R.P. Sowers invited the cream of Richmond’s medical community to that first open house. It was 1981, the night before the doors would open at his urgent-care clinic on the outskirts of town, just beyond the site of a former drive-in movie theater and near a 7-Eleven.
Sowers had quit his job as an emergency room doctor at a Richmond hospital and struck out on his own with a concept that in those days was considered crazy: a walk-in clinic offering convenient care for minor health problems.
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“All the big guys in town came out, and they were all saying, ‘This will never work,’ ’’ said Sowers, Patient First’s founder and chief executive. “Frankly, I worried about that myself.
“It was more of a novelty to a lot of people at the time.’’
But Sowers’s vision of storefront medical care, open late nights and weekends, has become a part of a sector almost as ubiquitous as fast-food chains.
The idea, once dismissed as “doc-in-a-box,’’ is now an integral part of the regional health system in the Washington area.
Richard P. “Pete” Sowers III, a former emergency physician, founded Patient First in 1981. (Rosem Morton/FOR THE WASHINGTON POST) Doctors may have turned up their noses in those early days, but amid rising health-care costs and an uninsured rate that’s ticking back up, consumers are voting with their feet.
The concept Sowers planted on a patch of land on the outskirts of Richmond has burgeoned into a chain of 74 Patient First medical centers spread along the Mid-Atlantic region, making it among the top 10 largest urgent-care chains in the United States.
Patient First’s distinctive green roofs and cookie-cutter designs sprout from shopping plaza parking lots from Pennsylvania to Virginia. Although none are within the District, 19 of the centers are sprinkled throughout the area, from Rockville, Md., to Waldorf, Md., to Fredericksburg, Va. The newest facility opened in December in Falls Church, Va. Five more are planned in communities including Largo, Md., and Dale City, Va.
In an industry known for high burnout and turnover, many members of Patient First’s clinical staff have longevity — the firm has a few hundred people with more than 20 years there. And that, company officials say, has been a key to its success.
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Like other Top Workplaces employers, Patient First has found ways to keep its personnel happy. The company has generous benefits plus a lower-stress environment that’s more akin to a family doctor’s office than an emergency room.
“Patient First provides a safe, encouraging environment to be a nurse,” said one employee in the survey. “I feel supported, encouraged and valued every day. I have multiple, accessible resources to utilize as needed. My current position has provided me with an incredible team, room for growth, and invaluable experience with providing patient care via telehealth/phone triage.”
Care on demand
Sowers, who goes by “Pete,’’ is 75. In a sport jacket and tie, he maintains the bearing of a clinician and easily mingled among the white-coated doctors, physician assistants and nurses in the teeming medical center on Midlothian Turnpike. It was a Monday morning and the waiting room was about two-thirds full, mostly with adults.
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The center hummed as providers shuttled between patients who waited in curtained cubicles arrayed on the perimeter of a large, brightly lit room. The caregivers communicated freely and entered patient data on centrally located computers. The center has an X-ray, a lab and a pharmacy.
One patient, Leroy Rainney, 69, a retired Phillip Morris worker, wandered back from the waiting room to greet the doctors. He said he has been treated at Patient First since it opened 38 years ago.
“To be honest, I believe Patient First has treated my whole family,” he said. “It’s better than going to the emergency room. I stay away from emergency rooms.”
Indeed, Sowers posed a competitive threat to family doctors, not just with his promise of convenient, episodic care, but also because he later offered patients primary care: His clinics could be their medical home, not just a place for a quick strep test or a weekend X-ray.
Making Patient First’s storefront centers the medical home base for patients was a prescient twist on urgent care and helped embed his centers into the regional health-care economy. Now more centers are offering those deeper primary-care relationships for patients, as insurance networks hunt for lower-cost settings for care, specialists say.
Millennials in particular see no reason they should have to wait for medical appointments and want medical care on demand — but they also want a steady medical relationship, said Tom Charland, chief executive of Merchant Medicine, an urgent-care consulting firm.
“Patient First figured it out way before anybody else,’’ said Charland, a former executive at Minute Clinic.
“There are certain physicians in the urgent-care market who were great clinicians but also great visionaries and strategists and attuned to what consumers were wanting — which is not typical,’’ he said.
The Urgent Care Association, the industry trade group, estimates there were 8,744 urgent-care centers in the United States as of November 2018, up 8 percent from 2017. Lower costs are a driver of interest from insurance companies. UnitedHealth Group said in a report this year that the average cost at free-standing emergency departments in Texas ($3,217) was 19 times more expensive than urgent-care centers ($167).
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UnitedHealth also happens to own the largest urgent-care chain, MedExpress Urgent Care, which has 250 clinics in 22 states.
Hospitals increasingly are affiliating with urgent-care centers or launching their own. In Massachusetts, for instance, the number of centers and retail clinics shot from 20 to 150 in the past eight years, with a third of them affiliated with hospitals.
Also CVS, seeking a bigger slice of the market, recently merged with Aetna to expand its in-store clinic model.
