Retail Medical Clinics

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ASDIC

The 9th Flotilla
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This is from CNN.com

http://www.cnn.com/2006/HEALTH/02/03/clinics.instores.ap/index.html

OMAHA, Nebraska (AP) -- Fearing bad news as her son suffered with a cough, aches and a sore throat, Donna Bultez found help in the most common of places -- her neighborhood grocery store.

Just feet from the beeping cash registers, a few steps behind the frosted-glass door, Bultez was relieved to find that her son Trevor Belmont wasn't suffering from strep throat. That she saved money by avoiding a trip to the emergency room was good news, too.

More and more stores -- from small-scale chains like Bultez' local Hy-Vee to megamarkets like Wal-Mart and Target -- have started trial runs with in-store medical clinics.

The concept is so new that analysts weren't sure how many clinics currently exist. They said retailers appear to be trying clinics as a way to increase foot traffic in their stores, rather than rely on the clinics as an entirely new revenue stream.

The ventures are promising enough that America Online founder Steve Case put $500 million into a company that buys stakes in smaller companies that set up the clinics.

Except for a 20-minute wait, Trevor's visit to the Hy-Vee clinic seemed convenient at every turn. His pediatrician was out of his office this day and, without the walk-in service, Bultez might have considered an expensive trip to an emergency room to seek treatment.

"This cost and convenience trend is coming to a head and that's what is driving this trend. My prediction is that it will move quite rapidly," said Matt Eyring, managing director of Innosight, a Watertown, Massachusetts, consulting firm.

The business model is simple -- a medical clinic operated by an outside company, and generally staffed by nurses or physician assistants, offers a limited range of basic tests and treatments at a lower cost than a doctor's office.

Case invested heavily in Revolution Health Group, a company that, among other things, is buying stakes in clinic operators. Its backers and board include former Secretary of State Colin Powell, former Hewlett-Packard CEO Carly Fiorina and former Fannie Mae Chairman Franklin Raines.

Seattle-based health care analyst Kathleen O'Connor said it's difficult to say how many in-store clinics exist because the trend is so new and it is not clear whether anyone is tracking it. These clinics are different from the stand-alone sites sometimes referred to as a "doc in a box."

The in-store clinics hope to evoke the idea of convenience with their very names -- Quick Care at the Omaha Hy-Vee; RediClinic, controlled by Revolution and one of four providers for Wal-Mart; and MinuteClinic, which has 70 clinics in CVS pharmacies, Target Stores and Cub Foods supermarkets.

Patients never need an appointment and can drop by after regular business hours. Many times, a patient might be heading to the store anyway for groceries and find it convenient to ask about that nagging cough or persistent headache.

Bultez knew her visit with Trevor, 9, was all about convenience.

"I will stay with my doctor. But if this works out good, I'd use it for a second alternative," said Bultez, 35, who stopped in the households aisle to buy laundry detergent while at the Hy-Vee.

Typically run by an outside source -- in Omaha's case, a state-wide health group called Alegent -- the clinics usually offer diagnoses and treatment for a predefined set of minor illnesses, from ear infections to strep throat to bladder infections. Most offer vaccinations.

Often, the price for care is listed on a message board, much like today's special on carrots or tomatoes. Quick Care will treat the flu or mononucleosis for $53. Treatment for bronchitis, colds and seasonal allergies costs $45.

The MinuteClinic will treat cold sores, ear infections and minor burns for $49 in Minneapolis, but in Atlanta those ailments will be treated for $59.

The RediClinic at Wal-Marts in Arkansas and Oklahoma and others, mainly in Texas, will not accept copays but will provide a detailed receipt for submission to insurance providers. Others readily accept insurance plans and will charge only the co-payment.

Eyring said the clinics can operate at a lower cost to patients because there is less overhead for medical office equipment. Cotton swabs, tongue depressors and simple lab work are all that's needed to diagnose strep throat.

That low overhead, of course, means there are limits on what the clinics can do.

"The biggest hazard is that people could get the impression that these things could be a usual source of care, which they can't be," said Dr. Larry S. Fields, the president of the American Academy of Family Practitioners.

Fields, who practices in Ashland, Kentucky, said clinics are a positive step because they expand access -- as long as the clinics can tell the difference between a minor ailment and something that needs a doctor's attention.

He said many of his patients have gone to walk-in clinics but still wind up with him because they don't sense a continuity of care. "They realize there's not that history. They're not familiar," he said.

But for the quick fix, clinics can generally see patients much quicker at a lower cost, Eyring said. When a patient's only alternatives are expensive visits to a doctor or an emergency room, he might forgo treatment altogether.

So far, the clinics are run mainly by local and regional startup companies. Kroger and CVS are testing clinics in select markets, as are large retailers Wal-Mart and Target.

"Wal-Mart is the kind of player that has the power to do it in a big way if it pans out for them and their test mode is successful," said Sandra J. Skrovan, head of food, drug and mass retailing research at consultant Retail Forward Inc. in Columbus, Ohio.

