Doctor Visits and Affordable Healthcare

There have been ups and downs during his long health care career, but Dr. Bruce Irwin is exactly where he wants to be right now.

Irwin, 63, is the founder and chief executive officer of Birmingham-based American Family Care, the nation’s largest chain of urgent care medical facilities. Given the growing shortage of primary care physicians, along with the pending increase in the number of Americans insured through the Affordable Care Act, Irwin sees nothing but growth ahead.

“With or without Obamacare, we have a perfect storm brewing in this country and have had it for some time, ” Irwin says. “There has been no emphasis on the training of primary care physicians for probably 25 years. The United States hasn’t built a strong healthcare provider base the way it should have, especially with primary care doctors.

“But we’ve been ramping up for this for years at American Family Care, and we’re ready for it, ” Irwin says. “The wind is at our back.”

American Family Care facilities are staffed with doctors, nurses, technicians and others who provide basic healthcare services, including X-rays, blood tests, physicals and other care. As more Americans have found it harder to find or maintain a primary care physician, AFC has watched its business take off — even during one of the worst recessions in American history.

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In late 2009, AFC had 20 facilities; it will have 47 in four states by the end of 2013. In the past four years, its number of employees more than doubled from 500 to more than a thousand. Patient visits increased from 320, 000 to more than 600, 000. AFC plans to have 65 facilities by the end of 2014.

What’s more, in April 2013 AFC bought Doctors Express, an urgent care company with 68 locations in 26 states. Combined, the two companies have 108 locations in 27 states and by the end of 2014 will have more than 170 facilities to handle an expected 1.5 million patients.

As an emergency room doctor early in his career, Irwin recalls seeing ER patients “who didn’t need to be there, ” which clogged the system, led to long waits and often resulted in poor treatment. He envisioned a handful of Birmingham-area medical facilities that could treat patients diverted from emergency rooms, and he wrote a business plan for that scenario.

Irwin opened his first unit in 1982 (the company was then known as Emergency Medicine South), but his model didn’t work exactly as he had planned. He got patients diverted from emergency rooms, but he also began attracting primary care patients. In addition, businesses sought services to meet their occupational medical needs — pre-employment physicals, drug screening and treatment of injuries. In 1984, the company’s name was changed to American Family Care.

“People use the expression urgent care, and I’ll talk the language that people talk, but to us urgent care means accessible primary care, ” Irwin says. “Our greatest opportunity is to provide the accessible primary care that this country so desperately needs.”

Irwin and the American Family Care team built the company’s foundation on providing basic services and backing that with great customer service. AFC doesn’t try to provide everything (MRIs or brain scans, for example), but they provide basic services as well and as efficiently as possible. “The patient wants the same thing in health care as they get from every other service provider, ” Irwin says. “They want good service at a reasonable price, and they want it when they want it.

“You go into our facilities, ” Irwin says, “and they’re well-equipped, they’re furnished very nicely, they’re in good places, and most of them are freestanding buildings.

And then there’s our competition. They’re often in a strip mall between a liquor store and a mattress store. Our greatest challenge is people who pretend to do what we do but don’t do it at the high level of quality that we do.”

Irwin believes that customer service is absolutely critical to AFC’s success. Go to AFC’s Web site, and it’s loaded with customer service content. That includes dozens of patient testimonials, many of which mention the fact that AFC calls all patients the day after their visit to see how they’re feeling and to follow up with them in general.

“We get less than one complaint for every 1, 000 customer visits, ” Irwin says. “And in those rare instances that we do get a complaint, we have a chance to fix it. We are serious about 100 percent customer satisfaction, and 47 percent of our customers come to us because somebody told them about us.”

Typically, an AFC facility will have about 20 employees, with one to four doctors on hand at any time. Irwin says AFC’s patients are usually 18 to 60 years old and that they are largely “working people who don’t have all day to sit in a doctor’s office. They want to get treated for whatever’s going on and then get back to their life. If they want a physical, they’re in and out in one hour. The thing our patients have in common the most is that they value their time.”

The United States has 20, 000 too few primary care physicians now, according to the Association of American Medical Colleges. And the Annals of Family Medicine expects the nation will need 52, 000 more primary care doctors by 2025. That bodes well for AFC, and the Affordable Care Act will increase both patient counts as well as patient visits, Irwin says.

Ten years from now, AFC expects to have more than 1, 000 units. “It’s very likely that in 10 years you’ll see AFC across the country, just like you see providers of other services, ” Irwin says. “We’re looking at buying other companies. We’re actively engaged in negotiations with smaller companies that do what we do. Typically, they have five to 15 units. They’re in Texas, Pennsylvania, Oklahoma and southern California.”

Looking back, Irwin recalls that starting AFC and making it work was a struggle. “It was tough at first, because we were doing something radically new, ” he says. “The health care industry is pretty conservative, and when a physician comes along and wants to do something different, it’s not looked upon favorably. Doctors who were my best friends turned their backs on me, and that was rough.

“Like any business, we had our ups and downs, times when cash flow was bad, when we had lots of worries. Especially in those tough times, I asked myself what I was doing. But the last four or five years, things really started to click again. We (Irwin and his longtime management team) feel like we’re a band, and all of a sudden we’ve got this great hit song on our hands, and everybody is saying we’re overnight sensations. But the fact is we’ve been playing in honky tonks for 30 years. But it’s fun right now. We’re having a lot of fun.”

It is a personal thing for Irwin, a Birmingham native, graduate of Birmingham-Southern and the University of Alabama at Birmingham’s Medical School. “I feel vindicated, ” he says. “I was right about trying to do what we’ve done.”

Charlie Ingram is a freelance writer for Business Alabama. He lives in Birmingham.

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