Drug store retail clinics for primary care? Not so fast

Drug store retail clinics for primary care? Not so fast

A version of this column was published in USA Today on July 3, 2013.

One recent day in my primary care clinic, I had a full schedule and was unable to see a patient for her cough.  She instead sought medical care at a local drugstore, where she was treated for bronchitis. Normally housed in pharmacies and department stores like Target or Walmart, such retail clinics have grown in popularity, numbering over 1,400 nationwide today. While convenient for minor ailments like sore throats or urinary tract infections, some of these clinics want to do more.

Walgreens recently announced that their clinics would manage chronic conditions normally handled by primary care physicians like myself, such as diabetes or asthma.  While retail clinics already monitor chronic diseases, they only do so after first diagnosed by an outside primary care physician.  Walgreens takes it a step further by having its clinicians diagnose these conditions themselves.  Competing clinics, like those found in CVS pharmacies, are considering following Walgreens’ lead.

While expanding the scope of retail clinics undoubtedly improves access, are they properly equipped for primary care?

Consider the population most likely to have chronic conditions: Medicare patients.  A New England Journal of Medicine study found that they already see an average of seven different physicians a year.  Seeking care at a drugstore adds another provider, and further fragments care. According to Dr. Jeffrey Cain, president of the American Academy of Family Physicians,“it is more difficult to comprehensively manage a patient’s care if they are treated in multiple settings.”

Indeed, I find managing diabetes or high blood pressure is far more effective after developing a relationship with patients and getting to know their individual preferences over time.  Patients who go to retail clinics are more likely to see a rotating set of providers.  And rather than personalize treatment, they follow standardized medical protocols to abide by the American Medical Association’s retail clinic policies.

Poor sharing of medical information also fuels fragmentation.  Electronic record systems of hospitals within blocks of each other often cannot speak to one another, let alone with one from a retail clinic.  It’s unlikely that a drugstore provider can access a patient’s medical record, which would mean starting care from scratch.  People with diabetes, for instance, commonly have concurrent conditions like kidney or heart disease, and may be on a medication regimen that has been fine-tuned over years.  Without records, important details may be missed, or duplicate tests ordered.

Patients with chronic disease are also more complicated than those retail clinics typically see.  In my office, a seemingly simple diabetes follow-up can turn into a lengthy, nuanced visit where a patient’s recent hospitalization is discussed, medication doses are adjusted, and perhaps underlying depression uncovered and treated.  These patients require close follow-up. They sometimes page me in the middle of the night or on the weekend with questions stemming from their visit.  Try that with retail clinics, which generally don’t forward phone calls to their providers and instead refer questions to call centers.

Finally, do providers employed by publicly traded, for-profit pharmacies have patients’ best interests in mind?  Drugstore clinics may be influenced to increase pharmacy revenues by sending prescriptions to be filled within the store or recommending products a few aisles over. According to Consumer Reports, the price of generic drugs at large U.S. pharmacy chains, including CVS and Walgreens, can be as much as 18 times more expensive than wholesale chains like Costco.

For retail clinics to be viable for primary care, they must not compete with doctors and siphon off patients, but instead join local primary care practices so that patient information resides on a shared electronic medical record and follow-up care closely coordinated.  Patients should also have the explicit option to have prescriptions filled at their pharmacy of choice, where prices may be cheaper.  Only then can patients enjoy the convenience of retail clinics, maintain continuity of care, and navigate the inherent conflict of interest of being treated by pharmacy-employed prescribers.

Until that ideal is realized, retail clinics are fine to treat your cough or sore throat, but should not substitute for your primary care provider.

Drug store retail clinics for primary care? Not so fastKevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

 

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  • Dr. Drake Ramoray

    Patients with chronic disease are also more complicated than those retail clinics typically see.
    ========================================

    This is the whole point of what they are doing. As payers move to bundled payments for people with diabetes, the retail clinics will collect the healthy simple diabetic patients and the doctors will be left with all of the very complicated difficult patients. Lower overhead with non-MD providers, self referral for medications within the phramacy, and collect the healthiest patients with the highest return in payment for time spent. From a pure financial perspective it’s brilliant.

    ===========================================
    Finally, do providers employed by publicly traded, for-profit pharmacies have patients’ best interests in mind?
    ===========================================
    And how would you view this differently than a physician employed by a for a publicly traded for profit hospital as more physicians are being pushed into big groups because of all the mandates and requirements for insurance?

    • Jason Simpson

      If MDs are seeing only the sickest patients, their compensation will increase dramatically due to higher billing levels.

      A regular checkup doesnt pay jack squat compared to a 75 year old with 20 different medical problems.

      • Alice Robertson

        You are right…it’s a problem doctors need to get into a different speed on. But the ACO’s and bundled payments oughta take care of a lot that problem because hospitals and some doctors really like bonuses:) But then again if Medicare reimbursements go down much more the elderly will be fortunate to find a doc to care for them at those rates, and when the new AMA codes and two strikes you are out on the billind codes go into full swing you won’t have to worry about doctors and compensation. And then once those appointed IPAB panel gets on a roll….well…well….you better start to visit grandma more while she’s in good health! Ha! Sorry….I am being cheeky but it’s the reality of what’s to come and there is a place for Minute Clinics and customers like them very much (my teens prefer them for sport’s physicals etc.). They are giving family physicians a run for their money. And…hey….aren’t many doctors who were on here screaming about NP’s now hiring them because they make them money?

      • LeoHolmMD

        What are you talking about? Chronic care is grossly undercompensated. You can crank through 10 sore throats in the time it takes to deal with someone with numerous chronic medical problems. Thats why our whole medical system is focused on volume.

        • querywoman

          What are you talking about? Lots of doctors love chronic care, like blood pressure management, It’s easy to whip out an ugly black cuff and a stethoscope and write up scripts for BP pills and order the patient to take them and come back.
          In fact, so easy that lots of docs either don’t know how or won’t waste the time to examine an illness with symptoms.
          Throw is some cholesterol pills while you’re at it. Send the patient for cancer screening.
          Doesn’t take much time at all. And that’s what most American doctors do.
          Must a person really see an ENT to get a sore throat or an ear infection treated?

          Prevention is not better than cure; it is more profitable.
          Without illness, there would be no need for doctors.

          • Trina K.

            When “chronic care” is that simple, the NPs at Walgreens will take it over. They will cherry-pick all those “simple” chronic cases, and leave the difficult ones to the doctors.

