It is not the strongest species that survive, nor the most intelligent, but the most responsive to change. – Charles Darwin

Imagine, if you will for a moment, that you’re a dinosaur. Specifically, a late cretaceous era one —any species you like. I tend to envision myself a triceratops. It’s about 66 million years ago (give or take an epoch or two) and animals like you have dominated the world for over 100 million years—not that you’ve been keeping track. New species of dinosaurs slowly arise while others disappear. Change comes gradually. Until one fateful day, seemingly like any other, you’re just minding your own business when you notice a ball of fire from space suddenly slicing through the sky. It smashes into the Yucatan Peninsula in what would (much) later be Mexico. A cloud of smoke as high as the sky bursts upward. And suddenly, in a moment, the world as you’ve known it has changed forever.

Now think about the experience of working in urgent care in 2020. Feels about the same, doesn’t it?

You may recall from your undergraduate biology course the terms gradualism and punctuated equilibrium. These are the two ways in which biologists describe evolution unfolding. When the world is relatively stable, the process of natural selection leads to slow, progressive changes over many generations. This is gradualism. However, sometimes the world suddenly changes and in a dramatic fashion. When this occurs, evolution picks up the pace.

            The phrase “survival of the fittest” is universally attributed to Charles Darwin, but he was only borrowing the line. It was actually Herbert Spencer, a much less remembered Victorian era British scientist and philosopher, who coined the phrase nearly a decade before it appeared in Darwin’s On the Origin of Species. However, Spencer’s most indelible mark on modern thinking was arguably the notion that the principles of evolution could be applied outside of the natural world to human systems—a concept that, in a tragically ironic twist of fate, came to be referred to as social Darwinism.

Spencer described how the ability to adapt was essential to survive changes in culture and economic environments, as well. This is the fundamental tenant of all nonbiological forms of “Darwinism.” Most recently, “digital Darwinism” has been coined as the evolution of consumer behavior when society and technology evolve faster than businesses’ ability to adapt. Importantly, unlike any given living organism whose fate is sealed at birth with the genetic material it inherited from its parents, businesses can adapt, change, and reinvent themselves in response to the changing world.

This is called “pivoting” in corporate-speak. In order to survive this period of rapid change, virtually all companies are being forced to pivot. This is perhaps most true for healthcare delivery businesses and urgent care, specifically.

Even during the last few months, many of our centers have seen dramatic changes in volume month-to-month based on Coronavirus activity in our individual communities. And the urgent care centers who’ve faired the best have largely been those who’ve embraced telemedicine services and rolled out rapid COVID-19 testing programs.

In other words, those who have embraced the “new normal” have benefited from these new niches opened by the changes. UCs who’ve focused on waiting for things to return to the way they were, unfortunately, have fared less well.

I’d like to suggest reframing the COVID-19 pandemic from disaster to opportunity. For the dinosaurs, the Yucatan meteorite may have been a disaster, but for early mammals, it was an opportunity. It’s simply a matter of perspective. For the more adaptable species, this represented a chance to expand in number and range because of the many new niches created by the extinction of the less adaptable. Urgent care is facing similar disruption currently and, fortunately, we have the ability to decide if we are going to be mammals or dinosaurs.

Furthermore, while the Mexican meteor strike caused the most recent mass extinction event, it was by no means the only, or even most significant, period of rapid species loss this planet has seen. And as is the case in the natural world, these sort of disruption events, while occurring at unpredictable times, predictably occur over and over. It is therefore worthwhile to see the broader value in honing the skill of adaptability itself beyond survival through our current state of upheaval. Disruption, in an as-yet unknown form, will occur repeatedly, and likely with increasing frequency in our exponentially changing world.

So, as we pivot from the core urgent care services to offerings like telemedicine and workplace and preoperative COVID testing, it’s also worth remembering what we’ve learned about the logistics of rapid adaption. If urgent care is to survive as a paradigm for healthcare delivery, we need to continue to embrace change as opportunity rather than disaster, and be willing to evolve. This is, and will continue to be, difficult. Change always is. But the alternative is extinction.

Opportunity is Knocking. Do you hear it?

Joshua Russell, MD, MSc, FAAEM, FACEP

Quality and Provider Education, Legacy - GoHealth Urgent Care, is affiliated with the University of Chicago Medical Center in Vancouver, WA, and is Editor-in-Chief of JUCM.
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