Who Gets Medical Care at the Grocery Store?
There's been a lot of heated debate in the last few years over the retail medical clinics cropping up in supermarkets and drugstores around the country. Open on weekends and evenings as well as days, the clinics are typically staffed by nurse practitioners who treat a limited number of simple but acute conditions—ear infections, strep throat, urinary tract infections, etc.—and offer some preventive care, mostly immunizations.
Physician reaction has been pretty negative, centering around concerns that nurse practitioners may not be qualified to correctly diagnose and treat these conditions and worries that the clinics disrupt the patient-physician relationship, since doctors may not know about treatment their patients receive there. Advocates for the clinics, on the other hand, have argued that the clinics offer a reliable and convenient source of medical care for many people who can't get a timely appointment with their doctors or who can't see them during regular office hours.
While the debate continues, more than a thousand clinics have opened their doors. Some have also shut up shop, but most experts attribute that to normal market shakeout after some operators realized they couldn't turn a profit as fast as they'd hoped.
What's been missing from all the back and forth about this new model of care and its effect on the healthcare system is any clear picture of who the users are. Thanks to a couple of new studies in the September/October issue of the journal Health Affairs, an interesting profile emerges.
Nationally, surveys indicate that about 80 percent of patients have a regular doctor whom they see for treatment or advice. Not this group. Nearly two thirds of retail clinic patients said they didn't have a primary care physician, according to an analysis of 1.35 million patient visits between 2000 and 2007—and they account for 74 percent of total retail clinic visits. Far from disrupting the doctor-patient relationship, "[F]or these patients there is no relationship to disrupt," said researchers at RAND and the University of Pittsburgh, who authored the study.
Retail clinic patients are more likely to be female, on the young side (between 18 and 44), and uninsured than patients who visit either primary care physicians' offices or emergency departments, the study found. It's interesting that a third of retail clinic patients apparently don't have health insurance, compared with a quarter of ER patients and 10 percent of those who visit a primary care physician. With roughly 45 million uninsured, retail clinics may be attracting people who otherwise would end up clogging emergency rooms with nonemergency problems.
Doctors who've fretted that retail clinics will encroach on their business can take comfort: More than 90 percent of visits were for 10 simple conditions such as sinusitis, upper respiratory tract infections, and sore throats. Those conditions made up just 13 percent of adult visits to primary care physicians, 30 percent of pediatric primary care visits, and 12 percent of emergency department visits, according to the study.
I've written in the past about the difficulties people have in arranging an appointment when they absolutely need to see their regular doctor. The problem is likely only to worsen: A JAMA study released earlier this week found that only 2 percent of fourth-year medical students say they plan to work in primary care internal medicine, down from 9 percent in 1990. Meanwhile, the general population is becoming older and inevitably sicker. As the RAND report notes, "At their most disruptive, retail clinics may shift the practice mix of traditional primary care clinics toward sicker patients." That sounds like a promising development: If primary care doctors weren't treating every sore throat and runny nose, maybe they could spend more time with chronically ill patients who could really benefit from their medical expertise.
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Urgent Care Light
Real Alternative Medicine
One possible solution to the occasional lack of access to, or shortage of, primary care doctors is what is known as retail care clinics, or convenience care clinics, and their popularity continues to increase somewhat 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.
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.
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
susan from WA
Learn how to write.
NP Versus Primary Doctor
My last 4 doctor visits were appointments with a doctor but when I got there I was seeing the nurse practioner!!
I have not ever seen the doctor listed as my primary care doctor and only once in the 4 years I have been with his office have I seen a doctor. Why is that?
NP's seem to have alot of knowledge and they listen when I am talking unlike the doctor I saw.
But when they are talking about me having serious health conditions I have to say I would feel better if I saw a doctor and not be sent to a specialist for all kinds of tests that turn out to be nothing and the specialists are wondering why I am even there.
with the premium and the co-pays I pay I do expect better service and the only good service I get are the NP's, I agree they should get a new name...and licenses and now I am wishing we would get grocery store clinics in NM
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