          • querywoman

            Trina, I have had a competent assemblage of doctors for about 8 years, I did not know until I started reading KevinMD that midlevels had sprogged in primary care like weeds in a well-manured grazing pasture.
            I have had lots of lesser-trained GP’s and midlevels try to meddle in conditions for which I see specialists, like diabetes.
            Once I went to a NP in a family doctor’s for an urgent URI. She started talking to me, while I was very ill, about my diabetes and the shoes I was wearing. Her boss wouldn’t have done that.

        • Cyndee Malowitz

          You got that right!

      • Dr. Drake Ramoray

        You are incorrect, at least for my practice. I easily make more money seeing three simple thyroid patients in the time it would take for me to see one complicated diabetic with multiple medical problems. Napkin math for E & M for BCBS in my state would be about 2x as much for the three simple thyroid vs. the one complicated diabetes.

      • rtpinfla

        Although this article really isn’t about compensation, your comment here (and your comment about antibiotics and OM, for that matter) , it is so ill informed and misguided it really needs to be addressed.
        For a “75 year old with 20 medical problems”, I can typically bill Medicare for will pay $102 and that patient will take a good 30-45 minutes, and often an hour or more.
        On the other hand, a “regular checkup” takes 15 minutes. I can bill a medicare $69. So if I can see 32 regular check ups in an 8 hour period I can collect $2110, On the other hand, if I can see 16 sick patients (and that is the best case scenario and assumes I can actually do everything in 30 minutes) in that same 8 hour period I can collect $1632. Rather than increasing my compensation dramatically, I’m losing about $2390 a week, or $124,000 a year.
        If you want to say it actually takes 20 minutes per regular check up(24 patients/8 hours) and all my complicated patients still only take 30 minutes, I still lose about $125 a day, or $6240 a year. Keep in mind I am not even including the fact that most of the complicated patients will take longer than 30 minutes, and I’m not including any of the non-visit time such as reviewing labs,X-rays, and coordinating care that the regular check up doesn’t need.
        No matter how you try to slice it, complicated do NOT result in higher compensation and result in a loss of income for a lot more work.
        By the way, current guidelines recommend antibiotics for otitis media depending on the clinical picture.

        • buzzkillerjsmith

          Way to put numbers to it! Please add how much you can bill a pt with good insurance for a 15 minute visit, and let us know what percentage of your pts have good insurance.

          • Cyndee Malowitz

            Just to make all the physicians feel better, the insurance companies reimburse me the same or less than Medicare. My overhead is as high or higher than any physician I know, since I have to pay a lot in overtime (my clinic is open 7 days a week and until 7 weekdays). Mind you, the patients who use our services are still paying the same premiums, which makes absolutely no sense. I want to see the insurance companies reimburse physicians 50% less for those visits seen by their NP/PA.

        • Guest

          Cite your current OM/antibiotic guidelines. I believe Jason is correct on that one. OM is horribly over treated; typical cases will resolve without antibiotics.

          • rtpinfla

            The 2013 American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guidelines are 2 that recommend treating OM under certain conditions. European guidelines recommend no or DELAYED antibiotic use, but they do not equivocally state that antibiotics are never indicated for OM.
            I agree that antibiotics are given too frequently but Jason’s blanket statement is not correct. Unless of course, he was there to get the patient history, concurrent medical problems, and looked in the kids ear himself.

        • querywoman

          I know you have a lot of expenses, but I live on a lot less than that.
          I am not the most profitable patient. My doctors usually just talk to me, and they usually give me my 15 minutes.
          It’s really sad to see doctors seriously talk about money issues and how they are losing so much, blah, blah, blah.
          You don’t tell us how many tests you order per patient either.

      • buzzkillerjsmith

        Seeing chronically sick people just doesn’t pay well. Seeing 75 year olds on 20 meds does not pay well, especially if you include the enormous, though invisible to non-physicians, train of paperwork, computer work, and general hassle that follows that pt into the room.

        Seeing huge volumes of healthies pays, and doing procedures pays. Healthies are almost paperwork-free. Taking care of people who actually have non-trivial illnesses, although kinda sorta the whole point of general medicine, is a fool’s game. Hence the primary shortage, hence the current Walgreenization movement.

        I expect current trends to continue as doctors and NPs and PAs, quite rationally, avoid the nightmare that is primary care. I expect the public, in its ignorance and powerlessness, to continue to rage at the poor access and quality. I expect nothing meaningful will be done to solve this problem.

        • Keith Williamson, MD

          I agree. Much that is good in medicine is being butchered on the alter of access, while the real perpetrator, patient behavior, gets a free pass.

          • querywoman

            Duh? When a medical doctor ignores my complaints, which has happened repeatedly, I have to pay someone else for my care. That costs the government and the insurance companies a pile of money! Sometimes, I’ve had to go to ER’s.

        • querywoman

          Buzz, I love you and your sense of humor. I understand that you will not take this personally.
          Seeing patients with chronic diseases, including the elderly, is usually not as profitable as doing annual exams on healthy patients, collecting a small copayment, and billing their insurance companies for all kinds of preventive tests.
          When I last had private insurance, for a state and federal agencies, an internist and a family doc did really extensive annual exams, including EKGs and chest rays.
          During the same period, if I went to an internist at a public clinic for an annual, he did not do an EKG or chest X-ray.
          Didn’t most of you go to school to treat sick people? There are a few who really went to med school to make good money!

        • Cyndee Malowitz

          Well, you’re the profit of doom. Not every provider is so hung up on money and they actually enjoy treating primary care patients. There’s more variety and it’s more interesting. I don’t care how much it pays, I would go crazy if someone stuck me in a room and I had to read Xrays/MRIs all day.

        • querywoman

          Buzz, who is supposed to treat the sick people? I really wish I had the time and energy to fax your post to every politician in this country and force ‘em to read your comments.
          Then we would seem something meaningful done to solve the problem. We educate doctors at public expense, and then they don’t want to treat sick people.
          I normally agree with you. This could be just an observation, and does not reflect the feelings in your own soul about sick people.
          When sick people can’t get medical care and repeatedly get conned into preventative care because they are in a medical office seeking treatment, it’s corporate theft!

      • southerndoc1

        A packed schedule every day with nothing but 75 years olds with 20 different medical problems: that’s really going to get med students to choose primary care.

        • Mandy Miller

          It’s not even “truth in advertising” to promote it to students as Primary Care, if all they’re going to be seeing is 75 year olds with 20 different medical problems. Primary Care actually has a societally-defined meaning — or used to.

          I’m glad I’m old. I’m not optimistic about the future of healthcare in America.

