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Ateev Mehrotra, Margaret C. Wang, Judith R. Lave, John L. Adams, and Elizabeth A. McGlynn Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison Of Patients’ Visits Health Affairs, September/October 2008; 27(5): 1272-1282. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Retail Clinics 2.0 Need to Emerge

Lawrence H. Stiffman   ( 16 September 2008 )

Medical Treatment No Longer Cumbersome Or Costly

Daniel W. Abshear   ( 29 September 2008 )

Comment on Mehrotra et al.

Dan Abshear   ( 12 November 2008 )

Retail Clinics 2.0 Need to Emerge 16 September 2008
Lawrence H. Stiffman, Owner Applied Statistics Laboratory Send comment to journal: Re: Retail Clinics 2.0 Need to Emerge aslinfo{at}aol.com Lawrence H. Stiffman	The market for primary care and disease prevention is characterized by excessive latent demand during policy babbling for EHRs, "better access," satisfactory quality, and "consumer directedness." Demonstrated by this study's findings, convenient care clinics have dented into all of the above, excepting continuity of care. Disintermediated specialists ought to be pouring some bubbly. Boring workloads exact severe opportunity costs related to more appropriate caregiving. As annual volumes move into the millions, referral spigots move from drips to stable demand. Workforce shortages can be reexamined as task shifting is a welcome breadth of fresh air which can be accelerated by private market players, the feds, and professional associations shedding their no-vision, CYA goggles. An emerging "all digital" model aligns these stakeholders with zero-price HRAs driving behavioral-targeted couponing for cash, goods, and services incentives for purchasing assistance as well as adherence/compliance monitoring, with win-win partnerships of local primary care providers (PCPs), insurers, and local health systems poised for follow-up. Retail clinics 2.0 could fulfill all USPHS (Public Health Service) disease prevention mandates and guidance, partnering with manufacturers, Google and Microsoft, visiting nurses and local health departments, and schools to establish new nexi for "medical homes." Given sunk investments, marginal costs are low. Given the doughnut hole of a willing PCP supply response when insurance finally chips away at the vast pools of no-shows, retail clinics 2.0 can grow and expand joining with schools, workplaces, and health department clinics to network into 3.0 systems. (See http://aslsurveys.com/docs/ideas.pdf) "Drill, baby, drill" reflects mass frustration and disempowerment. "Pill, baby, pill" isn’t much better. But this gateway alternative to primary care and disease prevention will prove to be cost-effective, acceptable to those of us capable of assisted self-direction, and equitable to the millions of medically disenfranchised Americans.
Medical Treatment No Longer Cumbersome Or Costly 29 September 2008
Daniel W. Abshear, Pharmaceutical Manager Brainblogger Send comment to journal: Re: Medical Treatment No Longer Cumbersome Or Costly diohdan{at}aol.com Daniel W. Abshear	Recently in the media, issues have been addressed regarding the specialty of primary care or family practice doctors and the shortage of them in the U.S. In summary, reasons for the shortage that exists are due to the specialty not being that profitable for a doctor compared with other specialties. As a consequence, the doctors view the specialty as not a desirable choice apparently quite often, although the specialty is greatly needed in the health care system and for the public health. As a layperson, I view primary care as ultimately a specialist in nothing in particular, yet knowledgeable in a large variety of medical areas, which, I believe, makes them very valuable to those patients seeking restoration of their health. Furthermore, there is a comfort level with those in this specialty compared with other specialties, one could speculate. So the shortage of primary care doctors is in fact disappointing. Perhaps most disappointing is the atrophy of the doctor-patient relationship unique with such doctors. Yet one possible solution is what is known as retail care clinics, and their popularity was increasing not long ago for a variety of reasons. First, I’ll offer a definition of a retail clinic: Retail clinics are usually located in a convenient location, such as a shopping area, and are smaller than most doctors’ offices in regard to geographical space. Usually, these clinics are staffed with nurse practitioners, who often have the ability and authority to provide the same quality care as a primary care physician, and do so with the same standards regarding accountability and autonomy. If you happen to go to one for what may be considered a mild ailment -- for example, for such conditions as allergies or the flu -- you will notice a unique and pleasant paradigm towards your care at such a clinic: They are quick. You are normally in and out of there within a half-hour or so. This includes a thorough assessment and treatment regimen offered. Unlike typical doctors' offices, these clinics are walk-in clinics, so there is no overbooking of patients. You actually dialogue with your health care provider more so than you have experienced in a traditional doctor’s office due to other doctors' offices often being incredibly busy from seeing too many patients during a typical day, as this is coerced and dictated by the health care system that employs these primary care doctors. The cost of going to such a retail clinic, which is sometimes termed an "urgent care light" clinic, is usually about three-fourths the cost of a typical primary care doctor visit. You will likely notice no decline in the quality of care that you receive. In fact, likely you will experience greater quality on many different levels, on both a personal and a clinical level. Critics of such clinics include the American Medical Association and various medical societies, yet in my opinion, they are simply vexed because of the invasion of these clinics on their turf. If it is discovered that you need greater medical care or attention than the retail clinic can provide for you, you will be referred to a location that can provide the care you are determined to need by the clinic’s heath care provider, who has likely relationships with the hospitals and others in the medical community. So most patients of these retail clinics are pleased with the care they receive from them, which is why they continue to grow in number under different names, as they have become franchises, yet the concept is new, so only time will tell regarding their popularity with various communities. The clinics provide a response to the shortage of primary care doctors, and possibly are an answer to other problems that exist in the U.S. health care system. The clinics are more authentic, and are therefore more beneficial for public health in many different ways.
Comment on Mehrotra et al. 12 November 2008
Dan Abshear, writer/consultant home Send comment to journal: Re: Comment on Mehrotra et al. diohdan{at}aol.com Dan Abshear	Recently we have heard about shortages of primary care and family practice doctors, partly because the specialty is less profitable than other specialties, meaning it is viewed as less desirable for physicians. Still, the function performed by the specialty is greatly needed for the public's health, partly because primary care doctors are knowledgeable in a large variety of medical areas, and, because many patients have a high comfort level with these physicians, they also promote good doctor-patient communication. One possible solution is retail care clinics. Usually these clinics are staffed with a nurse practitioner who often has the ability and authority to provide the same quality care as a primary care physician, and to do so with the same standards regarding accountability and autonomy. For treatment of mild ailments, these clinics hold advantages over traditional doctors’ offices. First, overbooking is not a problem, so these clinics are quick (normally in and out within a half hour or so). They also promote more dialogue between patients and health care providers than is experienced in a traditional doctor’s office, and these clinics are also cheaper, costing about three-fourths or less the cost of a typical primary care doctor visit, I understand. Most patients of these retail clinics are pleased with the care they receive from them, which is why they continue to grow in number under different names, as they have become franchises; yet the concept of this pay as you go health care is fairly new. Only the future will tell if this method is preferred by those seeking minor restoration of their health. Dan Abshear