S1 Ep159: The new front door to health care, with Andrea Giamalva, M.D., FAAFP, of Experity

Urgent care was never designed to be the front door to American health care, but that's increasingly what it has become. As the country faces a projected shortage of as many as 80,000 primary care physicians by 2037 and nearly 40% of Gen Z patients go without a primary care physician at all, more Americans are turning to urgent care as their first and often only point of contact with the health care system. Medical Economics Associate Editor Austin Littrell speaks with Andrea Giamalva, M.D., FAAFP, chief medical officer at Experity, about what urgent care is actually handling today, where its relationship with primary care breaks down and why she believes AI-enabled technology may finally help clinicians get the right patient to the right place at the right time. The conversation covers the generational shift away from primary care, the payer and cultural barriers that complicate care-gap closure, the growing role of advanced practice providers and how tools like AI scribes could bring humanity back to the exam room. Music Credits: Coffee Shop Sketches by Buurd - stock.adobe.com (http://stock.adobe.com/) A Textbook Example by Skip Peck - stock.adobe.com (http://stock.adobe.com/) Editor's note: Episode timestamps and transcript produced using AI tools. 0:00 – 0:24 | Sponsor message Copic medical liability insurance (https://www.copic.com/) . 0:24 – 0:51 | Cold open Giamalva previews the episode's central theme: the national shortage of primary care has turned urgent care into the front door to health care for many Americans. 0:51 – 1:44 | Introduction Austin Littrell introduces the episode and guest, previewing the data behind the primary care shortage and the case for using technology to get the right patient to the right place at the right time. 1:44 – 2:20 | Meet Andrea Giamalva Giamalva introduces herself as a family medicine physician and chief medical officer at Experity, the leading platform for on-demand health. 2:20 – 4:28 | How urgent care became the front door From its 1970s origins to today, urgent care has grown from a cough-and-cold clinic into a multichannel digital front door offering employer-paid services, weight loss therapy, hormone therapy and mental health care. 4:28 – 7:15 | Choice or access? The generational data Roughly 10% of baby boomers lack a primary care physician, rising to nearly 40% of Gen Z. Giamalva ties the generational shift, projected shortages of up to 80,000 primary care physicians by 2037 and health care deserts to the "Amazon-Uber-DoorDash" expectations now shaping patient behavior. 7:15 – 9:49 | Right patient, right place, right time Giamalva argues the hardest problem in health care is matching patients to the appropriate setting, and that technology could let urgent care safely handle straightforward cases while primary care focuses on complex, time-intensive ones. 9:49 – 11:28 | Reducing burden without adding fragmentation With one study finding it would take 27 hours a day for a primary care physician to manage their full panel, Giamalva says clear communication across the patient journey and better tools at the point of care are what let urgent care act as a partner rather than a competitor. 11:28 – 14:02 | Treating patients like customers Giamalva makes the case that patient experience directly affects outcomes, and describes tools like Care Agent and AI scribes that aim to keep patients informed and bring human interaction back to the visit. 14:02 – 14:53 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 14:53 – 17:55 | What primary care can learn from urgent care Urgent care's scheduling flexibility and retail DNA give it a head start on on-demand care. Giamalva says primary care could adopt a more hybrid, risk-stratified approach that routes patients to telehealth, urgent care or a full primary care visit based on need. 17:55 – 19:43 | The expanding role of advanced practice providers As APPs take on larger roles in both settings, Giamalva calls for team-based models, clear expectations and proper training so urgent care teams can manage common chronic conditions like diabetes, hypertension and thyroid disease. 19:43 – 22:01 | Closing the primary care gap Giamalva walks through what it takes for urgent care to help patients without an established primary care relationship, including patient willingness, payer contracts that can prohibit preventive care and the cultural shift required of clinical teams. 22:01 – 22:53 | The case for AI-enabled technology In her closing thoughts, Giamalva argues AI-enabled technology is more than a fad and could finally reverse the administrative burden that has chipped away at the patient-provider relationship. 22:53 – End | Outro Littrell thanks Giamalva and wraps the episode.