After not being able to get his son to the doctor for a strep throat test, Rick Krieger established the first retail clinic at a local grocery chain in 2000. The idea was to address issues of access to health care and allow patients to obtain care and treatment for minor conditions “in a quick, convenient way.” Since then, retail clinics have grown considerably in number in the United States—from about 1200 in 2008 to an estimated 2400 in 2013. However, they have also become a point of controversy. Their growth is threatening the traditional way that patients have sought health care—through hospitals and physician groups—and the “patient-centered medical home” approach to primary care, where the primary care physician coordinates treatment for the patient in order to ensure that the patient “receive[s] the necessary care when and where [the patient] need[s] it, in a manner [s/he] can understand.”
Retail clinics are characterized by their convenient hours and location, limited scope of services (although this is being expanded), comparatively low costs, quick service, and services being provided by nurse practitioners (NPs) and physician assistants. As suggested by their name, they are located in retail stores, such as Walmart and Target, and many offer extended hours on workdays and weekends. They also tend to be located in more affluent areas. The services provided and their cost are “prominently displayed” for patients, so that patients are aware of the cost prior to obtaining the service. For the most part, retail clinics accept both private and public insurance, and those with no insurance are charged somewhere between $15 to approximately $100.
Despite their growing popularity and proclaimed objective to improve access to health care, a number of concerns have been raised against them, some of which are discussed here. For example, there is serious concern that retail clinics disrupt the patient-(primary care) doctor relationship that is fostered through a “patient-centered medical home” system. Retail clinics lack the close familiarity with the patients’ history, which includes allergies and medications. While this issue could be addressed through coordinated sharing of the patients’ electronic medical records between the retail clinic and the patients’ primary care doctor, there is something to be said about the intimate relationship that can exist between the patient and the doctor that is more likely to drive the patient to comfortably discuss issues that may not be necessarily tied to the original purpose of the visit. Because retail clinics are geared towards addressing conditions on an “episodic” basis, such a situation is less likely to occur. Therefore, critics of retail clinics argue that certain conditions may be missed through this type of setting.
Furthermore, since the early stages of growth of retail clinics, critics have argued that retail clinics lack the coordination and sharing of electronic medical information that medical homes enjoy. Nevertheless, more and more, clinics are coordinating with the patient’s primary care physician and maintaining a relationship with them. Larger retail clinic chains are now engaging with medical homes to promote the integration of electronic medical records.
Additionally, retail clinics have been seen as undermining preventative care and chronic disease management. By promoting the “band-aid” approach to addressing health issues, patients may be more likely to seek care only for acute conditions and may not necessarily feel the need to seek preventative care or chronic disease care management. From a public health perspective, access to preventative care has been seen as one of the key solutions to addressing non-communicable diseases. However, retail clinics have or are now looking to expand their services to conditions such as diabetes. How effective they will be in helping to combat the worrying growing rate of individuals suffering from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases remains to be seen, especially if they continue to compete with hospitals and physician groups and if individuals become more dependent on them for receiving health care services.
Finally, because retail clinic services are not provided by physicians and they are largely limited to acute conditions, such as influenza and UTIs, there is concern that retail clinics are “ill-equipped” to detect, much less manage, underlying and more complex conditions on which the retail clinic provider is not trained and that would require a physician with more expertise. For example, the patient’s primary care physician may be more likely to identify a more serious immunodeficiency condition in a patient with recurrent episodes of sinusitis. That said, some states require physician oversight of retail clinics and some have argued that NPs have shown to be “just as effective” as physicians with respect to more complex conditions.
In spite of these and other criticisms, the reality is that the shortage of primary care physicians and the implementation of the primary care-centered Affordable Care Act are creating an environment where retail clinics can and will likely thrive. While medical homes and retail clinics have been largely perceived as being at odds with one another, there is promise for collaboration, such as in the case of retail clinics communicating and maintaining a relationship with the patient’s primary care provider. Each represents an invaluable definition of access to health care, and for both types of entities to co-exist, understanding this is critical.
 John B. McKinlay and Lisa D. Marceu, “From Cottage Industry to a dominant mode of primary care: Stages in the diffusion of a health care innovation (retail clinics),” Social Science & Medicine 75 (2012): 1134-1141,1135.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.