He takes exception with the AAP’s reasons for opposing these clinics. I think this physician commenter truthfully explains the cause of the fear:
The big threat to us is that they cut into our biggest financial gain – the 2-minute visit. I make way more in 10 2-minute visits than I do 2 diabetic checks. I don’t want to give our “bread and butter” (when it comes to revenue) to someone else and be left with the difficult longer visits.
I agree that they are likely here to stay for the long term. Partnering with them, rather than pushing them away, would seem to be the prudent strategy. Many of RBC utilizers may not have PCPs, and can be used as a referral source.
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Kevin–I give kudos to the AAP for having the cojones to take a stand against Retail-Based Clinics. The continuity of care is really the key issue, and that’s probably why the AAP came out against (unlike the AAFP or the AMA). The AAP has consistently pushed the medical home concept and fought any fragmention of care; the financial concerns are a distant second (especially since you could theoretically argue, if not completely convincingly, that the more complex visits would lead to higher-complexity coding and/or consult visits which pay more). Fragmented care is ultimately a disservice to the patient, since (1) they’re exposed to many different practice styles and often conflicting information (”but doctor, the urgent care center said I needed amoxicillin for my last URI!”), and (2)long-term care inevitably falls through the cracks. As a pediatrician myself, I’m often up a creek without the paddle when a kid comes in with their “umpteenth” sore throat or ear infection, when I’ve only got one documented in my notes. It ultimately takes that much longer to track down and review the outside records to determine if they really had recurrent strep throat or chronic otitis media and if they need to go to an ENT for more definitive treatment, or what antibiotic they have NOT been on in the past month. Never even mind the preventive care and immunizations. In my experience, parents like the convenience of these walk-in clinics–until problems become chronic or more complicated, and then they usually regret it. I don’t want to play phone tag recreating a patient’s record from an RBC (it’s bad enough tracking down info from our local ER), and I also don’t want to be left picking up the pieces from the RBC getting in over its head after a seemingly “bread and butter” case becomes more complicated.
Yes, the RBCs expose the need for more convenience for patients, and that is something for us to work on. But the RBC model of care doesn’t inevitably follow as a good solution. I think my office-based practice has far more value to patients, and most of my patients seem to think so too. The RBCs will exist only as long as compliant, do-anything-for-a-buck docs DON’T stand up for their profession and emphasize what sets them apart from the doc-in-the-box RBCs.
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