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All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.

We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan.

Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient safety standpoint, but there are powerful parochial issues worrying physicians. They are losing business. They have a point that patients should be rightly concerned about medical errors and missed diagnoses at these medical care drive-ins. These nurses, even with their advanced training, are not doctors. It is also true serious or even life threatening conditions can masquerade as innocent medical complaints and might not be recognized by a nurse who treats colds and ankle sprains.

The Annals of Internal Medicine, a prestigious medical journal, reported on the quality of these retail clinics and concluded that the quality of care for ear infections, sore throats and urinary tract infections in fast-medicine outlets was similar to that in physicians’ offices, but at lower cost. While this is ammo for fast-med aficionados, it doesn’t address a more important point. I’ll concede that if I take my kid with an ear infection to a Wal-Mart clinic or the pediatrician, then the outcome will be similar. (Many experienced Moms would also know what to do.) The tricky part is when the symptom is murky and the range of medical possibilities is broad. If my kid were having stomach pain, for example, I want a physician to decide if this is simple constipation, intestinal gas or acute appendicitis that needs urgent surgery.

These clinics are proliferating because the market demands them. The fundamental cause is the inadequate number of primary care physicians in this country. This shortage will become more acute when Obamacare extends coverage to tens of millions of uninsured. Massachusetts discovered this a few years ago when they provided coverage to the uninsured, but didn’t have enough primary care physicians to care for them. These clinics are also providing a service that physicians have been unable or unwilling to match. They offer evening and weekend hours at low prices. Patients come at their convenience and are seen without waiting.

Pharmacies and big box stores benefit from minute clinics. They bring shoppers into the store who are likely to purchase other items after their scraped knee is bandaged. And if a prescription is needed, guess where it gets filled? From a patient’s point of view, this experience sure beats an emergency room adventure.

Are these clinics a good idea? It doesn’t matter because they’re coming and they can’t be stopped. They fill a legitimate need that the medical profession cannot address and the public demands. Market forces created the opportunity and will monitor its success.

Will they survive? Remind me, how long have McDonalds, Burger King and all the rest been around?

Michael Kirsch, MD, is a private practice gastroenterologist in the Cleveland, OH, area. He shares his thoughts about issues in medicine and medical practice at MD Whistleblower.

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11 Responses for “Minute Clinics Threaten Doctors: Who Wins?”

  1. Dr. Mike says:

    I don’t think that docs feel threatened by minute clinics and similar NP staffed clinics. Us primary care docs are not losing business – we turn away new patients every single day. I can’t speak to every market, but in most places I know about the urgent care clinics are swamped while the minute clinics can see you right away – for a reason.
    I have to wonder if the business model of the minute clinics will survive the test of time. Are they profitable enough that they are worth more than what could be earned by devoting that retail space to some other function? I tend to look at them as loss-leaders for pharmacies and subject to rather sudden demise should market forces shift.

    • pcp says:

      Agree. I don’t feel any sense of competition with minute clinics. They offer a completely different product from what I offer in my office.

      Just don’t expect me to provide care coordination, cost management, and all the other buzz terms if the patient is free to roam from minute clinic to urgent care to ER at will.

  2. SJ Motew says:

    I’m not sure that access/manpower is the issue. Market research (at least in our region) has shown that price and convenience (ie care where you shop with no appointment) are the main determinants of choice for minute-clinics.

  3. There are two groups of people I feel, ones that want it fast that will go to these minute clinics, because they want answers right away. Then there are the people that will research and look around for the best regardless of the convenience and the price.

  4. nate ogden says:

    My use of Minute Clinic and Take Care, equal billing, is instead of not getting treatment at all. Like pcp said I see them as two totally different service providers.

    I wonder though how they will survive telemedicine. My trips to Minute Clinic or take care, both incredible experiences besides the ailment, cost 60-90. A call from my office or couch cost $38 and accomplishes the same thing.

    Some collaborative product combining both would probably increase the usage rate for both considerably.

  5. Chris Lev says:

    Hey Mr. Kirsch, why don’t you try getting off of your high-horse and addressing the issue at hand. The nurse practitioners are more than qualified to do this job and can do without your infantile side-remarks. I know, you think you’re a God because you have MD after your name….wrong! These nurses can do as good of a job as any family doctor does and it’s jack-asses like you that just make their job more difficult. Next time, don’t write the article and keep your worthless comments to the only one that cares….yourself.

    • Colleen says:

      Hi Chris,

      I absolutely LOVE a person who can “tell it like it is” and not mince words in a an attempt to be “politically correct.” Obviously I agree with everything you said and more…thanks for an awesome remark!!

  6. connie says:

    Minute clinic misdiagnosed my niece-they did not see she had strep throat and charged $80 even though they messed up. Be careful before going there.

  7. Lori T says:

    Wow…what an article. Years of training and experience have just been compared to that of a fast food joint. I think you are ill informed…many of the patients that to come clinics like these do not have PCPs and thus bridge the gateway to continuity of care by recommending and many times setting up appointments to get established as a new patient. Your article has a misleading analogy that belittles the value of these clinic to the communities that they serve. And we don’t serve fries.

  8. Bryan says:

    The minute clinic usually for me would not be a substitute for a PCP. The only time I would go to the minute clinic is if either the PCP is:

    1. Fully booked up and has no way of getting me in on that same day.

    2. The PCP office is closed especially on weekends and holidays.

    And I will not go to the emergency room or a place that charges a very high ER copay just for a cold or a minor illness.

  9. Robert says:

    There will always be room for retail clinics until the time that PCP’s can get their patients in for acute care visits the same day at a convenient time. Patients have flocked to Minute Clinic, for example, seeing over 18 million patients based on their model of care. Would you like some fries with that?

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