Are you willing to work for Walmart?

[exPCM]

---

Members do not see this ad.

The big giant Walmart with its $4 prescription drugs is now making a large move now into primary care. Would any of you consider working at a Walmart clinic in the future? I think Walmart and medicine are not a good mix.
see link: http://articles.moneycentral.msn.co...lth/WalMartExpandingInStoreHealthClinics.aspx

 

[AwesomO]

Would any of you consider working at a Walmart clinic in the future?

Some physicians already have http://www.quickhealth.com/ Well at least work IN a Wal Mart.

Do you think Walmart will put small primary care offices out of business?

It will certainly change things. Most physicians are use to holding the monopoly over health care. ie this is how we do it and this is the way everyone does it so you either take are care or get none. For example take this quote from the MSN message board

I loathe Wal-Mart and wouldn't go there but would be happy to visit such a clinic at a pharmacy or grocery store. This may be part of the solution to expensive health care costs. I called my pediatrician over the weekend for an antibiotic for my son's ear infection. They wouldn't prescribe over the phone. They wanted me to drive 45 min. to urgent care for a cost of $150 to be told "guess what- he needs an antibiotic for an ear infection." Think if I could walk into Walgreens, have the PA look in the ear and prescribe one on the spot. Sounds great to me.

Now that physicians offices are actually competing with another model they will have to find ways to adapt. Me personally I plan on starting a practice where patients can be seen in a timely manner and where I am available to them whenever needed. So I would be providing the convienence factor. Certainly I will not be able to be as cheap as a Wal Mart clinic but hey if you want the quality that comes with a physician you have to pay for it and I'm sure many people will. However if you want to save 30 bucks or so and see a mid level thats fine by me just know that you aren't getting the same quality. Although I guess that could be said whenever you buy anything from Wal Mart.

 

[JiminyCricket]

There goes the easy money, now we will need to see more complex cases.

Hopefully the malpractice lawyers can help regulate incorrect diagnosis made by Walmart.

I am considering FM as a career, or was, but this makes me nervous.

 

[deleted77919]

I'm sure she knew without carefully examining her child's ear that her kid had acute otitis media and not otitis media with effusion. And even with otitis media, do abx prevent middle ear effusions? Apparently not. In fact, looks like "wait and see" should be the standard of practice. Oh well, just give me the abx and send me on my way, EBM be darned.


**************************************************************************************
The concept and practice of a wait-and-see approach to acute otitis media.Spiro DM, Arnold DH.
Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. [email protected]

PURPOSE OF REVIEW: We review the contemporary management of acute otitis media, including symptomatic care, the rationale and literature for utilizing the wait-and-see approach, and the indications for immediate therapy with antibiotics. RECENT FINDINGS: Current guidelines recommend selective use of observation in children diagnosed with acute otitis media. Recent evidence suggests that a wait-and-see approach will reduce the use of antibiotics and decrease adverse events associated with their use. Earlier studies found that antimicrobials reduce pain and discomfort in the acute phase of illness compared with placebo. A recently published trial, however, suggests that when analgesics are utilized there may be minimal or no difference in otalgia whether antibiotics are prescribed or withheld. SUMMARY: Treatment of acute otitis media is the most frequent indication for prescribing antibiotics in the pediatric population. Evidence suggests there is marginal benefit from antibiotics for most children diagnosed with AOM. Based on current data, we propose an algorithm for the management of children with AOM that includes a wait-and-see approach with specific indications for immediate treatment with antibiotics. A wait-and-see approach to acute otitis media that empowers families by using a shared decision-making model will reduce the use of antibiotics and will decrease resistance to antimicrobials.


*********************************************************************************************
Antibiotic Therapy to Prevent the Development of Asymptomatic Middle Ear Effusion in Children With Acute Otitis Media: A Meta-analysis of Individual Patient Data.

Koopman L, Hoes AW, Glasziou PP, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Le Saux N, Rovers MM.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands. [email protected].

