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Is 'Quick' Enough? - washingtonpost.com

Is 'Quick' Enough? - washingtonpost.com

Some of the newest players in health care are rubbing doctors the wrong way.

You may know them: those small clinics at your neighborhood Wal-Mart, Target or CVS that promise quick attention for routine visits -- sore throats, minor aches and pains, flu shots -- with no appointments needed. The clinics, which go by such names as MinuteClinic, RediClinic, QuickClinic, Medpoint Express, Curaquick and MediMin, offer convenience and low price -- scarce commodities in today's medical marketplace. But while consumers are taking to the concept, physician resistance is building.

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At the MinuteClinic inside a CVS pharmacy in Potomac, Rachel Herman, 6, checks in with nurse practitioner Anne Pohnert. Rachel's sore throat is typical of problems seen at retail-based clinics, which are gaining in popularity.
At the MinuteClinic inside a CVS pharmacy in Potomac, Rachel Herman, 6, checks in with nurse practitioner Anne Pohnert. Rachel's sore throat is typical of problems seen at retail-based clinics, which are gaining in popularity. (By Preston Keres -- The Washington Post)
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"The quickest, most convenient medical care is not always the best," says Caroline Van Vleck, a Washington pediatrician. Particularly, she and a growing chorus of primary care physicians contend, when it comes to children.

But even as many doctors sound the alarm, others are scrambling to adapt. Increasingly, the discussion among physicians like me is focusing on how to compete with the new clinics -- even if that means stealing a trick or two.

Not that many are convinced this trend is good for patients. Within the past six months, the American Medical Association and the American Academy of Pediatrics have both decried it.

"Convenience is not enough," the AMA lamented in a recent editorial. Comparing the mini-clinic phenomenon to kudzu -- the tree-strangling vine rampant in the South -- the AMA complained these new services are spreading too far, too fast. In a policy statement issued this fall, the AAP "opposes retail-based clinics as an appropriate source of medical care for infants, children, and adolescents and strongly discourages their use.

James Woodburn, chief medical officer of MinuteClinic, emphatically disagrees:

"We've been around for nearly seven years now . . . with almost no adverse events," he says. "We have a long track record of quality medical care," he continues, expressing pride "with our ability to provide convenient and extremely high-quality and cost-effective care."

Buy This Photo

At the MinuteClinic inside a CVS pharmacy in Potomac, Rachel Herman, 6, checks in with nurse practitioner Anne Pohnert. Rachel's sore throat is typical of problems seen at retail-based clinics, which are gaining in popularity.
At the MinuteClinic inside a CVS pharmacy in Potomac, Rachel Herman, 6, checks in with nurse practitioner Anne Pohnert. Rachel's sore throat is typical of problems seen at retail-based clinics, which are gaining in popularity. (By Preston Keres -- The Washington Post)
Related Stories

* Is 'Quick' Enough?
* Is a Retail-Based Clinic for You?
* Where the Clinics Are

Who's Blogging?
Read what bloggers are saying about this article.

* Medicallead.com
* A Bag Full of Health and Politics
* A Bag Full of Health and Politics


Full List of Blogs (5 links) »

Most Blogged About Articles
On washingtonpost.com | On the web

Save & Share Article What's This?
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Rockville parent Meredith Salamon is inclined to agree. Dropping into a MinuteClinic in a nearby CVS pharmacy last month to get flu shots for four of her five children, she says she was in and out in 15 minutes. "The cost was good, and the location was good, so it was easy and quick," she said. By contrast, she says, the family's more expensive traditional doctor "kept running out" of flu vaccine and keeps inconvenient hours.

From a business point of view, RBCs look like a success story. Five years after the first RBC was founded by a Minnesota doctor, there are now about 200 nationwide. A survey last summer by the California HealthCare Foundation projected the number will reach several thousand by the end of 2007.

Filling a Need

Fueling this growth, says Anne Pohnert, MinuteClinic's manager of operations for the Washington area, is the appeal of lower cost, speed, convenience and after-hours availability.

"Many patients would like to get in to see their primary care physician, but when they call, there is no appointment available," she says. Choosing an urgent care center or emergency facility may involve "a long wait and considerably more cost," she adds. "We believe that a visit to MinuteClinic instead of an ER on a Friday evening for a five-minute strep test is a win-win for patients and insurers trying to save time and health-care costs."

To contain costs, the typical retail clinic is a bare-bones affair, usually a small room with a few chairs, a cabinet or two and perhaps, but not always, an examining table.

On-site medical staff usually consists of a single nurse practitioner or physician assistant. A doctor is generally available for phone consults only. Prices are posted for all to see. Some typical fees in Maryland's MinuteClinics: $30 for a flu shot, $59 for a strep test, $49 to diagnose and prescribe treatment for an ear infection. Also posted prominently are ad slogans that capture the concept: "You're Sick, We're Quick," "Get Well, Stay Well -- Fast," "On the spot relief," "Great Care, Fast, and Fair."

MinuteClinic, which began operating here two years ago, now runs a dozen clinics in Maryland and 146 nationally, making it the industry leader. In the Washington area, it has recorded about 80,000 patient visits, according to its chief executive, Michael Howe. (CVS acquired MinuteClinic in September and operates it as a wholly owned subsidiary.)

Even their critics concede the clinics are tapping public frustration with traditional delivery of health care.

"The retail clinics are sending physicians a message that our current model of care is not always easy to access," says Rick Kellerman, president of the American Academy of Family Physicians."

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