Retail health clinics grow in popularity
Some view them simply as a doctor office visit without the long wait. Some physicians contend the public may not understand the truly narrow scope of the services they offer. They may also be seen as a small island of opportunity for physician assistants or nurse practitioners. Regardless, retail health clinics are on the rise and could end up bringing a good portion of the needed care to the roughly 30 million more insured patients that should come online once health care reform takes shape in 2014.
Retail health clinics, such as the ones seen in Walgreens, CVS drug stores and even Walmarts, have been on the rise since 2005. CVS' Minute Clinic concept has about 600 sites nationwide and registers about 11 million patient visits annually. This growth comes after only having a handful of clinics in 2005, said Angela Patterson, regional director of operations for CVS' Minute Clinics in California, Nevada, Arizona and Texas.
The company, which has six locations in the valley, is also looking to add 100 clinics per year for the next four years. Walgreens has 350 of its Take Care clinics around the country, 13 locally, and Walmart has 140 nationwide.
These clinics are typically staffed by a lone nurse practitioner or physician assistant. During flu season, a greeter, or clerk, may assist the health provider, said Rick DiCarlo, local market manager for Walgreens' Take Care clinics.
Some sites are busy enough to possibly warrant a permanent assistant in the future, he added. On average, Take Care clinics see about 15 patients a day, DiCarlo said.
Patterson said the goal for a nurse practitioner or physician assistant at a Minute Clinic is about three patients per hour. When sites consistently see that many patients throughout a day, some are built to add a second nurse practitioner or physician assistant working simultaneously in a neighboring office space. If not, the company looks to open another location, preferably within three miles of the busy one.
Even still, some areas haven't taken to the retail clinics. Several years ago, CVS closed some California clinics.
"Some areas just have less of a need for the service. Period," Patterson added.
The clinics typically serve patients with sore throats, rashes, flu-like symptoms, allergies or other mild ailments. Some lab testing can be done on site, say in the case of strep throat or bronchitis, for example. But more extensive testing requires an outside lab.
A physician assistant or nurse practitioner is qualified to write prescriptions for patients, who can enjoy the convenience of an adjacent pharmacy, even though using the company's specific pharmacy is not required. The health provider can also direct patients to over-the-counter remedies as well.
The sites have become a favored spot for the uninsured, according to DiCarlo, who said the population segment enjoys the discounted and prompt service. The sites also have become known for offering flu vaccines, immunizations and sports physicals.
Perhaps the biggest driver of the concept these days is the speed of service. Patterson said customer surveys keyed CVS to what seemed to be the greatest frustration with health care today, time spent waiting. She said patients demanded what she referred to as a "reduction in layers to seeing their providers."
As a result, providers are very accessible from the outset at a Minute Clinic and are the first point of contact for the consumer. Technology, like electronic health records, is used to support physician assistants and nurse practitioners with the administrative pieces of the job. Most centers are open 365 days a year and commonly 10 hours a day, Patterson said.
"Some people are able come in before work or school or after work," she added. "The patients really set the hours."
Physician assistant and nurse practitioner demand
Physician assistant and nurse practitioner demand has been strong for the past 10 years and will likely continue. In its 2010 list of 100 "Great Careers," CNN Money listed physician assistants in second place and nurse practitioners in fourth. Median salaries are $92,000 and $85,000, respectively.
According to Patterson, the national average of nurse practitioners per 100,000 in population is 50. The Las Vegas Valley is near that ratio, while other areas of the country are seeing shortages, she explained.
"It's no secret that these jobs are in demand," she added.
Vicki Chan-Padgett, director of Touro University Nevada's physician assistant program, said she frequently gets calls from headhunters seeking out new graduates. Calls come from all around the country.
The 24- to 36-month master's level program has graduated about 230 students since it started in 2004. Most new graduates go into primary care or emergency medicine and some may specialize in orthopedics, she noted.
The physician assistant's nature is to be collaborative, despite working autonomously in many situations, she said. While she learned of a recent graduate taking a job at a retail health clinic, she said new graduates probably want to work more closely with a physician before they work alone in a clinic, she said. And many also want to delve into a variety of experiences before settling into one spot, too.
"Every P.A. that works with a doctor develops a special relationship. It all depends on how the doctor wants it to work. Some (doctors) may be tired of working seven days a week and might want them to work on weekends so the doctor has off. Some doctors work really closely with P.A.s and view them as a colleague," she said.
DiCarlo said Walgreens has a mix of predominantly experienced physician assistants and nurse practitioners with some newer graduates. The providers come from a wide range of backgrounds and many speak other languages, which is particularly helpful with tourists coming into its clinics on the Strip. There has been no turnover in the local positions in the past few years, he added, indicating that perhaps once physician assistants and nurse practitioners pick up a wide range of experiences, they are content to settle into these environments for the long haul.
Patterson said CVS collaborates with medical schools for internships and is considering creating a residency program at some schools where students may spend a year working alongside other physician assistants or nurse practitioners in the clinics.
"It helps to increase awareness about what we're really doing," she added. "This is unusual to some. It's not what folks are used to seeing, seeing health care in the retail setting."
But it shouldn't be construed that physician assistants and nurse practitioners in retail clinics are left alone on an island, both Patterson and DiCarlo note. Physician assistants and nurse practitioners must be supervised by a physician who reviews charts and meets with them regularly, per state law. Physicians are also available by phone during working hours both DiCarlo and Patterson explained.
In the case of Walgreens, one physician oversees between one and three nurse practitioners or physician assistants. CVS employs roughly 1,800 nurse practitioners or physician assistants systemwide and a few hundred overseeing physicians as well.
Locally, the group also has a contract with Divinity Health, owners of St. Rose Dominican Hospitals, to provide physician oversight. Walmart also has a contract with Divinity to oversee and run two clinics in Reno.
Beyond the clinics
Some doctors have criticized retail health clinics for not being clearer with their service limitations. Patterson emphasizes that the clinics are supposed to support, not replace, community-based health care like doctors' offices. DiCarlo even says his team tries to emphasize the importance of a person having that relationship with a doctor and not just looking to the clinics for all their health care needs.
"Ultimately our goal is to make sure these patients do have the appropriate follow-up care," he added.
Patterson said her group routinely has collaborative agreements, like its partnership with Divinity and other area physician groups, in place in all of its regions.
"Our success is impacted by our ability to work collaboratively. That's a huge priority for us," she added.
John Eddy, associate administrator for ambulatory care with University Medical Center's Quick Care division, said retail health clinics are not a business threat at all to the Quick Care model. They are much smaller and provide far fewer services than what his group offers.
"We don't view it as direct competition so much as adjunctive service," Eddy said. "Basically these are good places for a sore throat or sniffles. But anything past that, they may have no way of treating it."
Quick Cares are divided into two sections, one focusing on primary care and the other on urgent care. There are always four physicians on site, accompanied by support staff, he added. And Quick Cares are equipped for emergency transport for more acute situations.
Eddy's group has reached out to retail clinics, particularly ones that have locations in close proximity to Quick Cares, to help create what he calls "a collaborative understanding" between the sites. DiCarlo said his clinic staff is made aware of nearby options for more acute conditions and even help to coordinate transportation if necessary.
"We do have processes in place to get them the appropriate care," he said.
