Jessica Messner has bronchitis, and she's grateful that her family physician, Neal Erickson, M.D., of Kansas City, Mo., is able to see her today. Messner says she's never been to a retail health clinic, and she doesn't think she'll ever need to visit one.
FPs Challenge Retail Health Clinics
Innovative Scheduling Benefits Docs, Patients
By Sheri Porter
11/6/2007
FP Neal Erickson, M.D., left, is able to take care of more patients with acute care needs, such as Jessica Messner, right, since he tweaked his office schedule.
That's because Erickson and his partners at Kansas City Family Medical Care are making patient access to health care as convenient as possible. They offer walk-in sick clinic hours Monday through Friday from 8 to 8:55 a.m. In addition, Erickson's schedule is unblocked for nearly two hours every afternoon, leaving him available for patients with acute care needs.
Pink signs posted around the office tell patients that the sick clinic is available to them for urgent complaints, such as a sore throat, cough, fever and earache, but not for visits they would normally schedule with their regular doctor.
Erickson says the extended hours primarily are a competitive response to an influx of retail health clinics; the Kansas City area supports more than 20 such clinics, and two are just minutes from Erickson's practice.
Pink signs posted around the office tell patients that the sick clinic is available to them for urgent complaints, such as a sore throat, cough, fever and earache, but not for visits they would normally schedule with their regular doctor.
Erickson says the extended hours primarily are a competitive response to an influx of retail health clinics; the Kansas City area supports more than 20 such clinics, and two are just minutes from Erickson's practice.
Innovation Grows Practice
Erickson also was looking for a way to create more patient volume without straining the practice. Creative scheduling is working. "Numbers are way up," says Erickson, estimating an overall increase of up to 100 walk-in patient visits per month.
In addition, Erickson says his office staff members love the decrease in early-morning phone traffic; patients don't call, they just walk in. And he appreciates not getting "slammed" at the end of the day with 20 "work-in" patients.
The key to this kind of scheduling is speed and flexibility, he says. The morning sick clinic hour, which is staffed by two physicians, is chaotic, with anywhere from eight to 20 patients seen each day. But they're uncomplicated patients, "usually young, usually healthy, they just want to take care of their problem and move on," says Erickson.
In addition, Erickson says his office staff members love the decrease in early-morning phone traffic; patients don't call, they just walk in. And he appreciates not getting "slammed" at the end of the day with 20 "work-in" patients.
The key to this kind of scheduling is speed and flexibility, he says. The morning sick clinic hour, which is staffed by two physicians, is chaotic, with anywhere from eight to 20 patients seen each day. But they're uncomplicated patients, "usually young, usually healthy, they just want to take care of their problem and move on," says Erickson.
Physicians Express Concerns
Steven Adamson, M.D., chairman of the Department of Family Medicine at Mayo Clinic in Rochester, Minn., heard plenty of physician complaints about retail health clinics during a session he led on the topic during the Academy's recent Scientific Assembly in Chicago.
Most physician concerns revolved around the possible loss of revenue, erosion of the medical home and perceived lack of quality care provided by mid-level practitioners.
"You can be negative about this, but it's not going away," says Adamson. "It's a market response to the access issue." In addition, the "skyrocketing number" of mid-level providers coming out of training plays a part, he says: People are looking for a way to use those providers safely, effectively and efficiently. However, he points out, retail clinics staffed by mid-level providers are bound by a limited menu of services. "I've never worked with a mid-level practitioner who wouldn't be able to handle those things in fine fashion."
And don't forget, says Adamson, the United States is in the middle of a doctor shortage. "There's not enough primary care physicians to go around," he says, adding that he's not worried about mid-level providers replacing family doctors. However, if a patient calls with an acute problem, "it would be a good idea to try and get them in the same half-day. Otherwise, they will find a way to have their needs met that probably won't include you."
Adamson also points out that some patients have no interest in establishing a medical home, "and I don't know that you're going to get them, anyway."
Most physician concerns revolved around the possible loss of revenue, erosion of the medical home and perceived lack of quality care provided by mid-level practitioners.
"You can be negative about this, but it's not going away," says Adamson. "It's a market response to the access issue." In addition, the "skyrocketing number" of mid-level providers coming out of training plays a part, he says: People are looking for a way to use those providers safely, effectively and efficiently. However, he points out, retail clinics staffed by mid-level providers are bound by a limited menu of services. "I've never worked with a mid-level practitioner who wouldn't be able to handle those things in fine fashion."
