How are these new retail clinics going to impact PCPs?

[iqe2010]

Just read this article and I thought immediately that these retail clinics are going to be staffed primarily by mid-levels. Where do physicians fit in (outside of signing off on the charts)?

Welcome to Walgreens. The doctor will be with you soon

Walgreens plans to open full-service doctors' offices in hundreds of its stores across the US during the next five years.

www.cnn.com

Walmart is going to start opening clinics as well.

How do you guys feel this impacts the field of primary care?

(I'm just a lowly non-trad who's trying to see if I should jump ship. As a future DO student primary care is calling my name)

---

Members don't see this ad.

 

[VA Hopeful Dr]

CVS has had Minute Clinics for years. The main effect I see from them is patients come to me when they are misdiagnosed or treated incorrectly and so aren't any better.

 

[smq123]

I'm trying to picture people coming to Walgreens for their pap smears, rectal exams, depression meds, etc. I'm having a hard time imagining that.

Walgreens is just full of "interesting" ideas. First Theranos (The rise and fall of Theranos, the blood-testing startup that went from Silicon Valley darling to facing fraud charges) and now this.

 

[sunshinefl]

This does kinda worry me as someone who wants to do IM—>primary care. (Current 4th year)

As a patient, I only use places like this for immunizations, PPD tests, etc

 

[deleted87716]

This isn't anything new. Those places mostly end up just giving vaccines and inappropriate antibiotics. Their real purpose is to drive business to their pharmacy.

 

[AMEHigh]

Research has shown that primary care visits are down from 20 years ago.
However on an individual level it seems like getting a job in family med has been relatively easy and continues to be easy.
Also, like I always say family med is great because you can work in so many environments!

 

[VA Hopeful Dr]

Research has shown that primary care visits are down from 20 years ago.
However on an individual level it seems like getting a job in family med has been relatively easy and continues to be easy.
Also, like I always say family med is great because you can work in so many environments!

Got a source on that first part, because that's news to me (not doubting you, I have just never heard that before and am curious)?

 

[deleted87716]

Got a source on that first part, because that's news to me (not doubting you, I have just never heard that before and am curious)?

I’ve been in practice for 20 years, and I haven’t seen any decrease, nor has anyone else in my group. Given the graying of America, I’m not even sure how a decrease would even be possible.

 

[AMEHigh]

Got a source on that first part, because that's news to me (not doubting you, I have just never heard that before and am curious)?

Oops it's not over 20 years, this data is saying down over the past 9 years. Not sure where I got 20 from! Maybe another source? But this is the article I was thinking of because I got it in my email from what I recall.

Study Charts Downturn in Primary Care Office Visits

A recent study tracking a downward trend in primary care visits cited several contributing factors, including the high cost of care that the AAFP has been working to address.

www.aafp.org

 

[VA Hopeful Dr]

Oops it's not over 20 years, this data is saying down over the past 9 years. Not sure where I got 20 from! Maybe another source? But this is the article I was thinking of because I got it in my email from what I recall.

Study Charts Downturn in Primary Care Office Visits

A recent study tracking a downward trend in primary care visits cited several contributing factors, including the high cost of care that the AAFP has been working to address.

www.aafp.org

Huh, interesting. Guess the increasing/aging population more than makes up for it since total volume hasn't really gone down much. Would make sense as the article uses commercial insured patients only.

Slight tangent, but I do disagree with one premise. They suggest that increased patient cost has deterred some from seeking care but at the same time point out that specialist visits have gone up.

I wonder if larger patient panels has led to increased referrals and so less stuff managed by PCPs.

 

[AMEHigh]

Huh, interesting. Guess the increasing/aging population more than makes up for it since total volume hasn't really gone down much. Would make sense as the article uses commercial insured patients only.

Slight tangent, but I do disagree with one premise. They suggest that increased patient cost has deterred some from seeking care but at the same time point out that specialist visits have gone up.

I wonder if larger patient panels has led to increased referrals and so less stuff managed by PCPs.

Well I think that totally makes sense that people are worried about cost so they completely bypass the pcp if they have some health literacy and their insurance company doesn't require them to get a referral from a pcp.
If a patient has to pay $30 to see their pcp but thinks the pcp is just going to refer them anyway to the specialist that is going to be $50, most people are just going to bypass the pcp. People of privilege can do this, none of my underserved patients can do this though. I did exactly that with a minor health problem I recently had. I booked directly with the specialist and didn't even go to my pcp.

Also due to employers wanting to make every last dime out of pcp's schedules are overbooked and people have trouble getting in with a pcp. Why would you wait 5 days to see your pcp for uti symptoms if you can just go to urgent care or one of these minute clinics?

 

[VA Hopeful Dr]

Well I think that totally makes sense that people are worried about cost so they completely bypass the pcp if they have some health literacy and their insurance company doesn't require them to get a referral from a pcp.
If a patient has to pay $30 to see their pcp but thinks the pcp is just going to refer them anyway to the specialist that is going to be $50, most people are just going to bypass the pcp. People of privilege can do this, none of my underserved patients can do this though. I did exactly that with a minor health problem I recently had. I booked directly with the specialist and didn't even go to my pcp.

Also due to employers wanting to make every last dime out of pcp's schedules are overbooked and people have trouble getting in with a pcp. Why would you wait 5 days to see your pcp for uti symptoms if you can just go to urgent care or one of these minute clinics?

That's a fair way of looking at it. Around here pretty much every specialist requires a PCP referral but if that's not universal it could explain it.

