Is the ER Your Next PCP?

Millennials and Gen Z Think So.

OK. To be fair Millennials and Gen Z think just about everything (emergency rooms, urgent care, telemedicine, apps,...) is preferable to the current Primary Care Physician-as-gatekeeper healthcare model.

According to two recent studies, a quarter of Millennials and Gen Z view the emergency room (ER) as their primary care physician (PCP), e.g. not just for urgent needs. And nope, these are not uninsured young people. In a Kelton Global/ZocDoc study that included people from Boomers to Gen Z, 90% had health insurance and majority had a PCP. If it’s not about insurance, then what’s driving this? Two factors: (1) on-demand culture and, ironically, (2) having insurance.

We live in a world where Amazon—basically a logistics technology company that delivers everything from snacks to pre-fab houses—is king. Want a ride, a meal, a massage, weed, or a last-minute flight? There’s an app for that—and an expectation. It’s this on-demand delivery of retail, home, travel and other services that has created the expectation that's being met by the ER. 

In this context, and when compared to PCPs, ERs are efficient and comprehensive due the full diagnostic power of the hospital (ER physicians, specialists, nurses, rigorous testing due to limited information about patients) and their ability to prioritize based on acuteness of illness/injury versus appointment/arrival time. 

By contrast, PCPs are overbooked, have long wait times (average 24 days for new patients), and often must refer patients to specialists (average wait 13-45 days, depending on specialty and location). This, and the fact that younger gens move more often, commute long hours, and prize convenience above all, has also affected preference of ERs and telemedicine options over PCPs (47% of both gens prefer ERs, and 71% of millennials and 69% of Gen Z with a PCP would still go to the ER if they couldn’t get an appointment quickly enough).

Of course, the ER is not a perfect solution. Wait times can be long (1.33 in North Dakota hours to 3.55 hours in D.C., if patient is not admitted), and it can be expensive…which brings us to factor #2. 

Insurance. Participants in the Kelton Global study were largely insured and had a PCP. Also glaring in this and a WD Partners’ study (showed younger gens prefer urgent care over PCPs), was that the majority does not understand the cost. Likely because most have insurance and/or PCP prices are not transparent. One giant bill sent home and preferences might change. But, they still might not swing back toward PCPs (selected largely because they're covered by insurance), given the proliferation of convenient, PCP-like options with transparent pricing--digital health apps (325,000), subscription or concierge medicine (12,000 physicians), urgent cares (8,100), retail clinics (2,800+), telemedicine, Amazon again--that some of these options are covered by insurance, and that healthcare systems are incredibly slow to change.

How are/will you innovate the PCP model? How can we create a more cost effective ER model?