Prevent Retail Clinics from Taking Over Your Practice

Abstract & Commentary

By Rahul Gupta, MD, MPH, FACP, Clinical Assistant Professor, West Virginia University School of Medicine, Charleston, WV. Dr. Gupta reports no financial relationship to this field of study.

Synopsis: Because of cost savings and quicker appointment times, patients find retail clinics attractive alternatives when faced with minor illnesses.

Source: Ahmed A, Fincham JE. Physician office vs retail clinic: Patient preferences in care seeking for minor illnesses. Ann Fam Med 2010;8:117-123.

Recently, retail clinics in the united states have found a niche in becoming a viable option for patients seeking urgent care. Located in mostly metropolitan areas, these clinics are often established in retail stores such as pharmacy and grocery chains and are often designed to be a quick fix option to minor acute medical illnesses and are staffed by non-physician providers. The population served is often younger, uninsured, and without a regular primary care physician.

Ahmed and Fincham investigated the likely effects of cost of care, type of condition for which care is sought, type of care setting, and appointment wait time on care-seeking decisions at retail clinics and physicians' offices. The study sample was obtained by Georgia Poll, a statewide random-digit-dial survey of Georgians ages 18 and older. Almost half of the 493 respondents resided in the Atlanta metropolitan area. Overall, the respondents preferred to seek care from a physician at a private office rather than a nurse practitioner at a retail clinic for acute minor illnesses. However, they did not prefer to wait longer than a day in seeking care. Comparing the two preferences when considered in terms of how much they would be willing to pay to forgo either option, they clearly preferred a quicker appointment. In other words, while patients preferred the physician-provided care, they were willing to forgo such care if they could be seen more quickly by a non-physician provider. Patients also preferred to pay less for their care, which is to be expected. The study did not distinguish care obtained from a nurse practitioner or a physician assistant.

Commentary

Retail clinics have been the subject of much controversy since they first came into existence in 2000. Operators of such clinics assert that they provide a convenient, efficient, equal quality but low-cost alternative to traditional medical care rendered by physicians.1 However, many experts and several physicians groups have raised serious concerns about the provision of medical care in this innovative manner.2 The quality of care is questioned, as well as the lack of provision of preventive services, continuity of care, and the possibility of overprescribing of medications. There is a clear concern that providing such fragmented care to an already disenfranchised population has the potential to blow up in all our faces. Not only does such a concept go against that of the medical home model, but there is a strong possibility of missing important early clues in contagious diseases and other issues of public health significance. Due to their extensive training and scientific background, physicians are often the first ones to notice such trends or deviations from the norm and therefore play a vital role in public health as gatekeepers. Additionally, there are insufficient data to assert that such clinics follow the same evidence-based medical practice that occurs in a physician's office.

There may be several other additional reasons why retail clinics are a bad idea. However, that does not solve the issue at hand. What Ahmed and Fincham have identified is that patients strongly desire to be seen within one day for minor illnesses and are no longer willing to listen to their physician and wait. Therefore, a demand and the resultant opportunity for new entrants into the market have been created and such clinics are expected to keep growing unless physicians understand the basic principles governing a market microenvironment. Like it or not, the business of health care often mirrors the same market principles as any other business. The model for pure competition implies that as the bargaining power of consumers (patients) increases, there will be a threat of both new entrants and substitute products.3 Retail clinics are clearly filling a void as the new entrants and non-physician providers are the substitutes. Therefore, I am neither surprised nor offended. It is the nature of competition. However, it is imperative upon us as physicians to understand the significance of these changes in our microenvironment and not simply oppose them. Only then will we embark upon finding creative methods to accommodate patient choice in an effort to beat the competition and maintain the highest quality of care for our patients.

References

1. Mehrotra A, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med 2009;151:321-328.

2. Retail-Based Clinic Policy Work Group, AAP. AAP principles concerning retail-based clinics. Pediatrics 2006;118:2561-2562.

3. Porter ME. The five competitive forces that shape strategy. Harv Bus Rev 2008;86:78-93, 137.