Acquisitions are common, and Patient First, with a host of strong locations and brand identity, is seen as an especially juicy target in the Mid-Atlantic. But Sowers said he does not even entertain offers to sell to a larger chain.
Although he is working well beyond retirement age already, Sowers demurs when asked about his plan for succession at his company. He indicated he plans to be around well into the future: “I’m taking vitamins.’’
‘Family atmosphere’
Sowers has kept his company tightly private. The company says it employs 4,000 people, about 600 of whom work in administration.
Being a closely held, long-standing operation also provides Patient First with another major advantage over some other chains that are exploding in size: employee retention.
“What you are trying to do is deliver very high-quality medicine fast, and to do that safely you need to have a high-performing team, and high-performing teams are really dependent on retentions,’’ Charland said.
“The more privately held operators do a better job in building culture,’’ he said, while some of the largest national and hospital-owned urgent-care chains are “struggling’’ with high turnover.
As is the case across medical jobs, the potential for burnout among doctors, physician assistants and nurses is high in urgent care: Providers at urgent-care clinics can see six to eight patients per hour, according to industry statistics. Surveys consistently say emergency room doctors — who see high-intensity trauma cases and work brutal hours, including overnight shifts — have the highest levels of burnout among all physicians. Some switch to urgent care, looking for a respite.
But the vibe at urgent-care centers can vary widely, depending on leadership.
Nancy Diaz Delgado checks signs for patients waiting to be seen at Patient First in Richmond. She has been working there for two years. (Rosem Morton/FOR THE WASHINGTON POST) “Urgent care providers in particular — working in fast-paced practice environments that strive to maximize efficiency, emphasize patient throughput, and deliver speedy and efficient ambulatory care, on demand — find themselves at greater risk for burnout than ever before,” the Journal of Urgent Care Medicine wrote in 2017.
To retain staff, Patient First offers competitive benefits, including perks such as tuition reimbursement. Clinical staff are eligible for recruitment bonuses, repeat patient bonuses, patient volume bonuses and weekend bonuses.
But employees said the positives of working there go beyond benefits. Loyal employees are rewarded with top jobs.
Sowers would not release patient visit data, so it was impossible to judge patient throughput. The company also said it does not have a rule of thumb for how long a patient should wait before seeing a provider.
“Our people know what they are doing and are generally pleasant, which helps create a positive work environment,” Sowers said.
Sowers and his management team said they value the opinions and input of their staffs, who are focused on creating an overall positive experience for each patient, not just grinding through the cases. Sowers said his method has been to train his teams to continually practice the “basic blocking and tackling, staying on point for a long period of time.”
And he said he cares about the people who work in his centers.
“We have a sort of family atmosphere,” he said. “We have a certain element of protective feelings for our people.”
The company recently invited hundreds of employees to a theater in Richmond to celebrate the workforce. Seventy-eight people at the event were celebrating their 20th, 25th or 30th year with Patient First. The company has 228 people with more than 20 years longevity.
A novel concept
Sowers’s path from emergency room doctor to entrepreneur started in the late 1970s with a simple realization.
“I knew how long people were waiting in the emergency room,’’ he said. “You were making them wait unnecessarily.’’
Sowers visited a stand-alone emergency center in Warwick, R.I., and came back convinced he could make something similar work in Richmond. His colleagues in the medical field, he said, were “incredulous.’’ But it struck Sowers as absurd that hospital emergency rooms filled with cut fingers, sprains and sore throats on nights and weekends. He determined that Patient First would be open late in the evenings, and seven days a week.
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To build his first center, he chose a site on a freshly developing area on the opposite side of the James River from downtown Richmond. He also started his own computer medical records system, another novelty for the time. And he staffed it with about 20 medical professionals who were interested in building something new.
Eleanor Robertson met Sowers at a Halloween Party in 1980. Sowers went as “John Revolta’’ and Robertson was an alien, but more importantly, a nurse looking for a new gig.
The location “was nothing but a flat ground of dirt,’’ she said. “We talked about his vision and what he wanted to do. The concept was so fascinating. It was new to Richmond, and I thought this was really exciting,’’ she said.
Robertson is now the company’s vice president for human resources. Convenience and speed are crucial goals, just as they were at the beginning, she said.
Sowers cultivates that same culture for staff. Where else would you see the chief executive walk into a clinic to say hello on Sundays?
“Dr. Sowers usually comes in after church,’’ said Stephanie Bennett, a registered nurse who supervises non-physician staff at the Midlothian Turnpike location.
In his 36 years at the company, Dr. Scott Greenfield said he’s seen a dramatic shift in the once-negative perceptions of urgent-care centers, thanks largely to Sowers.
“When I first started, we were looked down upon. It was an unknown type of thing,’’ the doctor Greenfield said. “Once you’ve been around for a while, you get a reputation in the community, and our reputation has become very good. The proof is in the pudding.’’
Christopher Rowland covers the business of health care for The Post. He can be reached at christopher.rowland@washpost.com.
Editing by V. Dion Haynes. Design by Audrey Valbuena.