In my humble opinion, 25% of cases that seem “straightforward” are anything but.

Examples from this week:
1) Woman with throat pain and a normal exam on remicaide for IBD. I know of no official recommendations for this disorder, but the last NEJM article on pharyngitis would advise against treating her. Since I know what an anti-TNF agent is, I felt obligated to give her Pen VK. This is outside the bounds of algorithm care.
2) 24 y/o woman with recurrent cough. Had received antibiotics last week at a walk in clinic with little to no relief. Problem was actually asthma, which required a completely different set of tools and mindset.

The point of my rambling is that the general public has trouble distinguishing between convenience and charismatic staff and quality. Eventually something will be missed and the parent of a dead child or the widow of a dead man will sue. If medicine now is a free for all, let all play by the same rules. Given the frequency of ridiculous suits filed in my neighborhood, I doubt we will have this “competition” very long.

(and i will have it only for the next year, as I have decided to end my matrydom and go back to fellowship)
b

GTL:
Reasonable price? Please do have a clue what you are talking about before you pontificate. Most insured americans spend less on copay than 30$ for a flu vaccine and 45$ for an otitis infection when they see their doctor that’s the fact. Another fact is that reimbursement is stagnant in this country,cost of practice are not. PCP’s do not have the luxery in this quasisocalized reimbursment system to charge what they want (unlike you). Please do save the tired argument that we can just “opt out” of the present reimbursment system. Unless you do elective procedures or have a boutique practice that is just not an option. So, how do PCP’S manage? They see more and more patient’s.They are like rats on a spinning wheel faster and faster. Ask them if they like the current system… I can assure you the answer will be no. The result can be waits. Trust me the dr’s don’t like the current system anymore than the patients. Unfortunately I see PCP’s as a dying field of medicine which is sad. The medical student’s already know it..people aren’t going into family medicine. I don’t doubt well trained nurse pracs can do preventative health. But part of preventative health is knowing your patient’s (granted the express system of PCP’s offices is not ideal for that). Do you really think these essentially “urgent cares” will know their patient’s? Additionally, though NP’s can take care of straighforward issues, should a patient with diabetes, coronary heart disease, renal failure, and CHF be going to these “minute clinics”? Maybe this is the wave of the future, but will it be best for complicated patients (which there are more of everyday)?

From the article:
“Mr. Case says his epiphany came a few years ago when he took his young daughter to an emergency room on a Sunday for an ear infection. “We waited four hours and they just weren’t able to see us”
What part of “emergency” room is Mr. Case unclear about? ER’s work by the triage system and otitis comes after MI’s,codes, resp distress, etc etc. Did Mr. Case go to his daughter’s PCP or an urgent care? no.

Though I have little doubt these “minute clinics” have a place especially with our level of uninsured, I don’t think they should take the place of a PCP who knows the patient. That stated given the present reimbursment rates and PCP “burnout” I suspect family medicine will be dying out in the next 10-15 years. This will be replaced by NP’s which is OK for straight forward issues but not the complicated patient’s. A 2 year NP degree is not the same thing as 7 years of training that PCP’s have.

Maybe these new health care locations will actually provide a service for the disenfranchised, the uninsured, the tired-of-waiting and the indigent. The facilities and staff may actually carry medical malpractice insurance with decent limits as well.