      • heartdoc345

        You clearly have no idea what the billing codes reimburse. For a Medicare pt, E/M for an established patient maxes out at about $133 for a 99215 code. You could probably see 3-4 healthy patients, for $66 each (99213 code) in the same time for a lot more money and less headache. Oh – and make a lot more if they have private insurance.

  • rtpinfla

    The second sentence says it all… “I was unable to see my patient”.
    It is simply not good enough to complain that these types of clinics are not a good alternative to a primary doctor, no matter how legitimate that argument may be.
    The primary care doctor MUST demonstrate that he/she is truly the better alternative to a drug store clinic. Patients want convenience and access. When they are told that they will have to wait a week to be seen for an acute problem, they will go where they can get seen, even if you have been their doctor for 20 years.

    • Dr. Drake Ramoray

      Did the minute clinic gig once for an ear infection for my kid. My state frowns very heavily on writing prescriptions for family members (not all states do). Fast, efficient, and didn’t cost much more than my co-pay for her pediatrician would have been. You have hit the nail on the head.

      • Jason Simpson

        The Minute Clinic must not be following evidence-based medicine, which dictates that kids should not be treated with antibiotics for ear infections.

        • Alice Robertson

          That’s not iron clad. If there are sinus problems, etc. or bacteria an antibiotic is helpful (granted in most cases they are scripted for too long a time because most patients only need a couple days worth, but it’s still helpful for those few days).

          • Guest

            Jason is correct. Not sure why everyone is railing on him. OM is and has been overtreated with antibiotics and in general do NOT need antibiotics.

            Alice, 2 days of antibiotics won’t kill anything. All it helps with is creating drug resistance that is all the norm these days.

          • C.L.J. Murphy

            “2 days of antibiotics won’t kill anything. All it helps with is creating drug resistance that is all the norm these days.”

            Quite so.

          • Alice Robertson

            Not according to a bunch of medical journals. It’s why we have such resistant bacteria these days because doctors overprescribed and repeated the mantra you just repeated because you really believe it.

            How could I be wrong when we know now doctors are resistant to even scripting antibiotics unless it’s absolutely necessary while years ago they scripted it for everything and look at where we are today because doctors were wrong and the public obeyed them?

            I am not linking to stuff because it’s so far and widely available about overuse of antibiotics it’s mundane. But now with super bugs (thank you to the doctors who were doing research and didn’t do their job well and mislead their colleagues into overscripting) depending on what you have it *could* be wise to take it for ten days and *could* be wiser to let your body do what it was intended to do and fight it. I think I read about a Dutch study in the BMJ that proves you wrong:) But it was about antibiotics doing their job well in three days in most cases.

            The bottomline is all depends, and that’s a more honest statement than what was posted above in response to me. It’s good medicine has reached the state where one-size doesn’t fit all and human genome projects are showing just how individual we really are.

          • Guest

            Taking antibiotics for just two days, and then not finishing the rest of the course, is more likely to add to the problem of antibiotic-resistant bacteria than finishing the full course. Yes, antibiotics are over-prescribed, but taking them for just a couple of days instead of for the full course is more likely to hurt than to help the problem.

          • https://www.facebook.com/arobert6 Alice Robertson

            That’s illogical.

          • Cyndee Malowitz

            Are you a physician? If so, then you need to head back to medical school.

          • https://www.facebook.com/arobert6 Alice Robertson

            No, you need to learn how to read medical journals and stop believing bollocks:)

          • https://www.facebook.com/arobert6 Alice Robertson

            Aren’t you an NP? If so, that just means you are limited in what classification of drugs you can script. Therefore, that means you are the Antiobiotic Queen!:)

          • Cyndee Malowitz

            ????

          • https://www.facebook.com/arobert6 Alice Robertson

            To the people who voted down I am thinking you should spend less time berating and more time studying. Starting with an interesting article in the WSJ yesterday titled

            Antibiotics Do’s and Don’ts:

            Doctors Too Often Prescribe ‘Big Guns’; Impatient Patients Demand a Quick Fix

            (great chart about when to script, what to script. We don’t have to agree with it all to see the negligence of the medical community because of their arrogance and lack of research where they have created a worldwide problem with antibiotic resistance) I am writing more to patients who read here and need a good resource because the others know it all already:) It may best to just avoid the doctor and save your money and time. Problem is places like Minute Clinic rely on antiobiotic seekers to stay in business.

            So we have the CDC saying 60% of doctors (and I am sure this includes NP’s) prescribing the wrong antibiotic yet doctors and others rebuke patients online while they are clueless themselves? And we have the Journal of Pediatrics sharing that doctors were wrong another 25% of the time? Two snippets below:

            Snippet 1:

            Both studies also found that about 25% of the time antibiotics were
            being prescribed for conditions in which they have no use, such as viral
            infections.

            “This is upward of 30, 40 million prescriptions a year. And on top of
            it, these are conditions where antibiotics aren’t justified—coughs,
            colds, bronchitis—and the majority of the antibiotics prescribed are the
            broad-spectrum antibiotics,” says Dr. Hersh, also a co-author of the
            Pediatrics study.

            Snippet 2: In a July study published in the Journal of Antimicrobial Chemotherapy,
            researchers from the University of Utah and the CDC found that 60% of
            the time physicians prescribe antibiotics, they choose broad-spectrum
            ones. “There is overuse of broad-spectrum antibiotics both in situations
            where a narrower alternative would be appropriate and in situations
            where no therapy is indicated at all,” said Adam Hersh, assistant
            professor of pediatrics at University of Utah and a study author.

          • Mengles

            Don’t expect people like Alice to see evidence based medicine. They want their abx and they want them now.

          • Alice Robertson

            LOL You know I asked my doctor friend about this thread and he said, “It’s about job security.” At least he’s honest. I can give evidence based for anything you want. The deal is most people only need a couple days of antibiotics but about 20% need it longer so docs just script for ten days to make absolutely certain they got whatever it was.

            And now you have egg on your face because doctors are steering away from antibiotics because evidence based medicine proved them wrong.

            Now if they could just develop a drug to get anonymous posters who are full of shite to shut up the world would be much more rosy! Ha! Because we wouldn’t have dig through your silly posts to get to the truth.

        • querywoman

          I am an adult with a history of serious ear infections. Once I tried doing without antibiotics and ended up driving to a minor emerg center in the morning with severe pain.
          It took my ear about 24 hours to rupture, and a month to fully heal.
          Luckily, due to improved general health, my life is no longer a chronic cycle of ear infections, antibiotics, and yeast.

          • Cyndee Malowitz

            Good thing you didn’t end up with mastoiditis.

