Retail Medical Clinics: Here to Stay?

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The fundamental question about retail medical clinics is whether they represent a fad or a longer-term, lasting change in the way primary care medical services are organized and delivered in the United States. In the nearly 30 years I have been in health care, I have witnessed many changes.  The more successful (at least for a while) of these have focused on financing, payment, benefit design, new technology and scientific advances. Examples include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Health Savings Accounts (HSAs), Diagnosis-Related Groups (DRGs), new government benefit programs, and dramatic innovations for improved diagnosis and medical treatment.

On the other hand, changes that relate to the core processes of health care delivery that require physicians to alter ingrained habits, or that directly challenge the culture of medical professionals, have been harder to introduce. As examples, I would point to the enormous difficulty in getting physicians to embrace electronic medical records (EMRs), and the failure in the 1990s of business-driven entrepreneurs to effectively organize physicians into group practices. Similarly, the adoption of prevention and wellness practices has been very slow, despite their obvious benefit to the individual.

Where does the phenomenon of retail medical clinics fall along this spectrum? Somewhere in the middle, it seems. These clinics appeal to many consumers, but they are a direct challenge to the physician-directed model of care. I believe that retail clinics are an important change that is here to stay. Their rise is sponsored by large companies that wish to capture the loyalty of consumers for broader commercial purposes (the sale of pharmaceuticals, medical products, devices and other general retail products). These companies are well capitalized and do not commit lightly to major new ventures. I expect them to apply all of their know-how about serving consumers to these offerings and to be committed for the long term.

More important, the real drivers of retail clinics are consumers themselves – those busy mothers who cannot get timely medical appointments for their children or themselves for simple, routine health needs. Retail clinics also are an option for those of us who do not have established physicians or who simply value the convenience factor. (While transitioning to a new primary care doctor, I recently visited a retail medical clinic to get a flu shot. I had not planned on it, but I was in the store and the service was available.)

As a former practicing primary care physician and medical group practice leader, I hate to admit it, but primary care physicians have struggled to recognize a market need in making their services conveniently available to the busy American public. Many doctors have a difficult time accepting the notion that patients should be able to get “same-day appointments” or that convenient hours must include evenings and weekends.

To be sure, it is challenging to organize medical services to meet these growing demands. It is even more difficult to make a profit. As existing retail chains have realized, it requires economies of scale and the use of less-expensive professional services than those of physicians, such as nurse practitioners. These are things that large medical groups could provide, but many have not done so. On the other hand, solo or small medical practices probably cannot make the economics work.

Since health plans appear to support making payments for the services of retail medical clinics, and because there is an undeniable, serious gap in access to primary care services, I expect the retail clinics to continue growing and expanding. However, I do see two major risks to their longer-term success:

• First is the potential for significant medical liability cases with associated expenses and adverse publicity. Trial attorneys will find the deep pockets of large corporations that operate retail clinics even more appealing than that of practicing physicians. I offer these cautions: Watch out! You are operating in a target-rich environment. Providing consistently high-quality medical care is never as easy as it looks. Also, mitigate your risks by using evidence-based protocols, seek appropriate accreditation and find a group of expert medical advisors to guide your ongoing efforts.
• The second risk to the future of retail medical clinics is the prospect of efforts to regulate clinics to the point where they are not economically viable. Physician organizations will be the main protagonists, but state and federal lawmakers will be the ultimate determinants, as they must balance the obvious public needs that can be met with retail clinics with reasonable assurances of proper operation and oversight. On a personal level, having practiced for years with nurse practitioners and physician assistants, I believe firmly that such professionals can offer excellent medical care.

My hope is that physicians and hospitals will be supportive of retail medical clinics. Large integrated delivery systems in populated markets should consider partnering with retail clinic networks. This could facilitate seamless patient referrals and provide valuable cobranding opportunities. Otherwise, if providers themselves wish to compete, they should organize similar services.

It will take time to determine whether retail clinics will simply be a new venue for basic, self-directed medical services, or whether they will evolve into an entirely new platform for primary care. In the meantime, they provide a welcome service that fills an obvious gap in health care delivery.

Related Content:
Profile:  Meet Dr. William Winkenwerder 
2008 Survey of Health Care Consumers:  Retail Clinic Trends
Report:  Retail Medical Clinics: Disrupting Models of Primary Care