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Why Drugstore Clinics Are Under Fire

A shortage of primary-care doctors and rising health-care costs make retail medical clinics an increasingly common choice for primary health care. But as retail medical clinics expand their roles, there is reason for concern about the long-term relationships between doctors and patients.

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You have a sore throat or need a vaccination, but you can’t seem to find the time to visit your regular doctor—or he/she doesn’t have time to see you. Perhaps you don’t even have health insurance. What do you do? Retail medical clinics have become an answer.

Retail medical clinics, which sometimes are called convenient-care clinics and which focus on minor medical care, aren’t new. But you’ll likely see more of them as provisions of federal health-care reform kick in—depending, of course, on the fate of the Affordable Care Act.

The reasons for the existence of retail medical clinics are compelling. For example, the time that it takes between scheduling an appointment and the actual date that you see a primary-care doctor can seem like an eternity. It can take as long as 63 days in the Boston metropolitan area, according to research and consulting firm Merritt Hawkins & Associates. Add to that the fact that more than 50 million uninsured Americans will further drive the need for primary-care doctors. (The recently passed Affordable Care Act pushes Americans to get health insurance by 2014, although Congressional Budget Office estimates that when the act is fully implemented in 2019, if it isn’t altered before then, more than 22 million Americans still will be uninsured.)  

There simply aren’t enough primary-care doctors. Association of American Medical Colleges predicts that there will be a shortage of 29,800 by 2015 and 45,400 by 2020.

But American Medical Association (AMA), American Academy of Pediatricians (AAP) and American Academy of Family Physicians (AAFP) give retail medical clinics an unflattering diagnosis. These groups say retail medical clinics undermine the continuity of care. Further, they say the reach of retail medical clinics has exceeded their grasp as they move beyond treating minor ailments and take on chronic-disease management.

SMALL STUFF. Retail medical clinics sell convenience and transparent prices. These outfits typically provide treatment for such things as sinus, ear and urinary-tract infections; sore throats and flu symptoms; and skin rashes and allergies. They also give physical exams and seasonal flu shots.

The 1,200 retail medical clinics that are in the United States typically refer more-complex problems, such as severe respiratory distress, to an emergency room; and ongoing problems that are related to a chronic disease, such as diabetes, to the patient’s primary-care doctor. The clinic will recommend a local doctor to customers who don’t have one.

Nurse practitioners account for about 95 percent of the health-care providers who see patients at retail medical clinics, says Tine Hansen-Turton, who is executive director of Convenient Care Association (CCA), which represents retail medical clinics. Nurse practitioners are registered nurses who have had additional training, so they can provide primary care to patients. The rest are doctors or physician assistants, who are licensed to perform physical exams, diagnose and treat illnesses, and write prescriptions as needed. The physician assistants are required to practice under the supervision of a doctor, but what “supervision” means, such as the frequency with which a doctor is consulted, varies from state to state. (The health-care provider’s certification should be posted at the clinic. If it’s not, you should ask to see it, and if one can’t be produced, you should seek care elsewhere.)

The push to get more people signed up for health insurance and the ongoing shortage of primary-care doctors mean that the number of retail medical clinics is expected to increase. Industry researcher and consultant Tom Charland estimates that there will be 3,000 retail medical clinics by 2014.

As of last December, the biggest fish in the pond were MinuteClinic, which is a CVS Caremark company that has 451 outlets, and Take Care Health, which is owned and operated by Walgreens and has 357 outlets.

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