medical school starting in July, and I hope in the future I can advocate for some positive change through research and policy, but the changes that I’m seeing now after having worked here for a while is distressing to say the least. It is what it is, yes, but it doesn’t need to be. I was wondering if anyone had any thoughts!
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