Competition heats up in sports-physicals arena

In terms of revenue and public health needs, annual youth physicals required for sports participation or summer camp attendance may not appear large on the healthcare system's big-picture radar, but they appear to be a growing sore point between primary-care physicians and retailers operating nurse practitioner-staffed clinics in their stores.

MinuteClinic, a Woonsocket, R.I.-based subsidiary of CVS Caremark, announced in March that it had become the official physical provider for the Pop Warner Little Scholars program, which operates youth football, cheerleading and dance programs in 43 states. As part of the deal, children participating in Pop Warner activities get $5 off the cost of a sports physical at MinuteClinic, which, according to the company website, is now $49.

Even without a $5 coupon, you can get a cheaper physical at Take Care clinics, owned by Deerfield, Ill.-based Walgreen Co., which offers physicals for only $39 (though after Sept. 30, the price jumps to $60). In comparison, Oak Brook, Ill.-based Advocate Health Care offers $40 physicals at its hospital outpatient centers and, at the Careworks walk-in clinics run by Danville, Pa.-based Geisinger Health, physicals start at $49.

Dr. Joel Shalowitz, director of the health industry management program at Northwestern University Kellogg School of Management in Evanston, Ill., said this is not only cutting into the primary-care revenue stream, it's also affecting the development of doctor-patient relationships.

“It's another chance for the doctor to make contact with the patient, find out about their lives and see what's going on,” said Shalowitz, who practiced as an internist for 24 years. “It's part of being a primary-care doctor, especially for pediatricians. You love watching kids grow up.”

In a presentation of its growth strategy (PDF), MinuteClinic cites a Massachusetts Medical Society study that found the wait to see a family physician in the state has increased from 29 days in 2010 to 45 days in 2012. (Though not mentioned by MinuteClinic, the same study also notes how the wait time to see a pediatrician fell from 24 days in 2010 to 23 days in 2012.)

The waiting times appear to be driving annual-physical business to retail clinic operators. CVS, which does not divulge financial figures, reports that “non-acute services” are accounting for 16% of the care provided at its retail clinics. In 2011, it reported that physical exams accounted for 81% of non-acute services and projected that non-acute care and non-flu vaccinations could account for 25% of retail clinic visits by 2015.

Shalowitz acknowledged that it can sometimes be tough to schedule a doctor's appointment for these physicals, but said some of the blame lies with parents.

“Everyone waits until the last minute,” he said. “It's like if you were an accountant and everyone waited until April 10 to get their taxes done.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks