Comments on: Should primary care doctors embrace retail clinics?

By: K

Thu, 28 May 2009 20:41:16 +0000

One of the main advantages of the retail clinics is cost. I pay for my office visits and to see the NP that works for my doctor’s office costs the same as an appointment with a physician. I can be treated at a Minute Clinic for less than half of what my doctor would charge.

By: Dawn

Dawn — Thu, 28 May 2009 18:07:54 +0000

I’m not sure if Zoom Care qualifies as one of these “minute clinics”, but a friend of mine just spent an entire day searching in vain for a FP who would accept new patients. He had the same problem mentioned by Reality Rounds, having had changes in insurance coverage provided by his employer so many times he hadn’t been able to keep a primary care provider. Zoom Care had him come right over, saw him within 10 minutes, tested him for various possible illnesses – diagnosed him with a positive result on the fourth test (what private office would test for two flus and two streps? I’ve never seen it done). I cannot see what harm comes from having medical care available to people who do not have a primary care physician for whatever reason (like my own lack of insurance coverage, for instance). Regarding people who “don’t need to be seen at all” using these clinics, nurse advice lines would be very helpful in guiding the right people to the right kind of care. Most of your patients, realize, have not had medical training. How would the average patient know their problem (tick bite or otherwise) doesn’t require medical attention? Having an advice line to call to see whether a problem does or does not merit a doctor’s attention would be invaluable. Since most of us do not have access to an advice nurse line, these clinics serve, again as mentioned above, as a gateway to a medical provider, a screening for people who do not need care, or for quick access to care to non-critical but painful problems. (It really does suck to be dehydrating and losing weight from illness and have to wait 2-3 weeks or more to be seen by a doctor!)

By: Reality Rounds

Reality Rounds — Wed, 27 May 2009 00:15:20 +0000

Dear Health Conscious,
I have not seen any studies that show that “lesser-trained” NP staffed retail clinics are a disservice to patients and health care. Obviously NP’s do not have the years of education that an MD has, and their roles are completely different. Why can’t these NP staffed clinics serve as a gateway to the “highly academic and complex” care that the intelligent primary care doctor can provide for these types of patient’s? I would love to have continuity of care with my physician, but my employee based insurance has changed so many times, that I have been forced to switch physicians at least 5 times in 10 years, once while I was 5 months pregnant. This of course is not the physicians fault, but a fault in the system. At least I know I can walk to the Minute Clinic for minor ailments anytime I want.

By: Health Conscious

Health Conscious — Tue, 26 May 2009 22:26:27 +0000

Let’s fix the real problem with healthcare and stop trying to put a Bandaid over a gaping wound. Instead of MinuteClinics staffed by lesser-trained nurse practitioners, let’s train more physicians, give incentives to practice in underserved areas, and ensure appropriate primary care compensation to bring more MD’s into primary care. The retail clinics decrease comprehensivity of care and fail to recognize that primary care is highly academic and complex and requires an appropriately-trained and intelligent physician to administer it.

By: Carla Kakutani MD

Carla Kakutani MD — Tue, 26 May 2009 21:55:15 +0000

The problem is balancing convenience with continuity. In an integrated system with communicating EHR’s, the whole concept is quite reasonable. But in our current state it represents yet another layer of confusion, along with other stand alone concepts designed to “fix” little parts of our broken system (like chronic care management companies, for example).
My husband the auto mechanic is forever frustrated by people who take their car to a different place every time, until no one knows what’s been replaced or fixed. The trials and tribulations of a family doctor and a mechanic are very similar, which is why we get along so well!

By: GG Freeman

GG Freeman — Tue, 26 May 2009 21:08:44 +0000

Every day I spent in a primary care clinic as an MSIV, we had at least one patient who had been to a “minute clinic” earlier in the week (and probably 4-5 who had been in the ER or urgent care over the weekend) … and guess what?

It didn’t matter.

People are going to use whatever services they have available to the extent they are willing to pay for them (in either time or money) .. and the FP will always be blamed for being too busy and too expensive…

And the previous point of “minute clinics” pushing their own OTC remedies for various non-serious ailments is, so far as I’ve seen in follow up, 100% true. Patients go in with sinusitus and are given an OTC decongestant with NSAID pain reliever that is conveniently available right there (for about $4 more than it would cost at Wal-mart or Target)

Meh.

By: BookstoreMD

BookstoreMD — Tue, 26 May 2009 20:41:28 +0000

Biggest issue in retail clinics is the supervision of the physician extenders working there. The chances pof substandard care increases significantly when the supervising doc some miles away.
But on the other hand retail clinics can provide value – However early regulation of these clinics is necessary to make sure the patients get quality healthcare and not just fast health care.
Other issue is CONFLICT OF INTEREST. Many of the stores housing retail clinics are selling OTC meds etc. Patients are very vulnerable to suggestions when they are sick- Again we need more regulation to protect the patients.

By: family practitioner

family practitioner — Tue, 26 May 2009 19:49:21 +0000

The problem with retail clinics is not unassigned pateitns, but already established patients that think their primary care doctor is not “convenient” enough. I do not see much difference between retail clinics or urgicare, by the way.

Everyone of my patients is offered an appointment if they want one; we run into issues when the appointment is not quick enough to their liking. They run to urgicare with tick bites! Come on people! A little reality therapy: tick bites are not emergencies. This is a waste of healthcare dollars but is exploited by urgicare/retail clinics. The majority of patients seen at urgicare/retail clinics DO NOT NEED TO BE SEEN AT ALL.

By: Reality Rounds

Reality Rounds — Tue, 26 May 2009 19:30:26 +0000

I am a woman of childbearing age, who lives in an area full of the same type of consumer: urban, upper middle class, educated, all have health insurance. A lot my neighbors have visited the local “retail clinic” for minor concerns like rashes, kids ear pain, etc. All their interactions have been positive. The number one reason is for convenience. It is hard to interact with my doctor when I can’t get an appointment, or can only talk to office staff on the telephone. Then patients are lucky to get even 5 minutes of their time. Maybe these retail clinics would lessen the 2am phone call because the patient could address their concerns in person at the clinic? I do think that more creative doctor office hours would help in decreasing the desire of patients to go to these retail clinics.

By: Donald Green MD

Donald Green MD — Tue, 26 May 2009 18:49:59 +0000

These clinics are missed opportunities to interact with the patient. It is near valueless to the patient and will probably result in over treatment. Further who becomes responsible for the 2am phone call. I do not think physicians should oppose these clinics but should shore up any problems with access to the office for these patients.