Eight Wal-Mart stores have set up clinics since September and another four are scheduled to open by mid-March.

"We'll certainly grow this business if it makes sense," Wal-Mart spokeswoman Sharon Weber said. "I can tell you the customers have been very pleased."

With the number of Americans without health insurance at 45.8 million in 2004, the clinics hope to reach consumers who have to pay out of pocket for doctor's visits -- even for simple problems.

"Is this a trend that is here to stay? Yes," Eyring said.

Copyright 2006 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

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BrettBatchelor said:
I see that as the replacement & demise of FP.
i would think FP are not too happy about this, but its good for society. ive heard about this, i once read an article long back about an operation in the NE i believe, www.minuteclinic.com . solid med business :thumbup:

nm its not the NE, i dont know what the heck it is, it doesnt seem to have any geographical base. it makes me wonder how they chose their expansion method (if you look at the list of states on the main page)

but yeah this is good for all the griping about doc shortage, primary care shortage, blah blah. shortages are bogus, whenever theyre in place mischief is afoot and markets arent working right. no one ever heard of a diamond shortage or a gold shortage. i wonder if the perception of these clinics was once the perception of podiatrists and chiropractors back in the day? optometrists? ive heard optometrists are vying to perform lasik--dunno what to say about that, maybe the Administration does! ;)

anyway i read in "market driven healthcare" that it was competition between optometrists, opticians and opthalmologists for their overlapping services that produced the remarkable efficiency in the eyecare sector. but also that combined with the fact that much of eyecare is not life threatening. dunno if this would apply to the OP, sounds like it might though. competition...the crux of not only biology and evolution but also economics/markets/innovation. dammet i just like it.
 
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Shredder said:
i would think FP are not too happy about this, but its good for society. ive heard about this, i once read an article long back about an operation in the NE i believe, www.minuteclinic.com . solid med business :thumbup:

nm its not the NE, i dont know what the heck it is, it doesnt seem to have any geographical base. it makes me wonder how they chose their expansion method (if you look at the list of states on the main page)

but yeah this is good for all the griping about doc shortage, primary care shortage, blah blah. shortages are bogus, whenever theyre in place mischief is afoot and markets arent working right. no one ever heard of a diamond shortage or a gold shortage. i wonder if the perception of these clinics was once the perception of podiatrists and chiropractors back in the day? optometrists? ive heard optometrists are vying to perform lasik--dunno what to say about that, maybe the Administration does! ;)

anyway i read in "market driven healthcare" that it was competition between optometrists, opticians and opthalmologists for their overlapping services that produced the remarkable efficiency in the eyecare sector. but also that combined with the fact that much of eyecare is not life threatening. dunno if this would apply to the OP, sounds like it might though. competition...the crux of not only biology and evolution but also economics/markets/innovation. dammet i just like it.

I see several big problems with the CNN article which will probably force substantial changes in this purported market plan, or doom it to a very small scale experiment. First, it's pretty absurd to try to provide medical services for infectious things like the flu (or worse) at the same location that you are trying to sell food. These things need to be sectioned off pretty tightly. Walmart can probably make that happen, but your corner grocery store cannot. Secondly, it is a medmal attorney's wet dream to have medical services provided by a deep pocket the size of Walmart. Thus services are going to need to be pretty minimal or the medmal insurance premiums will be enormous. Finally, either this circumvents the HMO PCP loop, or they need to find a way to get health plan reimbursements to make this fly. The "paying" customers need this option, unless the goal is to lure the poor and homeless into Walmart or the grocery store (which limits the cross marketing abilities -- Walmart wants to lure in customers who will actually buy things). In sum, while this kind of retail avenue works great for things you can do en masse with little provider liability (such as providing vaccines - where liability is already covered by special laws), I don't imagine it will catch on. I'm pretty sure that retail dentistry never caught on although something similar was tried through one of the department store chains (and they have far fewer infection/liability problems).
 
There are some super Walmarts in my city that have a hair & nair salon, optomerist, and some retail food places up front in enclosed store fronts (like a mall). I could forsee the clinic being inside one of those locations.

People love convenience. Think about it...mom has the flu. Has to go to walmart for groceries, pops into the clinic, gets meds prescribed to the in house pharmacy, goes to shop, picks up pills on the way out. This sounds great except for as you mentioned having sick people around the food in a greater frequency. People do already go to the store when the are sick.

As I stated in the healthcare topics forum, if you increased the training via a 1 yr FP residency for NP/PA and taught the bread and butter cases it would greatly provide greater access to people. It is cheaper and more appealing for an NP/PA to go 1 year to treat colds and flu rather than a doc to go 3. If they got anything they couldn't handle, tell them to refer it out.
 
Law2Doc said:
First, it's pretty absurd to try to provide medical services for infectious things like the flu (or worse) at the same location that you are trying to sell food.