OBJECTIVES: To determine predictors of the development of asymptomatic middle ear effusion (MEE) in children with acute otitis media (AOM) and to assess the effect of antibiotic therapy in preventing the development of MEE in these children. DATA SOURCES: A systematic literature search was performed using PubMed, EMBASE, the Cochrane databases, and the proceedings of international otitis media symposia. STUDY SELECTION: A trial was selected if the allocation of participants to treatment was randomized, children aged 0 to 12 years with AOM were included, the comparison was between antibiotic therapy and placebo or no (antibiotic) treatment, and MEE at 1 month was measured. DATA EXTRACTION: Data from 5 randomized controlled trials were included in the meta-analysis of individual patient data (1328 children aged 6 months to 12 years). We identified independent predictors of the development of asymptomatic MEE and studied whether these children benefited more from antibiotic therapy than children with a lower risk. The primary outcome was MEE (defined as a type B tympanogram) at 1 month. DATA SYNTHESIS: The overall relative risk of antibiotic therapy in preventing the development of asymptomatic MEE after 1 month was 0.9 (95% confidence interval, 0.8-1.0; P =.19). Independent predictors of the development of asymptomatic MEE were age younger than 2 years and recurrent AOM. No statistically significant interaction effects with treatment were found. CONCLUSION: Because of a marginal effect of antibiotic therapy on the development of asymptomatic MEE and the known negative effects of prescribing antibiotics, including the development of antibiotic resistance and adverse effects, we do not recommend prescribing antibiotics to prevent MEE.

 

[earthling]

walmart addresses the unmet and basically snubbed off needs of the huge number of uninsured people cast out by the health care system in the US.

You are lucky if you are employed in a good company, fit the correct BMI and have no serious health issues. If you are unemployed but with a spouse or parent employed to provide you healthcare then u are still lucky to have coverage...At that time you may well see walmart as cheapo and trying to take over the FP market....if u have ever been out of work, unemployed or not in any of the above criteria, then u will know how important the service is they provide...

its better to see someone even if it is a CNA barely out of technical college but with the authority to evaluate you and prescribe an antibiotic to a DM with OM then not be seen because you are uninsured or cannot afford the copay. I think most people feel comforted that atleast in Walmart the door is always open and its cheap.....they have walmart coverage if nothing else.

i needed a ppd to start volunteering....i had no insurance and the FP would charge me $130 for the visit and $45 for the ppd.......total $175....this was just a ppd so i could start volunteering.....i happened to go to walmart...where poor people like myself have to go when they have no money and kids to support....the total cost of ppd was like $25 this included the visit and recheck two days later....

all i can say is that FP dont have much to worry about as they will continue to get the insured masses....the uninsured masses will head to walmart...as long as there is a need walmart clinics will flourish...if we feel bad and believe that it is unethical for the uninsured masses to get subpar medicine then maybe we need to address the cause at the root of this unfair system.

that being the fact that healthcare in the US is a free market system based on profit and not on the best interests of all our people.....

regards,
earthling

 

[racerx]

walmart addresses the unmet and basically snubbed off needs of the huge number of uninsured people cast out by the health care system in the US.

Ever heard of EMTALA? Anyone in the U.S., if it is a honest-to-God illness, can go to an ED and get seen and receive the golden prescription. No insurance needed. Read a few of the posts on the EM forum and you'll see that many people use/abuse the overwhelmed ED system for what is (for them) free. After the ED, your massive groundswell of uninsured proletariat can then stop by the Wally-World pharmacy to get the $4 prescription.

Don't be so fast to give kudos to a company that fought like hell to NOT provide its employees health insurance. Yes, Wal-Mart, that champion of the uninsured, is part of the problem with the uninsured.

...if u have ever been out of work, unemployed or not in any of the above criteria, then u will know how important the service is they provide...

You speak as if we were all born with the proverbial silver spoon in our collective mouth. Wrong. I have been there, done that, and have the government cheese t-shirt.

