Retail Clinics Now Part of Health Care Landscape

There are some new kids on the health care block. With names like Take Care and MinuteClinic, they offer limited medical services provided by nurse practitioners in chain and discount drug stores across the nation.

Launched by business entrepreneurs and backed by significant capital, these retail health clinics provide walk-in service for a defined range of health services, including immunizations, strep throat tests, sports physicals and other basic services. The clinics use a retail business model and view patients as customers in search of a product. Among the retailers leasing space to the clinics are Wal-Mart, Osco Drug, Target Corp. and CVS Corp.

Consumers like what they see. An October 2005 Harris Interactive poll (PDF file: 5 pages / 403 KB. More about PDFs.) found

The clinics, however, raise concerns among some physicians. Their convenience may come at the cost of quality and continuity of care, they say. Others worry the clinics could divert patients away from physician offices.

"Medicine has to have quality and accountability because you're dealing with people's lives, not fast food," said Missouri AFP President Thomas Kelley, M.D., of Liberty. "We want to be cautious when they present this as a health care model when it appears to more closely resemble a business model.”

Given that caution, the clinics may offer new prospects for family physicians. "Retail health could provide an opportunity for family physicians to become involved," said AAFP President Larry Fields. M.D., of Ashland, Ky. "The staff at the clinics will need supervising. So one way family physicians could extend their service is by developing a close working relationship with these clinics."

AAFP has been preemptive in holding discussions with some of the leading retail clinic chains, including MinuteClinic of Minneapolis and Take Care Health Systems, based in Conshohocken, Pa. Take Care has leasing arrangements with Osco, Eckerd and Rite Aid drug stores, said Fields. The result: Though not required to do so in some states, Take Care plans to seek physician supervisors for the nurse practitioners who provide care in all Take Care clinics.

"We're doing this across the board, because that's good medical care and in the best interest of the patient," said Lauren Tierney, spokeswoman for Take Care. "We're not out to be a means of competition to the physician. We look to refer patients to physicians in the communities where we're operating."

Internists don't serve children and pediatricians don't serve adults, so family physicians could hold a trump card in negotiating with retail health clinics because the facilities serve both children and adults, according to Kelley.

"That leaves family physicians in a critical role in many states where these business models are starting," said Kelley. "So there are family physicians who could really benefit financially" from these clinics.

However, he advised FPs who collaborate with retail health clinics to "remember their value in the marketplace." Those who work with the clinics must calculate -- and charge -- the true value of their time overseeing the clinic staff's work.

"Be cautious of these entities," he advised. "They may try to tell you what your time is worth. They may try to pay you a nominal hourly fee when you can see six patients in that hour."

Physicians also could try to compete with retail health by adapting part of the clinics' business model to their medical practices. For example, they may opt to move to open-access scheduling or expanding their services to include after-hours and weekend care, Kelley said.

"Family physicians need to review the Future of Family Medicine project. We can provide the same services that these retail clinics are providing in our offices," said Kelley. "And patients would rather see someone in their physician office than see someone they don't know," said Kelley.

True. The Harris poll found that 75 percent of respondents would worry that a serious medical condition might be missed or inaccurately diagnosed in a retail health clinic. Seventy-one percent would be worried about the qualifications of a retail health clinic's staff.

Both collaboration and competition with retail health confer potential financial benefits and risks. At the very least, family physicians should anticipate the growth and expansion of retail clinics and consider whether the care they currently provide in their offices is patient-friendly.