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Nobody has any illusion that clinics are in the business as an act of altruism. The companies make money money consumers might not otherwise have spent on health care. The Rand study showed that 90% of adult visits to retail clinics are for 10 common, often minor, reasons. But the same kinds of patients represent only 13% of traffic in doctors' offices. While some are migrating from their doctors to the clinics, others would have sought no medical help and would have gotten better on their own.
Doctors have emerged as the biggest critics of the new trend. "The most profitable part of a family physician's practice is exactly what retail health clinics are going after," says Dr. Ted Epperly, head of the American Academy of Family Physicians. A family doctor treating the same conditions can see five patients an hour. Take away this revenue and doctors will be left with only complicated cases that yield less profit.
But there are less mercenary concerns too. In 2007, the American Medical Association called for an investigation into retail clinics, arguing that drugstores, which position clinics directly adjacent to pharmacies, have a conflict of interest. For instance, floating above the pharmacy counter at many CVS stores are cardboard bubbles reading think minuteclinic, raising the worry that the clinics have an incentive to write too many prescriptions, which will then be filled at the pharmacy. (No AMA investigation took place.)
Family doctors also argue that retail clinics undercut the concept of a "medical home," a care provider who knows your history and can act as a director for all your medical needs. The clinics counter that with as many as 60% of their patients reporting that they don't have a primary-care provider, there's not much to undercut.
Nonetheless, clinics insist that they don't want to be anyone's medical home. They say they refer many patients particularly people who come in too often, which may indicate a chronic illness to doctors in the community. For uninsured patients who need more substantive treatment, a referral list includes low-cost community health centers or physicians who offer sliding-scale fees. "These clinics are a portal to the health-care-delivery system," says CVS's Chip Phillips, president of MinuteClinic.
That's important. Many clinic patients come in with an acute problem and, while there, learn they have a chronic one. "We catch a lot of things in people who just don't go to the doctor. Maybe they have high blood pressure and don't know it," says Anne Pohnert, a nurse practitioner and manager of MinuteClinics in Virginia. A retail clinic is not equipped to manage chronic hypertension, but spotting the problem is a first step.
Some retailers take this concept further, working with local health systems and hospitals. This eases ER crowding and helps a hospital extend its brand. The Cleveland Clinic is partnering with CVS in Ohio, and the Mayo Clinic has an outpost at a grocery store in Minnesota.
Despite the misgivings of doctors, retail clinics are changing the way family practices operate and possibly for the better. Surveys show that many family doctors are now lengthening their hours and leaving more appointments open on a first-come, first-served basis.
In times of economic crisis, the ability of the free market to solve problems may come into question. But in one vital corner of the economy, a little creative capitalism is helping fill a gap.