Beth Israel CEO Paul Levy expresses amazement at this, as do I: Some doctors’ groups want their umbrella organization to challenge the existence of retail clinics at places like pharmacies:
“The American Medical Association should call for a ban on in-store clinics being opened by retail giants like Wal-Mart Stores Inc. and Walgreen Co., several doctors groups urged at the AMA’s annual meeting in Chicago on Sunday.”
…“‘There is no more urgent issue than this for the AMA,’ Dr. Kamran Hashemi, a family physician from South Barrington, said, urging the organization to push for more regulation of retail clinics.
Amazing. 47 million uninsured, but Dr. Hashemi thinks there’s no more urgent issue than this.
And you know what? My hunch is that the AMA — in its actions if not its words — will agree and try to snuff this thing.
Any physicians out there? This OK with you?
But tell me this didn’t give you pause:
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Without knowing squat about medicine, I’m scratching my head. They work under the supervision of somebody not-on-site? We’re not talking about working in a phone bank or on computer code — I’ve got to believe there’s value to the doctor being able to observe both the patient and the nurses.
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I like the idea of these places being open 7 days a week… but I’d also like for a doctor to be on the premises. The restriction against treating young minors seems to make sense too. It seems to me that the two sides could come together and work out a system that benefits consumers by providing broader access to health care, while maintaining high standards.
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Still… I won’t buy ziplocs at Wal*Mart; I sure as hell wouldn’t buy medical services there. At the same time, my two tetanus shots [shoulda gotten three] were $65 each at the Boston University Health Center. These shots are exactly the kind of thing that could be offered at these retail clinics, and are also the kind of thing that public health policy experts could leverage to help expand vaccinations by offering free vaccines for things like MMR.
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One of the unsung wonders of our healthcare system is the increase and advancement of training for all healthcare providers. The nurse you see today has the knowledge, training (and often the experience) of a general physician of some twenty years ago. That’s how good they are as a baseline. Twenty years ago you, or perhaps your parents, went to the general care physician and got the equivalent care that you would get from a nurse today (minus prescriptions) and you (or they) survived just fine. In fact, the nurse you see today is light years away from the doctor your parents and/or grandparents received just some forty years ago. And they are getting better all the time.
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In addition to this, they have an even more completely trained doctor to which they can refer cases quickly. I don’t see the problem here. At all.
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Well, there’s your problem… you equate ‘doctors’ with ‘high standards’ and anything else as unacceptable. In other places this might be known as making the perfect the enemy of the good. While the doctors are the highest standard we have, no doubt, that does not, per se, make lesser standards unacceptable. Do you eschew driving the Ford because you can’t afford a Bentley? Of course not… Do you stop eating altogether because you can’t have steak every night? Of course not…
I’m not worried about the 90% of the time, or 95%, or 99% of the time when a nurse practitioner is likely overly qualified to provide help.
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I’m worried about the rest. Is that a reason to prevent the 90+%? Nope, and I didn’t suggest that it is.
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However, discount stores have a reputation for half-assedness. They always have, they always will. It’s the nature of the business. So, when you combine a history of unfair labor practices with a history of price cutting, and mix in the stigma of working at Wal*Mart for a trained professional, and methinks you’ve got a recipe to lower those numbers listed above, either due to only the least competent nurses choosing to work there, the nurses’ performance declining due to crappy working conditions, etc.
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I’ll take my crappy bike anywhere to get it fixed — but if I had a $5,000+ road bike, I’d only take it to highly reputable repair shops. I value my body like a $5,000+ road bike, not like my own $240 beater. As such, even for routine maintenance I’d avoid places like Wal*Mart’s clinics, low prices be damned. That doesn’t mean that I’d force those views on everybody by regulation, just that yeah, I think it warrants a lengthy discussion with all parties.
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Having written all that, I checked out the minute clinic stuff… and it looks like a pretty good system to my untrained eye. Again, my only concern is escalation: at what point of sunburn does the nurse say: “Get thee to an infirmary”? At what point does a nurse turn away an MMR request [and the fee that comes with it] because the person is displaying symptoms that suggest waiting? It’s not that I don’t trust nurses; rather, I don’t trust anyone working for retail in a for-profit organization. Period.
…these in store “clinics” are actually concessions leased by the retailer to concessionaires. That really isn’t unusual in retailing. Go into any department store (in the US) and one of the first things you run into is the cosmetic department. All concessions. Go to Bloomies, the Polo/Ralph Lauren department is a concession. Go to Barneys in NYC, virtually all of it is concessions to the various manufacturers.
