Thursday, August 9, 2007

"Minute Clinics" be afraid, be very afraid

We have lots of problems with access to care in the good ole' USA. Forty five million (and growing) have no insurance. Eight in 10 are from working families and 28% of young adults have no insurance. Even with health insurance, we are paying more out of pocket for health care.

So with all of these issues, isn't it amazing that the delegates to the American Medical Association have singled out retail clinics (also known as "quick care" or "minute clinics") as an area of burning concern.

These retail "drop in" clinics are showing up in Walmarts, drug stores and strip malls across the country. Staffed by advanced practice nurses or physician assistants, they limit their care to acute simple problems. Sore throats, urinary tract infections, rashes, and ear aches, managed using clinical guidelines, are the fare of these clinics and prescriptions can be quickly filled by the pharmacy close by. The clinics charge a flat fee (average $40-65) and no appointments are needed.

Some of the opposition comes from doctors that say these easy "in and out" patients are what keeps their practice viable and the clinics are unwelcome competition. Other opposition is concerned with patient safety (read: competition) and conflict of interest between the clinics and retailers that own them.

In Northern California a patient without insurance may call dozens of doctors before they can get an appointment. I challenge you to call a doctor in your community and try to schedule an urgent new patient appointment. The first question will be "What kind of insurance do you have?" There is a serious problem with access to care for patients who wish to pay!

For a single mom with kids, a busy college student or a blue collar worker who can't afford to take a whole day off trying to find a doctor, the retail clinics serve a purpose. The same organization that prides itself on autonomy and free market should focus on other more pressing issues facing health care.


Anonymous said...

I wish there was a quick easy way to get medical care near my neighborhood. The more minute clinics, the better as far as I'm concerned! Good post,Dr. Brayer!

Anonymous said...

A nurse is not a doctor. If I have a medical problem, I want to go to a doctor, not a kiosk with a nurse or assistant. This is not the way to solve the problem of access in America. I understand why these clinics are popping up all over but I wouldn't go there. Thanks

Rich said...

I would have to wait and see how these clinics get rated - like trying out a new car. I've been so lucky all of my life to have great health care benefits. I guess if I were in desperate need I would stop in. Any treatment may be better than no treatment for some people.

ER doctor said...
This comment has been removed by the author.
ER doctor said...

Agreed!! The AMA should focus on the myriad of other more pressing issues in healthcare that have already yielded very detrimental effects to us, and our patients.

Keep saying this Dr. Toni....if enough of us keep saying this, maybe we'll get other's to start saying it. And once enough of us are saying it....we can organize for change.

Ca NP said...

I completely agree with Dr. Bayer. How many people improperly use the ER for the common cold or flu? Or how many of us have waited hours in urgent care for minor concerns on the weekend only to see an NP or PA anyway. Something has to done to improve access to health care and free up our overcrowed ERs and NPs are well qualified to help. If they weren't then why are so many physicians employing them in their own practices? Patients and physicians who work directly with NPs appreciate the quality of care we deliver as a complement NOT a replacement, to their own practice. The public needs to educated on exactly what we're trained to do before passing judgment on these clinics run by them. We don't claim to be or want to be doctors. In fact, What we do, examine, diagnose, treat, educate and spend that extra time on issues/concerns on concerns and issues that don't need to take up a physicians time and our precious health care dollars. In fact, NPs set high standards for delivery of care based on national guidelines and frequently consult with and refer to physicians what is out of our scope of practice. If we used health care dollars more wisely without sacrificing quality care perhaps we could begin to control skyrocketing out of pocket health care costs. With all of the people in need of health care and overcrowding ERs I think the public will be pleasantly surprised to find their local NP will be happy to assist them with whatever is ailing them quickly and, within the MinuteClinics, stress the importance of having a primary care physician to manage their health and illnesses. This sounds like a win-win to me.

Anonymous said...

This concept is a very bad idea. It is a great money maker for the pharmacies in Walmart, but basically a fradulent way of providing medical care. Why not just have the patient look things up on the internet and write themselves a prescription. And charge them a few bucks to fill the prescription. Nurses and PAs can miss all of the important findings. $40-60 is too much to charge for bogus care.

Anonymous said...

As for "bogus care" by NPs, I am a Family Nurse Practitioner who has been treating pediatric through geriatric patients independently for over a decade without much difference in treatment provided by a family practice physician. In my graduate nursing program, I was trained by the same professors who taught at our medical school as well as local physicians. It is not legal for an NP to work without a license, and it is impossible to receive any state's license without having passed a standard national board certification. The truth is that the majority of patients who walk into a primary care practice do not have life threatening or complex ailmemts requiring the diagnostic skill of a hughly trained physician. NPs and PAs are ideally trained to care for the majority of patients. Let's better utilize our MDs for the complicated patient presentations and focus on providing great care for all.

Anonymous said...

I am a physician and am terrified by these minute clinics. Nurses are NOT doctors and they do not have the training to practice independent of physicians. NP's say they only treat the simple cases, but when you haven't had much training, everything is simple. What's worse, we physicians are going to have to put our names all over the charts of botched cases that come in to the ER. In my opinion, if you want to diagnose and write prescriptions then you need to go to medical school and receive the proper training. Fortunately, many of us are getting frustrated and are becoming more organized. I would be nervous if I were an NP.

Quiact said...

