Urgent care centers or “walk-in clinics” are popping up all over the place. Some people refer to them as a “doc in the box.” They offer convenience and same-day service without an appointment. So, when should you use them instead of your doctor?

The name should give you a hint – “urgent care.” They’re good for urgent problems that don’t quite fit into the “emergency” category. They became a popular place to be seen when the Covid pandemic hit and people needed to find out if they were Covid positive. Going to an emergency room didn’t seem right and they’re usually associated with long wait times. Going to an urgent care center got you a quick answer to the question of whether or not you had Covid. Primary care physicians generally discouraged Covid visits anyway.

But what about when your blood pressure is high? The urgent care center will probably give you a temporary fix for that problem, but won’t do the necessary testing and follow-up that is really needed. They also won’t keep up with your vaccinations and do needed health screening exams.

Sumathi Reddy, writing in The Wall Street Journal, says the ubiquity of walk-in and urgent-care clinics has changed the way many of us seek treatment for what we think are minor ailments such as the flu, pinkeye or a pulled muscle. Instead of trying to make an appointment with our primary care doctor, who might not be able to see you the same day, we often just go to the walk-in clinic.

“The urgent care center is going to focus on the problem at hand and move on, but their primary care is going to try to think more comprehensively,” says Dr. Ateev Mehrotra, a professor of healthcare policy at Harvard Medical School who has researched urgent care clinics.

The number of urgent care centers has grown by about 14% every year since 2016, says Lou Ellen Horwitz, CEO of the Urgent Care Association, a trade group. Mehrotra’s research found that the number of urgent care center visits per person more than doubled between 2008 and 2015.

When to see urgent care

Urgent care is a great place to go to address immediate medical concerns when you can’t get an appointment with your doctor or it’s a weekend or evening and the office is closed. (If it’s potentially life-threatening, though, you should go to the ER.) Urgent care centers can be better suited to treat certain injuries than your doctor’s office. Sprains, strains, cuts and burns are all things that urgent care centers are good at treating, says Dr. Rupal Bhingradia, a family physician who works at an urgent care clinic in New York.

Many urgent care centers have equipment that allows them to do more than your average primary care practice. “They’ll often have X-ray equipment, CT scans, ability to do sutures, IV and so forth,” says Mehrotra. “In general most primary care practices cannot provide those kinds of services.”

There are certain times where you should skip urgent care and head straight to the emergency department, says Friedman. This includes if you have any symptoms that might be a heart attack or stroke, such as chest pain or face numbness. If you’re struggling to breathe or have severe abdominal pain, it makes more sense to head to the ER rather than wasting time at an urgent care clinic that may end up sending you there, he says.

When to see your primary care doctor

The number one challenge with urgent care centers is that they generally don’t have access to your electronic health record, which details your medical history and other important medical information, says Mehrotra. An urgent care doctor isn’t tracking your health over the long term or looking for patterns that may require new treatments. So especially if you have a complicated health history or chronic illnesses, relying too much on urgent care for treatment may mean you miss bigger problems.

Cost can also be a factor when deciding whether to go to your doctor’s office or urgent center, says Mehrotra. It typically will cost more to go to an urgent care clinic than your primary care doctor’s office because they typically have more overhead expenses with longer hours and extra equipment. But it will be less than going to the emergency room.

You shouldn’t use an urgent care clinic as a replacement for a family physician or primary care doctor, says Bhingradia. Primary care doctors will manage your overall care rather than simply treating a one-off complaint, and should be your first point of contact for routine healthcare needs such as vaccinations, screenings and treatment of chronic conditions, she says.

In general, if the problem can’t wait for your doctor’s availability, but isn’t a true emergency, go to the urgent care center. If it can wait, see your primary care doctor.

As an orthopedic surgeon, you wouldn’t expect me to write about school choice. But some things “light my fire” and one of them is school choice. As someone who has benefited greatly from higher education (I’ve had 31 years of education including my orthopedic training), I understand the importance of getting a good education.

I grew up in the era of good public-school education when teachers unions didn’t exist. Today, the public schools have declined significantly as teachers unions have prevented school districts from firing bad teachers. The result is many students suffer from a poor education. This can be the difference between prosperity and poverty for many low-income students.

The Covid pandemic focused the nation on public school education as many children suffered from closed schools. The private and parochial schools re-opened long before the public schools, which were kept closed by demands of the teachers unions. This disparity between public and private schools highlighted the school choice movement and now it is gaining great momentum. The school choice issue has become a significant determinant in many elections as more and more low-income Democratic parents realize that school choice is the key to their children escaping poverty.

But there are limitations to the progress made thus far by school choice. Roland Fryer, writing in The Wall Street Journal, thinks he knows the reason. He says, “School choice is sweeping the nation. But school choice as we know it won’t fix the American education system. The movement must return to Milton Friedman’s vision of unfettered competition, which no existing school-choice program achieves. Friedman wanted parents to have the autonomy to select the optimal educational environment for their children, unbounded by geography or income brackets, and to take their full allotment of education funds with them.”