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It’s doubtful that the big-box retailers themselves are actually running the clinics, but instead concessaires. Find out who owns the concessions and what their practices are.
The Australians have been providing medical services remotely – by telephone or radio – for decades. Check out the Royal Flying Doctor Service.
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http://www.flyingdoc…
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The idea that the sky will fall in if a medical doctor is not on site at all times is ridiculous. More local clinics will mean more people will get early access to health care. (I don’t shop at Walmart either but years ago in W. PA, on a Sunday and far from a hospital, I did go to a clinic staffed only by a physician’s assistance and technician to get my broken fingers x-rayed and put in a splint.)
where my father lives, is a nurse practitioner who has regular office hours and sees anyone – about their colds, flues, aches and pains, medicine mix-ups, gets their weight and blood pressure, etc. to catch anything serious before it gets out of hand. She has access to their health records and knows when to send someone to the doctor.
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It is a very good system – allowing the people in the community to be safe, feel safe, to live on their own – all of which makes them healthier – without having to go out, across town, to the doctor’s office and wait and wait for something a nurse can take care of.
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Maybe the idea of clinics in pharmacies has merit that we haven’t seen.
The people at your dad’s community probably get as good or better care for the kinds of issues you mention. This CNN article reports a reasonably good academic study of a nurse practitioner clinic at a Columbia University–not exactly a fly-by-night institution.
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http://archives.cnn….
I was in the Midwest a few weeks ago, and had reason to visit a Target store. Near the cash registers was a Minute Clinic, one of the kinds of in-store health care providers opposed by the AMA. Seeing the place got me thinking about what we’re going to have to do to serve the public if we ever do get to universal health care. I’m simply not convinced that we have enough doctors to see patients. Moving routine care to lower-cost providers makes a lot of financial sense, and may be the only practical way to get health care to all.
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What impressed me about the in-store clinic was that it was clean, organized, and had a list of conditions treated and the price posted for everyone to see. It’s a pretty short list of routine conditions (here’s Minute Clinic’s Treatment List. It seemed to me to be a good idea for patients who have high-deductible insurance plans (or no insurance), and routine medical needs.
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Here in Massachusetts, CVS (the owner of Minute Clinics) has filed an application to open its first Minute Clinic in a Weymouth CVS. The five major medical organizations in the state have requested hearings, and expressed concern/opposition to the idea of retail store health clinics. Here’s the Boston Business Journal story CVS Clinic Plans . . ..
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My sense is that if we really want universal access to health care, we are going to have to try a range of experiments to increase availability and bring down cost. Retail clinics are one step. Increasing the number of paraprofessionals is another. It may well be that increasing the number of doctors is a third step. A fourth step is re-creating the public health system governments have spent time politicizing and dismantling. These steps are separate from restructuring the payment system, whether by single payer systems or other insurance reforms.
…in our little town just outside of Munich, we have the services of a Hausartz–a general practitioner who even makes house calls!
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The idea of having to go to a big-box retailer or to an Apotheke for routine medical care is ridiculous.
…is there anything wrong with Germany? You make it sound so perfect maybe I should move there. Just curious.
What could possibly go wrong in Germany?
So long as you follow Basil Fawlty’s famous advice (you tube clip)
Germany has a number of problems. Land use regulations stringently limit the amount of land available for housing–meaning quite a bit of congestion. Several people in the neighborhood have died recently. Their single family houses have been replaced by 6, 10, even 12 units on the same size lot. Insufficient underground garages have meant that the “main drag” in our neighborhood has become little more than a parking lot. We don’t have a car, and, fortunately, our house over there was built on the remnants of the family’s farm. We could probably sell the property (about 1300 square meters) for a fortune, to a developer, who would put up a 12 family apartment complex on the property.
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Germany’s educational system has recently been criticized for “channelling” students through the three tiers of schooling–Gymnasium (college prep), Realschule (occupational) and Lehrling (apprenticeship) at too young an age. There probably is more than a bit truth in that. The sad fact is that many students who are so channeled stem from families who were also college prep, occupational, apprenticeship, meaning something of a stratification of society.
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Germany has terrible corporate corruption problems. The most recent involving Siemens. In the early 1990s, the French oil company Acquitine Elf was caught sending campaign contributions to Helmut Kohl’s Christian Democrat party.
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Northeast Germany has terrible problems with hooligans and Neo-Nazis.
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Germany isn’t necessarily a paradise. But when I refer to it here in regards a particular topic, I am doing so as a suggestion that there are other ways of handling things.
…thoughtful comments, as usual. I guess I’ll stay here.