Diabetes Self-Management Blog

It is widely asserted that in the United States, there is a shortage of primary-care doctors — or at the very least, that if current trends continue, a pronounced shortage will occur in the future. The reasons for this situation are complex (the reimbursement practices of both Medicare and private insurance companies may be, in part, to blame) but there is little question that a solution is needed for the often long wait times that patients encounter when they attempt to schedule a doctor’s appointment.

One such solution that has taken off in recent years is the retail clinic: a walk-in clinic located in a retail area such as a pharmacy or shopping center. These clinics, which are often operated as subsidiaries of pharmacies and merchandisers, aim to provide services that primary-care doctors often do not, such as extended hours and on-site dispensing of drugs. Some people, however — medical professionals and patients alike — are skeptical of the care these sites offer because they tend not to have doctors on-site, instead offering nurse practitioners, physician assistants, and pharmacists. For this reason, the types of care these sites provide is necessarily limited. (Although nurse practitioners or physician assistants provide care for many people with chronic illnesses, there are limitations in terms of their scope of practice and ability to prescribe drugs.)

But in a recent essay published in the Journal of the American Medical Association, a doctor asserts that retail clinics offer several advantages and unique qualities that redeem many of their perceived flaws. Christine K. Cassel, MD, president of the American Board of Internal Medicine, writes that many retail clinics are making strides in coordinating with other health-care providers. Most clinics ask patients who their primary-care doctor is and notify that doctor’s office immediately following any interaction with the patient. Many patients at retail clinics, however, do not identify any primary-care doctor — which means, according to Cassel, that the clinics provide a valuable service to people who otherwise might have to wait or visit a far more expensive emergency room. In addition, many retail clinics are now equipped to develop plans of care for patients with chronic diseases, working to coordinate care with specialists. Because of the convenience that they offer, Cassel writes, retail clinics may be the preference of many patients for chronic care — especially since many primary-care doctors currently do not coordinate care with specialists, anyway.

But as Cassel notes, retail clinics cannot offer diagnoses of, or treatment for, complex conditions. In these situations, the clinics must send patients either to a primary-care doctor (providing a referral in the common event that the patient lacks a primary doctor) or to a specialist. They also may the lack the sense of a medical “home” that primary-care doctors, at least in theory, provide.

What do you think — do retail clinics appeal to you? If you’ve ever visited one, what prompted you to make this visit? How important is it to you that a doctor — rather than a nurse or physician assistant — coordinate your care? Even if you have some concerns about retail clinics, would the convenience that they offer tempt you to visit them? Leave a comment below!

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