Fryer believes school choice advocates must be bolder and refuse to settle for half a loaf. The underlying problems in U.S. education demand it. Despite being the world’s most prosperous nation, the U.S. ranks 36th in math and 13th in reading on the 2018 Program for International Student Assessment, a poor showing driven in part by racial achievement gaps. Despite decades of initiatives to close those gaps, black and Hispanic students lag behind their white peers in academics, graduation rates and college enrollment. The structure of American education is the culprit. We ask a system designed for standardization and conformity to innovate, personalize the educational experience, and address longstanding societal failures.

There is no doubt the existing school-choice system has helped thousands of families. But millions are waiting, and current choice programs operate within the same inadequate framework. Increasing choice on the margin through partial vouchers, magnet school or other measures has yielded disappointing results because of an imperfectly competitive market. Real competition doesn’t mean entering a lottery to attend a charter school or providing vouchers worth only a fraction of public-school funding.

This has led to mixed results in school-choice programs. While some charter schools have dramatically outperformed public schools, such as the Success Academy of New York City, others have done no better than public schools. A 2018 Wall Street Journal analysis of Milwaukee’s voucher system found that “voucher students, on average, have performed about the same as their peers in public schools on state exams,” and that vouchers seemed most effective at the schools that accepted the fewest of them. The District of Columbia’s voucher program, according to a 2013 study, improved high-school graduation rates but had uncertain effects on reading achievement and no clear effect on achievement in math.

The transformation of American education is bringing a more competitive and diverse array of schooling options for students. The most important development is the rapid expansion of education savings accounts, which 11 states offer. These accounts allow parents to channel public funds to a variety of educational services, from private-school tuition and microschools to tutoring and online courses, but they typically don’t match the funding provided to public schools. Even so, they are helping turn Friedman’s vision into reality.

In the interplay between ESAs and entrepreneurial zeal lies the revitalization of Friedman’s free-market vision for education. With more choices, parents are becoming informed consumers, prompting schools to refine their offerings. Fryer says, “If we can fully commit to free-market principles in education, we can create an education system that unlocks the talents of every student in our lifetimes. I dream of the day when the inadequacies in American education are consigned to history.”

I dream of that day, too.

How are you sleeping lately? Does it matter?

The answers to these questions may surprise you, as they did me. Getting enough sleep does matter, but how you sleep seems to matter, too.

Alex Janin, writing in The Wall Street Journal, says there is hope for those of us who live (and sleep) in the real world: Getting less than 8 hours of shut-eye a night doesn’t mean you’re doomed to an early grave. A recent study looking at sleep and longevity found that sleep “regularity”—going to bed and waking up at consistent times with few mid-slumber interruptions—matters more than how long you sleep. Sleeping six hours every night on a consistent schedule was associated with a lower risk of early death than sleeping eight hours with very irregular habits.

The study adds to a growing understanding of the links between sleep and longevity. Research in recent years has shown not only how important sleep is for health and lifespan, but also that the duration of sleep isn’t the only thing that matters.

“We’ve been missing maybe half of the story,” says Matt Walker, a neuroscientist and director of the Center for Human Sleep Science at the University of California, Berkeley, who wasn’t involved with the recent study. “Not just how much you sleep but the regularity with which you sleep has now come onto the map and exploded as perhaps the more important thing.”

More than a third of Americans don’t get the seven to nine hours of sleep recommended by sleep and medical organizations on a regular basis, according to Centers for Disease Control and Prevention data. Roughly 20% report rarely or never waking up feeling well rested, according to a recent U.S. News & World Report survey.

But there is hope for those of us in that third. A new study emphasizes the importance of regular sleep habits. The study, published in the journal Sleep, found that sleep regularity reduced the risk of premature death from any cause by 20% to 48% compared with those with the most irregular sleep. Irregular sleep habits included inconsistent sleep and wake times, interrupted sleep and napping. Sleep duration was still important: People who got long, consistent sleep had the lowest mortality risk, says Angus Burns, a research fellow at Harvard Medical School who co-wrote the study. But shorter, regular sleep was generally associated with lower mortality than longer, inconsistent sleep.

In a separate study, researchers looked at metrics such as how often people had trouble falling asleep and whether they used sleep medication. They found the healthiest sleepers had life expectancies of 4.7 years and 2.4 years longer than those with the worst sleep habits, for men and women respectively, according to the 2023 study published in the medical journal QJM.

Participants didn’t have to be perfect sleepers to reap longevity benefits, says Dr. Frank Qian, a cardiovascular disease fellow at Boston Medical Center and a lead author of the study. The benefits were cumulative with each additional good habit. Starting these good habits earlier in life also helped. “The longer you are able to maintain an optimal sleep pattern, that will probably have the greatest impact on your health and longevity,” he says.

There is an increased interest in the science of sleep. Among members of Life Extension and Anti-Aging, a longevity-focused Facebook group, sleep is one of the most frequent topics of conversation, says Nils Osmar, the group’s administrator. Just 1% of respondents to a September poll in the group said sleep isn’t a priority in the context of their health and longevity. Studies showing what aspects of sleep matter most for our long-term health can help us identify the habits to focus on. Even the healthiest sleepers had some variability in their bed and wake times, says Burns, who co-wrote the Sleep study, but he recommends people try to keep their sleep and wake times within a one to two-hour window.

I hope that includes my Sunday afternoon nap. I’m convinced that’s the key to living a long life, no matter what the study says.