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Over at Salon magazine, physician Rahul K. Parikh writes in support of the kind of quick-stop retail health clinics pioneered by Wal-Mart and now popping up all over the country. But many in the medical industry don’t like them a bit:
At a recent medical conference, I eavesdropped on a couple of doctors talking to each other about retail health clinics, small offices or kiosks that offer basic medical care in venues ranging from Target to Piggly Wiggly. These particular docs were not happy. One said some of his “easy business,” patients who needed only a few minutes to handle, such as those with sore throats or colds, had migrated to the clinics. The other seemed perplexed that some of the parents in his pediatric practice seemed just fine paying cash to clinics, rather than coming to see him, where they had only a low co-pay.
These views don’t surprise me. Doctors are naturally nervous about the rapid growth of retail clinics…Many medical groups, like the American Academy of Family Practice and the American Academy of Pediatrics (to which I belong), have published position papers opposing retail clinics. Their basic argument is that retail clinics run counter to the concept of “a medical home,” a place where patients receive care for any and all of their problems. They worry that patients will have no sensible place to follow up their test results, and that putting a clinic in a mall or a Wal-Mart could expose shoppers to people with a contagious illness.
Parikh disagrees. From low cash fees for services to accessibility of care to promoting competition and innovation, his column gives a detailed rundown on why these clinics are good for American healthcare. Have you tried them?
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Identity theft
Haven’t tried one. I don’t usually go unless I have a real problem. I figure colds and flus go away after a time.
I have gone to the “doc in a box” facilities which are usually a sub-organization of a larger hospital, rather than the emergency room when I had a nasty cut that needed stitches. The local one has some very good doctors.
Interesting take on the situation. I wonder what StuBob has to say?
If a trip to the doctor did not require a 1-2 hour wait, I don’t think these new clinics would be as popular.
It costs less. It’s more convenient. Yeah, that’s a real tough choice.
“. . .putting a clinic in a mall or a Wal-Mart could expose shoppers to people with a contagious illness.”
Uh, have they ever peeked at their own waiting rooms? It’s terrifying to go in for a routine check-up and see everybody coughing and sneezing in the doctor’s office. I always think, “I wasn’t sick when I got here, but I will be when I leave.”
Haven’t done here in Kentucky–we rarely get sick.
But when we were in Atlanta, as Make It Man says, many hospitals run affiliated walk-in clinics. I used one for a poisonous spider bite. No wait and got the treatment I needed. But since it was hospital-affiliated, I paid a co-pay, not a cash fee like the original topic’s version.
Our Wal-Mart doesn’t have one. If it did, and the wait and expense were less, I would go for the “easy business” type of care. If the doctor wants to keep the easy business at his office, he needs to make it easy for the patient also.
Why should I, as a patient, pay as much to have my doctor (who is hospital-affiliated but the clinic is not walk-in) look at my throat and prescribe an antibiotic (I only go when it’s hung on long enough that it’s clear it’s not just a cold) as for a longer and more involved visit for a more serious problem? (Not to mention the absurdly long waiting time - when I went with a sinus infection last month it was an hour in the waiting room and another half hour in the examining room before he came in.)
Whenever I see people feeling threatened by competition, I’m pretty happy. It reveals a lot more about their motives than they wish.
Oh yeah Pauline, and couple that with the fact that the hour and a half wait is followed by a five minute visit, and you have a recipe for folks going elsewhere in droves, if they have the opportunity. It’s irritating that doctors haven’t seen this already….
Don’t get me wrong, I like and need doctors, but this practice is just… stupid. They are shooting themselves in the foot. This separating out easy cases from the difficult ones should have happened long ago…
My last visit to the doctor was a breath of fresh air. Instead of a 1-1/2 to 2 hour wait, it was a five minute wait and a 2 hour evaluation. I was shocked. I thought I’d died and gone to heaven. I’ll go see him again tomorrow for another evaluation, after several weeks of therapy.
Another factor that may come in to play is the emergence of high-deductible health plans. Under such a plan you pay the first $2,500 (per person) out of pocket, after which everything is covered. This means that most people will be completely paying for all of their own health care. A high-deductible plan also allows you to have a Health Savings Account, which, unlike a Flexible Spending Account, you don’t loose at the end of the year if you don’t use it. This is what my company offers and I quite like it. Plus, in my company, it is free. So I have no premiums deducted each pay, but I do contribute heavily to my HSA so that any medical expenses I incur will be covered by it (tax free).
The point being that when I’m paying for it myself, cheaper is better.
We got one of these about a year ago in my local Wal-Mart. I haven’t gone, as I’ve been using the same doctor for 10 years, and I like him. But a lot of people do go there, and he said his income is down probably 25% since the clinic opened. At first he just got mad, but then he decided to do something about it, and fight back, and challenge Wal-Mart at its own game. So he fired his long time staff and replaced them all with lower wage workers, whose only conversational skills are replying “que?” and/or “no spee englee”. He has also started selling cheap Chinese imports out of the trunk of his Infiniti to patients after their visit is over.
Kyle: Whenever I see people feeling threatened by competition, I’m pretty happy. It reveals a lot more about their motives than they wish.
