In recent years, the landscape of health care has evolved, with many urgent care clinics popping up and filling a gap between traditional doctor-led primary care and conventional emergency room care.
These three types of care settings have some overlap, so knowing which type to visit isn’t always cut-and-dried, especially when you may be injured or feeling lousy.
What’s key to determining the right health care provider, says Dr. Douglas Kupas, an emergency physician at Geisinger in Danville, Pennsylvania, is “the type of injury or illness that you have, its severity and whether it fits with the resources at the site.”
In this guide, we dive into more detail about the differences between primary care, emergency care and urgent care and how to choose the right one for your situation.
When to Visit Your Primary Care Physician
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Scenario: You’ve been under the weather for a few days with a cough, sore throat, runny nose and a low-grade fever. Allergy medicine didn’t help, and neither did over-the-counter cold medicine. You don’t seem to be getting better, and now when you lie down, your ear hurts. It’s time to visit your doctor to find out what’s going on.
For most non-urgent situations, like the scenario above, or routine care, such as annual physicals or wellness checks, your primary care physician is the best option.
“It’s like going to the auto shop to get oil and filter changes,” explains Dr. Jay Ladde, senior associate program director and professor of emergency medicine at Orlando Health in Florida.
This kind of care can also include:
— Lab tests
— Treatment for some acute conditions, such as coughs and cold, ear infections and minor injuries
— Treatment for chronic conditions, such as diabetes and high blood pressure, that require regular follow-up appointments
— Preventive health care services, such as mammograms, colonoscopies and vaccines
— Women’s health services, such as pelvic exams, pap smears and other gynecological support
Your doctor can also handle some acute and urgent issues, such as fevers and minor pains. They can refer you to a specialist, such as a cardiologist or an orthopedic surgeon, if you need more condition-specific care.
“Any complaint that is not an emergency can and should be assessed at your primary care doctor’s office if possible,” notes Dr. William Adelman, a pediatrician and medical director of the Children’s Hospital of Orange County Primary Care Network in California. Primary care works best when you build a long-term relationship with a particular provider who can see your whole health picture. However, your primary care physician isn’t on call 24/7, so when you need care in the middle of the night or on a weekend, you may need to seek urgent or emergency care instead.
[READ: 8 Ways to Get Care When There Are No Primary Care Doctors]
When to Visit the Emergency Department
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Scenario: It’s 2 a.m., and you wake up with a stabbing pain in the abdomen. You’re feeling nauseated, you’ve vomited once and you have a slight fever that seems to be creeping up. It’s definitely time to head to the emergency room.
The emergency department or emergency room is “equipped and staffed for the most complex or critical needs, including situations that may threaten life, limb or eyesight,” Adelman says.
He offers a helpful mnemonic — ABCD — for determining when to visit the ER. That refers to conditions that affect:
— Airway
— Breathing
— Circulation
— Disability (neurological)
These conditions could include severe asthma attacks, allergic reactions or heart and blood pressure issues, for example.
More specific reasons to visit the ER include:
— Chest pain or heart attack
— Difficulty breathing or cessation of breathing
— Severe abdominal pain (like the scenario above) and appendicitis
— Major trauma or injury, like what you might experience during a car crash
— Head injuries or loss of consciousness and fainting
— Severe neck or spine injuries, especially if they produce tingling or numbness in the limbs
— Suicide attempts
— Seizures
— Uncontrolled bleeding and large wounds that require stitches
— High fever
— Fast or irregular heart rate
— Difficulty walking, speaking or moving
— Vaginal bleeding during pregnancy
— Mental health crisis
— Possible signs of stroke, such as slurred speech, confusion and weakness or numbness on one side of the body
— Sudden vision problem, such as double vision or blindness
— Severe dizziness
— Severe burns that have blistered
— Suspected poisoning
— Broken bones (an urgent care center may be able to take X-rays, but you may need to seek additional care at an ER)
Most emergency departments are attached to a hospital and can admit you directly if you need surgery or other critical intervention. Because of this proximity to more advanced care, the ER is typically able to handle just about any medical problem a person has.
