Why In-Store Clinics Are Good News for Your Health
You can now wait for your cholesterol, strep and other lab results while you grab some toothpaste and mascara. But before you dump your doctor, here's what you should know about retail health clinics.
Photo: Claire Benoist
Over the past year, Bridget Montgomery, a 36-year-old freelance writer in Chicago, has gone to her local CVS for sinus infections, pinkeye and a few very nasty colds. But she wasn't shopping for over-the-counter medicine—she was visiting CVS's MinuteClinic for treatment. "At first, there was a little voice inside my head saying, Really? The MinuteClinic?" admits Montgomery, whose only steady doctor is her ob-gyn. "But the instant I met my nurse practitioner, I felt confident. She was extremely knowledgeable and compassionate, and she took the time to listen. She prescribed an inhaler and a cough suppressant before my upper respiratory tract infection could graduate to pneumonia." Montgomery has been so satisfied that she's even brought in her 5-year-old son for persistent coughs and the occasional fever. "The wait at our pediatrician's office can be long. Then we have to see the nurse before the doctor, and with all the sick kids, the place feels like it's swimming in germs. The MinuteClinic is a ten-minute walk from my house, and I can pick up some toilet paper while I'm there."
Montgomery is hardly the only one enticed by the convenience of the miniature doctors' offices now nestled within drugstores and big-box giants like Target and Kroger. An escalating scarcity of doctors (the Association of American Medical Colleges estimates that the U.S. will be between 46,000 and 90,400 physicians short by 2025) plus a surging demand for fast healthcare has would-be patients heading to these clinics in droves with sore throats and mystery rashes. Consulting firm Accenture forecasts that by 2017, the number of retail clinics will surpass 2,800 (a 47 percent increase since 2014). Walgreens already has more than 400 healthcare clinics in 22 states and Washington, D.C., and CVS, which opened its 1,000th MinuteClinic in October, has recently witnessed an average growth of four million to five million patient visits per year.
Unlike most doctors' offices, the clinics tend to be open seven days a week, including evenings. "No appointment is needed, most insurance is accepted, and for those paying cash, prices are typically 30 to 40 percent less than what would be charged by most physicians' offices," says Angela Patterson, chief nurse practitioner officer for CVS MinuteClinics. Various tests at Walmart Care Clinic, including those for UTIs and strep, cost $8 (plus a $59 office visit fee). Wound suturing, flu visits and treatments for poison ivy at CVS MinuteClinic range from $79 to $99, while an average ER visit can cost $125 or more.
These types of clinics offer care for nonemergency problems and are typically staffed by nurse practitioners (NPs) or physician assistants (PAs). They can check your thyroid levels or remove that pesky wart; at Walmart, they can even perform a Pap smear. And that's actually not so different from what you'd find at an esteemed hospital: Jamie Bakkum-Gamez, MD, a gynecologic oncologist and associate professor of obstetrics and gynecology at the Mayo Clinic in Rochester, Minnesota, says a sizable number of her department's Pap smears are performed by NPs and PAs. "Whether it's a pop-up clinic or a medical institution, a lot of preventive services are provided by someone other than a doctor."
Pharmacies are also expanding their scope beyond pill counting and flu shots: Depending on the state and the pharmacist's level of training (the minimum is six years), they may test for strep, prescribe birth control or dole out travel immunizations.
It should come as no surprise, however, that some physicians' organizations are hesitant to endorse the drugstore-as-doctor concept. The American Academy of Family Physicians (AAFP) worries that retail health clinics may lead to fragmented care. "The relationship with your primary care physician is critical—she knows the most about your medical history," says Wanda Filer, MD, a family physician in Pennsylvania and president of AAFP. Filer recently treated a patient with a chronic cough who came to her after receiving antibiotics from a retail clinic. Turns out, the patient didn't have a bacterial infection—the cough was a symptom of congestive heart failure. "If she had come right to me, I would have known her other risk factors and treated her through that lens."
Some experts and doctors see the greatest potential in retail clinics as critical partners in the area of chronic disease management. "Nearly half of U.S. adults—about 117 million people—have at least one chronic health condition, such as high blood pressure, diabetes or heart disease," says Truls Østbye, MD, PhD, professor of community and family medicine at Duke University School of Medicine. "But high-quality management of the most common chronic diseases simply requires more time than primary care physicians can give." Patterson offers an example: "Let's say a diabetic patient comes in for her annual flu shot. We'll have the time to ask about her meds, discuss nutrition and exercise, and test her A1C levels, which show how well a patient's diabetes is controlled." Retail clinic NPs will also collaborate with her doctor, says Patterson, sharing test results and helping schedule appointments.
