Docs Split on Big-Box Clinics

Calls by the American Medical Association for a federal investigation into walk-in health clinics in "big-box" stores like Wal-Mart and Target have spurred a debate that could shape the way many Americans seek health care in years to come.

On one side are proponents of the clinics, who argue that they provide affordable and accessible care to those who might not ordinarily be able to get it.

On the other side are those who say such clinics fall short of offering a full spectrum of care, and that the medical professionals who work there could be tainted by conflict of interest.

"I think that it's a tough issue because we want to make sure patients get quality care," said Dr. Neil Brooks, former president of the American Academy of Family Physicians, who attended the AMA meeting this week.

"But we also need to make sure that the care is provided in settings that are appropriate and that it is within their scope of practice."

Attention Shoppers: the Doctor Is in

The clinics, which go by the names MinuteClinic, RediClinic and Take Care Health, are popping up in major stores, including Wal-Mart, CVS, Target and Walgreens.

And like the services offered by big-box stores or fast-food joints, they give customers an inexpensive and convenient alternative, in this case to the wait time of doctor's offices or the high cost of emergency rooms.

There are now 200 of these clinics operating in the country, and another 1,000 are projected to open by the end of the year.

Usually, these walk-in clinics are staffed by a nurse practitioner with physician oversight. They offer a menu of prices for treating a range of minor illnesses, such as sinus infections and strep throat.

If needed, the clinic can refer a patient with a more serious malady to a physician's office in the area.

But for many consumers, the main selling point of such clinics is that they offer affordable care.

In Minnesota, for example, seeing a doctor for a sore throat and getting a strep test costs an average of $109. A visit to a hospital emergency room for the same problem averages $328. MinuteClinic charges $48.

"Walk-in clinics offer a potentially promising alternative for people who have no coverage," says Dr. Peter Jacobson, director of the center for law and health systems at the University of Michigan School of Public Health.

"And therefore the burden is really on the AMA to show that poor quality health care is being practiced or that the clinics are not meeting the needs of the population being served."

Jacobson says that most people who visit these clinics either can't afford to go to physicians or don't have the time to see a doctor.

And, he says, these clinics may just force the primary care physicians to reconsider the way they do business, for example, by leaving open slots in their daily schedule for walk-in patients.

"I think before the AMA really attacks minute clinics, it would be appropriate to study the market niche they're serving," Jacobson explains.

According to one Canadian study conducted in 2003, the quality of care at walk-in clinics is actually higher than that of traditional physicians' offices.

Quality Concerns

But the AMA maintains that a host of potential problems exist with retail clinics.

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