 

[AMEHigh]

That's a fair way of looking at it. Around here pretty much every specialist requires a PCP referral but if that's not universal it could explain it.

Yeah I'm sure it varies by region.
And even so, during residency if it were a patient that I knew well and they messaged me saying they needed a referral to X I would usually just put the referral in without seeing the patient if it sounded reasonable to me. I wouldn't make them come in and waste their time or money if they really wanted to see a specialist.

 

[VA Hopeful Dr]

Yeah I'm sure it varies by region.
And even so, during residency if it were a patient that I knew well and they messaged me saying they needed a referral to X I would usually just put the referral in without seeing the patient if it sounded reasonable to me. I wouldn't make them come in and waste their time or money if they really wanted to see a specialist.

I will usually do the same. The interesting thing at least with my patients is the ones who ask for referrals rarely need them (no your first ever 5 minute nose bleed doesn't need an ENT referral) and the ones who don't want them usually desperately need them (yes your heart rate of 150 as a result of your new onset a flutter does need a cardiologist).

 

[Moose A Moose]

Let them have it. Decreases volume of the utterly mundane/boring visits to the clinic. There are still plenty of patients who require an actual visit to the doctor's office. Lots of screening and health assessments cannot be had at "minute clinics".

 

[Sushirolls]

It will be almost entirely run/staffed by midlevels. They will essentially function more as a low acuity urgent care on one end siphoning from some of the urgent cares, or on the other end cater to a lower SES population heavy on the medicaid.

They may serve to further fracture health care upon two divisions: quality of physician vs midlevels, and quality private practice vs these Big Box Shop. Which means Primary Care practices may shift toward only taking higher paying private insurance / cash, or just cash only.

As the payer mix division fractures, these clinics will have marginal profits, or even losses in some locations, that they will refine and contract to a smaller number of clinics.

Ultimately, I think the small private practice FM/IM will have more gratifying practices with patients that are more serious about their health care as those who value it less will go to these clinics.

 

[Bacchus]

If today was any indication... my schedule was filled before my first appointment was over. I think we will be fine.

 

[studentxx8800]

The combination of population increase, growth of aging population and baby boomer physician retiring can only means more needs so my guess is even if demand decrease in a percentile fashion, the actual number would still be an increase overall

 

[TableMD]

Someone who is happy/fulfilled by the care from a minute clinic is probably not someone you want as a patient. It isn't possible to get real medicine done in such entities.

When I was a resident and I had a URI, I had an attending lock at my ears and he broke down why I shouldn't be worried, gave me the supportive care spiel and I was happy because I appreciated his insight. I was convinced I somehow burst an ear drum because I was diving and swimming prior. If I wanted to get abx I didn't need I could gone to a ready care or some variant.

Since I don't trust them for a URI, why would I discuss something heavy with them?

 

[redpanda]

CVS has had Minute Clinics for years. The main effect I see from them is patients come to me when they are misdiagnosed or treated incorrectly and so aren't any better.

That "bronchitis" that we've treated six times of the last year with antibiotics without much change is either A) a giant lung mass (pretest probability of lung cancer >90%) you could've seen on a plain film or B) fun and interesting interstitial lung disease. Also, shockingly, the clinical diagnosis of "COPD" is evidently non existent on the first round of pulmonary function tests. Guess those weren't COPD exacerbations.

 

[Bacchus]

That "bronchitis" that we've treated six times of the last year with antibiotics without much change is either A) a giant lung mass (pretest probability of lung cancer >90%) you could've seen on a plain film or B) fun and interesting interstitial lung disease. Also, shockingly, the clinical diagnosis of "COPD" is evidently non existent on the first round of pulmonary function tests. Guess those weren't COPD exacerbations.

I hear ya. This rings too close to home. Chronic cough patient, followed pathway. Still got burned. She did well for a while but unfortunately it did not turn into a survivable outcome. ****.

 

[BocephusTim]

I went to a Walmart clinic a few years ago when I was in Chicago and had a bad case of the flu. The PCP gave me some amoxicillin and noticed by BP was 145/95 and told me "go see a physician about this" even though it said "M.D." on her lab coat.

Welcome to Walmart Medicine, folks. Pretty soon it's gonna be Amazon Alexa at the bedside doing the diagnosing.

 

[Dr Tapatio]

How is this not a conflict of interest? Obviously they'll have more reasons to give you medicines

 

[Sushirolls]

You as a physician can apply to expand your current DEA registration, to allow for dispensing of controlled substances even in your office. Already, as a licensed physician you are the original pharmacist before this modern era pharmacies. You can have medications in your office and dispense them if you wish. Pain to stay on top of the red tape and supply chain aspect of things, but yes you can.

If you can, why can't they?

 

[michaelrack]

How is this not a conflict of interest? Obviously they'll have more reasons to give you medicines

Yes it's conflict of interest, what's you're point???? The laws in this area (Stark, anti kickback etc.) serve to keep down individual physicians and promote corporate medicine/large hospital systems

 

[end stage fibro]

Yes it's conflict of interest, what's you're point???? The laws in this area (Stark, anti kickback etc.) serve to keep down individual physicians and promote corporate medicine/large hospital systems

quoting for emphasis. it’s only illegal if you’re a physician. a big corporation can do the exact same thing without issue under the guise of more comprehensive care. in similar vein, it’s illegal for physicians to own hospitals but not private equity. but which of 2 those groups do you think are in it for the money?