Urgent care is becoming the front door to American medicine

Urgent care was built for the cough, the cut and the sprain. It was not built to be the primary — and sometimes only — point of contact between a patient and the health care system. But that is increasingly what it has become.

Nearly 40% of Generation Z patients don't have a primary care physician. Millennials aren't far behind. And by the mid-2030s, the country could be short by as many as 86,000 primary care physicians. Andrea Giamalva, M.D., FAAFP, chief medical officer at Experity, a leading platform for on-demand health, has spent her career on both sides of that equation — as a family medicine physician who once managed a panel of nearly 3,000 patients, and now as a leader helping urgent care navigate what it is actually being asked to do.

Medical Economics sat down with Giamalva to talk through how urgent care got here, where its relationship with primary care breaks down and why she thinks AI-enabled technology may be the first real tool for getting patients to the right place at the right time.

How did urgent care go from treating coughs and colds to becoming a front door to the health care system?

Giamalva traces urgent care's roots to the 1970s, with more formal standardization through the 1990s and 2000s. What changed the trajectory was a combination of factors converging at once: a broadening clinical workforce — more family medicine, internal medicine and pediatrics physicians entering the space alongside the emergency medicine physicians who started it — and a primary care shortage that is no longer theoretical.

The patients showing up today are different from those for whom urgent care was originally designed. "They are coming through urgent care doors with a question that could lead down many paths," she said. Is it truly an urgent care visit? Does it need to escalate to specialty care? Does it need primary care follow-up? That triage question, which used to be simple, is now one of the central operational challenges of the field.

At the same time, the industry itself has diversified. Many clinics now offer employer-paid services, per-member-per-month models, weight loss therapy, hormone therapy and mental health services. "It is no longer just the cough-and-cold clinic," Giamalva said. "It is a multichannel digital front door where patients can come with a need and be guided to the right path forward."

Is urgent care growth driven by patient preference or by a system that can't keep up with demand?

Both, she said, and the generational data make the distinction harder to draw. About 10% of baby boomers lack a primary care physician. That figure climbs to roughly 20% for Generation X, 30% for millennials and nearly 40% for Gen Z. Some of that reflects choice. A lot of it reflects access.

Giamalva pointed to what she calls the "Amazon-Uber-DoorDash world" — a cultural expectation of on-demand access that health care has been slow to meet and that urgent care, by its nature, is better positioned to fulfill. "Patients want convenience and access, and urgent care has responded to that while still providing quality care," she said.

Cost is also a factor. Urgent care is significantly less expensive than an emergency department visit, and for patients deciding between the two, the math is usually obvious. Primary care, she noted, faces a different structural problem: the expectations of panel-based longitudinal care don't lend themselves to the same on-demand model. "It is just much harder for primary care to respond to that same expectation because of the pressures the specialty is under," she said.

In a well-designed system, how should urgent care and primary care actually work together?

Giamalva's answer centers on a principle she comes back to repeatedly: getting the right patient to the right place at the right time. The supply-and-demand problem in primary care isn't going to be solved by having every patient default to a primary care physician. Some patients need the full breadth of a longitudinal relationship — chronic disease management, preventive care, consistent follow-up. Others are relatively straightforward and would be well-served in a higher-volume, more transactional setting.

The breakdown happens when that matching doesn't occur. Primary care ends up absorbing patients who didn't need to be there, while urgent care sees patients whose complexity exceeds what it's built to handle. "We are at a point in time where we have to leverage technology to make that right patient, right place, right time trifecta happen," she said.

Communication is the other piece. When a patient touches both systems, both sides need visibility into what happened. "There has to be a clear conduit so everyone caring for the patient can see what is happening across the entire journey," Giamalva said. The "their world" and "our world" mindset, she added, has to go. "It is all our world when it comes to taking care of patients."

What could urgent care realistically take off primary care's plate without making fragmentation worse?

Giamalva cited a study finding it would take 27 hours a day for a primary care physician to fully manage the panel they are expected to carry. That's not a time management problem — it's a structural one. The question isn't whether primary care physicians are working hard enough. It's whether the system is directing patients in a way that matches visit complexity to the provider setting.

She sees a realistic scope for urgent care to absorb more of the routine, lower-acuity chronic disease management — diabetes, hypertension, hyperlipidemia, thyroid disease, common men's and women's health issues — while reserving the more complex, time-intensive work for primary care. That requires team-based models, the right technology and, critically, clarity about expectations for both providers and patients.

On the technology side, Giamalva pointed to tools like Experity's Care Agent, an agentic AI tool designed to walk alongside patients through their care journey, and AI scribes that she said can "start transforming office visits back into more human interactions while still delivering strong documentation, patient insights and follow-up plans." The administrative burden that has hollowed out the patient-physician relationship over the past two decades, she said, is a problem technology is now genuinely positioned to help reverse.

What gets in the way when urgent care tries to close care gaps for patients without a primary care relationship?

The obstacles are real and layered. Patients have to be willing to engage, and pushing a patient who came in for a sore throat into a broader care-gap conversation can backfire. "We do not want to create a situation where the patient feels uncomfortable returning for care," she said.

Payer contracts are another barrier. In some arrangements, urgent care clinics are contractually prohibited from providing preventive care or care-gap closure services. Those restrictions have to be addressed either through contract negotiation or broader market recognition that urgent care's role has changed.

And then there's culture. Many urgent care clinicians entered the field with a specific set of expectations about what they would be doing. If organizations want them to take on more primary care-adjacent work, that conversation has to happen intentionally. "If organizations want urgent care clinicians to do more around care-gap closure, then they also have to think about culture, provider expectations and whether their teams are truly comfortable with that more primary care-directed work," she said.

Her broader message for physicians and practice leaders was optimistic but grounded. The tools to do this better are arriving. The structural problems are real and won't resolve on their own. And the window for getting ahead of the primary care shortage — rather than simply reacting to it — is narrowing. "It is an exciting moment for what is coming next in health care," she said.