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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