“Emergency care is meant for true medical emergencies that would require hospitalization or surgery,” says Dr. Tania Elliott, dual board-certified internal medicine and allergy/immunology physician and digital health influencer.
If you’re uncertain, it’s best to err on the side of caution and visit the emergency department.
[READ 7 Signs You Should Be Readmitted to the Hospital]
What to expect at the ER
If you do head to the ER, you should be prepared to wait because many ERs see a large volume of patients. If you don’t have a life-or-death condition, you may have to wait for a provider to finish with a more severe patient before they can treat you. That’s because the ER triages patients based on acuity, while urgent care centers typically use a first-come-first-served approach (more on that below).
“Mondays are traditionally the busiest days in any ED in the country,” Ladde says. “If you have a problem on Saturday, it’s best to go on Saturday.”
Mornings also tend to be less busy.
[Ranking the Most Painful Medical Conditions]
When to Go to an Urgent Care Center
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Scenario: It’s 4 p.m. on a Saturday. You’ve just slid into second base at your baseball game but landed on your arm. It’s swollen and painful, but it doesn’t appear to be broken. Still, you’d feel better having a health care professional check it out.
If your concern isn’t emergent but needs attention sooner than your PCP is available, an urgent care center, also sometimes called a walk-in clinic or retail health clinic, can fill that gap.
“Urgent care is meant for nonemergency conditions and ‘one-and-done’ types of visits that don’t really require major follow-up,” Elliott says.
Examples of specific problems urgent care centers are well suited to handle include:
— Insect bites and stings
— Minor allergic reactions
— Sprains and strains
— Coughs and colds
— Flu symptoms, sore throat and earaches
— Minor eye infections, such as pinkeye
— Minor wound care and stitches
— Minor burns that haven’t blistered
— Fever that does not include a rash
— Vomiting and diarrhea
— Painful urination and urinary tract infections
If you’re in doubt, call your doctor for guidance on whether you should wait to see them or if you should visit an urgent care center.
Urgent care centers don’t typically have the same volume of patients as the local ER, so you may be able to see a provider faster there. If the problem is serious, though, you’ll likely end up in an ambulance on the way to the hospital.
Financial Considerations
Insurance is always a concern, and understanding what your financial responsibilities may be before heading to the ER, an urgent care facility or your primary care doctor is a factor worth considering.
Generally speaking, copays for visiting an ER are higher than those to visit an urgent care center or your primary care physician, but it depends on the specifics of your insurance plan. Ambulance rides can also be pricey and aren’t always covered by all insurance plans, so be sure you understand your coverage to avoid any financial surprises.
All that said, if you’re in dire need of medical attention, go to the ER. The Emergency Medical Treatment and Labor Act, enacted in 1986, ensures public access to emergency services and care in hospital emergency departments regardless of the patient’s ability to pay. You are entitled to appropriate medical screening to determine whether your condition is an emergency and to receive treatment until your condition has stabilized. If the hospital can’t treat your condition, you’re entitled to an appropriate transfer to another hospital.
Everyone in the U.S. is guaranteed these protections under EMTALA. That doesn’t mean you won’t be billed for the care you received afterward; it simply means that when you need emergency care, you should not delay — head immediately to the nearest ER.
Bottom Line
The types of services offered at a specific urgent care clinic can vary from location to location, and Ladde notes that some ERs are now offering some services for patients who need minor treatment, X-rays or basic labs.
Therefore, it’s not always easy to know which option is the best one. He recommends getting to know the facilities close to your home so that you know before a crisis hits where you should head first.
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Emergency Room, Urgent Care or Primary Care Physician? originally appeared on usnews.com
Update 05/10/24: This story was previously published at an earlier date and has been updated with new information.