To think that Wal-mart is going to not charge handsomely for its mid-level medical service (and I respect our hard-working service extenders), is just foolish. They are in this to make money. They are hoping that while mom is there with little Jonny for his earache, she decides she needs socks, toothpaste, or other goods for sale there. The $4 prescription plan (which I like BTW) didn't accomplish that, and many folks are betting that program ends sooner, rather than later. The Wal-mart Doc-in-box model isn't the answer to the uninsured problem, as they will still have to pay out of pocket.

its better to see someone even if it is a CNA barely out of technical college but with the authority to evaluate you and prescribe an antibiotic to a DM with OM then not be seen because you are uninsured or cannot afford the copay. I think most people feel comforted that atleast in Walmart the door is always open and its cheap.....they have walmart coverage if nothing else.

No state in the nation is going to allow a CNA to prescribe ANYTHING!

i needed a ppd to start volunteering....i had no insurance and the FP would charge me $130 for the visit and $45 for the ppd.......total $175....this was just a ppd so i could start volunteering.....i happened to go to walmart...where poor people like myself have to go when they have no money and kids to support....the total cost of ppd was like $25 this included the visit and recheck two days later....

Uh. . .have you never heard of the county health department? I have yet to find one that wouldn't place and read a PPD for, at most, a nominal fee.

that being the fact that healthcare in the US is a free market system based on profit and not on the best interests of all our people.....

regards,
earthling

Yep, it's all a plan of "the man" to keep us down. 🙄 Remember, hemp sandals are for WEARING, not smoking.

With a proletariat kumbayah,

racerx

 

[JiminyCricket]

I GOTS LOANS TO PAY OFF!!!!! 200K!

Anyone else in here sick of FP's getting the shaft! We take it up the a** from our specialist collegues who talk smack, medicare/medicaid/insurance who dont pay us s***, and patients who think we are the cause of the escalating costs in healthcare!

Have docs ever striked? I think it's time for an FP strike!

The entire reason we are in this situation is that we have become to compliant to taking it. How did NP's and PA's get the right to prescribe? PA's only go to school 2 yrs out of undergrad...THAT'S DANGEROUS!!!!!

 

[racerx]

How did NP's and PA's get the right to prescribe? PA's only go to school 2 yrs out of undergrad...THAT'S DANGEROUS!!!!!

Some PA's are the product of bachelors programs:

http://www.rit.edu/~676www/physician_assistant_Overview.html

 

[AwesomO]

walmart addresses the unmet and basically snubbed off needs of the huge number of uninsured people cast out by the health care system in the US.

You are lucky if you are employed in a good company, fit the correct BMI and have no serious health issues. If you are unemployed but with a spouse or parent employed to provide you healthcare then u are still lucky to have coverage...At that time you may well see walmart as cheapo and trying to take over the FP market....if u have ever been out of work, unemployed or not in any of the above criteria, then u will know how important the service is they provide...

This most certainly does not treat the uninsured. Are they going to manage their BP, HTN, HL, Depression? How about paps and culps? Birth control? Skin biopsies? Castings? Yeah they offer lab screenings but we all know that the population that uses this service is not going to pay for an extra visit just to have their PSA level checked. Looking at their page the only thing they really offer to treat are self limiting conditions. If your going to treat patients you better be able to address most of their concerns. If not you have no business treating them. None of this "well I can treat your cold (that would of gone away on it's own) but you'll have to see an actual doctor for your HTN, and DM." Where does this leave the patient? Out 60 bucks and right back where they started.

all i can say is that FP dont have much to worry about as they will continue to get the insured masses....the uninsured masses will head to walmart...as long as there is a need walmart clinics will flourish...if we feel bad and believe that it is unethical for the uninsured masses to get subpar medicine then maybe we need to address the cause at the root of this unfair system.

