LOS GATOS -- When Claire Shafer's young daughter got an earache, they could have jumped in the car, driven several miles in freeway traffic to their family doctor and wasted a lot of time on a common medical emergency. Instead, they drove a few blocks to a new urgent care clinic with an old-school approach to emergency medicine.

"I feel fabulous," Shafer said, plunking down a credit card for the $45 office visit. So did her daughter, Katie, who left with a prescription for antibiotics, happy knowing she could resume swimming lessons fairly soon.

"Just don't jump in the pool for a couple of days," said Laura Stillman, the physician assistant who tended to her.

Nothing on the American medical landscape is spreading faster than urgent and retail care clinics. Basically, urgent care clinics are walk-in medical storefronts that mend lacerations, earaches, minor bone fractures and other emergencies that are not life threatening. Retail care is more streamlined, with doctors, physician assistants or nurses stationed inside drug stores and even supermarkets.

First appearing first about 20 years ago as modest so-called "doc in the box" clinics, there are now between 4,000 and 7,000 urgent and retail care centers across the country, the vast majority of which are in the hands of medical corporations and insurance and pharmacy giants.


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"They're really driving this," said Ateev Mehrotra, a physician, an assistant professor at the University of Pittsburgh Medical School and a health policy researcher at the RAND Corp. who co-wrote a benchmark study in 2009. It said 17 percent of visits to expensive hospital emergency rooms could be treated at cheaper urgent and retail care centers for a lot less -- $4.4 billion a year.

That bodes well for "Obamacare", President Barack Obama's program that may soon extend health coverage to millions of uninsured Americans. But Mehrotra isn't convinced just yet. It's possible the newly insured patients will drop into urgent care clinics when they don't really need to.

"Let's say you have a bad cold," he said recently by telephone. "In the past you might just suck it up and stay home. Now you can go to urgent care. It's still cheaper than the emergency room, but there is still a cost."

At the After Hours Healthcare center where Claire and Katie Shafer visited, Dr. Richard Adrouny leaned back in his chair and said, "I think we are a good fit for Obamacare."

He opened the clinic in 2010 with his son, Gregory. Unlike corporate urgent care clinics that call attention to themselves with big signs in strip malls, After Hours is situated deep inside a medical office building, next to Adrouny's oncology practice.

About two dozen posters of the Beatles, Grateful Dead, Jefferson Airplane and other, iconic '60s bands hang in nice frames in the hallway. For a moment, it feels like the psychedelic second floor of the legendary Fillmore Auditorium in San Francisco's Haight-Ashbury neighborhood, and not a clinic near a busy Los Gatos intersection.

In addition to being a rocker, the 61-year-old Adrouny also helped launch the Colon Cancer-free Zone, a volunteer education campaign that's taken hold throughout Santa Clara County.

Adrouny said he was motivated to open an urgent care clinic after he noticed how his cancer patients went to hospital emergency rooms for bumps on the head, the flu and other routine stuff. But he also thought it a crazy idea for a lone doctor and shelved it.

According to Mehrotra, Adrouny's clinic is a throwback to the original urgent care clinics opened by individual doctors. The difference today is the competition comes from big urgent care chains.

Adrouny's opportunity came after his son graduated with an advertising degree from Duke University a few years ago, when the Great Recession was in full, deep bore, and Gregory Adrouny couldn't find a decent job in his field.

"Why don't you help me start this thing?" father asked son.

Now 24, Gregory Adrouny hesitated at the time. Although his grandfather, father and sister are doctors, he had sworn off a medical career as a young kid.

"Just to be different, I guess," he said. "Now look at me!"

As the father trained the new urgent care staff, the son started looking for patients through social media, mainly Google AdWords. The key to success was delivering old-fashioned, compassionate medicine in an emergency setting. That meant shorter wait times -- 20 to 30 minutes. Low cost -- $150 to $200 in cash for patients without health coverage. And friendlier, competent attention, which is hard to quantify but not impossible.

While walk-ins started slowly with only one or two patients per day, the number increased to about 15 a day at the end or the first year. Walk-ins today have reached 25 to 30 a day.

"The first time we saw 10 people in one day, my Dad and I danced around to 'Oye Como Va' by Santana to celebrate," Gregory Adrouny said. "Sure, it's great for the bottom line to see 50 or 60 per day, but then the quality of our care goes down and the patient feels marginalized."

The Adrounys said they like the patient traffic where it is but plan to open two more clinics in the region relatively soon. As hot, technology startups know, initial success often attracts buyers.

"We've thought about that," Gregory Adrouny said. "But I don't think we'd sell, at least not so soon. I like the way this would cap off my dad's career, and I really like how it has helped me start mine."

Contact Joe Rodriguez at 408-920-5767.