Barron Nason lived on Easy Street when he moved to Charleston in 1997.
That's not a figure of speech. It was the name of his boat - a 40-foot trawler he kept docked at City Marina on the Ashley River.
His slip was just a stone's throw from Roper Hospital's emergency department, which is where Nason worked back then - the reason he moved from Baton Rouge to South Carolina in the first place.
He lived on Easy Street in Louisiana too, all the way through his medical residency. It was kind of strange, he admits, for a young man who grew up on a cattle farm in West Tennessee.
Nason calls Sullivan's Island home now - "the bubble," he jokes - with his wife Jessica and their three children.
Life on Easy Street ended years before Nason became Charleston's celebrity physician, long before he envisioned building an urgent care empire or appeared in any TV commercial.
While "urgent care" as a specialty is one of the fastest growing sectors in the health care industry, it didn't really exist when Nason first started practicing medicine. Even today, with more than 9,000 urgent care facilities nationwide, there's disagreement about what the term actually means, including some criticism among doctors and hospital administrators who say for-profit facilities like Nason Medical Center are, at best, unnecessary, and, at worst, dangerous for patients who need critical emergency care in a hospital setting.
"Two days ago, I had a patient who was having a heart attack," Nason told The Post and Courier recently. "He could have easily died."
An ambulance took the patient from Nason Medical Center to a hospital, and he survived, but Nason said the man should have gone to a hospital in the first place.
"He didn't think he was having a heart attack. Here's the classic presentation: 'This indigestion is killing me,'" he said. "If everybody knew whether or not they were having a heart attack, it would be pretty dang straightforward. My job would be pretty easy, but we don't."
The vast majority of patients who think they are having emergencies are not, he said, which is one of the reasons why hospital emergency departments are so often clogged.
"The ERs are overwhelmed with patients that have a very low risk for having a life-threatening problem. It is a tremendous, tremendous burden," he said.
This is a revelation that took years of practicing emergency medicine in a hospital to understand, Nason said. "Only in the last year or two, from telling this story so many times, have I reflected on how I really got to this point."
That story starts in Paris.
Paris, Tenn. - population 10,156 - is roughly two hours northeast of Memphis, just south of the Kentucky border. Nason, 45, was raised there.
"In Tennessee, everyone has at least 10 to 15 acres. That's what you talk about at cocktail parties. It's a big part of the culture where I'm from."
To drive that point home, he likes to talk about a pig named Sue that he received for a birthday present one year. "I didn't know anything about pigs, of course. I was a little kid."
One night during a blizzard Sue delivered 14 piglets, one of which eventually earned a 10-year-old Nason top honors - Grand Champion Swine - at the local 4H fair. He kept the newspaper clipping to prove it.
"Barron has always been the type of person when he sets a goal, he has the initiative to get to where he needs to go," said his dad, R.O. Nason. "He hit the ground running when he was born and hasn't stopped since."
Nason left Paris in 1986 to attend the University of Mississippi on a full academic scholarship, where he studied biology, chemistry and English. In 1990 he began medical school at East Tennessee State University in Johnson City.
"I rely more on that English degree today than I do anything else," he said. "They really do a disservice to us in the educational system. When we graduate from medical school and when we graduate from residency, there's not one hour devoted to how you run a business."
He tells this next part of the story often - the cold, busy night in the ER that set the idea for Nason Medical Center in motion.
"We were very understaffed," he remembers.
By then, Nason had left his job at Roper Hospital for a position in the Trident Medical Center ER. He doesn't know the exact date and declined to state the year.
He called Trident's former hospital administrator that night because he needed help.
"I said, 'This is so far past bad service, we're going to kill someone tonight.'"
A nurse approached him while he was on the phone and said the administration had just decided to send one of his staff home. "I thought about it and I've got this guy on the phone and I'm telling him I need help and she's telling me this guy just sent home one of my nurses."
"Why would he do that?" Nason said. He realized the decision was based on maximizing the hospital's profit margin, he said.
"What's the number one expense in health care? Payroll. It's a very easy decision. Send someone home from each department."
That night he decided he couldn't practice medicine in a hospital anymore.
"Years earlier I would have been thrilled - the chaos, just out-of-control emergency medicine. Unless you've been in that environment, it's hard to appreciate the true chaos of it." But after that night, he said, "Man, I'll flip cheeseburgers before I do this the rest of my life."
Nason said he didn't leave the hospital system because he was burnt out and hated emergency medicine.
"I started Nason Medical Center because I loved emergency medicine and wanted to save it."
It almost sounds like a tag line from one his commercials, many of which he writes himself.
"Don't wait on health care. Let health care wait on you." That's a Barron Nason original too. "That took me a half a bottle of wine to get that one just right," he said.
"I get the credit of being the visionary of Nason Medical Center because my name is on the building, like I saw a burning bush or I had a dream, an epiphany and all this came to me. That couldn't be farther from the truth."
In fact, he said he didn't even like the name Nason Medical Center at first. Early financial documents show the business was first called Lowcountry Urgent Care. Nason and his business partner, Bob Hamilton, a former Kodak executive, also considered using other generic names, such as Palmetto, Tidewater or Seaside.
"Bob came to me and said, 'I think you need to consider using your name.' And I'm like, 'Are you crazy? No way.' I said, 'I will not be that guy. I'm an ER doctor. I will not. The next thing you know, you'll want me on TV.'?"
