Friday, July 01, 2005


One of the latest ideas in the brave new world of the health care biz is "MinuteClinics." As described here, MinuteClinics operate rapid-service, walk-in clinics located in such venues as CVS pharmacies, Target and food stores. The clinics are staffed by nurse practitioners and physicians' assistants, and treat a limited range of minor illnesses, such as "strep throat, pink eye, and bronchitis." As described by ABC News, patients are seen in a "tiny kiosk with a nurse practitioner inside."
The American Medical Associaton is wary of MinuteClinics because they do not provide continuity of care. One of our local physicians wrote an op-ed challenging their effects on the "efficiency" of primary care.
My biggest concern is that some people with apparently simple problems, even sore throats and bronchitis, actually have serious ailments. Will a nurse inside a "tiny kiosk" be able to identify them? The nurse may have a good protocol (although the contents of the protocols they use have not been made public), but I wonder how nurses in tiny kiosks can do adequate physical examinations, even for simple complaints. If they can't do a good chest examination, for example, they may miss the heart murmur that suggests a patient with a sore throat might merit antibiotics even with a negative rapid strep test, or they may miss the signs of pulmonary congestion that suggests a patient with "bronchitis" might have pneumonia or congestive heart failure.
But MinuteClinics also provide a telling example of how health care is now lead. This article provides a brief biography of MinuteClinics new Chief Executive Officer (CEO), Michael Howe, who was, it says, "recruited for his leadership experience." Howe is the former CEO of Arby's Inc./Triarc Restaurant Group, and had previously had executive positions with KFC. These days, leadership in selling fast food is now considered equivalent to leadership in health care. Would you like fries with that rapid test for strep?


Cetona said...

And while you're at it, damn it all, SuperSize that!

-- Russ Maulitz

Abby said...

Your concerns about continuity of care apply with equal force to student health services.

How much continuity of care do most people actually get from their doctor?

Anonymous said...

Quick, which is worse, a visit to a Minute Clinic, or a visit to the ER? Answer: The ER, because it costs a lot more. But neither provides continuity of care, unless you count being a frequent flyer at your local ER.

Roy M. Poses MD said...

The ER visit will surely cost more than the MinuteClinic visit. Does that make it worse? Yes, for those people who really don't have anything major wrong with them. But it seems likely that for the few people who have a more serious version of a sore throat, or "bronchitis," etc, the ER visit would offer a greater chance of finding out that the problem was more severe than the patient thought.

But actually, the question should also include as an option a visit to a physician's office or primary care clinic. And if we had more primary care physicians, and burdened them less with paper-work and other overhead, that might prove the quickest, most pleasant, cheapest alternative that would still be capable of discriminating the majority of patients with minor problems from the few with more severe ones.

InformaticsMD said...

Managed fast food and now healthcare? No problem.

Unqualified decision-making:


Martin said...

We have walk-in clinics here in Canada, Im not sure if they would be considered "minute clinics" since they have qualified medical doctors.

Personally I love these clinics, very fast service!

Anonymous said...

I agree that the idea of offering health services in a Target store needs further discussion. However, as a Family Nurse Practitioner I find it very offensive that you refer to NPs and PAs as "nurses in a kiosk." Perhaps you don't know that all nurse practitionershave at least six years of education and often as much experience as their physician counterparts. Please don't misunderstand me. The primary care physician is an integral part of the health care team but is not the only member. NPs are qualified and capable to appreciate murmursand adventitious lung sounds along with many other more complex conditions.

Let us not forget that NPs have extremely high patient satisfaction and compliance (in many studies, higher than physicians.) So, while we discuss "fast food" health care, let us remember to speak fairly and respectfully.

Roy M. Poses MD said...

Please read my original post.
My point was that the article described the setting as a "tiny kiosk with a nurse inside." I have great respect for nurses, but wonder how well a nurse in a "tiny kiosk," with apparently not enough privacy to do a physical examination, minimal to no equipment, and nobody else, much less a health care team, present, would be able to identify the occaisional patient with a serious illness masquerading as a simple sore throat, bronchitis, pink eye, etc.

