The growing number of retail health clinics in the United States has created both challenges and opportunities for family medicine, according to comments made by former AAFP President Rick Kellerman, M.D., of Wichita, Kan., during a forum on retail health clinics and their role in alleviating pressure on hospital emergency rooms here on June 18.
Former AAFP President Rick Kellerman, M.D., left, explains the importance of the patient and family physician relationship during a forum on retail health clinics in Washington.
The retail health clinic movement was a challenge to AAFP members, signaling that they needed to start looking at how they provide care and how they might do it differently, said Kellerman, who was one of four panel speakers to address the forum. "Some of our members hate retail health clinics, and others work well with them and have been working well with them for the past decade," he added.
Kellerman, who chaired an AAFP task force on retail health clinics a few years ago, said the AAFP held several focus groups with members on the subject. Some members saw retail health clinics as leading to more fragmentation of care. "More than once, we heard this is just one more thing getting between the doctor and the patient," said Kellerman.
In addition, FPs were concerned about retail health clinics skimming services by taking small but profitable services away from family physician practices. "Oftentimes, physician practices are small, private businesses -- they work on a very small margin," Kellerman said.
- Former AAFP President Rick Kellerman, M.D., said during a June 18 forum that the growing number of retail health clinics has forced some family physician practices to innovate.
- Some family medicine practices see the clinics as a threat to continuity of care and other see them as an opportunity to increase patient access.
- Kellerman enumerated several questions about retail health clinics that have yet to be resolved.
The "medicalization of symptoms," was another concern. "Just because you have a runny nose doesn't mean you need to go to the emergency room," said Kellerman. "It doesn't mean you need to go to a retail clinic, and it doesn't necessarily mean you need to go to your family physician."
The AAFP also heard from family physicians who support the concept of retail clinics. "They realized there are problems with access -- that we need new entry points into the primary care system," said Kellerman.
He noted that some family physicians are serving as local physician supervisors for retail clinics, and others consider retail clinics a source of referrals for their practices.
However, some questions about retail clinics still remain, said Kellerman. For example:
- Do retail health clinics fit into the system of care, or do they promote fragmentation of care and episodic care?
- Do retail health clinics integrate into a system of care, or do they stand alone?
- Where are retail health clinics located, and if their purpose is to provide an alternative to emergency care, are they close enough to emergency departments to readily allow patient access?
- Can retail clinics effectively expand their scope of practice from acute care to chronic care management?
- Do retail health clinics contribute to or detract from continuity and coordination of care?
- Do retail clinics support or detract from the financial health of primary care offices?
Also part of the panel was Tine Hansen-Turton, J.D., executive director of the Convenient Care Association (CCA), a trade group that represents most of the nation's retail health clinics. She sought to put the issue of retail health clinics into perspective by explaining that the clinics developed in response to a crisis in health care access, including limited access to routine and preventive care and a lack of established relationships between many consumers and their physicians.
Hansen-Turton described retail health clinics as "small health care facilities with one or two exam rooms" usually staffed by certified nurse practitioners or physician assistants. The clinics mostly operate in high traffic retail outlets with pharmacies and partner with local physicians.
"We see the medical home, our physician colleagues and our hospital colleagues as partners, part of the health care team," said Hansen-Turton.
She pointed out that when the CCA began in 2006, there were about 150 retail health clinics in the country; there now are nearly 1,400 clinics in operation. "We are in an expansion phase, and that is something we are excited about," said Hansen-Turton. "You are going to see more clinics, more clinic partnership with hospital services and others."
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