Retail clinics face reality

Duh: “It is very difficult to generate a profit with uncomplicated cognitive services . . . these clinics can not be profitable if they do not provide ancillary services. Ancillary services are not within the scope of practice for nurse practitioners in most states.”

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Anonymous
Kevin, can you fix that URL please?
Kevin
It’s fixed.
Kevin
Nurse Practitioner
“Another problem is these clinics can not be profitable if they do not provide ancillary services. Ancillary services are not within the scope of practice for nurse practitioners in most states.”
Exactly what does he mean by “ancillary services” and what states prohibit what he speaks of?
Anonymous
NP, I’ll stick my neck out and speculate they’re talking about laboratories, EKG, spirometry.
I don’t know if they’re “prohibited” by state law, or because of nurse practitioners. I supect NP scope of practice, if they can practice independently in the first place, they can at least do CLIA-waived work. I don’t know about CLIA-moderate work.
From what I’ve read, many of these retail clinics aren’t even plumbed. Don’t know how common that is. When you start getting into body fluid handling…..i.e., labs, there will be certain rules about plumbing and basic sanitation that at least some of the retail clinics won’t be to satisfy.
At the same time, if the retail clinic starts offering immunizations or labs, they may well be competing with the pharmacy within the same building. So the ancillary problem, in addition to the building issues of plumbing, there may be problems of competition with pharmacies. They often have agreements with the retailer. So you don’t end up with two pharmacies in the Wal-Mart. Along those lines, no other facility, even if not a pharmacy, offering competing services.
What’s always intrigued me is, the capitalization described for these retail clinics, is two, three, four times what it takes to capitalize my own solo Family Practice.
How it can be profitable after sinking that money is beyond me.
Anonymous
The fundamental problem with pharmacy owned clinics is hardly ever talked about–a massive conflict of interest. Pharmacies arose largely out of concern that physicians selling medicines rather than just recommending them was a conflict of interest–that we should only profit from our direct care.
Now those same pharmacies enter the business of medical care and do so with limited license practitioners more susceptible to corporate control–which must by law always serve the profit of the shareholder first–by the hiring pharmacy.
A few more prescriptions for the more profitable antibiotics each day can make the different between profit and loss and no MBA that I ever worked with is going to have the slightest qualm about communicating that fact to it’s NP’s and how their job may just depend on what they prescribe.
We are back to the pre-Flexnerian age of medical care. Buyer beware.
Anonymous
anon 6:39 PM – well said.
Nurse Practitioner
Same old rhetoric. Maybe investigate what the retail based clinics prescribe rather than providing false blanket statements.
NPs will not prescribe medications if its not in the best interest of the patient. Do you think that we are that unethical? There are plenty of other NP jobs out there.
Secondly, take a moment to examine the formulary of some of the popular retail clinics. Do you really think anyone is making that much money off of amoxicillin and penicillin. Nice theoretical arguement, bad facts.
Anonymous
“NPs will not prescribe medications if its not in the best interest of the patient.”
Unless they are plucked from Heaven and brought down here to serve us, that is a silly and naive statement.
A certain slice of any group of people no matter how selected, is going to readily serve it’s own interest in any and all circumstances. Clergymen, judges, physician, and yes even the sainted nurses. A much larger slice of any group is going to less readily do so but via displacement of responsibility to the commanding authority and rationalization going to engage in the same unethical behavior with the same result if the incentives support it–even while justifying it to themselves.
As long as NP”S are recruited from among human beings, with all that entails, they are no more above all risks of unethical behavior than any other groups of people when placed in a position of a conflict of interest–which having a pharmacy employee providing medical care clearly is.
It will take some time for the rot to set in, but as surely as it always has, it will.
concerned patient
Why we should have concerns about conflicts of interests of health clinics in Walgreens and CVS pharmacies. They are less than ethical.
http://www.cbsnews.com/stories/2008/06/13/eveningnews/main4180870.shtml
Anonymous
I am a Nurse Practitioner that worked in a Retail Clinic for a few months. The money was good. I thought the work would be a breeze. But I ended up feeling like I was not doing a good job with the people I provided services for. If I saw 30 people, only a couple would be really sick. Most wanted antibiotics for a child with a sore throat or an earache of less than 24 hours but the family was ready to go on vacation and didn’t want anyone to be sick.
I was told during orientation that it was all about how fast and how many people I could run through in my shift. There was a computer program for the charting that was awful and took a lot of time. We were to do teaching, that took time, and that ended up being a problem.
People could not get into see their own doctor and glad we were there. Many wanted a hour or more to see a NP and ended up mad because of the wait. The top of the peeking order only wanted one NP no matter how busy we were. As in all things, Retail Clinics are about money – making the money. It is a great concept but needs a lot of work or at least I think so. Maybe I except more from provider and patient contact and should lower my standards. Maybe I can do that but not today.

Retail clinics face reality

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