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Doc in a Box - An Insider's Perspective
Twenty-five years ago, I worked part-time in an urgent care facility in a strip mall. The medical community was horrified that patients could go to a shopping center to get medical care. What next? Jiffy-Pap? Now, walk-in clinics, affectionately termed "Doc in the Boxes" are a huge and growing business - nearly 1200 nationwide. Walgreens is projected to have over 400 MinuteClinics in their retail pharmacies this year. My own medical group opened up a dozen or so at RiteAid pharmacies in our area. In our area, we have Rapid Care, Med7, and Immediate Care.
Many people have problems seeing their own family doctors when they are ill. Why is that? When you are sick or have a cut that needs stitches, you don't want to be told that the next available appointment is two weeks away. In the past, people would crowd the emergency rooms with these "minor urgencies", grouped in with the auto accident victims and the drunks. Waiting for hours and hours to be seen is commonplace since the more-serious cases are seen first. The emergence of these quicky-care facilities are hoping to fill the void when you just need to see a medical provider...NOW.
The pharmacy-based clinics set up by our medical organization are basically little, free-standing kiosks consisting of one examining room and a tiny area with a computer to register patients, make chart notes, etc. There is no lab or x-ray. All of them are staffed by nurse practitioners for 12-hour shifts. It can take up the 30 minutes per patient, since the clinician has to register the patient, check insurance eligibility, take the payment or co-payment, as well as examine the patient and complete the chart notes. Basically, the clinician is their own front desk person and medical assistant. I could tolerate a wide variety of clinical situations, but I don't think I could do this job. It is just too weird, especially the money part. Most of these little facilities see only a dozen or so patients a day, and are limited to certain types of visits and ages. I like to stay busy. I would go stir-crazy seeing only 12 patients a day.
These rapid-care facilities serve an important role in medicine by keeping the mildly-ill out of the way of the more seriously-ill in emergency rooms. Colds, sore throats, ear infections, sports physical exams, and other routine visits are served well. However, if a more serious case walked to the kiosk, such as chest or abdominal pain, they are not equipped to handle it. It is really up to the patients to triage themselves.
Compared to emergency rooms, the charges in these clinics are much less expensive. A typical visit in one of our clinics is about sixty dollar. An emergency room visit could cost up several hundred dollars for a similar non-emergency service. People without insurance or those not established with regular medical providers love the convenience and affordability. A recent posting on WebMD's Ear, Nose, and Throat message board stated that her cost was $250 for a quick visit. I do not consider that visit fee particularly affordable.
Not wanting to make age generalizations, many urgent care facilities are staffed by younger, less-experienced clinicians, as well as older, near-retirement medical providers. The younger clinicians are slower and have to resort to their textbooks for information and medication dosages. Many have never worked in independent clinical situations where they did not have the ability to consult someone else when there were not sure of a particular finding. The older clinicians often practice "older medicine", using dosage schedules and medication choices that have been abandoned years ago. Again, this isn't always the case, but more often then never, I do follow-up care on patients where I question their diagnosis and treatment. In all business transactions, the client has to trust the service provider.
It is only a matter of time, when you will show up at a Super Store and have your eyes checked, have a hearing test, get your tires rotated, buy groceries, have a colonoscopy, get your prescriptions filled, order a birthday cake, get a haircut, fill of the car with gasoline, and get a new cell phone...all on the same visit. I love America.
Related Topics:
Many people have problems seeing their own family doctors when they are ill. Why is that? When you are sick or have a cut that needs stitches, you don't want to be told that the next available appointment is two weeks away. In the past, people would crowd the emergency rooms with these "minor urgencies", grouped in with the auto accident victims and the drunks. Waiting for hours and hours to be seen is commonplace since the more-serious cases are seen first. The emergence of these quicky-care facilities are hoping to fill the void when you just need to see a medical provider...NOW.
The pharmacy-based clinics set up by our medical organization are basically little, free-standing kiosks consisting of one examining room and a tiny area with a computer to register patients, make chart notes, etc. There is no lab or x-ray. All of them are staffed by nurse practitioners for 12-hour shifts. It can take up the 30 minutes per patient, since the clinician has to register the patient, check insurance eligibility, take the payment or co-payment, as well as examine the patient and complete the chart notes. Basically, the clinician is their own front desk person and medical assistant. I could tolerate a wide variety of clinical situations, but I don't think I could do this job. It is just too weird, especially the money part. Most of these little facilities see only a dozen or so patients a day, and are limited to certain types of visits and ages. I like to stay busy. I would go stir-crazy seeing only 12 patients a day.
These rapid-care facilities serve an important role in medicine by keeping the mildly-ill out of the way of the more seriously-ill in emergency rooms. Colds, sore throats, ear infections, sports physical exams, and other routine visits are served well. However, if a more serious case walked to the kiosk, such as chest or abdominal pain, they are not equipped to handle it. It is really up to the patients to triage themselves.
Compared to emergency rooms, the charges in these clinics are much less expensive. A typical visit in one of our clinics is about sixty dollar. An emergency room visit could cost up several hundred dollars for a similar non-emergency service. People without insurance or those not established with regular medical providers love the convenience and affordability. A recent posting on WebMD's Ear, Nose, and Throat message board stated that her cost was $250 for a quick visit. I do not consider that visit fee particularly affordable.
Not wanting to make age generalizations, many urgent care facilities are staffed by younger, less-experienced clinicians, as well as older, near-retirement medical providers. The younger clinicians are slower and have to resort to their textbooks for information and medication dosages. Many have never worked in independent clinical situations where they did not have the ability to consult someone else when there were not sure of a particular finding. The older clinicians often practice "older medicine", using dosage schedules and medication choices that have been abandoned years ago. Again, this isn't always the case, but more often then never, I do follow-up care on patients where I question their diagnosis and treatment. In all business transactions, the client has to trust the service provider.