Except that the grocery store is already FULL of sick people, as is any public place. Besides, the sick people were already coming to the grocery store to get their prescriptions filled at the pharmacy, so having them see a doctor in the same location makes little difference in the exposure potential.
 
All4MyDaughter said:
Except that the grocery store is already FULL of sick people, as is any public place. Besides, the sick people were already coming to the grocery store to get their prescriptions filled at the pharmacy, so having them see a doctor in the same location makes little difference in the exposure potential.

Must be a regional thing -- not many grocery stores with pharmacies here. Lots of chain pharmacies about for that, but they certainly don't sell produce or meats. A lot of folks with the flu and other bugs stay home unless they are seeking medical attention -- and save grocery shopping for when they are feeling better. It's one thing for someone sick who doesn't have anyone else helping out to happen to go shopping and another thing altogether for a grocery store to "invite" sick people to specifically come to the store for medical attention. It would tend to increase the spread of things.
 
Law2Doc said:
It's one thing for someone sick who doesn't have anyone else helping out to happen to go shopping and another thing altogether for a grocery store to "invite" sick people to specifically come to the store for medical attention. It would tend to increase the spread of things.
legitimate concern to raise. im interested to see how this all pans out. it has worked for optometry in walmart, but its different with this. i must say, i would feel slightly uncomfy having to skirt around contagious sniffles and sneezes during a trip to the store. getting sick is a real drag on productivity, worth avoiding if at all possible.

youre pretty good at being the pessimist in threads/discussions law2doc. thats valuable to prevent "irrational exuberance". ive noticed lawyer types are like this, not sure what it stems from. devils advocate or something
 
Law2Doc said:
Must be a regional thing -- not many grocery stores with pharmacies here. Lots of chain pharmacies about for that, but they certainly don't sell produce or meats. A lot of folks with the flu and other bugs stay home unless they are seeking medical attention -- and save grocery shopping for when they are feeling better. It's one thing for someone sick who doesn't have anyone else helping out to happen to go shopping and another thing altogether for a grocery store to "invite" sick people to specifically come to the store for medical attention. It would tend to increase the spread of things.

Maybe it is regional. I'm in KY and all of the major grocery store chains have pharmacies. My own place of employment, a grocery store pharmacy, is always FULL of sick people.

Staying home when sick is a luxery a lot of people don't have, unfortunately.
 
Law2Doc said:
I see several big problems with the CNN article which will probably force substantial changes in this purported market plan, or doom it to a very small scale experiment. First, it's pretty absurd to try to provide medical services for infectious things like the flu (or worse) at the same location that you are trying to sell food. These things need to be sectioned off pretty tightly. Walmart can probably make that happen, but your corner grocery store cannot. Secondly, it is a medmal attorney's wet dream to have medical services provided by a deep pocket the size of Walmart. Thus services are going to need to be pretty minimal or the medmal insurance premiums will be enormous. Finally, either this circumvents the HMO PCP loop, or they need to find a way to get health plan reimbursements to make this fly. The "paying" customers need this option, unless the goal is to lure the poor and homeless into Walmart or the grocery store (which limits the cross marketing abilities -- Walmart wants to lure in customers who will actually buy things). In sum, while this kind of retail avenue works great for things you can do en masse with little provider liability (such as providing vaccines - where liability is already covered by special laws), I don't imagine it will catch on. I'm pretty sure that retail dentistry never caught on although something similar was tried through one of the department store chains (and they have far fewer infection/liability problems).

well said. :thumbup:
 
Shredder said:
youre pretty good at being the pessimist in threads/discussions law2doc. thats valuable to prevent "irrational exuberance". ive noticed lawyer types are like this, not sure what it stems from. devils advocate or something

I spent years helping clients prepare for and circumvent worst case business scenarios -- it's a role that's ingrained and hard to shake. In law, you let the client be the optomist and you play realist -- and get them prepared for possible bumps in the road. Nobody wants to pay money for a "yes" man who agrees with them -- the real value is finding someone who can poke holes through their walls, and show them where the weaknesses lie.
 
Law2Doc said:
I see several big problems with the CNN article which will probably force substantial changes in this purported market plan, or doom it to a very small scale experiment.

These things jumped right out at me, as well. Maybe I should've been a lawyer. :D
 
Law2Doc said:
I spent years helping clients prepare for and circumvent worst case business scenarios -- it's a role that's ingrained and hard to shake. In law, you let the client be the optomist and you play realist -- and get them prepared for possible bumps in the road. Nobody wants to pay money for a "yes" man who agrees with them -- the real value is finding someone who can poke holes through their walls, and show them where the weaknesses lie.
yes thats a good way of putting it into words. we joined sdn at the same time and end up interacting often, yin and yang must be. was your faith in the justice system shattered after oj?
 
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Shredder said:
but yeah this is good for all the griping about doc shortage, primary care shortage, blah blah. shortages are bogus, whenever theyre in place mischief is afoot and markets arent working right. no one ever heard of a diamond shortage or a gold shortage.