He laughs now because he never dreamed how successful those commercials would be or that the first Nason Medical Center in Mount Pleasant, which opened in 2005, would become five centers in the metro area by 2012.
An online market research study paid for by the company last month showed that customers would consider taking themselves or someone they cared about to a Nason facility for prompt medical care before any of the area hospitals.
They also love the popcorn, he said.
Urgent care critics
Some doctors have been less keen to embrace the overall business model.
"I get lots of criticism from the hospitals, lots of criticism," Nason said. "For the first few years, it was a big challenge because we're not just a 'doc in the box.' We're much more than that."
He said he used to stop referring patients to doctors who disparaged his practice.
"I learned my lesson there. If I hear a doctor in the community say something, you know what I do? I send him three patients. Boom! Boom! Boom!" Those patients are his business' best advocates, he said.
"He sends a lot of patients our way with orthopedic problems, and I've heard nothing but good things about Nason Medical Center," said Brodie McKoy, an orthopedist who works for a practice owned by East Cooper Medical Center. "We've looked at what he's done and tried to model some of that in our practice."
Some of the criticism coming from the medical community may be based on jealousy, McKoy said.
"I think probably people may feel threatened by how well he's done and how efficient he's been," McKoy said. "When you set the bar high, if you can't jump that high, you get upset."
Urgent care is actually an umbrella term that could mean different things to different people. Urgent care facilities include primary care clinics staffed by nurses and nurse practitioners, like CVS Minute Clinics, as well as large, acute-care centers staffed by emergency medicine doctors, such as Nason Medical Center.
While CVS Minute Clinics mainly offer basic services like flu shots, larger urgent care centers can set broken bones, order X-rays and treat more serious illnesses.
While Nason said his services cost a sixth of what they would in a hospital ER, a report published last year by the Center for Studying Health System Change concluded that the impact of urgent care centers on health care costs is still unclear.
Some experts fear that larger urgent care facilities like Nason Medical Center may end up costing more money as patients flock there for quick service, instead of making appointments to see their primary care physician.
"'Urgent care' is a marketing term. It's not even really a medical term," Nason acknowledged. "We struggled with using that term because no one really knows what to do with it. It could mean incompetency. It could mean lack of technology."
Nason repeated several times over two interviews that he maintains good relationships with area hospitals.
While the South Carolina Hospital Association declined to comment on his reputation for this article, the association's executive vice president, Allan Stalvey said, "Urgent care centers play an important role in the delivery of care to patients who don't need the intensive service of a hospital emergency department."
"The hospitals are busier than ever," Nason said. "The ERs are overflowing. We're not putting anybody out of business."
'A big risk'
Nason and Hamilton, his business partner, declined to disclose specific financial information about the company, or how much they borrowed to launch the business.
"It's a big risk. I guaranteed every loan - it's a tremendous debt, a tremendous risk, even today," Nason said. "All my chips are in the middle of the table."
Nason said medical center employees in green scrubs - like himself - don't talk about money. Only the employees wearing red, like the front desk staff, are allowed to discuss payment with patients.
Even without disclosing any specifics, the company seems to be prospering. The five Nason Medical Centers around the Lowcountry treated 16,000 patients in January. By comparison, the Medical University Hospital ER saw about 4,100 that month.
Two years after opening the first location in Mount Pleasant, Hamilton said the business grew 15 to 20 percent a year. "It was a strong indication that the public liked what we were doing," he said. Since 2005, staff have seen more than 300,000 patients, many of them more than once.
'Just good service'
In late February, Franklin Johnson, a local manager of Papa Murphy's Take N Bake Pizza, was worried about skin lesions on his hand and leg. He came to Nason Medical Center on Rivers Avenue in North Charleston to have the red spots checked out.
"What have you been up to?" Nason asked as he walked into Johnson's exam room.
"Not good, if I'm here," Johnson said.
"Come on!" Nason said. "You're hurting my feelings!"
This is how Nason acts around patients. He jokes with them, lays on the country charm with his Tennessee accent. He talks loudly and quickly, but doesn't use much medical jargon. That's why they've come to Nason Medical Center, he said.
"The last reason they're here is for the health care that makes them better," he said. "The main reason they're here is because they don't want to wait, they want to be treated like human beings and they want to be talked to in a language they can understand."
Good customer service, often absent in a hospital ER, is an inherent part of his mission, he said. His centers are able to treat patients quickly, he said, essentially by being overstaffed, so that a sudden onslaught of customers wouldn't derail his "they don't want to wait" mantra.
When Nason Medical Center organized a patient service orientation last spring to teach new employees how to treat customers, the company invited local hospital staff to attend. MUSC sent seven doctors, nurses and administrators who listened to the two-hour presentation.
"They invited me to come to (MUSC) and talk to them and I said, 'Guys, I'm busy enough running my own medical practice. I don't have time to come train you,'" Nason said.
But he insists there are no trade secrets.
"There's no free Lortab. There's no hidden agenda. There's no smoking gun. It's just good service."
Reach Lauren Sausser at 937-5598.
Dr. Barron Nason, Nason Medical Center Tuesday, reads a patientís image after being scanned last month at the center in North Charleston.×
Dr. Barron Nason moves between examination rooms checking on patients at the Nason Medical Center in North Charleston.×
Nason, the brains behind Nason Medical Center, jokes with Jaci Johnson, 16, after diagnosing his condition.×
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