Several states, including California, passed laws barring clinics from advertising or using the word "emergency" unless the facility meets strict standards. The intent of such legislation is to decrease the chance that someone with a life-threatening emergency will seek treatment at a facility incapable of helping them.
"People who were injured or needed true emergency care may think they can get it from one of these clinics, and that might not be the case," said Sen. Henry J. Mello (D-Monterey), author of the California measure.
The law, which became effective January 1, bans use of the word "emergency" in a clinic's name or advertising unless the facility meets such guidelines as being open 24 hours a day and maintains true emergency equipment and backup services. Clinics are being given a one-year grace period to comply with the law's provisions.
Despite the name changes, some emergency cases still show up at clinics, acknowledged John A. Rupke, president of the National Assn. for Ambulatory Care and owner of six Grand Rapids, Mich., clinics called the Butterworth Med Plus Center.
"Every now and then, we get someone who thinks he has a chest cold or a stomachache, and he's really having heart problems," said Rupke, who said that doctors at one of his centers even delivered a baby for a passer-by.
Like Rupke's facilities, many clinics stay open 12 hours or more a day. They claim to charge fees slightly higher than private physicians but as much as 60% less than hospital emergency rooms charge.
The American Hospital Assn., in a January survey, disputed those cost savings and said that the gap in fees has disappeared. But the clinics still boast of one advantage over hospitals: Many promise to treat walk-in patients within an hour. It's that fast food-like efficiency that earned clinics the description "docs in a box."
Clinics may not be as ubiquitous as the fast-food restaurants they model themselves after, but experts say they are transforming the $425-billion-a-year health-care industry in much the same way that fast food changed the manner in which Americans eat.
Hospitals and group medical practices, in particular, are scrambling to become more consumer-oriented because of the competition from emergency clinics, experts say.
Many hospitals have more flexible fees so that patients with less serious ailments such as the flu pay less than patients needing more extensive care, said Keith Deisenroth, a partner in the Los Angeles office of the Ernst & Whinney consulting firm. He added that hospitals are also paying more attention to providing more rapid service.
EMERGENCY CENTERS The number of walk-in clinics grew dramatically in the early 1980s, but a glutted market seemed to slow growth in the last two years.
Number % Year of clinics gain 1980 180 --- '81 260 44 '82 600 131 '83 1,100 83 '84 2,000 82 '85 2,500 25 '86 2,700 8
Source: National Assn. for Ambulatory Care