A woman stops by her local Target on her way home from work. With errands to run, dinner to make, and kids in tow, she doesn't have time to attend to the sinus infection that seems to have cropped up overnight. Except that if she's shopping at one of MinuteClinic's 61 locations throughout the country, she can be seen by a nurse practitioner, fill her prescription, and be on her way in less than an hour — no appointment, and no doctor, necessary.

Launched in Minnesota in 2002, MinuteClinic is a mini healthcare office set up inside supermarkets and pharmacies including CVS and Target. The rapidly expanding company is currently operating in seven states. The competing Take Care Health launched in Portland, Ore., in October 2005 and plans to open 1,300 clinics in Rite Aid, Osco Drugs, and Brooks/Eckerd pharmacies by the end of 2007. Other, similar projects are cropping up all over.

Most follow a similar model: the clinics are staffed entirely by nurse practitioners (NPs) or physician assistants (PAs) who treat about two dozen common ailments, including strep throat, pink eye, and ear, bladder, and sinus infections, as well as provide certain health screenings and immunizations. Most clinics operate seven days a week, have evening hours, and see patients age 18 months and up entirely on a walk-in basis. Both claim any wait time is minimal. At MinuteClinic, patients pay $44 or an insurance copay. At Take Care Health, fees range from $48 to $68 per visit.

Is this bad news for primary-care physicians, or a much-needed jolt to a healthcare system that's failing to meet patients' need for convenient, affordable care?

Competition or Collaboration?

Since these quick-access clinics — also called retail health clinics or onsite health clinics — are fairly new, chances are, many of your patients haven't seen them yet. Only 7 percent of U.S. adults have ever used an onsite health clinic in a pharmacy or retail chain, according to a recent Wall Street Journal Online/Harris Interactive Health-Care Poll. Among those who have never gone to an in-store clinic 59 percent say they would be not very or not at all likely to use one, and 41 percent say they would be somewhat or very likely to use one for basic medical services.

Of those who have used these health clinics, however, the vast majority were extremely satisfied with the experience. MinuteClinic claims to have a 99 percent customer satisfaction rate. According to the Harris Interactive poll, clinic users were most satisfied with the convenience (92 percent say they were somewhat/very satisfied), followed by the quality of care (89 percent), and the cost (80 percent).

MinuteClinic and Take Care Health are adamant about emphasizing that they in no way intend to replace primary-care physicians. Nurse practitioner Deb Benoit, MSN, manager of Baltimore operations for MinuteClinic, tells patients, "If you can get in to see your primary-care physician, that's definitely the preferred way to go. But if it's late at night, or they're out of town, or you can't get in" then quick-access clinics are a good alternative.

In fact, Benoit says physicians and school nurses regularly refer patients to MinuteClinic, and the clinics are happy to refer patients to primary-care physicians if patients don't have one or require more in-depth medical care. MinuteClinic, like Take Care Health, maintains a list of physicians in each market who are accepting new patients and have expressed interest in getting referrals from these clinics.

Initial response from patients seems positive, but how do physicians feel about this new player? "I'm intrigued by them," says Craig Wright, MD, a family physician in Beaverton, Ore. "They're responding to a niche market that's probably becoming a bigger issue as consumer-directed healthcare becomes a bigger part of the marketplace."

Wright, CEO of Providence Medical Group, a 27-clinic, 150-doctor group, has met with Take Care Health to discuss working together. He says, "As I talk with the docs in our group, I think the natural reaction is that they feel that this is competitive ... . But I think we need to realize this is going to be happening more and more in healthcare and our challenge is, as both primary care and medical group services in the community, that we need to be able to meet the same patient needs that [retail health clinics] are responding to."

Larry Fields, MD, president of the American Academy of Family Physicians (AAFP), has also encountered some resistance from doctors in response to retail health clinics. "In my experience, the general feelings of most physicians when they first hear about it is some skepticism about what they can do, their capabilities and all that ... . But what we think as an academy is that [these clinics] may have some benefit as far as increasing access to care, particularly on a quick time frame, for a very limited number of problems, all of which are acute and minor in nature." He adds, however, that retail health clinics should not overstep their bounds. "Where they have no role is in any kind of diagnosis beyond [these] limited types of things" nor in follow-up care, says Fields. "If somebody's not improving, they need to see a physician."

Quality of Care

Since retail health clinics are staffed entirely by NPs (and, in some markets, PAs), many physicians are concerned about the quality of care patients receive. Both MinuteClinic and Take Care Health rely on proprietary software based on medical guidelines to guide the visit via computer monitors in each exam room. The program allows NPs to take patients' medical history, check a drug interaction database, print a prescription and diagnostic record for the patient, calculate any copay, and submit the record to the insurance company for reimbursement.

It also allows retail health clinics to easily send a record of the visit to the patient's primary-care provider. Notes Fields, "It is incumbent on these retail clinics to notify the patient's personal physician whether or not that physician is associated with the clinic ... . It's important that they not be an obstacle to continuity of care."