          • querywoman

            Cyndee, once I ended up in the hospital dehydrated after repeated bouts. I quit my job 7 months later and went back to my mother. The doctors didn’t care to try and fix me. I did have one devoted young GP and later a good public internist, but all they could do was treat the infections.
            I can’t go into it all here. I took up yoga, along with certain medical treatments. I was going through some nasty URI’s with salty taste, and re-enrolled in yoga, which reduced the incidence and severity.
            At that time, my blood sugar was getting higher and higher, getting closer to 300. But yoga was very powerful even with sugars that high. Surprisingly, I never went to pneumonia after all those URI’s. Last year, I got pneumonia after catching something flu-like.
            I usually get Amoxicillin when I get URI”S now, because of my tendency to ear infections. I like it better than I do the C-antibiotics, unless I have had too much of it recently.

            Are you an NP? You might suggest yoga to your patients.

          • querywoman

            So far six dislikes! I talk about yoga helping me, even with ever-climbing blood sugar.
            I guess I should have had a mammogram throughout my eternal ear infection years.
            Then I could have woke up from anesthesia and had more ear infections.
            Do doctors fear sickness? I’ve been to lots who can’t treat real illnesses with symptoms.

          • querywoman

            Cyndee, you, the lowly NP. made a cogent observation about a serious complication I didn’t know about! The alleged medical doctors are not commenting, and are probably the ones clicking on dislike when I talk about having been really sick with serious dislikes!
            Guess which licensed healer I’ll be seeing when in Corpus Christi!

          • querywoman

            Wow! Some mystery voter, probably a doctor, thumbed this down. Poor schmuck!
            Don’t you know how to see the positive? Wouldn’t you rather a Cyndee Malowitz see a mouthy patient with a real illness than you?
            I wouldn’t want to take your filthy hands away from your prostate exams, pap smears, and mammograms to look at my infected ears!

          • querywoman

            Wow! Five dislikes when I talk about having a real sickness! Then I talk about improved health now.
            The dislikes just had to come from doctors.
            Doctors, why do you hate sick people?

          • EmilyAnon

            People longing for the old days when patients were seen, but not heard.

        • Cyndee Malowitz

          I know a lot of physicians who prescribe antibiotics for viruses and allergies.

          • querywoman

            I am on disability and can sleep off illnesses. People who work and got to school often need treatment to get them well faster. Doctors are most enriched by employment-based private insurance. They need to appreciate that jobs are their best cash cow.

          • querywoman

            Four dislikes here! The truth hurts!

      • Alice Robertson

        Well there are good and bad NP’s (noctors:) just as there are good and bad doctors. I have had good care there…and a couple of Attila the Huns too, but the last time I took my daughter in and shared why her neck was cut from one side to the other (neck dissection) the NP (a nice guy) does the exam on the side of the scar and announces there are no swollen lymphs. I remind him that she has no lymphs on that side because of a neck dissection. He is speechless:) I honestly don’t think he knew what a neck dissection is.

        That said the NP’s we know say the Minute Clinics in Ohio are risky to work for because no doctor is available and they push the limits continually. It also means there are times a patients needs care and will wait there only to be referred elsewhere (an Urgent Care center or one of the newer ER’s that are tremendously expensive), or simply not get the care they need because the NP is scared to treat.

      • querywoman

        Re-reading your post, you didn’t even tell us what kind of meds your kid got. The blast against antibiotics appears to have been directed to you.
        It’s not good medical ethics to treat your own family members; you don’t see them as clearly as you should.
        I am sure all doctors with families treat them to a certain extent.
        I think you probably had sense enough to see that you child was not getting well without meds and decided to take her in.

        I hated kneejerk reactions. Sadly, medicine is full of them.
        Ear infections are not a childhood disease. I’ve had plenty of nasty ones as an adult.
        Last year, I had one, and it had been a long time. I have a friend with HIV, who does quite well. He was down. He called me one night while I was suffering from an ear infection.
        He asked me how I cope.
        I told him that I had been researching fatal ear infections that night on the net. I doubt I would have told anyone else about that. Just the incidence.
        He’s not the only one who feels lousy at times, and I have my bad days too.
        And I can be very ill with ear infections: dizzy, nausea, trouble breathing, sometimes pain, bruises all over me, fever, then weak as I recover.

        • Alice Robertson

          I sure hope Drake answers you (or whoever is playing that role now as the resurrected doc with a sick child…and apparently nine lives…(meow:)….we really must talk to those writers quite soon about these travesties:), Anyhoo….once Drake comes back from the dead…AGAIN…he usually takes to writing and quite well mind you… he can answer much better than I….a mere viewer! Ha! This may help…it’s on the AMA site. Now if we could just write the AMA out of existence:)

          Opinion 8.19 – Self-Treatment or Treatment of Immediate Family MembersPhysicians
          generally should not treat themselves or members of their immediate
          families. Professional objectivity may be compromised when an immediate
          family member or the physician is the patient; the physician’s personal
          feelings may unduly influence his or her professional medical judgment,
          thereby interfering with the care being delivered.

          • querywoman

            Whomever this dude is who goes by a soap opera pseudonym and purports to be an endocrinologist was a daddy with a sick child who took her to the closest place.
            Beats an ER for an ear infection! I have sat in ER’s before with an ear infection.
            Once I had a very good family doc with several kids. I asked him if he took his kids to a family doc or a pediatrician.
            He told me he treated his kids himself.
            I knew he really shouldn’t be doing that.
            Eventually, he wrote one of his kids a prescription for an amphetamine-type ADD medicines. The medical board found out and disciplined him.
            He told them he didn’t know he was supposed to treat his family members.
            I suspect the pharmacist had let scripts for other childhood illnesses slide, but felt compelled to report the ADD med.
            A parent is absolutely not the best person to treat ADD!
            Drake may have had meds around his house that he could use to treat his child, but he was wise to take her to someone else.
            As an example, all meds have side effects and can be fatal, like salt and water. A parent does not need to be prescribing meds for his or her own child and take that responsibility!

          • https://www.facebook.com/arobert6 Alice Robertson

            Well…my…my….did you and I make someone mad. I am thinking it’s an anonymous doc we addressed. We keep getting dislikes even to the mundane. Sensitive little bugger on the loose, pressing the dislike button on our posts:)

          • querywoman

            Hey Alice, gee I like you, gee I do.
            I hope Drake doesn’t tell us what treatment his kid got at the minute clinic.
            I think I accidentally clicked dislike on you here, cause it’s showing red now. I was trying to click.
            The anonymous Dr. Bugger sounds like a menance! Probably makes snap kneejerk decisions before the patient spits out 3 words!

