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Doctor runs clinics with surgical precision

Dr. Stephen Dickey got started in the convenient urgent care business in 1980 after being ER director at St. Joseph’s Hospital in Tampa. He recently sold his eight Doctor’s Walk-In Clinics to a West Virginia chain.

MICHAEL C WEIMAR | Times

Dr. Stephen Dickey got started in the convenient urgent care business in 1980 after being ER director at St. Joseph’s Hospital in Tampa. He recently sold his eight Doctor’s Walk-In Clinics to a West Virginia chain.

In 1980, Dr. Stephen Dickey did something about all those patients jamming hospital emergency rooms where they ran up big bills for minor treatments. He quit as ER director at St. Joseph's Hospital in Tampa to set up his own Doctor's Walk-In Clinic across the street, where he offered minimal waits to treat minor ailments at a fraction of the cost seven days a week. Last week he sold his eight clinics that generate $16-million in billings to MedExpress, a bigger chain backed by a private-equity fund. He remains in charge locally with a stake in the parent that he hopes will nearly double the network here to 15 locations in five years.

How quickly did patients warm up to your brand of convenient urgent care?

The first day we had only two patients. But after we got on the TV news, we had 27 in two hours. It took off after that.

Insurance companies now encourage patients to opt for less expensive clinics like yours. They also cover drug, grocery and discount stores that flocked to put mini clinics staffed by nurse practitioners (with a doctor a phone call away) in stores. You use a team of medical assistants, registered nurses and onsite doctors trained for emergency room work. How do you assess the mini clinics that charge about half the $99 a visit you do?

We've lost some of the easier cases to them, but we get a lot of referrals for treatment they cannot handle. We have a lab and X-ray on site. We aren't trying to sell prescriptions. So we will routinely prescribe the six most popular antibiotics, which Publix offers free, rather than a new one at $150. Mini clinics don't have the space. There's only one nurse practitioner to do it all, so they can't see more than a couple patients an hour. I don't see them proliferating.

You sold Doctor's Walk-In in 2002, then bought it back in 2006 to restore profitability. What happened?

Wall Street figured doctors were lousy businesspeople and they could provide management know-how to scrape off the inefficiencies. The people I sold to resold to another chain with 500 clinics. The bottom fell out, and they learned the doctors they paid a premium to buy out were pretty efficient after all. Now everybody is building chains again. I chose MedExpress because their model is close to mine. It's run by ER doctors in a culture of quality care.

How do you make urgent care seem more convenient?

We're opening clinics with a third more capacity and still get the average patient in and out in an hour. We build for peak times so our waiting room looks half-empty most of the time. It's like restaurants: people will leave if they can't find a parking space or must wait for a table. We're shifting to leased space in shopping centers — preferably near malls.

You are among the first walk-in clinics to digitize patient records. How did the switch from handwritten charts go?

It was our biggest undertaking in 28 years. We spent $300,000 adapting software and use screen prompts to lead physicians through diagnosis. We trained everybody, even a few doctors in their late 50s who didn't know what a computer mouse is. Some could not adjust and still see five patients an hour. So we parted company.

Any memorable case?

We had a carpenter who worked with a power hammer come in with a headache. Our X-ray showed a huge nail in his skull that somehow missed hitting everything vital. We stabilized him and got him to Tampa General. He survived. But most of our work is episodic: respiratory and urinary tract infections, bronchitis, the flu. A broken arm is a big day. A third of our business is pre-employment physicals, workers' comp and drug screening. Today, most patients have insurance.

You accept Medicare, but not state Medicaid. Why not?

Reimbursement is too low and takes too long to get.

Mark Albright can be reached at albright@sptimes.com or (727) 893-8252.

Doctor runs clinics with surgical precision 01/04/09 [Last modified: Monday, January 5, 2009 4:24pm]
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