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Doc in the Big Box: Shopping for Health Care
Written by Ardena L. Flippin, MD, MBA   
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Remember when the concept of urgent care clinics was called “Doc in the Box”? Well get ready for “Doc in the Big Box”.

Approximately 400 clinics already exist, and an additional 1500 will be up and running by the end of this year (Kevin B. O'Reilly, AMNews. June 4, 2007 amednews.com). Wal-Mart will open 400 new retail clinics by the year 2010 (Baltimore Business Journal, February 7, 2008).

Which do we anticipate: patients judiciously exercising their consumer-directed healthcare options or will we see examples of arbitrary decisions to obtain ”drive-by” healthcare?

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Retail health clinics are an emerging business/care model. The issues that revolve around the model, in no particular order are:

  • Access: “…over 50 percent of our current customers are uninsured”, as per Sandra Kinsey, general manager of InterFit Health RediClinic division (, May 2006). Will this help to decompress expensive emergency room care?
  • Insurer incentives: Insured pay low (or no) co-pay as an incentive to avoid emergency room care or even primary physician office visits. (Managed Care Magazine)
  • Convenience: Retail health clinics are open evenings and on weekends.
  • Provider quality: Nurse practitioners or physician assistants generally staff retail clinics; this may change to actual physician staffing. Will precious time be wasted when it is determined that the diagnosis or treatment is complicated?
  • Follow-up: How consistently will this occur?
  • Continuity of care: Who takes responsibility of reporting retail visits to the patient’s primary care physician?
  • Competition: The advent of emergency medicine as a specialty came about at the expense of surgeons (and to a lesser extent internists) abdicating/relinquishing their interest in what has become the “bread and butter” of emergency medicine, e.g., ankle sprains/fractures, lacerations, upper respiratory infections, etc. Do retail health centers portend a similar situation for family medicine and other specialties?
  • Investor concerns: “There is an appetite in the investment community for innovations in health care. Delivery. Clinic companies are attracting a lot of attention because of their revenue and margin potential, and because there are few other options for entrepreneurial investment in health care services.” (Health Care in the Express Lane: The Emergency of Retail Clinics, California Health Care Foundation, July 2006).

Supposedly these clinics will treat minor ailments (sore throats, sinus infections, bladder infections and earaches); with the key word being “treat” and the convenience of in-store pharmacies - I’m having horrors of drug-resistance even as I write. (Any of us who practice clinical medicine know how difficult it is to dissuade a patient from demanding an antibiotic, when they don’t need one for their diagnosis.) And what about policy and regulatory constraints?

Although it’s “early days” as to whether this new paradigm will succeed, I can’t help but think that this reminds me of how we as physicians became victims of managed care – we weren’t proactive then, and we’re not proactive now. Again, we seem to be taking a wait and see approach. Haven’t we learned anything from previous experience?

REFERENCES:

www.managedcaremag.com/archives/0606/0606.minuteclinic.html

Family Practice Management, May 2006

Baltimore Business Journal, Thursday, February 7, 2008

Health Care in the Express Lane: The Emergency of Retail Clinics, California Health Care Foundation, July 2006.

Also see: Retail clinics - "Kermit the Frog's dad died of a sore throat"

Dr. Ardena Flippin

About the Author

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.

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