      • querywoman

        Drake, I assume you are not one of the really bad endos from my past. When I had chronic ear infections, I think I was already diabetic. I had several readings of around 140, and the standard was soon dropped to 126.
        Getting diabetes treatment, among other things, has dropped my incidence of ear infections.
        I’ve been through what your child live through. After neglecting an ear infection and getting a busted eardrum, I won’t neglect them again.
        You got blasted for exposing her to antibiotics without even saying that’s what she got.
        Your child could have received ear drops. Maybe her ears got cleaned. Maybe she got a Netipot and pain medicine. Odds are she got oral antibiotics, maybe my face, amoxicillin.
        Doing without antibiotics for ear infections has not worked for me. I’ve gone through the yeast infections, rounds of changing antibiotics due to resistance, etc.
        I read that garlic oil in the ears can help. I put garlic oil in my ears and smelled garlic for a week. Never again!
        Supposedly chiropractic treatment can help ear infections. Never tried it, but I wouldn’t rule it.
        Yoga helped.
        Inhaling salt water helps all upper respiratory infections.
        A poultice of onions might help.
        The new Clinere strips are great for cleaning out ear wax.
        But sometimes antibiotics are needed!
        I suspect that most American docs still prescribe antibiotics for ear infections.

  • http://www.thehappymd.com/ Dike Drummond MD

    The businesses that house these clinics are for profit, pharmacies. This expansion is a business project based on the primary directive of increasing profits. You have no idea what their internal quality standards are or if they intend to be “good neighbors” to the physician practices in the towns where they are established. They might not care or even be aware of the concerns expressed in this article.

    What you can bet on for sure … is that they will make money either on the service they provide or the additional sales their clinics drive or both.

    Their value proposition is convenience and availability. It is important for physicians to get clear on what your value proposition is to your patients and then communicate it clearly and provide it consistently. You are marketing now … there is competition … you must prove your case to the patients for the superiority of your service … not to the readers here on KevinMD.com.

    Interesting times eh?

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • querywoman

      And the average medical doctor is in bizness for personal profit, regardless of who pays the salary! Public hospitals are in business for profit and to provide lab subjects to the medical schools!

      • http://www.thehappymd.com/ Dike Drummond MD

        Profit is a business concept that is foreign to the average employed physician. If you mean doctors get paid for what they do … then you are spot on. There is a huge difference between a for profit pharmacy stepping in to give you medical advice — inside the walls of the place where they can sell you stuff — and your doctor treating you in their office.

        The wallgreens clinic could recommend you buy “X” and have it waiting for you to check out … and we might mistake that for “convenience” until we examine if what their non-doctor recommended was the right choice for you or even needed at all.

        My two cents,
        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • querywoman

          Dike, I understand your viewpoint. I really don’t have any problem with greed, if people will admit, which the funeral home where I buried my mother and brother refused to admit with their post-burial calls.
          I already waxed eloquent about how Walgreen’s and CVS pass the cost of their massive lawsuits on to us in other products.
          I was crippled for more than 24 hours – no internet. Time Warner came and cleaned my waterlogged, rusty external cable box this morn.
          A project that I hope to get around to is to see who really owns these clinics in Walgreen’s and CVS. It should be public info. There is reason why the eye doctors have a separate office and door on the outside of Wal-Mart and whichever store.
          The sick are like the poor whom you have always with you. Nothing we ever do dries up the pool of sick people.

  • Kaya5255

    Thank heaven for free-standing urgent care centers!!! At least they have on-site physicians supervising the PA’s and NP’s.

  • PrimaryCareDoc

    Kevin’s mistake was being unavailable for an appointment for a cough. Honestly, no matter how “full” my schedule is, I’d never tell a patient with a simple acute issue like this that I couldn’t see them. Honestly, how long does it take to see someone with a URI? Five minutes? I tell them to come on over and I see them in between scheduled visits. You know that someone on your schedule will be five minutes late, or need to pee, or take forever to get from the waiting room to the exam room.

    • Suzi Q 38

      You are so right.
      My PCP has an “open door” policy for me.
      I have been his patient for over 12 years.
      I know his schedule.
      He is easy to see at 2:00 (right after lunch) and 4:00 (towards the end of his day). I usually call the nurse or receptionist and ask for permission to stop by and why.

      He already knows what my problem is so I do not take long.

    • querywoman

      If he couldn’t see the patient, whose his backup? Does the backup charge a new patient fee?
      I long for the old days of 24/7 docs with house calls, but logically a doctor is not superhuman.
      A doctor needs rest and a life away from medicine.
      Cover for yourselves, docs. I’d be in a group practicd.

  • SarahJ89

    “Finally, do providers employed by publicly traded, for-profit pharmacies have patients’ best interests in mind?”
    My experience since the local “nonprofit” hospital (which pays its CEO 3/4 million per year) has bought up all the practices in a 30-mile radius has been that my best interests are not even on the table.

    • _userM9801

      Truth.

  • medicontheedge

    Many patients wants their healthcare delivered to them like fast food: cheap, quick, and without much effort on their part.

    • C.L.J. Murphy

      On the other hand, if you’re hungry and you’re told there’s a two week wait at your favorite fine restaurant, but Chick-fil-A will satisfy your hunger in 10 minutes, you may well go to Chuck-fil-A. Especially if your favorite fine restaurant has been bought out by a big CorpFood conglomerate and half the time you go, you are shunted off the the midlevel “cafe seating” where they only serve microwaved Salisbury steaks anyway (but still charge you Boeuf Bourguignon prices).

      • openyourmind

        Oh good grief….what a crock. I’ll eat where I want. You just provide care like you were trained and quit fretting over everyone else. Your pent up anger is ridiculous. I’m not accessing healthcare so you can eat your fancy steak anyway.

        • Guest

          I feel so sorry for your doctors. I’m sure you don’t have any but God help you when you need one!

  • C.L.J. Murphy

    “Patients who go to retail clinics are more likely to see a rotating set of providers.”

    Sounds like a so-called “patient-centered medical home”, where a patient may have a real primary care physician “on paper”, but he or she will in fact be screened by a receptionist and shunted off to any one of a number a various midlevels whenever they come in. They might go in four different times, and see four different “providers”.

    Patients are becoming used to never being seen by their real doctor but by “a rotating set of providers”, and it’s the folks who used to be their doctors who have conditioned them to this. If the traditional medicos had wanted to retain the sacredness of the patient-physician bond, they shouldn’t have broken it in the first place. You can hardly blame Walgreens for this.

    • southerndoc1

      It’s not “a rotating set of providers,” it’s “team-based care.”