Diamonds are not bought and sold in a free market - it's almost exclusively controlled by deBeers (about 95%). In fact, diamonds appreciate at a fixed rate every year (set by deBeers).

In reality, really small diamonds are plentiful in our world. There are tons of them. I'm talking about those that are at or below 30-40 points in size.
 
Shredder said:
youre pretty good at being the pessimist in threads/discussions law2doc. thats valuable to prevent "irrational exuberance". ive noticed lawyer types are like this, not sure what it stems from. devils advocate or something

Umm...reality?
 
is this the medicine of tomm?

i guess the lack of overhead costs wud attract FPs from owning their own offices into retail
 
thegenius said:
Diamonds are not bought and sold in a free market - it's almost exclusively controlled by deBeers (about 95%). In fact, diamonds appreciate at a fixed rate every year (set by deBeers).

In reality, really small diamonds are plentiful in our world. There are tons of them. I'm talking about those that are at or below 30-40 points in size.
yeah diamonds wasnt the perfect example bc of that which i suspected someone might point out. but the point is you never hear of diamond shortages. shortages are just a sign of market trouble, diamonds or not. such as the gas shortages in the 1970s. supposedly the lines for gas disappeared as if they were controlled by a light switch the day after the price controls were lifted. there are small diamonds in plenty but theyre mostly useless, as diamond value vs size is not linear but exponential

as for reality (unrelated to diamonds)--"reality" to some is pessimism to others and optimism to still others. nobody can predict the future. if any investors touted reality and didnt invest during the late 90s they wouldve been called a fool. as for the last laugh bit--who knew? not wall street. what if law2doc is 100% wrong and this thing becomes a hit, what of reality in that case? or i may be wrong, or this person and that person may be wrong/right. im surprised you stated that "reality" bit, it belies your user name
 
Shredder said:
as for reality (unrelated to diamonds)--"reality" to some is pessimism to others and optimism to still others. nobody can predict the future. if any investors touted reality and didnt invest during the late 90s they wouldve been called a fool. as for the last laugh bit--who knew? not wall street. what if law2doc is 100% wrong and this thing becomes a hit, what of reality in that case? or i may be wrong, or this person and that person may be wrong/right. im surprised you stated that "reality" bit, it belies your user name

There a difference between optimism and throwing money at a bad idea. There will always be negatives, and the key to a good investor is to identify which ones are going to tank the idea. But sometimes the holes are just too big for the boat to still float.

I think you can be 100% right about problems with a business, and yet have that business still succeed, for a time. Dot coms in the 90s you hinted at are actually a perfect example -- folks said they were overvalued from day one, and yet they continued to go up in stock price, and have solid offerings for almost a decade. But the naysayers ultimately proved to be correct and those busineses came crashing back down to reality. Could you have made money in the upward ride on the bad idea? Sure. Could you have lost your shirt when they plunged back down to reality? Many did. There are some out there who bemoan not getting into the dot com party and others who bemoan losing everything not listening to their advisors that the emporer had no clothes. I'm not sure which group I would call the "fool" - the one who made money throwing it into patently bad ideas or the ones who missed the profit years, but didn't lose their shirts when the flaws were revealed. (Obviously those people who threw their money into the patently bad ideas too late, didn't profit, and lost their shirts should win the prize here, although they really had the same mindset as the initial group).
 
all are wanting in reality assessment save buffett. maybe donald too :hardy: its easiest to be yeasayer or naysayer in hindsight

:sleep: early bird classes = :thumbdown:

there are businesses that, beyond all expectations, work. too sleepy to think of examples...maybe google for one. the entire operation based on one thing, a better mousetrap
 
Shredder said:
as for reality (unrelated to diamonds)--"reality" to some is pessimism to others and optimism to still others. nobody can predict the future. if any investors touted reality and didnt invest during the late 90s they wouldve been called a fool. as for the last laugh bit--who knew? not wall street. what if law2doc is 100% wrong and this thing becomes a hit, what of reality in that case? or i may be wrong, or this person and that person may be wrong/right. im surprised you stated that "reality" bit, it belies your user name

I don't know whether these retail clinics will become the norm in a couple of decades. But you did state in your previous post that

"youre pretty good at being the pessimist in threads/discussions law2doc. thats valuable to prevent "irrational exuberance".

There was lots of discussion about the effectiveness of such measures (retail clinics), almost to the extent of gloat. Perhaps that is "irrational exuberance". Then another opinion comes in with all of the problems that these retail clinics might raise, and all of a sudden the "irrational exuberance" becomes tempered. I described that tempering change to reality or pragmatism.

