Tuesday, September 23, 2008


My colleagues scoffed when I told them almost 10 years ago that I had seen the construction plans for a Walgreen's with a clinic in it. At the time they laughed but I knew that pharmacists were taking "Physical Diagnosis" classes where I was teaching. I was pretty sure that pharmacists would be staffing outpatient clinics and moving for more scope of practice. Well I wasn't far off.

image The 1,000th retail health clinic in America was christened in August, eight years after the first clinic of its kind was unveiled. Walgreen's, CVS, Wal-Mart and others are on the fast train to drive thru medicine mostly staffed by Nurse Practitioners. And I think it's GREAT! Just what we need...a jolt of down home capitalism and competition to try to give what the people want and need. They are attempting to do what the mainstream medical community can't...won't. Good hours, convenient locations, at a great price. If I didn't know better, I would think there was child labor involved.

What is likely to happen as this phenomenon grows is that people will stop going to their own primary care doctors for simple problems...the bread and butter of practices.  Why wait for hours, for an appointment you can't get, when you can walk in and walk out with your antibiotic du jour after you pick up your milk and a pair of shorts on sale? 

  And we are talking about big numbers too. It is estimated that over 3,000,000 patients will be seen at these centers and maybe more. The growth has been imagestaggering. The need was there.  The fee generated by the two largest totaled over $150,000,000. Oh and the 3  people that co-founded one the first, MinuteClinic, sold out to CVS Pharmacy for a cool $170 million in 2006. Hard to ignore the numbers.

Physician groups are keeping an eye on retail clinics. That's what they do best...react, and defend territory. Some forward thinking practices have already begun to compete by offering better hours, quicker access, walk-in appointment, and enhanced locations.  On national association of physicians has a "Retail Health Clinics" pledge", which requires them to limit the scope of their services and to partner with local doctors. The first sign of fear.

The bottom line is likely to drive the future in retail, coupled with the consumer demands for convenience and lower cost...particularly in this day and age of medical insurance mayhem. If you can drive up and get a doctor's visit as easily and as satisfying as a Jiffy Lube oil change (minus the fraud), we are likely to see (and have to compete) with such centers for a long, long time.  In the words of the NP that gave me a free cholesterol screening and 30 minutes of her time in patient education at my local CVS clinic, "We are just doing it better...", and she did.  Great lesson for my future.