MinuteClinic employs consulting physicians in each market to oversee their clinics. "We think it's a really good practice to have physicians available for NPs to call if necessary because we have such a limited scope of services," says Jim Woodburn, MD, Chief Medical Officer for MinuteClinic.

As for Take Care Health, "In markets where it is required, we work with a collaborating physician or doctor group that are on call as consultants to the NPs if needed," says spokesperson Darren Brandt.

Some physicians, like Wright, worry about the implications of a patient visit in a setting that is, by design, very limited. "At Take Care Health you're being seen by a nurse practitioner in a pharmacy with a limited scope of diagnostic and therapeutic options," he says. "When you come to one of our clinics you're seen by a physician in a setting that has a diagnostic lab and X-ray and support staff, specialists ... . It's a different experience in terms of ability to handle a whole range of acuities every time you walk through the door."

Wright also wonders whether there will be sufficient demand to see an NP in a pharmacy setting. In fact, his medical group considered developing its own retail health clinic and decided not to. "It takes a lot of time and energy to do something like this, and I think that if someone else is going to provide good care that's consistent with [ours], it probably makes more sense for us to partner with them than to try and compete," says Wright.

Fields sees retail health clinics as an opportunity to bring patients into the healthcare system. "Another role that these places could play is to identify patients who don't have a personal family physician and send them into the system in that way."

Changing the Way Physicians Do Business?

Opinions are divided on whether the rise of quick-access clinics will force physicians to change the way they run their practices. "So far I haven't heard of any physicians who are actively going to make large changes in their practice situation just to respond to this," says the AAFP's Fields.

But in markets where these clinics are already operating, it has spurred physicians to prioritize issues they have already been considering. "Accessibility, hours of operation, getting people in and out the door — those are all things we should be doing and this is probably a good reminder for us in a real way that we need to be doing that," says Wright.

Mary Figueroa, MD, a family practitioner in Edina, Minn., and medical director for MinuteClinic, says she has adapted her practice hours to be more flexible for walk-in patients, but she hasn't seen a negative impact from the MinuteClinics in her area. "I think the minor illnesses that I haven't seen have been balanced out by the referrals." Her four-physician practice has differentiated itself by focusing on sports medicine and holistic medicine. "To be competitive ... we have to find a different niche, so that's our niche. Our clinic has just done great because of that," she says.

Figueroa takes a historical approach to doctors' reaction to retail health clinics. "Like anything that's new, it's kind of taken the whole medical community by surprise," she says. "Look at what happened with the urgent care concept 20 years ago. At first, doctors were horrified. Now, urgent care centers are all over the place. And doctors and the public see them as a necessary thing."

Like many physicians, Figueroa sees the rise in quick-access clinics as inevitable and necessary. "When one of my patients comes to my clinic for a throat culture ... they're helping pay my overhead," she says. "But the reality is that healthcare cannot sustain that anymore." Retail health clinics are cutting the cost of healthcare for simple ailments that don't need to be seen in a doctor's office.

MinuteClinic's Woodburn says that while he's gotten a variety of reactions from doctors, "the vast majority say it's a good thing because it relieves pressure because they're busy enough. ... Everybody's got to look at the healthcare system and figure out how we can improve it.

Abigail Green, MA, is a freelance writer who specializes in topics including healthcare and higher education. She can be reached via editor@physicianspractice.com.

This article originally appeared in the January 2006 issue of Physicians Practice.