I think you're right - it doesn't take a genius to suggest that in reality, these retail clinics, as described in this post, may only succeed in select situations and environments.
 
settled but your tact was slightly wanting in the post that started it. oh well it doesnt matter, lets not be girly men. optimism and pessimism are equally important but neither should be belittled for there is no telling of true reality
 
I think it would be awful, but that's my perspective as a soon to be pharmacist and dental student. The corporate world has all but destroyed the pharmacy profession in my opinion, and I think retail's direct involvement in FP will do the same. They worry more about their corporate dividends and meeting the needs of their shareholders than the lives of their patients. I am all in favor of big business and capitalism, but having these huge corporations in charge of a chunk of the FP market will be a disaster. It will become about volume and more volume.
 
I don't think big business can be blamed for franchising medical fields. Doctors are readily taking these jobs, rather than staring thier own businesses. Why? because its easier. Perhaps those to blame for this are lazy graduates. In my home town I saw three private pharmacies converted to a CVS, riteaid, and wallgreens (all by the way on the same street corner) in the last 20 or so years. Pharmacists and likewise optomtrists pitched the idea to corporate america, not the other way. However what do we get in return? Better service for the patient/client. Isn't that why we got into this game
 
blotterspotter said:
I think it would be awful, but that's my perspective as a soon to be pharmacist and dental student. The corporate world has all but destroyed the pharmacy profession in my opinion, and I think retail's direct involvement in FP will do the same. They worry more about their corporate dividends and meeting the needs of their shareholders than the lives of their patients. I am all in favor of big business and capitalism, but having these huge corporations in charge of a chunk of the FP market will be a disaster. It will become about volume and more volume.

Can you say HMO.
 
blotterspotter said:
They worry more about their corporate dividends and meeting the needs of their shareholders than the lives of their patients.
if patients are viewed as consumers, and its established that consumers hold the power in free markets, shouldnt corporate dividends+shareholder needs go hand in hand with providing quality service to the patients/customers? i never understand the argument that greedy CEOs care more about dividends and shareholders than the 'little guys'. for example if word gets around that mcdonalds is making little kids cry then the stock quote is not quite going to jump up

however the healthcare market is far from perfect so things can get complicated
 
How will working for walmart be any different than working for say Kaiser, Etna, Gould? Would it really be that much different than a Kaiser building opening up right next to the Walmart?

I think if this does pan out, walmart will just provide competition for the other HMO type of groups. Might effect the incomes of FPs, but i think it would be very slight.
 
The AMA and AOA should speak up against this stuff. They should penalize or blacklist them or whatever for working for Walmart. Then when they get sued, the lawyers will see that they were black listed by the AMA and there goes their license.
 
NRAI2001 said:
The AMA and AOA should speak up against this stuff. They should penalize or blacklist them or whatever for working for Walmart. Then when they get sued, the lawyers will see that they were black listed by the AMA and there goes their license.
Firstly, it isn't docs who are staffing these booths. It is NP/PAs.

Second, why should the AMA and AOA penalize doctors for trying to innovate the way medicine is practiced?

Thirdly, while I do see this as hurting FP overall, an FP with the entreprenuerial spirit could actually capitalize on these clinics.

WHY would they get blacklisted for working for Walmart? This isn't OD or PharmD such that the MD would turn into a "behind the counter" since only FP would be affected.
 
BrettBatchelor said:
Firstly, it isn't docs who are staffing these booths. It is NP/PAs.

Second, why should the AMA and AOA penalize doctors for trying to innovate the way medicine is practiced?

Thirdly, while I do see this as hurting FP overall, an FP with the entreprenuerial spirit could actually capitalize on these clinics.

WHY would they get blacklisted for working for Walmart? This isn't OD or PharmD such that the MD would turn into a "behind the counter" since only FP would be affected.

Whats stopping them from later opening other clinics? Now its FP, later Peds, optho, then cards, and everything else.

Is it really that bad....probably not. But i think it hurts our profession and our projected incomes. I dont think most doctors dont want to work for walmart.
 
increased competition trumps protectionism and licensing, from consumers' perspectives. if the market is moving toward wal mart docs, let it have its way. selfishness benefits society under the invisible hand but not under political clout. business savvy docs should adapt, not run to politicians and lawyers when the going gets tough. outsourcing follows the same reasoning

im not saying this business model will work but it shouldnt be nipped in the bud for dubious reasons. if we did that with everything innovation would be dead. i say do it for peds, cards, and everything. that called genuinely "caring about people" and not just lip service, especially "less fortunate" ppl
 
NRAI2001 said:
Whats stopping them from later opening other clinics? Now its FP, later Peds, optho, then cards, and everything else.

Is it really that bad....probably not. But i think it hurts our profession and our projected incomes. I dont think most doctors dont want to work for walmart.
I am positive a physician could increase their business and income with the right business plan incorporating these clinics.

As for most of the other specialties, the overhead is still quite large for them to "pop" up in walmart.

Would most FP's want to work for walmart? NO. Would they if Walmart begins to get a large "market" share of the FP pt population and drives the others out of business? Yes. AKA what happened in Pharmacy.
 
BrettBatchelor said:
AKA what happened in Pharmacy.

