Wal-Mart can be good for your health

The medical establishment is opposed to drop-in clinics in Wal-Marts and other retail stores. But self-interested doctors need to get over their archaic ways of doing business.

By Rahul K. Parikh, M.D.

Read more: Health, Medicine, Life

Feb. 19, 2008 | At a recent medical conference, I eavesdropped on a couple of doctors talking to each other about retail health clinics, small offices or kiosks that offer basic medical care in venues ranging from Target to Piggly Wiggly. These particular docs were not happy. One said some of his "easy business," patients who needed only a few minutes to handle, such as those with sore throats or colds, had migrated to the clinics. The other seemed perplexed that some of the parents in his pediatric practice seemed just fine paying cash to clinics, rather than coming to see him, where they had only a low co-pay.

These views don't surprise me. Doctors are naturally nervous about the rapid growth of retail clinics. About a dozen companies have opened some 400 shops with slogans that range from catchy, such as "You're sick, we're quick" (MinuteClinic), to direct, such as "We Make Quality Care Affordable and Convenient" (QuickHealth). According to industry experts, the number of clinics is expected to grow to over 700 this year. Wal-Mart began dabbling in retail health in 2005, when it opened 76 clinics. It says that over the next three to five years, that number could expand to 2,000.

Many medical groups, like the American Academy of Family Practice and the American Academy of Pediatrics (to which I belong), have published position papers opposing retail clinics. Their basic argument is that retail clinics run counter to the concept of "a medical home," a place where patients receive care for any and all of their problems. They worry that patients will have no sensible place to follow up their test results, and that putting a clinic in a mall or a Wal-Mart could expose shoppers to people with a contagious illness.

The medical community needs a second opinion. Retail clinics are good for American healthcare. By giving doctors a run for their money, they force us to do something we don't do well: innovate. At their best, retail clinics can make doctors look like smart entrepreneurs instead of a self-interest group futilely trying to protect archaic ways of doing business.

To understand why that's the case, look at the business-as-usual model of medicine. Anybody who wants to run a competent medical practice -- from the country doctor to the tertiary care hospital -- must measure success in terms of access, quality and cost. It's safe to say traditional medical practice is struggling to succeed here. Access is unpredictable for almost any practice. Most of us simply don't have the ability to provide round-the-clock care, short of the mediocre phone service of an on-call doctor or the chaotic, overcrowded emergency room. Costs keep rising and being shifted to consumers in the form of higher premiums, deductibles and co-pays.

Despite having the brightest medical minds and therapies, basic medical quality in America remains poor. According to a 2004 report by the Government Accountability Office about Medicare preventive services, 30 percent of people over age 65 did not receive a flu vaccine and 37 percent had never had a pneumonia vaccine. Another example: In 2000, Medicare estimated that 6.6 million beneficiaries were never told by their doctor that they had high blood pressure.

On the other hand, retail clinics are thriving. They provide excellent access. After all, what's more convenient than showing up any day, night or weekend to have your sore throat checked? No telephone time spent on hold trying to make an appointment, no shuffling your personal schedule to get there.

Then there's cost. Retail clinics operate on a fee-for-service basis and don't accept insurance. Most charge a maximum of $50, which is significantly cheaper than the $100-plus your insurance company (or you, if you carry an increasingly popular high-deductible insurance plan) will pay when see your doctor for the same concern. That relative savings makes retail clinics a great place to go if you're uninsured and have a minor medical problem.

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