Dr Dushyant Singh’s vision for a private ER

Emergency doctor Dushyant Singh always felt bad for patients waiting hours in emergency departments, so he did something about it.

  4 minutes

Emergency departments in hospitals all around the country work in similar ways—a realisation Dr Dushyant Singh had after working in emergency departments across Australia and in his native India. “There's a general trend,” he explains. “If the patient is not dying, they are classified as a category four or a category five in the triage system.  The overwhelming number of cases that present to emergency departments means that the critically ill are always first priority. Patients with non-life threatening injuries and illnesses will end up waiting for extended periods of time before they receive treatment.”

This impacts the doctors as well as the patients, he explains. “When I have to attend to the patients who are really unwell, there's literally no time to worry about a low-acuity case. In my experience of going back to the low-acuity patient after they have been waiting for five hours, I feel super guilty, often saying, ‘Sorry, you had to wait.’ I realised there's a big need for a low-acuity emergency centre, where patients don’t have to wait for that long.”

With no specialised services available for treating non-life threatening medical emergencies, Dr Singh had identified a gap in our healthcare system. “GPs are booked out and hospital emergency departments are busy looking after life threatening emergencies,” he explains. “So I wanted to provide a model of care that could help to address this problem.

“With my extensive experience in emergency and understanding of business, I decided to set up a service where non-life threatening medical emergencies don’t have to wait anymore. There's a big niche for it. It could be one, it could be 10, it could be Australia-wide.”

However, setting up this new service would require extensive research, planning and development. There was also a high level of risk involved as people in Australia are not used to paying for healthcare—most GPs still bulk bill. “The Medicare rebate was not enough to provide this special care,” says Dr Singh.

Making it happen

Dr Singh had originally trained in India in emergency medicine, before his family arranged a marriage with a woman who lived in Australia. They discussed where they were going to live, and she suggested he try visiting Australia to see if he liked it. If he didn’t, she would move to India.

“So I decided, ‘Okay, let's give it a go,” he recalls. He arrived in 2013, completed all his exams and a fellowship with the Royal Australian College of General Practitioners, before settling into his emergency department work. “I worked for multiple emergency departments Australia-wide, fast-tracks and small district hospitals. I have my extended family in Brisbane, so that's why we ended up here. It’s a good area to walk around, and it's quite centrally located.”

A couple of years ago he started planning in earnest to develop a private urgent care clinic. His priorities were working out the location, the financial model and how it should be run. For a while, he approached several potential partners but found few who were willing to commit to an untried idea.

“I did quite extensive research,” he adds. “There is extensive data on the demography of any given place, including the number of patients who visit the emergency department, their duration of wait time, what other alternatives they have, plus information on what their financial capacity is if someone provides the service privately.”

That data informed his final choice of location as Indooroopilly, west of the Brisbane CBD. More specifically, he made his final decision based on demographics, data, and the other tenants in the space he was looking at. “I looked at how many medical presentations happen every day in this area and where the patients can go, what options they have, how many hours they have to wait, and their financial background, to determine whether they could afford private fees if they had to pay for it. I realised this was the right decision. I think most patients who came in never had a complaint about paying an affordable fee, especially if they didn't have to wait for hours in the emergency department.

“However, we also needed a place that could offer imaging on site. With the fast-track urgent care, every second person needs some sort of imaging. We researched all of the places where there was a radiology set-up to see whether we could co-locate in the same building. I found a building where a radiology service by Queensland QDI (now rebranded as Lumus Imaging) was also based. It took me a while to partner with them, but I knew if we did, we could provide all the radiology services as well.”

Achieving that partnership wasn’t easy. “It took a while because any new business is slow in the beginning and they wanted to put that financial burden on me for the on-call radiographer charges,” he recalls. “I had to convince them this model would work well. I told them, ‘You'll be so busy with just our patients that you may not even need external referrals’. I had to convince their area manager, and many other people, but finally they agreed.”

Full steam ahead

Dr Singh sought finance for the project from one of the big four banks, but found he was limited in what he could borrow. “Then I contacted BOQ Specialist,” he says, as they had a reputation for understanding the profession and its business models. “They were happy with the proposed project and because of them, it all went ahead straight away.”

“Dr Singh approached me last year,” says BOQ Specialist’s Tim Gaynor. “We ended up having quite a long in-depth conversation over the phone initially, and then we caught up in-person to speak more about his vision to create Brisbane's first walk-in urgent care clinic.

“He was extremely passionate when he was talking about his plans, but it was also quite daunting for him. He'd been speaking to another financier at the time and I'm assuming they were potentially quite overwhelmed with this new type of business model too.

“Of course, at the end of day we're backing the individual, but we were impressed by Dr Singh’s vision and his business plan. Thankfully, we were able to put together his application quickly. The other finance provider was taking a seat at the time, and we were able to prepare this application and have an approval all within a couple of days. We could do that because of our understanding of the industry. It made it a lot easier for Dr Singh to be able to make his dreams a reality.”

As the Urgent Care Clinic (as it was branded) started up, others started to see the potential in the business model. “Not long afterwards, a big investor approached me to set up another clinic in Southport on the Gold Coast,” Dr Singh says. “That investor is providing the premises, and at the moment I'm working on the fit-out plan, the business plan, and the model. I have also partnered with a radiologist who is providing a CT scanner, X-ray and ultrasound machines.”

Everything seemed to be going well for Dr Singh until February this year—when Southeast Queensland was hit with one of the nation’s worst flood disasters on record.

“There was a major leak in the roof which affected about 50 per cent of the practice,” he says. “So we weren’t directly flooded, but as a result of the leak, the practice was badly damaged and filled with mould. We had to shut down for four months until it was repaired.”

The insurance company was slow to respond to their claim, so Dr Singh funded the repairs himself. Meanwhile, he continued with planning the Gold Coast site, overseeing the architectural drawings, finalising deals with equipment suppliers as well as continuing his own emergency department work.

“Everything is back on track now, and it's busy,” he says. “The model has significant traction and it's going well at the moment. People are appreciating it. Ambulances are bringing in patients, and its full steam ahead.”

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