Published on: February 20, 2008Salon.com
has a fascinating piece written by a doctor, Rahul K. Parikh, M.D., in which he notes that most physicians seem to be opposed to the in-store medical clinics that have become popular in retailers across America: “Their basic argument is that retail clinics run counter to the concept of ‘a medical home,’ a place where patients receive care for any and all of their problems. They worry that patients will have no sensible place to follow up their test results, and that putting a clinic in a mall or a Wal-Mart could expose shoppers to people with a contagious illness.
“The medical community needs a second opinion. Retail clinics are good for American healthcare. By giving doctors a run for their money, they force us to do something we don't do well: innovate. At their best, retail clinics can make doctors look like smart entrepreneurs instead of a self-interest group futilely trying to protect archaic ways of doing business.”
Essentially, Parikh makes the following points:
• Traditional medical practices “must measure success in terms of access, quality and cost,” but don't fare well in any of these areas. Access is a problem simply because most practices can't or won’t offer round-the-clock service or even extended hours. . “Costs keep rising and being shifted to consumers in the form of higher premiums, deductibles and co-pays,” he writes. And despite all the chest-beating about the superiority of the US health care system, there clearly are problems.
“Despite having the brightest medical minds and therapies, basic medical quality in America remains poor,” Parikh writes. “According to a 2004 report by the Government Accountability Office about Medicare preventive services, 30 percent of people over age 65 did not receive a flu vaccine and 37 percent had never had a pneumonia vaccine. Another example: In 2000, Medicare estimated that 6.6 million beneficiaries were never told by their doctor that they had high blood pressure.”
• “On the other hand,” Parikh writes, “retail clinics are thriving. They provide excellent access. After all, what's more convenient than showing up any day, night or weekend to have your sore throat checked? No telephone time spent on hold trying to make an appointment, no shuffling your personal schedule to get there.
“Then there's cost. Retail clinics operate on a fee-for-service basis and don't accept insurance. Most charge a maximum of $50, which is significantly cheaper than the $100 plus your insurance company (or you, if you carry an increasingly popular high deductible insurance plan) will pay when see your doctor for the same concern. That relative savings makes retail clinics a great place to go if you're uninsured and have a minor medical problem. This desire to pay out of pocket is a not-so-subtle sign that consumers are asserting their purchasing power in the health sector, just as they would with other goods and services.”
The quality of care, Parikh suggests, may actually improve because of health clinics: “Retail clinics don't do everything. Literally, a customer has to choose what he or she wants from a menu of choices posted on a marquee. Choices are limited to simple, easy-to-handle medical problems like sore throats, allergies and cold sores or a request for routine flu or pneumonia vaccinations. No acute medical problems, like injuries or asthma, are addressed. All decisions are made using very strict decision trees, leaving no room to treat issues beyond or outside of them.”
In addition, given the state of technology today, it isn’t hard for these clinics to communicate with family doctors and medical practitioners … and, in fact, electronic medical records systems are making this easier all the time.
“Most important, by relegating minor complaints to the walk-in clinic, a doctor can be a doctor,” Parikh writes. “Many of us didn't get into this job to become ‘diaper-rash doctors,’ the kind who pack their day seeing patients with minor complaints to pay the bills. Yet after years of training and preparation, too many of us become just that. We simultaneously complain that we don't have the time to address the challenges that come with complex, chronic health issues, like obesity or childhood asthma. Adopting the retail model in-house could change the way we spend our time, allowing us to get back to practicing challenging and more satisfying medicine.”