Recently, the American Academy of Pediatrics issued a policy statement opposing the use of Retail-Based Clinics (MinuteClinic, RediClinic, etc.) for the care of infants, children and adolescents. The AAP is especially concerned about care becoming increasingly fragmented and uncoordinated if patients use these facilities. This isn't the first time organized medicine has voiced its discomfort with the retail clinic movement. The American Academy of Family Physicians and the American Medical Association have proclaimed their own concerns about the proliferation of clinics in pharmacies, supermarkets and other retail locations.
Organized medicine has every right to raise these issues, but I wonder if the real concern isn't more about business and turf than quality. From what I've seen, retail clinic executives and clinicians are every bit as emphatic about the quality and safety of the care they provide as executives and clinicians overseeing care in more traditional healthcare settings. I think the question organized medicine needs to ask is; Why is there a market opportunity for retail clinics in the first place and why does the movement appear to be flourishing?
Retail clinics are flourishing because they are giving people what they want; a convenient, lower cost alternative to more traditional healthcare delivery settings. Healthcare has become too expensive. People without health insurance, people with health savings accounts, and people facing higher co-pays and deductibles are looking for choice. They want transparency in the cost and quality of the care they receive. They want to know what services will cost before they receive them. They are demanding excellent and timely service. They think healthcare providers should compete for their business like other service industries do; by continually innovating and delivering higher quality products and services at lower cost.
Retail clinics may not be for everyone, and no doubt some patients will be harmed. But let's not forget the findings of the Institute of Medicine on the failings of our traditional healthcare delivery system, a system that kills or injures tens of thousands of patients every year due to preventable medical errors. There's room for improvement across the board. The challenge for organized medicine is to beat the retail clinics at their own game by providing even better service, convenience, and "customer relationship management". When was the last time your doctor's office called to recommend a needed "service", or to remind you of an overdue health screening or exam? You can be sure the retail clinics are totally digital, use the best business and clinical software available, and have CRM and customer service at their core.
Organized medicine, the next move is yours. The age of the guild is over. Get on with what you need to do as if your future depends upon it,,,,,,,because it does.
This is a refreshing perspective. I left my practice of "organized medicine" to innovate pediatrics in a way that will emerge as a "BLUE OCEAN" of healthcare with regard to strategy. A mother of three, I felt that rather than to continue to adopt to healthcare pressures as my collegues and see more patients, I'd fire all my staff, start making house calls with a laptop and a treo and see children where they are most comfortable, at home. I created the Personal pediatrics Administrative Support system, a patented system of hardware and software to enable a return to a simpler form of practice that is paperless and delivers lengthy visits and enhanced doctor patient communication. Our business team is rolling out our offering nationally and we are poised to create an entirely new niche of healthcare. Actually when I had the idea, I was reading Bill Gates book " Business at the Speed of Thought" and he foretells the whole evolution!! " The Pediatrician of the Past and Future...Today" www.personalpediatrics.com
I think the comments about the death and injury rates in traditional medical care is telling. I think that because of the pressures for clinicians to see patients in 7 to 15 minutes (usually it is less time and not more) causes them to cut corners. I have heard many comments from patients, friends and family about the fact that the MD they saw really didn't seem to listen to them and more importantly never did a physical examination of any kind or if they did an exam it was attenuated and not even to the appropriate level that should have occurred based on the patient's complaint and subjective information.
Physicians should take charge. The covenience clinics industury offers physicians an opportunity for expansion more so than a source of competitions. Hop on board this train!
Retail clinics and sick children is a scary combination. I have seen countless children misdiagnosed by family physicians and internists. They are not trained in pediatrics. In a family practice training program the resident physicians have a few months of pediatric training (sometimes just three!), but almost three years of learning about adults. Internists don't learn about children at all. Nurse practitioners, who staff most of these retail clinics, don't go to medical school at all- they graduate from nursing school and have a few months of training as a nurse practitioner. Some even complete training on-line. Children are growing and developing both physically and mentally, and this development has to be assessed by a pediatrician. There are many parents who never take their children for well child checks, so the only contact they have with a physician is when the child is sick. Retail clinics will not be able to recognize other problems the child may have. Also, there are extremely serious acute medical conditions which can easily be missed by a non-pediatrician. A child with a high fever and irritability will often be given an antibiotic and sent out the door by an E.R. doctor, but that child could have Kawasaki's, an illness which can many times result in heart damage (and heart attacks) in young children if not diagnosed early. Pediatricians are usually the lowest paid field of medicine, despite working long hours. How dare the retail clinic people criticize us for objecting to their subpar care of children while they rake in the profit with no conscience!
Thanks for writing. I totally agree that when it comes to the care of young children, nobody does it better than a board certified pediatrician. The challenge for our healthcare system is making care more accessible and affordable. Let's face it; even if every American family could afford such care, there aren't enough pediatricians or even primary care doctors to fulfill the demand. Like it or not, retail clinics are here to stay because they are delivering the convenience people want at a price they can afford. The challenge for "established medicine" is learning how to work with the retail movement. You should take comfort in knowing that the most successful retail clinics are those being operated by, or working closely in association with, local hospitals and physicians.
Bill Crounse, MD
Of course Pediatricians are best for delivering care to children - nobody would argue that. That doesn't mean that a physician at a retail clinic would not recognize a serious illness. You should not look down on Family Physicians and Nurse Practicioners because they are not as well trained in Pediatrics. At a convenience clinic, they are the ones best suited to see a variety of patients. Would you feel comfortable seeing an adult with congestive heart failure or signs of a heart attack? Probably not. You would tell that person to see another physician. Part of the training for Family Physicians, Internists, Pediatricians and other Primary Care Providers is recognizing when they are out of their league and when they need to refer. If these clinics can reduced the number of children with gastroenteritis and earaches that go to Emergency Rooms - why not? If the patient is sick enough, providers will recognize when things need to be dealt with by someone else more qualified. Pediatricians are primary care providers and, I assume, are taught just like other PCP's when to refer.