And the market is driving change as well. Retail clinics are growing rapidly around the country and now total around 1,400. These clinics generally are staffed by nurse practitioners who operate without onsite physician supervision. In 2010, an estimated 4.1 million families used a retail clinic, according to a study by the Center for Studying Health System Change.
Getting care in retail clinics tends to be cheaper than care in physician's office or hospital-based care, and that's attractive to patients who face increasing cost-sharing burdens under their health plans. The average cost of a 14-day episode for the 10 most common diagnoses treated in a retail clinic was $484 to $543, depending on the state, according to a report in the November Health Affairs. The comparable cost of treatment for those diagnoses in doctors' offices, hospital outpatient departments and hospital emergency departments was $704.
There are more than 750 MinuteClinic locations owned by CVS Caremark Corp. in 25 states and the District of Columbia, and they have expanded from dealing with minor illnesses and injuries to monitoring chronic conditions such as diabetes and hypertension, and administering children's physicals. CVS plans to have 1,500 MinuteClinics by 2017.
Deerfield, Ill.-based Walgreen Co. has opened more than 400 Healthcare Clinic locations staffed mostly by nurse practitioners. The clinics administer vaccines; do physical exams; conduct screenings for common conditions; and monitor and manage some chronic conditions.
In late October, Walgreen's clinics were accredited by the Accreditation Association for Ambulatory Health Care, based on providing patient-centered, accessible, comprehensive care in coordination with a patient's primary- and specialty-care providers.
Pharmacists are also playing a bigger role. Last year, Walgreen launched its WellTransitions program in which its pharmacists work with local hospitals to prevent hospital readmissions by helping make sure patients receive and take their medications.
Along the same lines, in April the University of Nebraska Medical Center's College of Pharmacy, Omaha, was awarded a $369,000 grant from the National Association of Chain Drug Stores Foundation to test how pharmacy-provided medication management could help patients in ACOs and medical-home practices control their diabetes and high blood pressure. Walgreen, the Kearney (Neb.) Clinic multispecialty practice, Blue Cross and Blue Shield of Nebraska and the Nebraska Health Information Initiative are participating in the initiative.
So while some are fretting about a physician shortage, others are essentially saying, “We don't always need a doctor.”
Follow Andis Robeznieks on Twitter: @MHARobeznieks
(This story contains a correction. A study by Rand Corp researchers was originally attributed to the wrong authors.)