Looking for a place to moonlight?

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Well I guess that's one way to look at it... Wonder how much will they pay residents per hour.

http://money.cnn.com/2008/02/07/news/companies/bc.wal.mart.clinics.ap/index.htm

Wal-Mart expands health clinics
World's largest retailer to open about 400 walk-in, in-store clinics with Wal-Mart brand name by 2010.
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Wal-Mart will open 400 in-store medical clinics under its own brand name by 2010.

BENTONVILLE, Ark. (AP) -- Wal-Mart Stores Inc. will open its first in-store medical clinics under its own brand name after leasing space in dozens of stores to outside companies that operate the quick-service health stops.

The world's largest retailer said Thursday it will open "The Clinic at Wal-Mart" as a joint venture with local hospital systems in Atlanta, Dallas and Little Rock, Ark., starting in April.

Bentonville, Ark.-based Wal-Mart is among several U.S. supermarket and drug store chains that in the past couple of years have begun opening store-based health clinics, which are staffed mostly by nurse practitioners or physician assistants and offer quick service for routine conditions from colds and bladder infections to sunburn.

About 7% of Americans have tried a clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed in 2006.

That number is expected to increase dramatically, as chains like Wal-Mart, CVS Corp. (CVS, Fortune 500), Target Corp. (TGT, Fortune 500) and Walgreen Co. (WAG, Fortune 500) partner with mini-clinic providers like RediClinic and MinuteClinic to expand operations. The trade group estimates there will be more than 1,500 by year-end, up from about 800 in November.

Wal-Mart (WMT, Fortune 500) has clinics in 77 stores, including nine in Wisconsin and Florida operated by local hospitals. Clinics in 23 locations in Florida and three other Southern states have been in limbo since last month when New York-based CheckUps shut down.

A death in the walk-in clinics market
Now Wal-Mart has signed a letter of intent to work with local hospital systems and RediClinic to open cobranded walk-in clinics in 200 Wal-Mart Supercenters.

Wal-Mart has also signed a letter of intent to partner directly with St. Vincent Health System, a part of the Catholic Healthcare Initiatives system, to open four cobranded clinics in Little Rock.

'Cobranding' means the clinics will jointly bear the names of Wal-Mart and its partners and have an identical look and record keeping system, Wal-Mart spokeswoman Deisha Galberth said.

Having the local hospital system involved will also increase the level of trust among shoppers, Galberth said.

Wal-Mart said this is the first step toward opening 400 cobranded clinics by 2010.

Retail analyst Patricia Edwards of San Francisco-based Wentworth Hauser and Violich said the move benefits Wal-Mart by giving the clinics added credibility.

"Especially among middle- and upper-income shoppers, it becomes more like stopping in at any location of their group health care provider. It doesn't have that connotation of going cheap," Edwards said.

Edwards said putting Wal-Mart's name on the clinics also fits with the retailer's drive for a public role in health care to counter union-led criticism that it skimps on employee health insurance.

Wal-Mart has introduced the clinics as well as $4 prescriptions for some generic medicines, and Chief Executive Lee Scott pledged last month to find other ways to help cut health care costs, including promoting the use of electronic health records instead of paper files.

 

[NotAProgDirector]

I doubt there will be any MD's in these clinics. They will be staffed by NP/PA's, I bet.

 

[Faebinder]

You dont think a resident with an independant license can get some part time hours? Why? They got their independant license.. can get malpractice.. it's part time so perfect for walmart that hates giving benefits. They can claim physicians are here working not a PA or NP.

What more can you ask for?

 

[Tired]

You dont think a resident with an independant license can get some part time hours? Why? They got their independant license.. can get malpractice.. it's part time so perfect for walmart that hates giving benefits. They can claim physicians are here working not a PA or NP.

What more can you ask for?

I saw this. Next year I will be a GMO with an independent license and DEA number.

Pending command approval, you better believe I'll be calling every Walmart in the area. Someone has to want a full-fledged MD one weekend day per week and per diem.

 

[Mad Dog]

Many FNPs only make around $35/hr. I would be surprised if Walmart would pay much more. Not such great cash for a physician, maybe for a resident with no options it might be ok. If they would hire you.