I think the big difference here is that pharmacy is a product driven industry. Patients need to just come and pick up their medicines. By contrast medicine is a service driven industry. Results in a totally different model, and one that hasn't fared well as a niche side business. Dental in department stores didn't catch on. Nor did legal. I wouldnt start sewing "walmart" onto your white coat any time soon.
 
BrettBatchelor said:
I am positive a physician could increase their business and income with the right business plan incorporating these clinics.

Personally, I couldn't care less if some "nurse-in-the-box" wants to see some of my patients' runny noses. Typically, these are level 2 or 3 (at the most) office visits, scheduled in appointment slots that could easily be filled by somebody with multiple chronic diseases (a level 4 or 5 visit). By seeing fewer low-complexity visits in favor of more high-complexity visits, a physician could potentially make more money under current reimbursement with help from retail clinics. Furthermore, if the patient is part of a capitated HMO plan and decides to go to the retail medical clinic for their sore throat, that's fine with me. I'd just as soon not see them in the office in the first place, as I won't be paid any more for it (bear in mind that I'm speaking in purely pragmatic terms here, not as I actually practice). Sure, there's always the issue of continuity, but many of these patients are already going to urgent care centers for these things, and I don't really see this as any different from that.
 
KentW said:
Personally, I couldn't care less if some "nurse-in-the-box" wants to see some of my patients' runny noses. Typically, these are level 2 or 3 (at the most) office visits, scheduled in appointment slots that could easily be filled by somebody with multiple chronic diseases (a level 4 or 5 visit). By seeing fewer low-complexity visits in favor of more high-complexity visits, a physician could potentially make more money under current reimbursement with help from retail clinics. Furthermore, if the patient is part of a capitated HMO plan and decides to go to the retail medical clinic for their sore throat, that's fine with me. I'd just as soon not see them in the office in the first place, as I won't be paid any more for it (bear in mind that I'm speaking in purely pragmatic terms here, not as I actually practice). Sure, there's always the issue of continuity, but many of these patients are already going to urgent care centers for these things, and I don't really see this as any different from that.
That was the gist of what I was thinking. Ship all of the lower level stuff that isn't worth the hassle of insurance or time to the retail clinic and have the more chronic/serious stuff be at the main office.
 
Law2Doc said:
I think the big difference here is that pharmacy is a product driven industry. Patients need to just come and pick up their medicines. By contrast medicine is a service driven industry. Results in a totally different model, and one that hasn't fared well as a niche side business. Dental in department stores didn't catch on. Nor did legal. I wouldnt start sewing "walmart" onto your white coat any time soon.
I think some would argue that medicine is turning into a results based industry. All some pts want to do is feel better no matter if they talk to the doc for an hour or get a script immediately.
 
BrettBatchelor said:
I think some would argue that medicine is turning into a results based industry. All some pts want to do is feel better no matter if they talk to the doc for an hour or get a script immediately.
the market will eventually determine which camp of premeds/docs is in the right boat--the touchy feely docs or the machine like docs. touchy feely will start to encroach on shrinks' territory and maybe piss them off a little
 
BrettBatchelor said:
I think some would argue that medicine is turning into a results based industry. All some pts want to do is feel better no matter if they talk to the doc for an hour or get a script immediately.

There are always exceptions, but they don't prove the rule. The biggest complaint voiced by patients is that doctors don't spend enough time with them, and don't listen. Personally, I hear it all the time from patients about other docs (typically specialists) who pop into the room, touch them with a stethoscope, write a few prescriptions, and then leave. Rarely does this leave the patient feeling satisfied, whatever the outcome (and you can bet that if the outcome isn't good, the patient will be pissed!) This is one thing that the retail clinics need to be careful about, to not let protocols and "cookbook medicine" get in the way of providing quality care.
 
Shredder said:
touchy feely will start to encroach on shrinks' territory and maybe piss them off a little

You'd be surprised. In this day and age, there are precious few "Dr. Frasier Crane"-types around. Most psychiatrists engaged in medication management spend less time talking to their patients than I do as an FP. Talking is for psychologists. ;)
 
KentW said:
There are always exceptions, but they don't prove the rule. The biggest complaint voiced by patients is that doctors don't spend enough time with them, and don't listen. Personally, I hear it all the time from patients about other docs (typically specialists) who pop into the room, touch them with a stethoscope, write a few prescriptions, and then leave. Rarely does this leave the patient feeling satisfied, whatever the outcome (and you can bet that if the outcome isn't good, the patient will be pissed!) This is one thing that the retail clinics need to be careful about, to not let protocols and "cookbook medicine" get in the way of providing quality care.
Maybe this is what I sense is coming from my generation (not that you are or aren't included) based upon personal experience. In the time of instantaneous everything now, medicine seems to be the old maid who doesn't latch on. Then again, I don't have a chronic ailment that I seek out medical attention for. Mostly acute infections that need a script and I will be on my way without WANTING to tie up the docs valuable time in which he could use for another pt.

KentW, Do you see "boutique" medicine as a viable counterpart to the urgent care center?
 
