Who Gets Medical Care at the Grocery Store?

Most people who use retail medical clinics don't have a doctor of their own, and many lack insurance.

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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.