 

[3dtp]

Many FNPs only make around $35/hr. I would be surprised if Walmart would pay much more. Not such great cash for a physician, maybe for a resident with no options it might be ok. If they would hire you.

MD, we see eye to eye on a lot of things! This is absolutely correct. I was asked last summer by one of the "chain gangs" in my field if I wanted to moonlight for them as a resident. The offer was $50/hour and I nearly choked on my tea. Let me get this straight, I told the recruiter, you want me to travel 50 miles to your center, be paid only for the time in the clinic, pay for med-mal tail coverage? Yes, she replied. We can get retired FPs to work for that, why won't you? Have a nice day, I replied and went back to studying for the boards.

ed: in the time I'd spend there for $400, they'd bill in excess of $20k.

 

[NotAProgDirector]

I saw this. Next year I will be a GMO with an independent license and DEA number.

Pending command approval, you better believe I'll be calling every Walmart in the area. Someone has to want a full-fledged MD one weekend day per week and per diem.

I doubt they'll be open on the weekends. Prob M-F 9-7 or maybe even 12-7 or something like that.

 

[Faebinder]

MD, we see eye to eye on a lot of things! This is absolutely correct. I was asked last summer by one of the "chain gangs" in my field if I wanted to moonlight for them as a resident. The offer was $50/hour and I nearly choked on my tea. Let me get this straight, I told the recruiter, you want me to travel 50 miles to your center, be paid only for the time in the clinic, pay for med-mal tail coverage? Yes, she replied. We can get retired FPs to work for that, why won't you? Have a nice day, I replied and went back to studying for the boards.

ed: in the time I'd spend there for $400, they'd bill in excess of $20k.

I bet you could have negotiated to have them pay the malpractice while you are working for THEIR institution.

 

[Tired]

I doubt they'll be open on the weekends. Prob M-F 9-7 or maybe even 12-7 or something like that.

At least one in New York is open 9a-6p Saturdays and 11a-5p on Sundays. Giving up the weekend business would just be stupid, since they'd catch all the people who can't go to their regular doc. Or the working parents who need school physicals and immunizations.

 

[Blade28]

I was asked last summer by one of the "chain gangs" in my field if I wanted to moonlight for them as a resident. The offer was $50/hour and I nearly choked on my tea. Let me get this straight, I told the recruiter, you want me to travel 50 miles to your center, be paid only for the time in the clinic, pay for med-mal tail coverage?

Crazy!

I can make $50/hour here just sleeping a night a week at an LTAC. Easy money.

 

[NotAProgDirector]

At least one in New York is open 9a-6p Saturdays and 11a-5p on Sundays. Giving up the weekend business would just be stupid, since they'd catch all the people who can't go to their regular doc. Or the working parents who need school physicals and immunizations.

Good point.

 

[medicinesux]

Primary Care is a sinking ship. Why pay a doc 50-60 an hour, when you can get some NP to do it for 30-35? If govt cuts to physician salaries don't drag down salaries, you sure can bank on these allied "professionals" to do so.
Envision this:

1995:
Primary Care Physician- 130-150K
Skilled Blue Collar Worker (Plumber, Mechanic, etc) 50-70K
Nurse Practitioner- 50-70K

2008:
Primary Care Physician- 130-150K
Skilled Blue Collar Worker (Plumber, Mechanic, etc) 80-120K
Nurse Practitioner- 80-120K

2020:
Primary Care Physician- 130-150K
Skilled Blue Collar Worker (Plumber, Mechanic, etc) 130-150K
Nurse Practitioner- 130-150K

Meanwhile inflation and med school tuition keeps chugging along at 3-5% per annum.

 

[Rasengan]

The only way for these guys to stay profitable is to NOT hire many doctors-- thus they are staffed by NP/PAs.

My question is how does malpractice work for these NPs/PAs and arent they legally required to be supervised?

This really feels like a tenuous industry... their margins are so low that a couple malpractice suits will kill their bottom line.

Plus, since the NPs/PAs are literally paid by and work for the drug store, they have financial incentives to overprescribe. One could argue the same thing for MDs, but our salary is mostly independent of the number of Rx's we write out at least.