One possible solution to the occasional lack of access to, or shortage of, primary care doctors is what are known as retail care clinics, or convenience care clinics. The popularity of these clinics continues to increase progressively for a variety of reasons.
Of particular note is that most of these types of clinics is that are normally staffed with nurse practitioners or physician assistant. Both are health care providers and are actually favored by many as treatment providers progressively.
Surveys reveal that over half of all people prefer seeing a nurse practitioner at a convenience clinic because the visits do not take up so much of their time, as well as the visits being less expensive than traditional doctor visits.
The growth of such clinics, and the patient volume of each clinic, may slow at times, but the unique benefits of such urgent care light clinics do in fact exist and are desirable for many.
While the first retail clinic began in the year 2000, presently, there are over 700 of these convenience care clinics, and that number is speculated by some to increase to thousands within the next few years.
First, I’ll offer a definition of a retail clinic:
A retail clinic is a medical treatment facility that is usually located in a convenient location, such as a shopping area, and is smaller than most doctors’ offices in regards to geographical space. Again, these types of clinics are staffed with a physician assistant or nurse practitioner.
Both types of these health care providers have the ability and authority to provide the same quality care as a primary care physician, and do so with the same if not superior standards regarding accountability and autonomy.
If you happen to go to one for what may be considered a mild ailment, for example, for such conditions as allergies or the flu, you will notice a unique and pleasant experience regarding your medical care at such a clinic in comparison with many other doctor’s offices that often appear to be possibly demoralized if not largely apathetic, in regards to their disposition.
These urgent care light clinics are normally and amazingly quick for a patients who are medically treated at such locations. You as a patient are normally in and out of there within a half hour or so. This includes a thorough assessment and treatment regimen offered by the health care providers at such clinics.
Unlike typical doctor offices, these clinics are walk-in clinics, so there is no over-booking of patients, which is what typically occurs at current offices of doctors. Many are focused on the daily volume of patients for a variety of reasons.
With these convenience care clinics, you as a patient actually dialogue with your health care provider more so than you may have experienced in a traditional doctor’s office due to possibly other doctor offices often being incredibly busy from seeing too many patients during a typical day for reasons described above.
And this is not to imply that the health care providers at typical doctor offices do not care about you and your particular health issues, yet possibly is a result of having limited resources related to patient care. As a result, they may be unable to do so.
The cost of going to such a retail clinic typically is about 25 percent less expensive than a normal doctor visit, others have said. Yet you will likely notice no decline in the quality of care that you receive. In fact, likely you will experience greater quality on many different levels, both from a personal level and treatment level if a patient at such a clinic as a retail clinic, others have said.
Critics of such convenient care clinics include the American Medical Association, and various medical societies. Yet in my opinion, such critics may be simply vexed because of the invasion of these other clinics on their turf and their infiltration into their typical medical practice paradigm without being invited, perhaps.
Or maybe such groups and associations do not see NPs and PAs as having the ability to provide quality medical care as they do as medical doctors. Regardless, most patients seem pleased with the retail clinics and the treatment providers who care for them at these convenience care clinics..
If it is discovered that you need greater medical care or attention than the retail clinic can provide for you during your visit at a urgent care light clinic, you will most likely be referred to a nearby location that can provide the care you are determined to need by the clinic’s heath care provider.
The clinic’s health care provider likely has some familiarity as well as some relationships with the hospitals and others in the medical community for which they serve. It should be noted that both NPs and PAs are quite capable of determining the severity of your illness, and will act accordingly.
So most patients of these retail clinics are pleased with the care they receive from them, which is why such clinics continue to grow in number under different names, as they have become franchises, yet the concept of this ‘pay as you go’ health care is fairly new.
So only the future will tell if this method is preferred by those seeking minor restoration of their health. It seems to be preferred by many presently, once again. And presently, Take Care Health Clinics, owned and located inside Walgreen’s pharmacies, are the market leader with retail clinics. Walgreens plans to add more clinics next year.
These retail clinics are in a way a response to the shortage of PCPs that exist presently, and delays others experience in our health care system when they seek restoration of their health on occasion. In other words, retail clinics are quick when you are sick, yet quality and assessment of your medical condition are not compromised.
One could conclude that the retail clinics seem in a way more authentic than the dominant system, and may be more beneficial ultimately for the public health, with exceptions, of course, depending on the individual circumstances of the patient.
Dan Abshear

Anonymous said...

Nurse practitioners provide competent care. I think theses comments posted by idiots who judge NPs as not being an asset to care is hilarious. NPs are on the rise because now that they have had a chance to prove them-self. Patients love them because they care and treat the patient as a person and not a disease. I hate it for the MDs who are losing opportunities to NPs.

Anonymous said...

Nurse practitioners provide competent care. I think theses comments posted by idiots who judge NPs as not being an asset to care is hilarious. NPs are on the rise because now that they have had a chance to prove them-self. Patients love them because they care and treat the patient as a person and not a disease. I hate it for the MDs who are losing opportunities to NPs.

Anonymous said...

These clinics are convenient, yes, but the newly minted NP with <1 year experience shouldn't be the only staff on hand. I visited a clinic in GA with my son and the employee was so clueless that we ended up at a doc-in-the-box with an MD. I submitted a complaint and looked up the CVS "provider" and she'd graduated less than a year before our visit. Poor thing, no wonder she was overwhelmed and unable to cope!

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