Sam Dyer, PA-C, MHS, is a NCCPA-certified physician assistant with more than 20 years of practice experience in orthopedics. He also holds a Certificate of Added Qualifications in Orthopaedic Surgery from the NCCPA. He practices at Emerge Orthopedics in Chapel Hill, North Carolina, and Durham, North Carolina. He is the current president of the PAOS, and writes an orthopedic blog on the PAOS website titled the OrthoPA-C. He has also authored an onboarding manual for PAs new to orthopedics, which can currently be read by PAOS members on the PAOS website, and plans to publish the work in the future. He has written numerous forum posts for the PAOS website and PAOS newsletter. He enjoys seeing a variety of patients and conditions in his practice. He also has developed a charity advocacy program for the PAOS titled PAOS CARES, where he teaches primary care providers at community health centers and rural health clinics MSK injection techniques.


BLOG: Orthopedic urgent care offers new revenue stream

Mike Harvey

by Mike Harvey, PA-C, MBA

Orthopedic urgent care is the current evolution of the same-day appointments or walk-ins that orthopedic practices have been doing for years. The current trend of extending office hours into the evening and into the weekends has created many new job opportunities for physician assistants/nurse practitioners working in orthopedics.

There have been many different ways that orthopedic practices have decided to design their “walk-ins.” Some have the physicians see all of them. Some have the physicians cover the daytime and have physician assistant/nurse practitioners (PA/NPs) cover the evening and weekend hours. Some have designed their program solely around PA/NPs.

Many challenges come up when starting an orthopedic urgent care (OUC). Staffing was one of my biggest challenges. The role of an OUC PA/NP is a bit of a change from the traditional private practice PA/NP. In our area of the country, most orthopedic surgeons and private PA/NP have a specialty practice. Transitioning out of a total joint practice or a spine practice into OUC can create some challenges. Many of the younger PA/NPs have only done one specialty their entire career. An OUC will see patients with cervical spine pain all the way down to that crooked small toe from kicking the bed last night and everything in-between. The OUC PA/NP needs to be a generalist. They need to expand their knowledge to be able to deal with all body parts and all chronicity.

The OUC PA/NP needs to be able to work efficiently while providing quality musculoskeletal care. The OUC PA/NP needs to be friendly and helpful. Often the OUC is the first exposure the patient has to the orthopedic practice. This is an opportunity to capture new patients and retain them for the remainder of their musculoskeletal needs during their lifetime.

The OUC can be a great working environment for the orthopedic PA/NP. It often creates an opportunity for increased autonomy. It also creates opportunity for expanding the PA/NP’s knowledge base and increasing skills. Treatment may include doing a subacromial cortisone injection on one patient and reducing a distal radius fracture on the next or counseling the athlete who just tore his or her ACL. For some, it creates an opportunity to supplement their income by picking up shifts in the OUC.

According to the 2018 PAOS Survey 26% of respondents reported that their practice offers some form of OUC. From the orthopedic practice standpoint, adding an OUC is a potential new revenue stream.


Mike Harvey, PA-C, MBA, is the director of Urgent Care OrthoIndy in Indianapolis.


Disclosure: Harvey reports no relevant financial disclosures.