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The Doctor Will See You in Aisle 3

By Dr. Nilesh Kalyanaraman

It’s impossible to get in to see your doctor on short notice.  When you get a sore throat that just won’t go away and call your doctor’s office for an appointment you’re told that the earliest one available is next week. Going to an urgent care center or an emergency room seems like overkill. Frequently, the best option is to go to a retail heath clinic (RHC).

Retail health clinics offer care for minor injuries and illnesses, provide vaccinations and in some locations do health screenings and preventative care. They are located in pharmacies, large stores and malls. It’s easy to be seen the same day and the pricing is transparent. Physicians Assistants (PA) and Nurse Practitioners (NP) staff the clinic with a supervising physician providing oversight. In talking with patients who have gotten care at RHCs and colleagues who have worked there the convenience offered by RHCs is unrivalled in the medical system.

The medical profession is not as enamored with RHCs. The American Association of Family Practice (AAFP) earlier this year reversed its stance on RHCs by ending a five-year relationship with five RHCs. The AAFP opposed the expanded services offered by RHCs and worried that they would interfere with the medical home model. The American Medical Association (AMA) in 2007 urged state and federal agencies to investigate RHCs for potential conflicts of interest due to their location in pharmacies. At present time the AMA and American College of Physicians (ACP) offer no official position on RHCs but suggest a code of ethics that they should follow.

The main concern about RHCs is that they should strive to ensure continuity of care and limit their scope of practice. Maintaining continuity of care is crucial but should no more be a challenge for a RHC than it is for an urgent care center or ER. More telling is the concern that RHCs need to limit their scope of practice. The real fear is that RHCs offer stiff competition to the traditional medical model by utilizing PAs and NPs instead of physicians to provide care for common conditions.

According to a study released last month by the RAND Corporation RHCs, physician offices and urgent care centers all delivered the same quality of care. The cost of care at RHCs was 30-64% lower than at physician offices or urgent care centers. Not surprisingly, in multiple studies patient satisfaction was very high with 86-96% of patients being somewhat or very satisfied with their care.

Retail health clinics have raised the bar on treating low complexity problems by providing convenient quality care at low cost. Instead of viewing them as competition, physicians should embrace these clinics for delivering needed care to our patients. We can learn a few things from them such as having more evening and weekend hours or having more open access hours. It’s the least we can do for our patients since we can’t see them until next Thursday.

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