Minute Clinics Threaten Doctors: Who Wins?

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.

16 replies »

  1. I thought the urgent care clinics for children would be great because I work at clinic in the lab as a Phlebotmist and run POCT testing such as RSV, Rapid Streps, Influenza A& B, and draw blood on children. I am ASCP Certified (BOC) with 10 years at this clinic and I work for a big hospital but work at the off site clinic. The problem I incountered was losing my position to a MLT. Who is educated with a Associates degree in performing lab results and had a course of drawing blood from adult patients and only had to draw blood from 150 adults no children, but not as well trained as a phlebotomist. Now my director wants me to train the MLT in POCT testing and who salary is more than mine. UHS would rather pay a MLT an buy more Instruments for quick results. The problem I have is the MLT was educated in lab results and not precise at drawing blood from adolescence or infants. I was offered to work back the hospital 12 hour shifts. What I will miss is working Monday – Friday 8 to 5 off weekends and Holidays. Now I must choose to take the position back at the hospital working long hours and always on call working Holidays and weekends. Why would my director make this change and just think about bringing in a I-stat machine wouldn’t it be less cost efficient and save thousands of dollars instead of costing thousands if not more? I am 45 years old and can’t afford to go back to school full-time with two kids. I don’t know what to do. Yes I am whining I hate working at the hospital but who cares right it’s not saving or making more money is it?

  2. Minute clinics are not at all meant to replace the relationship between a PCP and patient. When people are traveling and need care for minor illnesses minute clinics are excellent options over going to the ER or urgent care for a sore throat. New to town and need vaccination for school or sport physical and haven’t established with a PCP, minute clinic is great. Up all night with child with ear infection and PCP can get u in once again minute clinic are appropriate. Minute clinics DO NOT treat GI issues or abdominal pain simple because the means to do so properly is not available in that small room. There is no ultrasound machine or way to do labwork ect. CVS does not even have an AED in the building. They have no intentions to treat chest pain or pretend they are able to. Many times PCPs send there patients to minute clinics because they have no appointments available. Anything beyond the guidelines is sent to urgent care if liability is high and anything chronic is sent to PCP to monitor. People are just extremely ignorant about the services and goals at minute clinics. The Nurse Practitioner are highly qualified to treat even more acutely ill patients but the setting is not appropriate for more then basic healthcare. We are all colleagues in the healthcare system and disrespecting one aspect of healthcare because it is new or you don’t fully understand the intentions is just unprofessional and pathetic. Have some class and respect for these professionals who are serving a valuable need in many communities and helping to keep our ER’s and urgent care center wait times downs. That way more severally ill patients can be seen quicker. Here is an idea ..,, hire and NP for your practice to treat these patients there instead of expecting sick people to wait days to be seen.

  3. Chris, we have to guard against dumbing down of health care. What if a online ‘doctor’ from Nigeria starts treating Americans for $ 10 a visit?

    Price is what you pay and Value is what you get. One has to carefully evaluate both to decide if a proposition is worth saving. Aereo was just struck down by the Supremes & Nurse Practioner Clinics may meet the same fate in law suits over the coming years………

  4. Wait till the authorities realise that the flu epidemic is being worsened by the flu patients at CVS/Minute Clinic possibly shopping & spreading the flu to other shoppers. What if this news spreads and CVS loses shoppers ?

  5. It is upto the patients if they feel comfortable in being treated by a nurse in a few square feet ‘room’
    In my state the county is very strict in approving a doctor’s office while the CVS can put up thin walls and make a few square feet ‘room’ to see patients. Where is the fair treatment of competitors?
    Also, wait till the law suits come and the discovery process shows that the supervising physician does his ‘job’ offsite. Wait till the juries get their hands on an appropriate medical malpractice case. Wait till the nurse practitioners get sued and CVS corporation has to pay big bucks to settle.
    The nurse practioner clinics will go away as Americans will not accept the lower standard of care. The only question is when not if….

  6. 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?

  7. 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.

  8. 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!!

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.