BrettBatchelor said:
I don't have a chronic ailment that I seek out medical attention for. Mostly acute infections that need a script and I will be on my way without WANTING to tie up the docs valuable time in which he could use for another pt.

That puts you in the minority. Those with chronic diseases have a much bigger stake in the game, and there are more of 'em every day.

Do you see "boutique" medicine as a viable counterpart to the urgent care center?

The two concepts address vastly different needs. I think retainer practices have their place, but they'll only work for a very small minority of patients; the same goes for retail clinics. The majority of patients will still want/need a "medical home", e.g., a primary care doctor who takes their insurance.
 
KentW said:
You'd be surprised. In this day and age, there are precious few "Dr. Frasier Crane"-types around. Most psychiatrists engaged in medication management spend less time talking to their patients than I do as an FP. Talking is for psychologists. ;)
youre right, poor diction on my part. i meant to refer to psychologists, with their big leather chairs, notepads and all
 
Shredder said:
the market will eventually determine which camp of premeds/docs is in the right boat--the touchy feely docs or the machine like docs. touchy feely will start to encroach on shrinks' territory and maybe piss them off a little

You will see when you get to med school that that ship has sailed. The market has already decided. There is no support for the machine-like efficiency docs -- and thus if they are not good with patients they are not going to get good refs or pass clinical. This has come not because of a touchy feely sense of medicine, but because patients have demanded it. Massive studies have been performed to determine the type of doc patients want, respect, wont sue, etc. And guess what -- it's not the result getter. I know you personally have said you would prefer the doctor who cures you but is brusque to the more compassionate one. But most patients are not curable. So most results are nil. Or more accurately, the bedside manner IS the result you can provide.
To some extent the "shrinks" are big proponents of this inclusion of empathy and compassion into the clinical curriculum. So they are not worried about the competition.
It's easy to spout what you think the world should be while in undergrad. But once you see what's what, you will have a better sense of what battles are left to be fought, and which ones were won well before your time. :laugh:
 
Shredder said:
the market will eventually determine which camp of premeds/docs is in the right boat--the touchy feely docs or the machine like docs. touchy feely will start to encroach on shrinks' territory and maybe piss them off a little

You will see when you get to med school that that ship has sailed. The market has already decided. There is no support for the machine-like efficiency docs -- and thus if they are not good with patients they are not going to get good refs or pass clinical. This has come not because of a touchy feely sense of medicine, but because patients have demanded it. Massive studies have been performed to determine the type of doc patients want, respect, wont sue, etc. And guess what -- it's not the result getter. I know you personally have said you would prefer the doctor who cures you but is brusque to the more compassionate one. But most patients are not curable. So most results are nil. Or more accurately, the bedside manner IS the result you can provide.
To some extent the "shrinks" are big proponents of this inclusion of empathy and compassion into the clinical curriculum. So they are not worried about the competition.
It's easy to spout what you think the world should be while in undergrad. But once you see what's what, you will have a better sense of what battles are left to be fought, and which ones were won well before your time. :laugh:
 
Shredder said:
the market will eventually determine which camp of premeds/docs is in the right boat--the touchy feely docs or the machine like docs. touchy feely will start to encroach on shrinks' territory and maybe piss them off a little

You will see when you get to med school that that ship has sailed. The market has already decided. There is no support for the machine-like efficiency docs -- and thus if they are not good with patients they are not going to get good refs or pass clinical. This has come not because of a touchy feely sense of medicine, but because patients have demanded it. Massive studies have been performed to determine the type of doc patients want, respect, wont sue, etc. And guess what -- it's not the result getter. I know you personally have said you would prefer the doctor who cures you but is brusque to the more compassionate one. But most patients are not curable. So most results are nil. Or more accurately, the bedside manner IS the result you can provide.
To some extent the "shrinks" are big proponents of this inclusion of empathy and compassion into the clinical curriculum. So they are not worried about the competition.
It's easy to spout what you think the world should be while in undergrad. But once you see what's what, you will have a better sense of what battles are left to be fought, and which ones were won well before your time. :laugh:
 
spyyder said:
I don't think big business can be blamed for franchising medical fields. Doctors are readily taking these jobs, rather than staring thier own businesses. Why? because its easier. Perhaps those to blame for this are lazy graduates. In my home town I saw three private pharmacies converted to a CVS, riteaid, and wallgreens (all by the way on the same street corner) in the last 20 or so years. Pharmacists and likewise optomtrists pitched the idea to corporate america, not the other way. However what do we get in return? Better service for the patient/client. Isn't that why we got into this game

Two quick points. There is no better service for the patient/client. You'll be "forced" to give up the care you might otherwise deliver because you can actually take your time. If your only goal is volume and dollars because of corporate pressure, you don't really have a choice but to handle it or go work elsewhere.