 

[Rasengan]

Primary Care is a sinking ship. Why pay a doc 50-60 an hour, when you can get some NP to do it for 30-35? If govt cuts to physician salaries don't drag down salaries, you sure can bank on these allied "professionals" to do so.
Envision this:

1995:
Primary Care Physician- 130-150K
Skilled Blue Collar Worker (Plumber, Mechanic, etc) 50-70K
Nurse Practitioner- 50-70K

2008:
Primary Care Physician- 130-150K
Skilled Blue Collar Worker (Plumber, Mechanic, etc) 80-120K
Nurse Practitioner- 80-120K

2020:
Primary Care Physician- 130-150K
Skilled Blue Collar Worker (Plumber, Mechanic, etc) 130-150K
Nurse Practitioner- 80-120K

Meanwhile inflation and med school tuition keeps chugging along at 3-5% per annum.

NPs cant do an FP's job... no matter how much they want to believe they can. If anything, I think there will probably be a resurgence in primary care esp the way healthcare is changing and people are trying to minimize costly specialty consults.

 

[Mad Dog]

Ah, the beast has emerged from the cage! The conversation couldn’t have gone far without igniting the old FP vs. NP debate.

Let me just say as a consumer that the NP who works in Walmart provides a lower cost service than a physician can. And I am all for people saving their hard earned dollars.

Let me say as a physician that I shudder at a nurse practicing medicine, and believe we sold our profession down the river in allowing it. We allowed it for the bucks we make by hiring them!

This seems however like an very smart business move for Walmart. I think it will be a success. As noted, the increased business at their pharmacy may be the biggest winner.

So mostly, I worry about the rise of the superbug from the NPs treating every sneeze and sniffle with a course of antibiotics!

 

[oudoc08]

This seems however like an very smart business move for Walmart. I think it will be a success. As noted, the increased business at their pharmacy may be the biggest winner.

My wife is a pharmacist at Wal-Mart and apparently, it will not be allowed for the in-store clinics to refer patients to the in-store pharmacy. (I don't know the exact details, such as whether they will have wall posters, etc.).

However, it obviously doesn't stop the customer from walking over to the pharmacy on their own, and it seems like many would do so.

I was a little surprised. Many free-standing clinics have their own pharmacies
and I don't see the problem with it.
As long as you don't mandate someone use your pharmacy, what's wrong with advertising that you have one? Capitalism haters.

 

[Tired]

The only way for these guys to stay profitable is to NOT hire many doctors-- thus they are staffed by NP/PAs.

I'd work for $50 and hour as long as medmal is covered. No sweat. Might even do it for $35 if it's close to home. Easy cash. Easy work. Probably be better than most NPs, since I have more clinical hours . . .

 

[carrigallen]

I might do it for 90 or 100/hr. This is a little different from moonlighting in a hospital. Remember the burden of maintaining all the medical records, referrals, medication dispensed or prescribed, documentation and liability coverage falls on you. If wallmart loses your records you may end up with big problems. The initial paperwork you'd go through might make it unappealing for residents who might only do it for a year.

I could see retired physicians doing this though. People who don't want a practice and just want to step down from regular responsibilities. It does have some attractive features, like no call or off-duty responsibilities, custom schedule, no chronic illnesses, and no upfront investments.

 

[Faebinder]

I might do it for 90 or 100/hr. This is a little different from moonlighting in a hospital. Remember the burden of maintaining all the medical records, referrals, medication dispensed or prescribed, documentation and liability coverage falls on you. If wallmart loses your records you may end up with big problems. The initial paperwork you'd go through might make it unappealing for residents who might only do it for a year.

I could see retired physicians doing this though. People who don't want a practice and just want to step down from regular responsibilities. It does have some attractive features, like no call or off-duty responsibilities, custom schedule, no chronic illnesses, and no upfront investments.

90 or a 100 per hour???? That's like a full fledge FM in an urgent care center. Maybe even a slacker EM doc. (Or are my numbers old ARGH!) I think $50/hr is about the right price. You are not going to be doing major procedures.... those will be refered to the ED.