I'm not about to let go of the uninsured to sub par care just yet Theres already innovative docs from NYC to rural Tennessee who have designed practices that allow them to see predominately uninsured patients. I'm sure the trend will only continue and I hope to be a part of it. And I wont be providing some sham medical care that Wal Mart is offering. You come to my office and you can be assured you will be getting your medical issues addressed. Now I wont be able to offer you a 2 dollar off coupon for Tide detergent but hopefully my medical expertise will make up for it.

 

[AwesomO]

I'm sure she knew without carefully examining her child's ear that her kid had acute otitis media and not otitis media with effusion. And even with otitis media, do abx prevent middle ear effusions? Apparently not. In fact, looks like "wait and see" should be the standard of practice. Oh well, just give me the abx and send me on my way, EBM be darned.

The ideal situation would of been for the physician to have explained that to the patient. However "mom always knows best" and would say to hell with your studies I know when my child is sick A resident told me that he was friends with this girl since high school. One day she showed up at his place wanting an antibiotic for her sons ear infection. He took a look said it was fine and he didn't need an antibiotic. She got pissed and hasn't spoken to him in 3 years. 🙄

 

[earthling]

they do many of the health screening and preventive stuff that maybe insurance coverage will not provide to those in lowpaying jobs even if they have coverage...
they do paps, immunizations, flu shots, std screening etc etc

if u have insurance where u have to pay the first $2500 of all costs and u have to pay out of pocket to see your FP or OBGYN and then to have a pap....wouldnt it be better to go down and get it done at walmart for less than half the cost..that is far better than postponing it becoz of lack of funds.

well perhaps many have the choice to say no...but if it means the only access to a pap that u can afford then it is a good thing walmart will do it.

and to paint walmart as evil is a joke.....walmart epitomizes the way the US works...every aspect revolving around making that extra $
whether u like it or not.....capitalism rules...welcome to walmart=welcome to america

 

[racerx]

and to paint walmart as evil is a joke.....walmart epitomizes the way the US works...every aspect revolving around making that extra $
whether u like it or not.....capitalism rules...welcome to walmart=welcome to america

I don't mind capitalism. I don't believe making money is a sin. You are the one complaining about "the man." I wass simply pointing out that for all the praise you heaped upon Walmart, you conveniently forget that it is the corporate ,onster that's helping to keep you down.

You condemn capitalism while praising the bastion of it as embodied by Walmart? You can't pick and choose who to condemn for turning a profit. Seems like as long as you benefit, capitalism is alright by you. When it doesn't benefit you, it is evil. It's hypocritical to condemn certain aspects of capitalism that do not benefit you, and praise the aspects that do benefit you.

Oh yeah, if the U.S. is so horrible and not to your personal standards, don't let the door hit you in the behind. I'm sure there is some worker's paradise somewhere where all your needs could be taken care of with minimal effort on your part. Isn't that what you're really saying you want?

 

[earthling]

it was a sarcastic statement.

The US needs to adopt Universal healthcare or we are all doomed....not just the patients but the docs too.

 

[earthling]

and i find it difficult to digest the fact that rather than condemn the system as it is and call for a change to the shambles that is the US healthcare system.....docs would rather condemn walmart and its contempories.

 

[JiminyCricket]

Some PA's are the product of bachelors programs:

http://www.rit.edu/~676www/physician_assistant_Overview.html

Ha ha, OMG, what is our nation's h.care coming to?! (Not a bad gig though, considering they make about 80k coming out...LOL)

My physician brothers and sistas, we need to unionize or we face a dismall future. The govt needs to at least pay our med schl loans off for us if they are expecting us to work for peanuts.



The RIT physician assistant program is a four-year curriculum focusing on primary care and awarding a bachelor of science (BS) degree upon completion. The first two years involve core courses in basic sciences, mathematics and liberal arts. The third and fourth years, considered the upper division of the program, encompass 21 months. (Students participate in the program during the summer between these last two years.) This includes nine months of clinical course work and 12 months of clinical rotations. Qualified transfer students are accepted into any one of the first three years of the program.

