Doctors express concern as retail clinics flourish

State medical group plans to seek greater oversight

By GETAHN WARD • Staff Writer
Johnny Daniels has a doctor, but after feeling dizzy one afternoon last week, he went to the Take Care Health Clinic inside a Walgreens drugstore near his home in Hermitage.

“It was convenient, fast, I didn’t have to wait and the dizziness went away immediately,” said the 71-year-old snack food vendor who had his ears cleaned by nurse practitioner Michelle Aull.

Daniels is among the growing number of people across Middle Tennessee seeking care at so-called retail clinics — mini-offices staffed by nurse practitioners — that promise shorter waits and lower fees for treating common illnesses.

MinuteClinic, part of CVS/Caremark, arrived two years ago, opening clinics inside six CVS drugstores throughout the Nashville area.

Over the past few months, that chain has been joined by two others — Take Care, which is owned by Walgreens, and The Little Clinic, a Brentwood-based company with offices inside area Kroger stores.

Patients such as Daniels like the fast service and low prices. The clinics keep longer hours than most doctors’ offices and charge about $60 to treat most common complaints, from sprained ankles to sore throats.

The fast growth of the concept — one trade group predicts the number of retail clinics nationwide will double to about 1,800 by year’s end — is drawing concern from doctors about issues such as safety of patients at the clinics staffed mostly by nurse practitioners.

The Tennessee Medical Association had planned this week to propose new rules to the state’s Board of Medical Examiners that would have required that a supervising doctor be within 30 miles of a clinic and spend more time there.

Currently, nurse practitioners must be supervised by a physician, but there are no requirements concerning the location of the supervising physician.

The medical association changed its mind about proposing new rules after weighing the potential effects on other types of clinics, especially in rural areas, but it still plans to recommend changes after more talks with other stakeholders.

“We’re not trying to keep the MinuteClinics from delivering a good service,” said TMA Chairman Dr. Michael Minch, referring to the convenience care concept by a well-known brand.

“We want to make sure they’re safe, effective and doing the appropriate services.”
Clinics ‘fill the gap’

Paul Keckley, executive director of the Washington-based Deloitte Center for Health Solutions, said the concerns raised by the doctors reflected their belief that they’re the most appropriate clinical decision-makers on behalf of patients.

Retail clinics, however, help ease crowds in emergency rooms at hospitals, Keckley said, and safety of patients isn’t compromised because the clinics handle uncom plicated diagnosis and refer serious conditions to physicians.

“Our goal is to meet those unmet needs and fill the gap in the health care delivery system as it stands today,” said Dr. Tunde Sotunde, the chief medical officer with The Little Clinic.

The company, which moved its headquarters to Brentwood from Louis ville, Ky., last spring, has its clinics inside grocery stores. John Gryz bowski, the company’s chief operating officer, sees that as an advantage over rivals Take Care and MinuteClinic, which typically are inside drugstores.

People usually visit drugstores once or twice a month but go to the grocery store an average of eight times a month, Gryzbowski said.

Despite concerns raised by physician groups, clinic operators say they offer quality health care.

In fact, some large health-care organizations are opening retail clinics of their own, Keckley said. Next week, for example, the Mayo Clinic plans to open the first Mayo Express Care in a strip mall in Rochester, Minn.

“They’re saying, ‘This is just an extension of our brand — we can do this and extend
our reach in the community,’ ” Keckley said. Some lesser-known hospital systems might not follow the Mayo Clinic’s example because they don’t want to create tension with their doctors, he said.
Profits are slim for now

An upcoming study by the Deloitte Center showed that most users of the clinics have insurance coverage and are attracted because of their convenience.

Most of the locations are marginally profitable, Keckley said. The Little Clinic’s Gryzbowski said it could take two years for a location to become profitable, although the length of time varies by region.

Lauren M. Tierney, a Take Care spokeswoman, said that the retail clinics weren’t intended as a substitute for seeing the family doctor.

“We’re not there to replace physicians,” Tierney said. In fact, the company’s nurse practitioners tell patients with serious illnesses to see a doctor, she said.

Daniels, the patient who went to the Hermitage location after feeling dizzy, doesn’t plan to dump his doctor but added that he would not hesitate to go back to the Take Care Health Clinic.

“I would go there in a heartbeat,” he said. “I’m for convenience. Time is money for
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