As for the "Can you say HMO" comment, it's totally off. You won't find an HMO selling retail merchandise, will you?! Customers that shop at retail stores have the mentality that the customer is ALWAYS right and that hence they can get whatever they want. Medicine can't become about the patients wants, but rather their needs. Customers want to be attended to RIGHT AWAY. Can you imagine how insane a medical practice would become if they just kept complaining to managers about how you're not getting to them fast enough?! Corporate pressure will trickle down to ensure you keep customers happy.

Also, you don't want your medical staff to start helping customers with their groceries and other items because of corporate pressure to keep them happy. Who knows, maybe you'll have physicians ringing on the register when the "office" is less busy. Obviously this is the extreme, but it's what happens when you have people that aren't in the medical field running YOUR patient care.

Anyway, just my take on the situation.
 
Shredder said:
if patients are viewed as consumers, and its established that consumers hold the power in free markets, shouldnt corporate dividends+shareholder needs go hand in hand with providing quality service to the patients/customers? i never understand the argument that greedy CEOs care more about dividends and shareholders than the 'little guys'. for example if word gets around that mcdonalds is making little kids cry then the stock quote is not quite going to jump up

however the healthcare market is far from perfect so things can get complicated

I think you make some good points, but, in the real world, the free market simply isn't perfect. Greed is everywhere and people will do incredible things for it. The government has to enforce product/service safety and efficacy not because it necessarily wants to, but because it must. Remember the climate of the early 20th century when there was little government intervention in business that led to people working in unsafe factories making unsafe products?! The motto was "buyer beware." It was the consumer's responsiblity to make sure a product was safe, not the manufacturer.

Even though consumers could buy other products, the major manufacturers had such control over the market that they could manipulate it anyway they wanted. If they didn't want to spend the extra money to ensure safety, they didn't have to.

For a practical example, remember ENRON?! (I know it's not the perfect example because it was employees that lost the most, but it's a good illustration of corporate greed). Those greedy CEOs cared more about their executives than the consumers. It's not a mentality, it's a reality. Sure, the market would eventually correct itself if the government hadn't gotten involved, but what about the harm done in the meantime? Listen, I'm a huge advocate for a free market, but there are certain things, like healthcare, that we can't compromise.
 
blotterspotter said:
It was the consumer's responsiblity to make sure a product was safe, not the manufacturer.
im just pretty big on this, personal responsibility vs govt paternalism that assumes a myopic populace. if information was made readily available about healthcare, the way it is with consumer reports and the auto industry, it might work. the early 20th century was also the time period when america laid the foundation for its ascent to the top of the world following ww2. i think enron might be a case of fraud however, and fraud is something that cannot stand. i think transparency should be important but it is a tradeoff between that and too much regulation.

law2doc ill just wage more battles when the time is ripe. history is the story of battles! there are some patients who want touchy feely then, and others who want efficiency. walmart docs can take cater to the latter. undergrad or not, neither of us are docs and can comment astutely on the real state of medicine. also its overgeneralizing to say that most ailments are incurable and thus docs are relegated to the role of patting patients on the back and hearing their woes. priests would begin to compete with docs if that were so.
 
Shredder said:
also its overgeneralizing to say that most ailments are incurable and thus docs are relegated to the role of patting patients on the back and hearing their woes. priests would begin to compete with docs if that were so.

Perhaps saying "most" was overbroad. But I would suggest that an enormous precentage of patients will not be cured, making "results oriented" medicine impossible. Certainly a large percentage of folks most will see in the hospital as a resident won't be curable. Go to a CCU and tell me how many of those folks are going to be "cured". Thus the only thing you can do is provide care, make them comfortable, with no hope of any tangible result. I suspect the machine-like efficiency doc will fall short in this kind of task. That's all I'm saying. And that's a lot of what medicine is. (There are chaplains in every hospital for those who want them, but doctors won't ever be in competition with priests because comfort, compassion and religion are not necessarilly overlapping ideologues. In fact, compassion for the ill likely predates all religion.)
 
Law2Doc said:
Perhaps saying "most" was overbroad. But I would suggest that an enormous precentage of patients will not be cured, making "results oriented" medicine impossible. Certainly a large percentage of folks most will see in the hospital as a resident won't be curable. Go to an ICU and tell me how many of those folks are going to be "cured". Thus the only thing you can do is provide care, make them comfortable, with no hope of any tangible result. I suspect the machine-like efficiency doc will fall short in this kind of task. That's all I'm saying. And that's a lot of what medicine is. (There are chaplains in every hospital for those who want them, but doctors won't ever be in competition with priests because comfort, compassion and religion are not necessarilly overlapping ideologues. In fact, compassion for the ill likely predates all religion.)
yes priests have some involvement in medicine, but most would prefer the doc if theyre sick any day. ICU is mostly auto and moto wrecks, as well as domestic violence and other violence (crimes, gunshots, etc) so yes they are curable. its only the terminally ill who are not, which is mostly old ppl and cancer victims. gtg but ill look up curable percentages sometime vs incurable, more and more im tending toward using numbers as arguments since its more concise and concrete
 
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