| Near Future for US Health ccre
If Obama's plan is implemented we'll have a huge increase in demand for all medical care and long waits for that care. If McCain's plan is implemented we'll have a huge demand for medical care at bargain basement prices, because there will be a surge of people with no insurance or junk insurance with high deductibles and high co-pays.
Current Retail Clinic Market
Retail clinics are another sign of 47 million uninsured, physician abandoment of primary care and the failure of US' dysfunctional health care system. They are the result of niche marketing.
Statistically, people with no insurance and no regular doctor are likely to give them a whirl rather than blow the weekend waiting in an emergency department with no on site pharmacy. The retail clinic is easier access to care and costs significantly less to use than the ED.
William Winkenwerder, Jr. a consultant for Deloitte, believes these that pharmacy, pharmaceutical and (CLIA exempt) lab test supplier funding fuels their existance. Considering the fact that many of these clinics are located in pharmacies or big box stores, that's probably true; but that doesn't mean they aren't meeting patient needs and it doesn't mean they are getting rich. In fact, their market is shrinking. He does have one point:
they are a direct challenge to the physician-directed model of care.
Doctors (not all doctors), these pediatricians specifically, are against retail clinics mostly because they aren't staffed by doctors, but their argument is framed by the supposition that people go to a retail clinic for inappropriate things like cancer and the ARNP isn't smart enough to bow out of the case. They complain about measuring the quality of care or the lack of facilities, but fail to offer similarly flexible services.
The Rand coporation's study shows that 90% of a retail clinic's visits are for 10 acute issues that make up 12 percent of ED visits, 13 percent of adult Primary Care visits and 30 percent of pediatric Primary Care visits. I can understand the pediatrician's concern; I wouldn't want to lose 30% of my business either, but they would be losing 30% of a market they don't have in the first place. The Rand study went for appeasement and managed to throw red meat to the physician objectors by stating:
"Since most of these patients do not have a primary care physician, there is no relationship to disrupt," "However, future studies should investigate quality, the likelihood that patients are getting needed preventive and follow-up care."
That's a straw man argument because the quality of care standard has been studied between physicians and Advanced Nurse Practitioners. The ANA points to a standard, randomized study published in the January 5th, 2000 issue of JAMA. The patients' outcomes were comparable between medical doctors and nurse practitioners within the same managed care organization.
The other problem with the physician's argument is that it's almost impossible to get new physicians to select primary care for their specialty. It's not the money so much as it is the structure of providing primary care. Only 2% of doctors in this survey selected to become generalists. If physicians aren't going to fill the void, then they need to get out of the way of ARNP's who will. Both Obama and McCain will need to address the shortage of physician generalists with either student loan forgiveness for service or some other mechanism like encouraging reimbursement for telemedicine and other remedies.
The other issue is office hours and a lack of respect for the patient's busy schedule. Doctors like the 9-5 office hours with a 2 hour break in the schedule mid day (which shrinks to 1 hour because of scheduling overruns and then shrinks to nothing while the physician takes care of other job tasks) with an optional every other Saturday morning. Patients hate it. If the patient is paid on an hourly basis, they resent having to take 4 hours off work for 20 minutes face to face with their physician. The retail clinic eliminates this annoyance.
Patient's favor retail clinics because of the convenience.
These clinics run from 8 in the morning to 8 at night, 7 days a week. They are better than an ED for the uninsured. There's usually no waiting. The patient sees the nurse, then turns around and walks across the store to have their prescription filled. It's one stop shopping as only America knows how to put together. It's not appropriate for a heart attack, but not bad for tetanus shot after a Sunday afternoon mishap, lingering flu or the sudden fever in a child and you aren't sure what to do.
Either way the campaign goes (and I'm pushing for Obama!), these clinics are going to be necessary in the months to come.
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