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Doctors Debate Mini-Clinics: Pros and cons of retail clinics

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The turn of this century ushered in what could be the beginning of a new era in medicine.  Whether this era is more akin to the Renaissance or the Dark Ages is currently up for debate.


RETAIL CLINICS HISTORY

In the Minneapolis-St. Paul area in 2000, health clinics started popping up in, of all places, grocery stores.  And instead of a doctor, there was a nurse practitioner.

To some, this was a revolutionary answer to long waits and inconvenience.  To others, it was a disastrous slope destined to end in the demise of family doctors and quality health care.

Today, in places like Wal-Mart and Walgreens, there are over 1,200 such clinics, estimates the Convenient Care Association, which represents retail clinics.

In the summer of 2007, the Illinois State Medical Society proposed two resolutions at the annual American Medical Association meeting.  One called for the AMA to oppose retail clinics and the other called for it to encourage tighter regulations.  Delegates rejected the first proposal but amended and passed the second, asking both state and federal authorities to investigate the clinics.

Here, Steve Cooley, M.D., CEO of the SmartCare Family Medical Centers retail clinics, and William E. Kobler, M.D., chair of the Illinois State Medical Society board of trustees, take on the issue.

Have you visited a retail clinic? Share your opinions here.



IN SUPPORT OF RETAIL CLINICS

Doctor argues benefits of retail clinics

Convenient-care clinics are 200- to 400-square-foot health clinics located in neighborhood drug stores, grocery stores or large retail stores.  They are staffed by a nurse practitioner or physician assistant, open seven days per week, 10 to 12 hours per day, and require no appointment.  Patients are typically seen within five to 10 minutes of arrival; the entire visit usually takes less than 30 minutes, and the average cost is $50 to $60.

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Importantly, convenient-care clinics are limited in scope to minor medical problems such as cold, flu, ear infections, sore throats, bronchitis, immunizations and employment physicals.  Each nurse practitioner also receives physician oversight through chart review, clinical protocol development and physician availability for consultation.  Published guidelines of the American Medical Association and American Academy of Family Physicians are followed, as well as the more comprehensive standards established by the Convenient Care Association.

As a result, the convenient-care industry has now seen over 1,000,000 patients since its inception in 2000 without a single malpractice case while consistently achieving patient satisfaction rates in the 95- to 98-percent range.

All convenient-care clinics support the concept of a medical home:  Patients with a physician are sent back to that physician and patients without a physician are given a list of neighborhood physicians who are accepting new patients.

By using electronic medical-records software, each convenient-care clinic can provide a copy of the patient encounter to the patient and/or the patient’s doctor via e-mail, fax or traditional hard copy.  Additionally, prescriptions can be transmitted to the patients’ pharmacy of choice; the nurse practitioner makes no recommendation regarding where any prescription should be filed.

The rapid growth and acceptance of convenient-care clinics has occurred because they fill a need for affordable, accessible, convenient minor health care at a time and place chosen by the patient.  Now is the time for the traditional health-care system to embrace this welcome change and help ensure its success.

—Steve Cooley, M.D., CEO, SmartCare Family Medical Centers retail clinics



AGAINST RETAIL HEALTH-CLINICS

Doctor argues retail health-clinic dangers

Retail health-clinics are the newest example of “consumer-driven health care” to appear on the scene.  Doctors are concerned that without state standards and supervision of retail health clinics, patients’ overall medical care will be in jeopardy. Retail health-clinics focus on quick treatment and rapid turnover of patients—goals that don’t necessarily put patients’ needs or safety first.

For more than two decades, health experts and insurers have stressed the importance and effectiveness of a “medical home”—a place where patients have a personal physician who oversees and coordinates their care.  Now this core medical value is being challenged by the latest trend of retail medical care, where physicians are typically not present to see patients and provide or coordinate care.

A long-term patient/doctor relationship is the optimal scenario.  While these clinics claim they will see only minor illnesses, doctors often use this type of visit for diagnosis, treatment and counseling regarding other medical problems.  Physicians are also better trained to differentiate between an apparent minor illness and a more serious medical problem.

Potential conflicts of interest also exist between the clinics’ practitioners who order prescriptions and the pharmacies that fill them.  Not surprisingly, the clinic is often near the pharmacy counter.  Doctors’ primary focus is patient safety and patient care. Retails’ mission is to sell products and prescriptions.

Public-safety concerns also merit regulation of retail health-clinics.  There have been reports of some clinics seeking exemption from basic hygiene requirements like the necessity for handwashing by clinic staff between seeing patients.

Your best choice is to establish a relationship with a physician who meets your needs and your schedule.  Then you can be sure that your health is the main focus, not the well-being of the retail industry’s bottom line.

—William E. Kobler, M.D., chair, Illinois State Medical Society board of trustees



REBUTTALS

Dr. Kobler’s
Regulation of retail health clinics is needed to ensure both public safety
and comprehensive patient care.  For example, would you feel comfortable buying produce from a stand adjacent to a clinic serving patients with respiratory infections?

Also, retail health clinics should do more than simply refer a patient to a community doctor.  They must alert a patient’s designated doctor about visits and treatment outcomes.  We don’t want missing information in a patient’s medical chart that could later affect treatment of an ailment.


Dr. Cooley’s

There is no actual evidence that the theoretical concerns expressed by Dr. Kobler, the ISMS and the AMA have actually been problems in the more than 1,000,000 patient visits to convenient-care clinics to date.

Perhaps physician organizations could best spend their time answering the question, “Why do patients find convenient-care clinics so appealing?” and examine the manner in which they are meeting—or failing to meet—the needs of their patients.

I think they will find that offering no-appointment, same-day, affordable access to high-quality minor medical care is an option that is greatly valued by the public.


RELATED ARTICLES


Introduction last updated and/or approved: August 2009. Original article appeared in September/October 2007 issue. Bios, arguments and rebuttals current as of September 2007.

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Re: What cost a life?
written by Leigh Ann , April 11, 2011

I'm so sorry for your loss, Cynthia. Thank you for sharing your story.

Leigh Ann Otte
Managing Editor
MyFamilyDoctorMag.com

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What cost a life?
written by Cynthia , April 08, 2011

I am against retail health clinics because on March 21st my only child died from misdiagnosis of appendicitis as a direct result of having not been seen by an m.d., but a p.a. in one of those places. I, in my ignorance, was unaware that he was not being seen by a real doctor. My son was 27 and uninsured, so I took him there for treatment (myself to pay). I was in the examination room and witnessed the exam (if you could call it that), I had to direct her in everything. When all was said and done, despite so many red flags that an m.d. would have immediately recognized, this woman diagnosed my beloved son with viral gastroentritis, gave him nasea meds and sent him home where his append*x burst. He later died from peritonitis in the e.r. All of the senseless horror and unending grief I must endure, and that he endured could have been avoided if he had just been seen by an m.d. even just for the examination.
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Short Wait Times Mean a Lot
written by Greg , December 21, 2010

In our experience short wait times are one of the most appreciated aspects to mini, private or retail clinics. Even if that means a higher prescription cost at times.
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