By mid-October, Indiana area residents will have their pick of three so-called urgent care centers, medical practices that specialize in providing treatment quickly during convenient, extended hours and with no need to make an appointment.

One is owned by a local doctor; the other by a privately owned chain. And the third belongs to Indiana Regional Medical Center.

With an opening scheduled for Oct. 15, it will be the latest entrant to the Indiana market. And it will be the second such facility the hospital operates. The other is in Burrell Township. It opened in 2009.

Meanwhile, privately owned MedExpress Urgent Care, a chain with offices in Colorado, Florida, Maryland, Pennsylvania, Virginia and West Virginia, where it is headquartered, is to open along Oakland Avenue in White Township on Aug. 28.

It is located directly across the street from another urgent care center, Dr. H. William Fegley's Walk-In Medical Care Office, which opened in 2007.

Wolfe said the hospital had been thinking about opening an URGI-Care in Indiana when it learned that MedExpress was planning to plant its flag here. That, he said, helped spur the hospital to make the investment, even if some, including himself, believe that the market is not large enough to support three urgent care centers.

"We believe not all three will survive," he said. "Market forces will probably narrow it to two."

Although being the last entrant to the local market isn't ideal, he said he believes URGI-Care has an advantage because of its affiliation with the hospital. Additionally, he said the numbers at URGI-Care's Burrell Township facility provide encouragement.

It's been receiving great feedback from patients, he said, and it has exceeded expectations in terms of the number of people who have used it. In fact, he said, it has surpassed estimates by 140 percent.

But still, why take the gamble in the first place?

Wolfe said it's because the hospital has to, if it wants to preserve itself as an independent, community hospital.

The problem for IRMC is the region's predominant insurer, Highmark, which owns a share in MedExpress.

As Highmark vertically integrates itself to compete with UPMC, providing not only health insurance, but health care through its acquisition of the West Penn Allegheny Health System, the worry is that Highmark will use MedExpress as an entry portal to the system, referring patients who need continued care to Highmark doctors at Highmark facilities.

"Urgent care centers are one part of Highmark's broader plan to put together a new care delivery system aimed at providing high-quality care at a lower cost for western Pennsylvanians, while also preserving access to nonprofit community assets and creating a more positive patient experience," said Highmark spokesman Michael Weinstein in a statement.

State Sen. Don White, R-Indiana, chairman of the senate's banking and insurance committee, said he's seen local health care providers throughout his district adopt strategies to preserve themselves as a result of the Highmark-UPMC battle, and sometimes to the detriment of others.

For instance, Butler Health System recently established a trauma center about a quarter-mile away from ACMH Hospital in Kittanning, he said.

He said he's keeping an eye on the three urgent care centers here.

"I'm watching it a little optimistically, but I'm a little concerned," he said.

Aside from the competition between institutions for patients, the establishment of three urgent care centers here gives rise to a different problem -- the effect of urgent care centers on traditional family practitioners.

And if Dr. Richard Barnes' experience shows anything, it's that they will reduce the number of people suffering from acute illnesses who turn to their family physician for treatment.

Barnes, of Homer City Family Medicine and an IRMC-employed doctor, is critical of such facilities, saying they provide "fast food medicine" and that they reflect the culture's need for instant gratification.

That comes at cost to the patient, he said, because urgent care centers can't provide what doctors call "continuity of care," which is another way of saying the ongoing relationship between a doctor and a patient.

He said that in urgent care facilities, the doctor doesn't know the patient and his or her history. So what winds up happening, he said, is that the doctor treats a one-time illness and not the person as a whole.

For example, he said, say a 60-year-old seeks treatment for an acute sinus infection. Sure, an urgent care center can treat the problem, but the doctors may not recognize how that illness -- and the treatment -- affects any other ongoing problems that patient might have.

That aside, he said he believes the hospital's urgent care centers are understandable strategic moves. In his opinion, the Burrell Township facility, he said, was meant to fend off the Excela Health in neighboring Westmoreland County, and the Indiana facility is to fend off incursions from larger operations.

But, he said, he is certainly not thrilled to see MedExpress here.

"I don't think anybody wants to see them in town," he said.