It is only a matter of time, when you will show up at a Super Store and have your eyes checked, have a hearing test, get your tires rotated, buy groceries, have a colonoscopy, get your prescriptions filled, order a birthday cake, get a haircut, fill of the car with gasoline, and get a new cell phone...all on the same visit. I love America.
Related Topics:
- WebMD Video: Walk-In Clinics Revealed
- Retail Clinics Catch On in U.S.
- A "Minute Clinic" Visit for Your Kids?
Labels: retail clinics
3 Comments:
A relationship has to be established for a doctor to treat you adequately. There is no way this concept would be effective for anything other than sprains, sore throats, blood draws, etc. The more simple things. I would never recommend this type of service to anyone.
at this point, I would love to have a "doc in the box" available. My provider is a popular OBGYN,who hasn't seen me or my kids in ages because she is booked with pregnant women, I am no way going to go into the ER (I once had an anaphylactic reaction to a sulfa med I was on for polonged time, and I didn't want to go in because of cost. When my husband finnaly dragged me in, gasping for air, carrying the silver sulfadiazide cream prescribed for my major burns, the doc said, we'll probably never know what caused this reaction, and sent me home to keep using it, along with some steroids. Gee, that was excellent, glad I went!($600.00)
I amin pain, and I will stay that way untill something bursts or it goes away.
that is the world we live in in rural missouri
Real Alternative Medicine
One possible solution to the primary care doctor is what is known as retail care clinics, or convenience care clinics, and their popularity continues to increase somewhat for a variety of reasons. And their eventual need by others has yet to be determined and is only speculated by others at this time. Of particular note is that most of these types of clinics is that are normally staffed with nurse practitioners or physician assistants, who are, like doctors, more thorough than others, but are favored by many as a vocation and sought as treatment providers progressively. The growth of such clinics may slow at times, but the benefits of such urgent care light clinics do in fact exist and are desirable for many.
First, I’ll offer a definition of a retail clinic: A retail clinic is a medical treatment facility that is usually located in a convenient location, such as a shopping area, and are smaller than most doctors’ offices in regards to geographical space. Usually, these clinics are staffed with a nurse practitioner that often have the ability and authority to provide the same quality care as a primary care physician, and do so with the same standards regarding accountability and autonomy. If you happen to go to one for what may be considered a mild ailment, for example, for such conditions as allergies or the flu, you will notice a unique and pleasant paradigm towards your care at such a clinic in comparison with present medical doctor offices that are possibly demoralized if not largely apathetic, others have said
These urgent care light clinics are normally and amazingly quick for a patient treated at such a location. You are normally in and out of there within a half hour or so. This includes a thorough assessment and treatment regimen offered. Unlike typical doctor offices, these clinics are walk-in clinics, so there is no over-booking of patients, which is what typically occurs at current offices of doctors, as many are focused on daily volume of patients, as they are usually a member of a large health care system that instructs these offices in such a way.
With these convenience care clinics, you actually dialogue with your health care provider more so than you have experienced in a traditional doctor’s office due to other doctor offices often being incredibly busy from seeing too many patients during a typical day for reasons described above. And this is not to imply that the health care providers at typical doctor offices do not care about you and one’s particular health issues, yet possibly is due to limited resources, possibly.
The cost of going to such a retail clinic typically is about 25 percent less expensive than a normal doctor visit, others have said. Yet you will likely notice no decline in the quality of care that you receive. In fact, likely you will experience greater quality on many different levels, both from a personal level and treatment level if a patient at such a clinic as a retail clinic, others have said..
Critics of such clinics include the American Medical Association and various medical societies, yet in my opinion, they are simply vexed because of the invasion of these clinics on their turf and their infiltration into their group without being invited, perhaps. Or perhaps such groups and associations do not see NPs and Pas as having the ability to provide quality medical care as they do as medical doctors. Regardless, most seem pleased with the retail clinics and the treatment provider others experience at these locations.
If it is discovered that you need greater medical care or attention than the retail clinic can provide for you during your visit at their urgent care light clinic, you will most likely be referred to a nearby location that can provide the care you are determined to need by the clinic’s heath care provider, who has likely has some familiarity and possibly some relationships with the hospitals and others in the medical community for which they serve. It should be noted that both NPs and PAs are quite capable of determining the severity of your illness, and will act accordingly.
So most patients of these retail clinics are pleased with the care they receive from them, which is why they continue to grow in number under different names, as they have become franchises, yet the concept of this ‘pay as you go’ health care is fairly new, only the future will tell if this method is preferred by those seeking minor restoration of their health. It seems to be preferred by many presently. And presently, Take Care Health Clinics, owned and located inside Walgreen’s pharmacies, are the market leader with retail clinics. And Walgreens plans to add more clinics next year.
These retail clinics, it appears, provide possibly provide a response to the shortage of primary care doctors that some believe exist, and possibly are an answer to other problems that exist in the health care system in the U.S., which includes delays in getting needed medical treatment, and incomplete assessment provided by your doctor presently due to variables such as the large volume of patients your doctor normally sees on a daily basis. One could conclude that the retail clinics seem in a way more authentic than the dominant system, and may be more beneficial ultimately for the public health, with exceptions, of course, depending on the individual circumstances of the patient.
Dan Abshear
“Compassion is the basis of all morality.” --- Arthur Schopenhauer
Author’s note: What has been written is based upon information and belief.
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