      Good post.

      • querywoman

        A rose by any other name would smell as sweet.
        A sewer by another name would smell as bad.

    • _userM9801

      Sad but true.

    • Cyndee Malowitz

      It all started with greed and laziness on the part of the physicians. The best part is when the PA or NP leaves and takes the business with them. Sometimes we get what we deserve.

      • Mengles

        Yes, bc I’m sure you have absolutely no greed based on your history of reporting doctors and being involved in lawsuits.

        • querywoman

          Mengles, it appears to me she reported a doctor based on concern for patient safety.

  • Frank Lehman

    “They sometimes page me in the middle of the night or on the weekend with questions stemming from their visit. Try that with retail clinics, which generally don’t forward phone calls to their providers and instead refer questions to call centers.”

    Try contacting your primary care physician after normal business hours, much less on weekends (or when they are closed for lunch for 1 1/2 hours). All you will be able to get is an answering service. So what do you do? Go to the emergency room? I would much rather go to a clinic at Walgreens than go to the emergency room.

    When primary care physicians start to respond to emails and after hours (and lunchtime) phone calls, they can then start complaining about how they think the Walgreens clinics will handle those after hours phone calls.

    • southerndoc1

      Bullshit.

      • Frank Lehman

        Mengles and southerndoc1

        You just don’t get it, or you really did not read my comment.

        Pho made the argument against the Walgreen’s clinics because he expected that they would not respond in the middle of the night to patient requests. But, as you (ie. Mengles and southerndoc1) demonstrate, most primary care physicians do not either.

        So don’t critiicze the Walgreens clinics for failing to do something that you won’t do either. That is hypocisy on your part.

        • southerndoc1

          Every family physician I have ever known, including myself, has provided 24/7 coverage for their patients: that’s why I’m calling BS.

          • Frank Lehman

            I am sorry you got lumped in with Mengeles.

            If I need to see contact a doctor at night/weekends/etc., I certainly cannot expect my family physician to be available.

          • Alice Robertson

            Oh don’t be bullied by anonymous, supposed docs (you never know for sure when they are anonymous and besides that it’s often really bad etiquette to criticize unless you do it under your real name. Otherwise it’s just sour grapes from a silly blue gravitar:).

            I don’t know one single patient who thinks they are seeing a doc at Walgreens (in my state a doctor oversees the NP’s and they can script a certain class of drugs so it’s limiting and patients usually know that). And I don’t know one single doctor who answers his phone during the night unless it’s an emergency (and they usually have groups of docs who cover for each other).

            Most the patients I know are so fed up they try to treat themselves if they can (and docs want natural alternatives regulated because that’s another job security loophole they want closed up, and most docs are ignorant about it except that it’s costing them money). Then depending on the time of day (if it’s after-hours the patients go to the Minute Clinic because their doctor isn’t available no matter how much chest beating you hear here).

            Medicine is changing. Patients are better educated than ever (sometimes well, sometimes not)….doctors are being pounded from every angle and in many cases aren’t getting the respect they think they deserve or the money. And they don’t like someone with less education trying to do their job, nor patients who like or defend those of the lesser level of education (so they use scare tactics or as you have seen sometimes the cyber bully pulpit).

            Then you get a couple of self-proclaimed health wonks here (usually liberal minded who say outlandish things and blame conservatives for everything because they know where their future income comes from while proclaiming conservatives selfish….um…hmm….:).

            Ultimately, it’s agenda-driven medicine and posting because too many livelihoods depend on it. Bottomline….do what works for you (no matter how much doctors tell you that you don’t really know that without asking them first:)

          • Frank Lehman

            Alice

            Who do you think is being bullied? Certainly not me.

          • Alice Robertson

            My whole post was a generalized summation about a segment of doctors who post loudly (online, not just here), usually anonymously (which, oddly, can be quite introspective….I really like Drake and Buzzkiller’s posts), and sometimes childishly. They are just like we are, but they have a whole lot to lose….hmmm….actually so do we:) If you hang out here long enough some of their names are amusing. There is the Dr. Grumpy, and Whitecoat, or Movin’ Meat, etc. Interesting group, but again a segment just needs their vision cleaned up a bit and patients are pretty helpful that way:)

          • openyourmind

            On the spot. I post anonymously but agree with you. Get the care where you feel comfortable. I’m not gonna be told who to see and where to go. I know the difference between all health care professionals from physicians to water witchers. You just do the job you were trained for and I’ll decide what type of professional I want to see. You are there for me. I’m not there for you.

          • querywoman

            I am 57. The family doctor I had from ages 17 to 33 didn’t have an answering service. When voice recorders became common, after hours we got a message not to leave a message, that it would no recorded, and to call a local hospital ER.
            Shortly before I finally fired him, I called that ER. They barely knew him, he was associated with them, but seldom admitted patients. The nurse said she would report him for having that on his machine.
            He would never discuss the issue with me. I quit him. My mother and brother kept using him. He eventually did start covering for himself.
            He was a fairly good family doc, with a few limitations. That’s why I kept using him.
            I think I had an especially irresponsible doctor.
            I agree that patients should automatically get what concierge practices offer. I have better docs now, but seldom call after hours, since I’m not used to it.
            The alternative to the retail clinic is trying to call the doc or going to the ER.

        • Cyndee Malowitz

          You got that right. Hope they don’t lose patients to the NP at Walgreens :-)

        • Mengles

          My post was saying that your doctor is not available to you 24/7 to the point that he/she is not even able to eat lunch or use the bathroom, bc you feel that your call should be returned. I didn’t say doctors don’t return phone calls. What I am saying is that doctors aren’t your slaves.

    • Mengles

      Your primary care doctor is not your indentured servant to where every waking moment is spent fielding your phone calls. They have families as well and deserve the same rights to life, liberty, and pursuit of happiness. If you don’t like it, then get a concierge doctor. Your sense of entitlement is absolutely disgusting. If you want a doctor at your beckon call you’re going to have to….wait for it….pay for it – a.k.a. concierge medicine.

      • LIS92

        Or go to Walgreens….

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          …or take a walk in the park. Either way, you will not be seeing a doctor.

          • LIS92

            I won’t be seeing a doctor anyway…

          • openyourmind

            Ridiculous. Who cares?

        • Mengles

          I was talking about doctors. If you want PAs and NPs at your beckon call – I’m sure they’re available.

      • querywoman

        What’s your state law about being available or covering for yourself? Or is it just an assumed medical ethic that you should be?