Such partnerships have been shown to work: A new study in the journal Innovations in Pharmacy reports that when roughly 15,000 patients with diabetes, high blood pressure or high cholesterol were paired with pharmacists for medication management, one-on-one education and regular follow-up between doctor visits, their health improved significantly. The number of diabetics who met their A1C goal increased by 25 percent; cholesterol patients saw their bad (LDL) cholesterol levels drop by an average of 16 points. And all patients' healthcare costs decreased between 14 and 32 percent. "It makes sense," says lead study author and pharmacist Barry Bunting. "Who better to make sure medications are being used appropriately than the people dispensing them?" While retail clinics aren't going to put doctors out of business anytime soon—nor should they—it's comforting to know relief may be waiting for you around the corner.
Montgomery is hardly the only one enticed by the convenience of the miniature doctors' offices now nestled within drugstores and big-box giants like Target and Kroger. An escalating scarcity of doctors (the Association of American Medical Colleges estimates that the U.S. will be between 46,000 and 90,400 physicians short by 2025) plus a surging demand for fast healthcare has would-be patients heading to these clinics in droves with sore throats and mystery rashes. Consulting firm Accenture forecasts that by 2017, the number of retail clinics will surpass 2,800 (a 47 percent increase since 2014). Walgreens already has more than 400 healthcare clinics in 22 states and Washington, D.C., and CVS, which opened its 1,000th MinuteClinic in October, has recently witnessed an average growth of four million to five million patient visits per year.
Unlike most doctors' offices, the clinics tend to be open seven days a week, including evenings. "No appointment is needed, most insurance is accepted, and for those paying cash, prices are typically 30 to 40 percent less than what would be charged by most physicians' offices," says Angela Patterson, chief nurse practitioner officer for CVS MinuteClinics. Various tests at Walmart Care Clinic, including those for UTIs and strep, cost $8 (plus a $59 office visit fee). Wound suturing, flu visits and treatments for poison ivy at CVS MinuteClinic range from $79 to $99, while an average ER visit can cost $125 or more.
These types of clinics offer care for nonemergency problems and are typically staffed by nurse practitioners (NPs) or physician assistants (PAs). They can check your thyroid levels or remove that pesky wart; at Walmart, they can even perform a Pap smear. And that's actually not so different from what you'd find at an esteemed hospital: Jamie Bakkum-Gamez, MD, a gynecologic oncologist and associate professor of obstetrics and gynecology at the Mayo Clinic in Rochester, Minnesota, says a sizable number of her department's Pap smears are performed by NPs and PAs. "Whether it's a pop-up clinic or a medical institution, a lot of preventive services are provided by someone other than a doctor."
Pharmacies are also expanding their scope beyond pill counting and flu shots: Depending on the state and the pharmacist's level of training (the minimum is six years), they may test for strep, prescribe birth control or dole out travel immunizations.
It should come as no surprise, however, that some physicians' organizations are hesitant to endorse the drugstore-as-doctor concept. The American Academy of Family Physicians (AAFP) worries that retail health clinics may lead to fragmented care. "The relationship with your primary care physician is critical—she knows the most about your medical history," says Wanda Filer, MD, a family physician in Pennsylvania and president of AAFP. Filer recently treated a patient with a chronic cough who came to her after receiving antibiotics from a retail clinic. Turns out, the patient didn't have a bacterial infection—the cough was a symptom of congestive heart failure. "If she had come right to me, I would have known her other risk factors and treated her through that lens."
Some experts and doctors see the greatest potential in retail clinics as critical partners in the area of chronic disease management. "Nearly half of U.S. adults—about 117 million people—have at least one chronic health condition, such as high blood pressure, diabetes or heart disease," says Truls Østbye, MD, PhD, professor of community and family medicine at Duke University School of Medicine. "But high-quality management of the most common chronic diseases simply requires more time than primary care physicians can give." Patterson offers an example: "Let's say a diabetic patient comes in for her annual flu shot. We'll have the time to ask about her meds, discuss nutrition and exercise, and test her A1C levels, which show how well a patient's diabetes is controlled." Retail clinic NPs will also collaborate with her doctor, says Patterson, sharing test results and helping schedule appointments.
Such partnerships have been shown to work: A new study in the journal Innovations in Pharmacy reports that when roughly 15,000 patients with diabetes, high blood pressure or high cholesterol were paired with pharmacists for medication management, one-on-one education and regular follow-up between doctor visits, their health improved significantly. The number of diabetics who met their A1C goal increased by 25 percent; cholesterol patients saw their bad (LDL) cholesterol levels drop by an average of 16 points. And all patients' healthcare costs decreased between 14 and 32 percent. "It makes sense," says lead study author and pharmacist Barry Bunting. "Who better to make sure medications are being used appropriately than the people dispensing them?" While retail clinics aren't going to put doctors out of business anytime soon—nor should they—it's comforting to know relief may be waiting for you around the corner.
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