So you call rapid throughput in a medical office some kind of capitalistic ideal? As well as surgery by the lowest bidder and perhaps hospitals with nurses only for those who can pay for them?
Sadly for you, there are some services which are important enough for the buyer that imposing pure market-driven principles puts the buyers at risk for their lives. And there are some principled providers who recognize that.
The practice of medicine, at least in my experience, is much more an art than a science or a production line of lab results. To be done correctly it requires time spent getting to know families and individuals and providing a great deal more than a simple diagnosis and a scrip.
Our society has chosen to ignore these facts and, in the name of “efficiency” allows the kind of “lowest bidder” services to substitute for comprehensive, quality care. I have little doubt but that these large retail chains will, if they don’t already, wind up in contracts with the same type of firms our prison administrators use to care for convicts.
We have refused to pay for enough medical education and personnel to do the job right.
And people, some not even in jail, are dying…
Arcadia - We don’t have enough providers (anywhere) for the potential demand. Here care is rationed by price & economic means. Elsewhere it is rationed by waiting times. If we are going to get to “universal coverage” it will end up looking more like this.
Well, this is an interesting debate for sure. There are merits to both sides.
A few things to note:
You get what pay for.
If one goes to a “minute clinic” (like CVS or Wal-Mart), one will get basic care for a few minor illnesses like strep, sinus infections, etc. If you like the service Wal-Mart gives (think of your last experience in the Auto department for example), then you’ll have an idea of what you’ll get in their clinics. It’s fast, cheap, and basic. It’s not about quality, but quantity.
If one goes to a regular “doc in the box” or walk-in clinic, you get a moderate level of care at a premium price. You’re paying to have a doc and lab on the premises for extended hours. It’s sort of like using a “rent to own” store to buy a tv or furniture. It’s an expensive way to go, but if it’s your only option, you do what you gotta do. If you’re sick on the weekend or after 5, it’s the only option other than the ER. The wait can be long, given that they take all comers on a first-come, first-served basis. The doctors are usually moonlighting from ER’s, just out of med school, between jobs, or unable to set up a private practice for some reason. Turnover is significant.
If one goes to their regular doctor, you will usually get comprehensive care at premium prices. The advantage is that the doctor will most likely be far more competent and thorough. He or she will know your medical history and give at least a minimum of personal attention. He or she will be there 6 months from now, six years from now. You can have a long relationship with your regular physician.
The bottom line is money in this issue. Regular physicians count on the minor illnesses that take a minimum amount of time to care for to subsidize their more complex patients and procedures. If the “minute clinics” siphon off that business, they’ll be hurting even more than they are now. I know doctors make a lot of money, but I don’t think people realize how expensive it is to get trained, to set up a practice, and stay in business. Staff salaries, equipment, and malpractice insurance cost a lot of money.
The thing to think about is, do we want an “assembly line” type of health care that places like Wal-Mart are offering? Are we just like a car that needs new tires?
You know, if you’re poor and you’re sick, places like “Wal-Mart” may be the only option. It’s disappointing that we spend more than any other nation on health care, yet we have such great disparity
It’s disappointing that we spend more than any other nation on health care, yet we have such great disparity.
Apparently, Wal-Mart shoppers would rather spend more on health care and less on heath insurance. I wonder if we Americans really spend that much on health care?
I like the idea of these clinics. Now when I really need to see the doctor for a real illness or infirmity, the office won’t be crowded with all the folks who only need to take an aspirin and go to bed. Why do so many go to the doctor for sniffles and simple coughs? Go to the retail clinics and leave the real doctors available for real medical needs.
I have never used one of these walk-in clinics as there are none in my area. My son-in-law has used one near his office a few times. The reason he did so was that he could run on his lunch hour or only miss work a short time, rather than the whole day or several hours at his regular clinic. They will not treat everything and will tell that to the patient.
I have to laugh, though, when one talks about consistency of doctors, so they can get to know “the family”. I have never had that. We had a real shortage of family doctors and internists. It was a challenge to find one and get in before they decided they were too busy for new patients. My husband and I tried to get the same doctor a few times and never could. One was always refusing patients or leaving before we could both get in. I finally found a doctor that I hope to be able to keep. My husband has his own doctor. When you go to a specialist, you still have to fill them in on everything in your chart, if you can remember. I’d like to see a little consistency. Oh–I do have some, my new doctor’s receptionist was also one to two former doctors from a few years ago.
We have had a new clinic come in a few years ago and I notice that the old one is more interested in getting patients into the doctor quicker. I have even been apologised to more about the wait. As I see it, competition can be very good.
A problem with clinics of these sort is that they depend on patients to decide whether their illness is trivial or a manifestaion of more ominous problems, and will tend to treat them as relatively benign whether or not they are. A no-wait decongestant and antibiotic for the sniffles and cough of someone with pneumocystis pneumonia may seem like a cheap efficient fix up front. But, for instance, the drive-in/take-out visit is unlikely to disclose an underlying pattern of opportunistic infections secondary to HIV. Over the long haul, I suspect the patient pays if you look at groups and not just individual instances.