      • Cyndee Malowitz

        Absolutely agree. There are some people out there who have a doctor at their beck and call, like the president of the U.S., the royal families of the world. Michael Jackson had one until he got iced.

  • querywoman

    Here’s an example of a patient who one of these drugstore clinics. might serve very well.
    When I worked in public welfare, I had a young woman who was literally going from emergency room to emergency room with diabetic crises. She told me they working with her to get a family doctor for her. She had Medicaid, so there was no excuse for her not having one.
    I talked to her myself about how good having a family doc to manage it all can be. She told me that she was in denial about her diabetes.
    If someone like her had a walk-in clinic in her own neighborhood t hat took Medicaid, she would probably go.

  • ninguem

    http://www.justice.gov/dea/divisions/mia/2013/mia061113.shtml

    Walgreens Agrees to Pay a Record Settlement of $80 Million for Civil Penalties under the Controlled Substances Act

    And you want these people to control primary care clinics in their pharmacies?

    They cannot be trusted to be ethical in their distribution of controlled drugs.

    And CVS is just as bad.

    http://www.justice.gov/dea/divisions/hq/2013/hq040313.shtml

    And ALL these pharmacies sell cigarettes, liquor (when allowed by state law), and junk food, and you want a primary care clinic under that same roof?

    With chain pharmacies controlling primary care practices, their unethical and illegal practices can grow exponentially.

    • querywoman

      Conflict of interest is a valid point. Doctors are no longer allowed to own interest in laboratories. When doctors had financial interest in labs, they ordered more tests.
      Retail pharmacies buy and sell products, and leave a specific trail with patterns. Doctors and hospitals may be commit massive fraud, but it’s not as easy to track them.
      These huge fines don’t seem to deter the pharmacy biggies!

      • Cyndee Malowitz

        I know many physicians who own laboratories, imaging/sleep centers. In the state of Texas this is perfectly legally. They’re not allowed to own pharmacies in Texas though. A physician wanted to order a sleep study on me. Amazing, considering I sleep very well and certainly don’t have any symptoms of sleep apnea, not to mention I wasn’t even a patient of his. Another physician reminded me that idiot owned a sleep center. I’m sick of the public being taken for a ride.

        • querywoman

          Thanks, Cyndee. You gave me a new project for the next time I get bored: research med labs, etc., on the property rolls.
          Our big state has more public info on the net than any other state.
          Researched and read about the pain doctor who tried to shut you up.
          Gonna make private contact with you.

          Tests, tests, tests! No doc ever suggested I do yoga or put pure olive oil on my skin, two of the things that have been most helpful to me!

          • Cyndee Malowitz

            I’ll always be a patient advocate – first and foremost. It’s difficult to understand how so many physicians have lost their way. It’s very sad and disturbing. Unfortunately, the good guys get lumped in with them.

          • querywoman

            Cyndee, I lived in and worked public welfare over 9 years in a big Texas county. We have a public hospital, several church hospitals, and public and religious clinics.

            Everything is available here, except adult dental.
            I am always curious about the smaller counties, and I am not all impressed with what you tell us about yours.
            The state constitution delegates the care of indigents to the county. Yours must not have a very good county health system.
            By the way, I’ll type it here instead of an another post of yours. It’s easier to type or say, “NP,” or, “PA,” than “midlevel” or “physician extender.”
            Like you, I have a problem with docs who delegate visits down to the NP or PA and charge full doc fees.
            I know that you are not doing your work in lieu of a doctor. You are a fully qualified NP doing your own type of primary care.

          • Guest

            Cyndee, I agree with you. I am a physician. However, I see the fraud and abuse is not restricted to physicians. I hate being so cynical all the time.

            My 42 yr old husband who has a normal BMI, is vegetarian, healthy, and has PPO insurance was recently taken for a big ride when he got his “annual” physical. Of course he would not listen to me; he “needed” his CXR, EKG, exercise treadmill test and full panel of labs. So annoying.

    • Skip Hatter

      Also, let’s not forget that these pharmacy chains own and operate some
      of the largest pharmaceutical benefit management companies (PBM’s) in
      the country. They already underhandedly direct beneficiaries to company
      owned pharmacies, now they can direct those same beneficiaries to
      company owned primary caregivers and complete the circle.

      • https://www.facebook.com/arobert6 Alice Robertson

        And let’s not forget if it wasn’t for docs scripting a whole lot of patients would just go to chiros. Docs know most patients like and want drugs and that means places like Walgreens are going to be around for a long time. It is a bit amusing when doctors condemn alternatives. Patients are curious about that because if it were scripted the docs would suddenly find it profitable and recommend it.

        Many doctors want health food stores shut down too. It’s hard to take them seriously when they spout that mantra. Then tell us to regulate it then they can get a piece of the pie and suddenly….like LSD their world is wonderful and bright, and let’s not forget colorful! Ha!

        • querywoman

          Medical doctors have never been able to put the chiros or the health food stores out of business.

    • https://www.facebook.com/arobert6 Alice Robertson

      And how many doctors were sued last year for negligence? Or hospitals, etc. Ortho’s sell plenty of extras at about ten to 20 times the going rate as well as other inflated prices (I got an MRI today at Cleveland Clinic for $2600 while my insurance company called and asked me to get the exact same MRI closer to my home for $400. I would have taken it but I hurt too bad to wait, but next time I think I will use this cost-saving feature (it’s at the Anthem site under the “Compare” section) to start a trend towards getting hospitals to stop this over-pricing). So the example towards Walgreen’s starts to look more like doctor’s being green-eyed with envy than a true trumpet call to any patient. Walgreen’s services are so limited that most people who seek help there know it’s temporal. The truth is most of the patient’s seeking help there would get better on their own because the NP’s can’t treat anything severe. It’s purely a money maker but often a visit to the internist reflects that too (please don’t read “always” into this. Internists play a vital role but edgy patients who are sick do seek relief at wherever or whoever will serve them at the right time. Walgreen’s may very well prevent ER visits at times?).

      I find this thread interesting because at first when it was mostly doctor’s posting the “Likes” were very good in an atta boy fashion, then (what I assume are) doctors started to dislike patient’s opinions. That’s troubling when doctors get to the point they can’t handle rebukes or the ability to handle constructive criticism. While they proclaim their undying devotion to patients who aren’t buying the dying swan acts a couple of docs proclaimed with their I am available eight days a week:)

      • querywoman

        I posted below on how it is much easier to sue a pharmacy than a doctor or hospital.
        CVS and Walgreen’s are still raking in the dough, passing on the cost of their lawsuits to the rest of us.
        They are also paying an astonishing amount for their misdeeds, much more than other companies like auto manufacturers have had in their lawsuits.

