Medical care creates conundrum

When you have a skin infection, a stomachache or trouble breathing, you might not be sure whether you should head straight to the hospital or visit an urgent care clinic.

That can be a tough call for doctors too, said Dr. Russell Davidson, a Vancouver Clinic urgent care physician. He has worked in emergency rooms and urgent care clinics, so he has seen the consequences of choosing the wrong setting.

Some patients arrive at urgent care clinics with severe injuries requiring an ambulance ride to the hospital, while others spend hours waiting in a hospital emergency department for conditions that could have been treated quickly at a clinic for less money. The stakes are high, given ER overcrowding and skyrocketing healthcare costs.

"It's very hard to know if someone does actually need to go to the ER," Davidson said. "Every person's so different in how they experience things. I think it's part of why people end up in the ER sometimes."

Research estimates that up to 40 percent of emergency department visits are for nonurgent conditions that could have been managed in alternative care settings.

Timing, however, plays a role. PeaceHealth and Legacy Salmon Creek medical centers are open 24/7. Urgent care clinics' hours vary.

For example, the Grand Central location of the regional chain ZoomCare stays open until 10 p.m. Monday through Wednesday but closes at 5 p.m. other days of the week. The Orchards and Camas locations of AFC Urgent Care, a national chain, close at 7 p.m. Kaiser Permanente members have one urgent care option in Clark County at the Cascade Park Medical Office, which closes at 7 p.m. weekdays. Vancouver Clinic operates six urgent care clinics in Clark County, with the Salmon Creek location open until 11 p.m.

While some new clinics have opened, others have closed. Financial challenges led Legacy Health in November to shutter all Washington Legacy-GoHealth Urgent Care clinics, which included locations in Camas, Cascade Park, Hazel Dell and Salmon Creek.

Trade-offs

The time patients spent in the emergency department before leaving from the visit was a median of roughly 4 1/2 hours at Legacy Salmon Creek and close to five hours at PeaceHealth Southwest, according to data from the Centers for Medicare and Medicaid Services.

At an urgent care clinic, the average visit time is 56 minutes, according to the Urgent Care Association.

However, a shorter visit doesn't necessarily mean urgent care is always the right choice. Davidson said emergency departments are equipped to offer CT scans and other forms of medical imaging on the spot. Urgent care clinics may require hours or days to schedule a scan.

A timely scan can be the lifesaving difference for someone experiencing, say, severe abdominal pain without an immediately apparent cause.

Emergency departments also have access to a wider range of medications, some that require careful handling.

"A lot of medications can be very dangerous if not used in the right setting because of side effects or consequences in order to treat those dangerous, life-threatening conditions," Davidson said.

You likely need immediate emergency medical attention if you've lost consciousness, are experiencing severe chest pain, have broken bones jutting through the skin or are feeling sick to the point of vomiting or losing consciousness, Davidson said.

Age is also a factor to consider. Generally, if you are 50 and older, lean toward going to the hospital, Davidson said.

At Vancouver Clinic's six urgent care clinics in Clark County, clinicians stay busy treating people of all ages with ailments that aren't life threatening. The clinics offer labs, X-rays and other diagnostics in the same building like emergency departments do, but typically treat a different subset of symptoms or conditions.

The most common are flu, strep throat, early stage pneumonia, rashes, skin infections, cuts requiring stitches, dislocated or broken bones, and various sprains or strains.

Hundreds of other conditions can be treated at an urgent care, Davidson said, which is why patients should use nurse advice lines to decide where to go.

For example, Vancouver Clinic's nurse advice line is available 24/7 to patients who need help deciding next steps. Almost all major health insurance providers offer similar telehealth or nurse advice lines that evaluate the urgency and severity of patients' medical conditions.

"Our overall goal is taking care of people, and ultimately, we have to decide the level of care for someone," Davidson said.

Like ERs, urgent care clinics are in high demand. In 2025, Vancouver Clinic's six urgent care locations saw a combined 154,000 patients, spokesperson Kelly Love said.

She said Vancouver Clinic plans to extend hours this fall for urgent care at its Camas location, which currently closes at 7 p.m. on weekdays, to keep up with growing demand.

"It's an ecosystem," Love said. "Urgent care for our patients is as important as primary care or specialty care."

The goal is to provide patients with the right level of care at the right time.

"We get a lot of in-between patients that aren't quite sick enough to go to the ER, but would have gone if there wasn't urgent care," Davidson said. "Hopefully, it's lessening the burden on the emergency department."

This story was made possible by Community Funded Journalism, a project from The Columbian and the Local Media Foundation. Top donors include the Ed and Dollie Lynch Fund, Patricia, David and Jacob Nierenberg, Connie and Lee Kearney, Steve and Jan Oliva, The Cowlitz Tribal Foundation and the Mason E. Nolan Charitable Fund. The Columbian controls all content. For more information, visit columbian.com/cfj.

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