Supermarket Medicine: Helpful or Harmful?

Instead of going to a traditional doctor’s office, I’ve noticed a trend in patients going to grocery stores, pharmacies or retail stores for a cold or for a checkup. “Retail-based clinics” – also known as “convenient care clinics” – are rapidly gaining popularity. However, they are stirring up a lot of controversy in the medical community – for the right reasons.

What Is a Retail-Based Clinic?

A retail-based clinic offers basic health-care services in retail stores. These clinics are run by privately-owned services, and some clinics are also affiliated with a local hospital network like Cleveland Clinic in northeastern Ohio or Mayo Clinic in Rochester, Minnesota.

Many patients use the clinic as an alternative to a traditional doctor’s office or an “emergency room” for emergent illnesses like strep throat, sinus infections, or urinary tract infections. A nurse practitioner or physician assistant, who has mostly been trained in primary care, usually staff these clinics and provide physical exams, prescribe antibiotics, administer vaccinations, and order routine lab tests. Some clinics are taking it a step further and treating patients for common chronic illnesses like asthma, diabetes or high blood pressure.

These clinics have many appealing qualities that draw patients in. They usually have lower fixed fees and do not require an appointment. They also tend to be open during the evening and on the weekends – when traditional doctors’ offices are closed. In fact, 44.4% of retail-based clinic visits take place when physicians’ offices are likely closed.

How Popular Are They?

A Health Affairs report on retail-based clinics indicate a sharp increase in use. In 2009, these clinics clocked a total of 5.97 million visits – almost double the 3.52 million visits from the previous year. A Wall Street Journal poll revealed that 83% of those who use the clinics are “satisfied with the convenience provided by such clinics” and 90% were “satisfied with the quality of care.”

However, despite the growing number of retail–based clinic visits, it still takes up a small share of overall visits. Every year, emergency rooms handle nearly 117 million visits and physician offices handle 577 million visits. The business of retail-based clinics are merely a drop in the overall bucket of primary care; however, it may be what this country needs to solve its shortage of qualified primary care physicians.

The Kaiser Family Foundation estimates 60 million Americans, nearly one in five, “lack adequate access to primary care due to a shortage of primary care physicians in their communities.”

Do They Help or Hurt?

This complicated question has no straight answer. Despite the clinics’ increasing popularity, The American Medical Association, the American Academy of Family Physicians, and the American Academy of Pediatrics have indeed all spoken out against retail-based clinics.

You may assume my physician colleagues may be against this idea because it threatens their pay. However, there are genuine reasons why physicians would be concerned about the presence of retail-based clinics. One main reason: a lack of a patient-centered medical home (PCMH).

Having a PCMH is vitally important. It’s where one’s complete medical records are kept and where a primary care professional can manage a patient’s overall long-term care – a concept called continuity of care.

As a cardiac surgeon, I get my patients’ health information through collaboration with their PCMH. I rely on my patients’ primary care physicians to inform me of my patients’ health history and to “medically clear” my patients for surgery. I’ve seen patient-doctor relationships that have lasted longer than 15 years.

In contrast, retail-based clinics mostly serve as a quick fix for people who need assistance between doctor’s visits or who need a physical exam for a job – some advertise themselves as such. Therefore, physicians worry that these clinics may “fragment” health care. Some may confuse these clinics for a traditional PCMH and never go through the process of selecting one.

Furthermore, the PCMH is designed to coordinate care focused on long-term wellness. For example, if a test reveals high blood sugar levels, that person may require years of medical care, which include multiple visits and/or referrals to endocrinologists or special surgeons (of course, all surgeons think they’re special). If a person falls sick and needs to be hospitalized, the hospital may coordinate the treatment plan with the primary care provider; some even visit and treat sick patients at the hospital.

However, despite the complaints, the numbers of retail-based clinic visits are growing. Hence more and more physicians are suggesting collaboration. If you can’t beat them, join them, right? I’m interested to see how this retail-based clinic-physician relationship pans out over the next 10 years.

In the meantime, I’ve always advocated patient self-awareness. Knowledge is power, and if retail-based clinics make it easier for patients to get affordable health care and find out the important five numbers for their health, in that regard, it can’t hurt.