Anonymous said...

I am just as offended by the NP's remarks as the NP is offended by the MD's remarks. 6 years of training as an NP is hardly the equivalent of the 11 years required by a family practice or internal medicine physician, not simply in number of years, but the intensity of the training, and yes, I will say it, the sheer brain power required to complete training as an MD. And don't even get me started on comparing the experience of an NP with the experience of an MD--there is no comparison.

The real tragedy I see to these MinuteClinics is the fact that they are skimming off the "cream" of health care services that a doctor's office currently provides; these are the easy, acute visits that take little time, are reimbursed well, and balance out the difficult visits that take a lot of time and are reimbursed poorly (relatively speaking). This is particularly true when you add in the vaccination revenue. Primary care docs are getting squeezed in every direction, so don't be surprised when you see more and more well-trained docs throwing in the towel and choosing MDVIP as their practice style. Don't worry, there will be lots of foreign-trained docs ready to step in for them, but are you really comfortable with an MD who did their training in Iraq? Well, I guess if you are satisfied with being evaluated by an NP with absolutely no MD supervision, that type of health care is just up your alley.

Senior 2 Senior said...

An MD taking offense at anything is funny all by itself. Too bad the revenue pie is being divided more broadly but live with it like I have to live with your my-way-or- the-highway-diagnostic attitude, snooty staff, billing procedures, waiting on the phone for upwards to an hour for an appointment "sometime" in the future and on and on and on.

Oh yeah, when I ask about the side effects of the medication you prescribe and you can't, or won't, tell me, how should I react? Do you have an any obligation to tell me the medication you just prescribed was a result of that pharma rep's recent visit?

How do you provide continuity of care once I leave the office? Gee, maybe you don't and maybe, just maybe, that puts you on the same level as a "kiosk" provider.

I guess it is all in how you look at it, ey?

Roy M. Poses MD said...

I would like to hope that Senior 2 Senior's experience was the exception, not the norm.
I would still point out that a "kiosk" provider 1- by definition can't provide continuity of care, while many primary care doctors still strive to do so; and 2- the list of medications a "kiosk" provider can provide, and the problems a "kiosk" provider can treat are strictly limited.

Anonymous said...

Health care in America right now is at the best and worst of all times.
An excellent clinican with M.D., D.O or N.P. behind their name is worth their weight in gold, and it usually costs that much to get to see one. The kiosk moment is just that, quick care in a time and financial pinch. Everyone needs ongoing care, many can't find it even if they have the resources and time to spend due to the structure of our health care system. Excellent clinicians are time pressured and stressed.
My observaton is that there is a higher level of satisfaction and that there are less law suits for N.P.because of it. I believe that is because N.P.'s are educated to spend more time in patient education and discussion.

Anonymous said...

I support such urgent care light clinics, and apparently am not alone, considering there is rapid growth now with such clinics.

Most diagnosis offered by the providers are accurate, and makes health care treatment much less cumbersome. Furthermore, at busier doctor offices that exist, many of thier patients are passed on to thier NPs or PAs anyway. The attention provided at such clinics is more personalized, and in some ways superior in relation to thoroughness of care. The AMA clearly is opposed to these clinics due to turf threat, but they provide a much needed solution to the fallacies of the existing health care system.

Anonymous said...

Quick When You’re Sick

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: A retail clinic is usually located in a convenient location, such as a shopping area, and are smaller than most doctor’s offices in regards to geographical space. Usually, these clinics are staffed with a nurse practitioner that 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 t o 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 doctor offices, these clinics are walk-in clinics, so there is no over-booking 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 doctor 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 you may have seen in the past, which is typically the case.
The cost of going to such a retail clinic, which is sometimes termed an ‘urgent care light’ clinic, is usually about ¾ 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, both on a personal and 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 during your visit at their urgent care light clinic, 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 for which they serve.

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 health care system in the U.S. The clinics are more authentic, and are therefore more beneficial for public health in many different ways.

Dan Abshear

“Follow where reason leads.” --- Zeno of Citium