The American Medical Association is calling for a federal investigation of what it terms a clear, inherent conflict of interest in health clinics co-habiting with pharmacies and other retail stores. The AMA also questions whether these facilities contribute to fragmentation of care by harming the traditional doctor-patient relationship and lower the overall quality of care.
There is nothing wrong with a study of a new sector in healthcare, but the AMA may not like the outcome. These one-stop-shopping facilities have sprung up in response to a clear need, and so far there is no evidence they are doing anything but muscling in on a corner of physicians turf.
At the clinics, patientsincluding many without health insurancecan have a simple medical condition such as strep throat or conjunctivitis diagnosed and a prescription written and filled, all for one low price, often in just minutes. The clinics are staffed by licensed nurse practitioners and registered nurses, always under the supervision of an on-call physician. Prices for carelower than at most physician offices and hospital emergency roomsare posted prominently.
Despite a scenario set out by the AMA, clinics arent overstepping their bounds. They refer serious cases to physicians and hospitalssometimes even summoning ambulances.
We have a major shortage of primary-care doctors in this country, as anyone who has had a minor ailment can attest. Getting a timely appointment with a family doctor is rare, and when you can, the wait times are often horrendous. Talk about a niche waiting to be filled.
Studies find that anywhere from 3% to 7% of Americans have used an in-store clinic. There were only about 330 such operations found by a recent study by the California HealthCare Foundation, but the report predicts there will be 1,500 by the end of 2008.
An online survey conducted by Harris Interactive in March found high patient satisfaction with these clinics. Ninety percent of respondents were satisfied or very satisfied with the quality of care provided, and nearly that many liked the clinics cost and convenience.
There is no doubt that a patient with prescription in hand is likely to walk outside the clinic walls and head for the nearby pharmacy counter. Is that a major problem? It does raise the issue of whether pharmacy-owned clinics have incentives to overprescribe, but it is worth noting that insurers are now encouraging patients to use these facilities because they lower the cost of basic care.
Not every clinic is owned by retail chains. Wal-Mart and Target Corp. contract with third-party clinic operators, though Walgreen Co. and CVS Caremark Corp. own their facilities. Many of the nations largest health systems own and operate such clinics, throwing more cold water on the AMAs overheated claims about fragmentation of care.