 

[pgg]

I saw this. Next year I will be a GMO with an independent license and DEA number.

Pending command approval, you better believe I'll be calling every Walmart in the area. Someone has to want a full-fledged MD one weekend day per week and per diem.

You're going to Lejeune, right? As a single, new GMO at Camp Lejeune, you'll get paid about $75K/year - of which about $15K isn't taxable (more if you deploy). Cost of living is reasonable. Presumably you've got no med school debt because of HPSP.

You'll probably work 10-12 hour days in the months leading up to and following your 7 month deployments to whichever dirt patch your unit goes to, with 6-8 weeks of time sleeping in the field before you deploy (AP Hill, 29 Palms, etc).

If you blew each of your Saturdays at Wal-Mart for an entire year, you'd make what, a measly $10K or so extra?

Granted, the Lejeune Wal-Mart's a happenin' scene on Friday nights, what with the guys trolling for chicks across the parking lot from the Chuck-E-Cheese's.

I'd rather shock myself like the kid in the picture than do primary care at Wal-Mart with my time off. But more power to you. 🙂

 

[core0]

I'd work for $50 and hour as long as medmal is covered. No sweat. Might even do it for $35 if it's close to home. Easy cash. Easy work. Probably be better than most NPs, since I have more clinical hours . . .

Except you are not actually allowed to be a Doctor (or an NP). They have a computer algorithm which you must follow. They rate the providers on how well they follow the algorithm. They even publish crappy articles in mid tier journals to justify their actions:
http://ajm.sagepub.com/cgi/content/abstract/22/6/457
(you can probably get the full (depressing) article at your library).

So if you actually see a patient that falls outside their guidelines and treat them properly, you get punished for it.

David Carpenter, PA-C

 

[Tired]

I'd rather shock myself like the kid in the picture than do primary care at Wal-Mart with my time off. But more power to you. 🙂

I'm not cut out for having too much time off, I just end up getting in trouble. And 10k a year for two years would go nicely for my house downpayment fund for when I get back up to D.C.

Plus, since I'm not allowed to drink anymore (wifely command), what the hell else am I going to do in North Carolina on a Saturday?

 

[Tired]

Except you are not actually allowed to be a Doctor (or an NP). They have a computer algorithm which you must follow. They rate the providers on how well they follow the algorithm. They even publish crappy articles in mid tier journals to justify their actions:

So if you actually see a patient that falls outside their guidelines and treat them properly, you get punished for it.

I'm a surgical intern, it might be better if someone gave me an algorithm to follow. As long as there aren't too many big words.

I suppose my attitudes will change over time, but right now, I'm just not all that worked up over having "clinical autonomy". At least not in a Primary Care clinic setting, which I despise anyway. I mean, it's just medicine, not rocket science.

 

[novado]

I have a few close relatives who work for Wal Mart, and they are not going to be looking for too many doctors. They are going to be looking for PA's and ARNP's with a few doctors to supervise over mutliple clinics. Plus, this whole arrangement has gotten many FP and IM doctors very angry with Wal Mart, and they are trying to fight this. If I were you, I would stay away from this idea, as you will have to work with many of these FP and IM doctors in the future (and count on them for referrals). Unfortunately, many people hold grudges even years later.

 

[Tired]

If I were you, I would stay away from this idea, as you will have to work with many of these FP and IM doctors in the future (and count on them for referrals). Unfortunately, many people hold grudges even years later.

Actually, I will never work with them or count on them for referrals, which is one reason why it is so attractive to me. I could care less about primary care docs in an area of the country I will never live in.

Depending what they pay, I will float my services at NP rates. I'm sure they'll be more than happy to take me up on that offer.

 

[Rasengan]

Actually, I will never work with them or count on them for referrals, which is one reason why it is so attractive to me. I could care less about primary care docs in an area of the country I will never live in.

Depending what they pay, I will float my services at NP rates. I'm sure they'll be more than happy to take me up on that offer.

And you wonder where surgeons get their reputations from 👎

 

[Faebinder]

And you wonder where surgeons get their reputations from 👎

We're diverting off topic. Surgeons get their bad reps from putting down everyone else to make themselves shine.