But I also was thinking that it took us only 100 years to figure out that it’s all about the patient! I used to tell my employees that if I weren’t practicing orthopaedics they wouldn’t have a job; what I should have been saying is that if there weren’t any patients, I wouldn’t have a job. Finally, I, too, have realized that it’s all about the patient.

AAOS Now

Published 5/1/2009

An emerging emergent clinic: It’s all about the patient

I work for an orthopaedic clinic that is celebrating 100 years of orthopaedic care in the community. To commemorate this milestone, we decided to establish an “after-hours night clinic.” We wanted to send the following messages to the community:

  • This clinic has provided orthopaedic care for 100 years and is a stable pillar of the community
  • We are willing to try something new and exciting for our patients—something to make access to patient care easier.

In my community, as I am sure in most, access to emergency or even minor emergency care through a hospital emergency room (ER) is at least a 3- to 4-hour ordeal—worse than having a root canal and an IRS audit at the same time! So I am excited about this after-hours night clinic. If the patient has a minor orthopaedic problem, he or she can be “in and out” quickly, bypassing the ER. How simple, how easy, how smart.

S. Terry Canale, MD

In 1999, Robert D. D’Ambrosia, MD, as president of the AAOS, had a theme: “Expand your scope of practice.” Our clinic did just that: we added a magnetic resonance imaging suite, an outpatient surgery center, podiatrists, physiatrists, a dual energy x-ray absorptiometry (DEXA) scanner for osteoporosis, and more. Some of the ventures have come and gone, but most have “stuck,” improved the quality of patient care we can provide, and expanded our practice.

I believe that the after-hours night clinic will do the same. I think it is a win-win situation for patients and providers. I am sure other practices around the country have had this service for years, but here in the South, I guess we’re just slow learners. Or maybe it’s just Tennessee; we got the idea from Triangle Orthopaedics in North Carolina, which has three orthopaedic urgent care centers.

The nuts-and-bolts of the operation are as follows:

  • It functions as an after-hours office, not an orthopaedic emergency department, to avoid competitive issues with hospital emergency departments and minor medical emergency clinics; this also enabled us to bypass the Certificate of Need process.
  • It is currently open from 5:00 p.m. to 8:00 p.m., four days during the week, with future plans for Saturday morning hours.
  • It is staffed by an orthopaedist or physician assistant with a cast technician/nurse assistant, X-ray technician, and a receptionist, with an administrator on call.
  • Each orthopaedist (in our 35-person group) is required to be in the after-hours clinic for one night approximately every 6 weeks.
  • No patient appointments are made—“walk-in” only.
  • Patients are screened at the door for nonorthopaedic conditions or severe orthopaedic trauma and are referred to a hospital if appropriate.
  • Definitive care is rendered at the visit, including scheduling of surgery, lab tests, imaging tests, and casting.
  • Follow-up with the same orthopaedist is arranged if needed, or the patient is referred to a specialist (hand, foot, spine) within the group if appropriate.
  • A minimum of 9 patients must be seen each evening to cover the cost of overhead.

The pros and cons

As I see it, the downsides (cons) of providing this type of service in a community are few:

  • It is probably not feasible for a small orthopaedic practice because each orthopaedist may have to staff the night clinic several times a week.
  • In some communities, a night clinic may be in competition with a local hospital or clinic. In my community, however, the minor medical emergency clinics and hospital ERs welcome any relief we can give them from their ever-increasing patient load.
  • If the after-hours clinic is a success, it may not be long before other orthopaedic groups in your area begin to provide the same services, generating a competitive situation.

The upsides (pros) seem numerous:

  • This access for patients is a true after-hours clinic facility, allowing them to bypass the ER or minor medical emergency clinic, where minor orthopaedic problems often go to the end of the line in the face of major trauma, resulting in long waits and less than optimal care. Instead of a homeopathic splint and advice to “see an orthopaedist” the next day, patients get definitive care. The night clinic is “one-stop shopping” that saves both the patient and the healthcare system time and money.
  • In most cases, today’s patients are sophisticated enough to know the difference between an orthopaedic (musculoskeletal) problem and a nonorthopaedic problem. They can also recognize the difference between a minor orthopaedic emergency and a major orthopaedic trauma.
  • This is an excellent marketing tool in the community. I believe it to be legitimate and ethical. “The Graceland Orthopaedic Clinic is now open after hours for minor orthopaedic emergencies” is just another example of providing optimal access and care for our patients.
  • I don’t know whether the revenues will be significant, but we have already had patients thank us for being available. If nothing else, it sends a message to the community that we care about patient access to our facility and our doctors.
  • It’s a good feeling to know that your clinic is open at night and seeing and treating patients while you’re eating dinner with your family!
  • It’s a good feeling to tell a patient who calls after hours that “we will see you NOW” in the after-hours clinic.
  • But the best feeling of all is that, after 100 years in the business, Willis Campbell would be proud that we once again have discovered “it’s all about the patient.”

What’s been your experience?
If your group currently operates an after-hours clinic—or has done so in the past—let me know your reasons for establishing the clinic, any tricks or roadblocks you ran into, and how your clinic is doing. I’m sure our readers would like to have some other perspectives in addition to our very preliminary experience. You can contact me at
stcanale@campbellclinic.com or click on “e-mail the editor” on any page of the AAOS Now Web site.