A number of doctor groups have called on the American Medical Association to seek a ban of all in-store health clinics.
The physicians are claiming that the facilities, largely staffed by advanced practice nurses, put patients at risk for a number of reasons including what the groups see as a lack of government regulation and oversight.
Dr. Rodney C. Osborn, president of the Illinois State Medical Society, described what he saw as primary differences between the relationships patients have with doctors or nurse practitioners in retail store clinics on a MedPageToday podcast from the AMA convention: "The patient relationship with the physician - the patient comes in and they've had a 10, 15, or 20 year history. The physician may recognize the cough for what it is, a symptom perhaps of a lung cancer. In a retail clinic, a mid-level practitioner may believe the cough to be associated with an acute viral or bacterial infection and treat it thus and not follow through on what's been a long-term history of medical care for that patient. There have been examples of that given. There have been examples of additional problems with misdiagnosis of breast cancer (and) cervical cancer for women where the appropriate care by that midlevel practitioner isn't delivered."
Dr. Osborn also suggested that the basic mission of doctors and retail stores offering clinic services makes physicians the better choice for consumers. "The basic business mission (pharmacies) is one of selling products and prescriptions. The medical mission is the patient's care, the patient's health, the patient's safety. Our members are very concerned about that aspect."
When asked if he had specifics to back up his assertions about patients at risk, Dr. Osborn said, "There hasn't been time to obtain objective study. There will be on the care given in a series of settings versus the standard physician office setting will be evaluated. Right now, the evidence is anecdotal and there are stories. So, I can't point to a study because this is such a new animal."
A Chicago Tribune article addressed concerns by pediatricians over parents bringing small children to clinics for care. While most in-store clinics do not treat children below 18 months of age, many pediatric groups believe kids should be at least three.
There's no doubt that physicians also have financial concerns about the impact that clinics that are open seven days a week and do not require an appointment may have on their practices.
Walgreens expects to have 400 clinics operating in its stores by the end of 2008. Company spokesperson Michael Polzin said, "We would be disappointed if the AMA adopted a policy that is counter to what patients are demanding, which is more accessible and affordable health care that reduces overall costs. It would be hard to argue against those principles. The bottom line is, retail clinics are improving health care access and health outcomes while keeping the patient's doctor informed as the patient desires."
Dr. Peter Carmel, an AMA board member, told The Associated Press, "If we believe in consumer-driven medicine, if we believe that it is the responsibility of medicine to respond to the needs of our patients and if there is a strong consumer demand, then we in fact are going to have to compete in this arena."
Discussion Questions: What is your reaction to the strength of opposition, including calls for an outright ban, to in-store clinics from physician groups? What actions should the retail industry and in-store clinic operators be taking to address this reaction from at least some elements of the medical community?