      • ninguem

        Walgreen sent this blast fax to physicians all over the country.

        Dear valued prescriber,

        Walgreens wants to ensure that our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances. Our intent is to partner with you to ensure that patients receive their appropriate therapy and that the necessary information to confirm the appropriateness of the prescription is documented to satisfy DEA requirements. This process is designed to protect both you and the pharmacist.

        According to title 21 of the Code of Federal Regulations, section spell 1306.04, pharmacists are required by the DEA regulations to ensurethe prescriptions for controlled substances are issued for legitimate medical purpose. The regulation states the following:

        A Prescription for a controlled substance to be effective must be issued for legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist to fill the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21U.S.C. 829) and the person knowingly filling such purported prescription, as well as the person using it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.

        Our pharmacists are required to take additional steps when verifying certain prescriptions for controlled substances. This verification process may, at times, require the pharmacist to contact you for additional information necessary to fill the prescription. While the information requested may vary, potential questions could include information about the diagnosis, ICD-9 code, expected length of therapy and previous medication/therapies tried and failed. Privacy laws allow you to share this information with other healthcare professionals providing care to this patient.

        We realize that this process may generate questions and concerns from both you and the patient and we will do our best to respond in a professional and courteous manner. We recognize that sharing appropriate information with our pharmacists may require additional time from you or your office staff and want to thank you in advance for partnering with us to provide the best care to our patients.

        Be well,

        Your Walgreens Pharmacist

        ===========================

        These are the people you want to control primary care clinics?

        • https://www.facebook.com/arobert6 Alice Robertson

          Ninguem….I like your posts (most of the time and did try to “Follow” you at one point [you have some weird setting I couldn't be bothered with], but we disagree on a lot of things which is understandable).

          I know you are trying to make a point, but your vantage point is different than a patient’s vantage point in this medicinal arena.

          Most patients know that between the DEA (who just called one of my doctor friends wanting him to rat on a colleague. The doctor was terrified and called a lawyer), and the government and in my state doctors lose their license over pain pill scripts and in another state five CVS pharmacies were shut down over filling scripts.

          So can you please succinctly tell us why you keep warning us against Minute Clinics when all they are good for is antibiotic related scripts and sport’s physicals.

          Are we really in such jeopardy or is it the private practices that simply don’t like that patients like the places?

  • querywoman

    Dr. Pho,

    I address you formally here because you are writing professional as a man who cares about his patients.

    Thank you for your site as a free forum for expression. I am making close friends on your site.
    It’s impossible for you to be available 24/7, so you have to make a plan and deal with it. Even if you have another doctor covering for you, phones lines can fail, the other doctor could fall asleep, get blown up in traffic, get mugged, have a heart attack or stroke, etc.
    A cough is usually not a major problem. People who still work often need their coughs treated ASAP, so they go where they can. At the least the patient told you.
    You didn’t feel comfortable calling in some medicine? I don’t blame you. I want to be seen when I am ill.
    That said, I have had lots of general doctors, PA’s, and NP’s try to meddle in chronic conditions for which I have specialists.
    I have a thyroid problem. Before I became diabetic, big thyroid dosage adjustments would throw my entire body out of whack. So I started using endocrinologists.
    I discovered everyone thinks they are thyroid experts. Ditto for diabetes. I’ve been some bad endos, but I have a great one now.

    • https://www.facebook.com/arobert6 Alice Robertson

      Querywoman…I would love if you would write to me privately. My daughter has thyroid and lymph cancer. If you feel let please write to me at: alicerobertson@ameritech.net

      • querywoman

        Private contact info sent to you.
        Dr. Pho, you are helping a childless woman who has lost her parents and one brother heal. I have very little immediate family.
        Though this may not be the primary purpose of your site, I thank you.

    • ninguem

      Walgreen sent this blast fax to physicians all over the country.

      Dear valued prescriber,

      Walgreens wants to ensure that our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances. Our intent is to partner with you to ensure that patients receive their appropriate therapy and that the necessary information to confirm the appropriateness of the prescription is documented to satisfy DEA requirements. This process is designed to protect both you and the pharmacist.

      According to title 21 of the Code of Federal Regulations, section spell 1306.04, pharmacists are required by the DEA regulations to ensurethe prescriptions for controlled substances are issued for legitimate medical purpose. The regulation states the following:

      A Prescription for a controlled substance to be effective must be issued for legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist to fill the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21U.S.C. 829) and the person knowingly filling such purported prescription, as well as the person using it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.

      Our pharmacists are required to take additional steps when verifying certain prescriptions for controlled substances. This verification process may, at times, require the pharmacist to contact you for additional information necessary to fill the prescription. While the information requested may vary, potential questions could include information about the diagnosis, ICD-9 code, expected length of therapy and previous medication/therapies tried and failed. Privacy laws allow you to share this information with other healthcare professionals providing care to this patient.

      We realize that this process may generate questions and concerns from both you and the patient and we will do our best to respond in a professional and courteous manner. We recognize that sharing appropriate information with our pharmacists may require additional time from you or your office staff and want to thank you in advance for partnering with us to provide the best care to our patients.

      Be well,

      Your Walgreens Pharmacist

      These are the people you want to control primary care clinics?

  • querywoman

    They better not be transmitting the visits without a signature.

  • Cyndee Malowitz

    There are a lot of physicians in my area who won’t treat patients who are uninsured or have Tricare or Medicare. They have no option but to go to minor emergency clinics. It’s either that or the ER.

    • Mengles

      Before you go about badmouthing physicians and getting involved in lawsuits with physicians, and reporting physicians to the board, you may want to look at your profession that has shown to be LESS likely to take someone on Medicaid.

      • querywoman

        She’s a primary care NP serving her own area and is no more responsible for what other NP’s do than you are other physicians. Plus, your kneejerk barely touches on her subject.
        She doesn’t even mention Medicaid. I don’t know if she accepts. Re-read her post.
        I’m impressed that she told the truth about a physician and he sued her to try and shut her up. It backfired on him, like it always does!

  • Richard Willner

    I say let the market decide. The pharmacies with the NPs are convenient but the providers do not have optimal training nor do they follow-up. Many patients expect the same SOC as from a Physician and there will be some patients who are misdiagnosed or will have other issues. The first time a non-physician provider gets tagged with a Medical Malpractice action, all of the glamor of “playing doctor” will come grinding to a halt. There is just no substitute for the excessive education and training under fire of a strong Residency and Fellowship.

    Richard Willner
    The Center for Peer Review Justice
    info@PeerReview.org