And don't forget, says Adamson, the United States is in the middle of a doctor shortage. "There's not enough primary care physicians to go around," he says, adding that he's not worried about mid-level providers replacing family doctors. However, if a patient calls with an acute problem, "it would be a good idea to try and get them in the same half-day. Otherwise, they will find a way to have their needs met that probably won't include you."
Adamson also points out that some patients have no interest in establishing a medical home, "and I don't know that you're going to get them, anyway."
Clinic Expansion Continues
Tine Hansen-Turton, executive director of the Convenient Care Association, or CCA, confirms that the number of new retail clinics is climbing. In February 2007, the CCA, which was established in 2006 to advance the mission of convenient care clinics, reported 280 clinics in almost 30 states. Now, there are 630 clinics operating in 36 states.
The biggest change Hansen-Turton is seeing is a surge of interest in her organization from large physician practices. She says that recently, 15 to 20 practices have called looking for advice and technical assistance on how to set up their own convenient care clinics. "Physicians' reactions (to such clinics) were initially negative, but now they're looking for solutions," she says.
The biggest change Hansen-Turton is seeing is a surge of interest in her organization from large physician practices. She says that recently, 15 to 20 practices have called looking for advice and technical assistance on how to set up their own convenient care clinics. "Physicians' reactions (to such clinics) were initially negative, but now they're looking for solutions," she says.
Proactive Practices Plan Ahead
Some folks were ahead of the retail health trend. Melissa Gerdes, M.D., of Whitehouse, Texas, initiated "QuickSick" hours in her practice, Trinity Clinic Whitehouse, in February 2003 before retail health clinics became prevalent.
Gerdes says initially she was looking for a way to accommodate seasonal increases in patient volume during cold and flu season. QuickSick hours are available every day from noon to 1 p.m. and again from 4:30 to 5 p.m. Gerdes guarantees patients they'll be in and out of the office in 30 minutes.
A little newspaper and in-office advertising was all it took to train patients to call and ask for QuickSick appointments by name. Schedulers remind patients that the "emphasis is on service and convenience," and ask them to limit their visit to only one complaint so patients next in line won't have to wait.
QuickSick "allows the schedule to be an accordion," says Gerdes. "I can see two to 12 patients in an hour, depending on the need." The unique scheduling also keeps sick patients from mingling with healthy patients scheduled for well-patient exams.
Gerdes says initially she was looking for a way to accommodate seasonal increases in patient volume during cold and flu season. QuickSick hours are available every day from noon to 1 p.m. and again from 4:30 to 5 p.m. Gerdes guarantees patients they'll be in and out of the office in 30 minutes.
A little newspaper and in-office advertising was all it took to train patients to call and ask for QuickSick appointments by name. Schedulers remind patients that the "emphasis is on service and convenience," and ask them to limit their visit to only one complaint so patients next in line won't have to wait.
QuickSick "allows the schedule to be an accordion," says Gerdes. "I can see two to 12 patients in an hour, depending on the need." The unique scheduling also keeps sick patients from mingling with healthy patients scheduled for well-patient exams.
Focus on Patient-Centered Care
Another part of the country that's not yet seen retail health clinics is Selmer, Tenn. Nonetheless, four months ago, Timothy Linder, M.D., and his practice partner, AAFP President Jim King, M.D., opened a "fast-track" room to address patient access issues.
"With the fast-track room, if a patient really needs to be seen that day, we don't have a reason that they can't be seen," says Linder, a member of the AAFP's Commission on Governmental Advocacy.
The sign on the door says "fast-track room," and the room is full most of the day, says Linder. When Linder, King or their nurse practitioner exits an exam room and sees a patient in the fast-track room, "we'll go right in and take care of them between appointments," says Linder. Three-hour waits have shrunk to five to 10 minutes. "It's actually just moving patient flow better," and those inevitable gaps in the schedule are gone, he says.
Family physicians who don't offer this kind of service to their patients should, says Linder. "Patient-centered (care) means patient-centered (care). It doesn't mean 'Gee, I have no openings today, so tell them that they can't be seen.'"
"With the fast-track room, if a patient really needs to be seen that day, we don't have a reason that they can't be seen," says Linder, a member of the AAFP's Commission on Governmental Advocacy.
The sign on the door says "fast-track room," and the room is full most of the day, says Linder. When Linder, King or their nurse practitioner exits an exam room and sees a patient in the fast-track room, "we'll go right in and take care of them between appointments," says Linder. Three-hour waits have shrunk to five to 10 minutes. "It's actually just moving patient flow better," and those inevitable gaps in the schedule are gone, he says.
Family physicians who don't offer this kind of service to their patients should, says Linder. "Patient-centered (care) means patient-centered (care). It doesn't mean 'Gee, I have no openings today, so tell them that they can't be seen.'"