Physician assistants' duties vary depending on the state and the specialty in which they practice. In most states, PAs also prescribe medications. Specialties include general medicine, emergency medicine, geriatrics, pediatrics, obstetrics/gynecology, general surgery, orthopedic surgery, neurosurgery, neonatology, etc. The clinical rotations during the upper division provide the student with an opportunity to explore these specialty areas.

 

[AwesomO]

if u have insurance where u have to pay the first $2500 of all costs and u have to pay out of pocket to see your FP or OBGYN and then to have a pap....wouldnt it be better to go down and get it done at walmart for less than half the cost..that is far better than postponing it becoz of lack of funds.

What we need is a doctor who is willing to buck the system. Some like say..
http://www.patmosemergiclinic.com/Fees.html
Check out his fees. Very competitive with Wal Marts with the added benefit of having someone who is willing to manage chronic diseases. For example your PPD skin test at Wal Mart cost 25 dollars. Under his plan you would pay 10 bucks for the nurse to administer the test and 10 dollars for the PPD test. If a patient comes in with a cold he can charge for a simple or even very simple visit which can be a 20 or 30 dollar savings over Wal Mart.
Something of note is that nearly all his patients are uninsured.

and to paint walmart as evil is a joke.....walmart epitomizes the way the US works...every aspect revolving around making that extra $
whether u like it or not.....capitalism rules...welcome to walmart=welcome to america

😕 Evil I said no such thing. Incompetent and providing sub standard care yes but evil no. I go to Wal Mart all the time. I would stop shopping there if these clincis opened but not out of outrage but because I don't want to be in a closed space with a line full of people with influenza

Competition is great, what you will eventually see if the Wal Mart clinics do become more widespread there will be more people like Dr. Berry who provide affordable care. In the end the patients will be the winners 👍

 

[Faebinder]

walmart addresses the unmet and basically snubbed off needs of the huge number of uninsured people cast out by the health care system in the US.

You are lucky if you are employed in a good company, fit the correct BMI and have no serious health issues. If you are unemployed but with a spouse or parent employed to provide you healthcare then u are still lucky to have coverage...At that time you may well see walmart as cheapo and trying to take over the FP market....if u have ever been out of work, unemployed or not in any of the above criteria, then u will know how important the service is they provide...

its better to see someone even if it is a CNA barely out of technical college but with the authority to evaluate you and prescribe an antibiotic to a DM with OM then not be seen because you are uninsured or cannot afford the copay. I think most people feel comforted that atleast in Walmart the door is always open and its cheap.....they have walmart coverage if nothing else.

i needed a ppd to start volunteering....i had no insurance and the FP would charge me $130 for the visit and $45 for the ppd.......total $175....this was just a ppd so i could start volunteering.....i happened to go to walmart...where poor people like myself have to go when they have no money and kids to support....the total cost of ppd was like $25 this included the visit and recheck two days later....

all i can say is that FP dont have much to worry about as they will continue to get the insured masses....the uninsured masses will head to walmart...as long as there is a need walmart clinics will flourish...if we feel bad and believe that it is unethical for the uninsured masses to get subpar medicine then maybe we need to address the cause at the root of this unfair system.

that being the fact that healthcare in the US is a free market system based on profit and not on the best interests of all our people.....

regards,
earthling

And you go to the CNA and they give you the bactrim and all is well... until you get the same problem 10 days later and you go to them again and they give you ampicillin and you get the same problem 10 days later.. never realizing that you actually have fistula from first time Crohn Disease. And the next thing you know... you are in the ER with a pelvic abscess that is growing Staph resistant to ampicillin and bactrim..... mmmmm... recipe for disaster?

Fine, I suppose if we as physicians are keeping people TOO healty... we might as well have some mid levels around to make the cases complicated.

 

[The Janitor]

Would any of you consider working at a Walmart clinic in the future?

Work there? I won't even shop there.

 

[futuredo32]

Work there? I won't even shop there.