With the implementation of the Affordable Care Act in 2014, the shortage of primary care physicians is expected to increase as the newly insured search for their own medical homes. Do retail medical clinics and urgent care centers present a solution?
Retail medical clinics and urgent care centers help to bridge the gap between primary care physicians and emergency departments. Both are walk-in centers that allow patients to be seen on an as-needed basis, but there are some fundamental differences between the two models of care.
Mid-level providers, such as physician assistants and nurse practitioners, staff retail medical clinics, and the clinics’ scope of practice is fairly limited, focusing mainly on treatment of minor acute illnesses and on wellness. Since their development 14 years ago, retail medical clinics have experienced continued growth in both number and consumer popularity. For example, CVS MinuteClinic — the largest retail medical clinic provider in the United States — added 150 locations during 2013, and 1,500 clinics are expected to exist by 2017.
Urgent care centers offer a broader array of services. Physicians generally oversee the care provided, and due to the availability of X-ray, sprains, strains and breaks are also managed at urgent care centers. According to the American Academy of Urgent Care Medicine, there are approximately 9,300 urgent care centers in America, with 700-800 clinics opening each year.
Walk-in clinics can ease primary care physicians’ workloads by offering care for acute minor concerns, such as sore throats, earaches and sinus infections. Some physicians have expressed concern, however, that use of walk-in clinics could result in care fragmentation. The American Academy of Family Physicians also opposes the management of chronic conditions and care for health concerns beyond minor, acute illness in a retail medical clinic setting.
“We understand there are times when a patient has a minor acute medical illness and needs attention and evaluation [outside of office hours],” says Robert L. Wergin, MD, FAAFP, President-Elect of the American Academy of Family Physicians. “Mid-level providers [at retail medical clinics] should use an evidence-based protocol. To avoid fragmented care, the care provider also needs to communicate with the patient’s family physician so they know what treatment was provided at the center.”
Another concern is missed-opportunity care, which is not offered by providers who are unfamiliar with a patient’s medical history.
“If a patient comes in with a sore throat, the missed opportunity may be preventive medicine,” says Dr. Wergin. “For example, if you are 57 years old, I can look at your record and say, ‘Hey, you haven’t had a mammogram in eight years. It may be time to do that.’”
To ensure primary care physicians remain informed about their patients’ care, many retail clinics have systems in place to maintain communication with community physicians.
“With permission, we will share a copy of the medical record with the patient’s primary care provider, typically within 24 hours,” says Nancy Gagliano, MD, MinuteClinic Chief Medical Officer. “As a result, the physician knows exactly when and why the patient was seen, what medications (if any) were prescribed and whether any follow-up appointments with the primary care physician are recommended.”
If the patient does not have a primary care physician, retail medical clinics typically have a resource list of physicians in the area who are accepting new patients. Partnerships have also been formed between entities such as MinuteClinic and hospital systems.
Meeting the Needs of a Changing Practice
As the landscape of medicine continues to evolve, walk-in clinics may offer a useful adjunct for primary care physicians who are already operating at full capacity.
“You have to look at all the factors that are changing the landscape of medicine and putting a tremendous strain on our system,” says Dr. Gagliano. “We have a severe primary care shortage estimated to be as many as 50,000 physicians by 2025. We have millions of newly insured patients coming into the system as a result of the Affordable Care Act who will be seeking care. We have an aging baby boomer population and a nationwide epidemic of obesity with associated hypertension, hyperlipidemia and diabetes conditions. I believe retail clinics, like MinuteClinic, are well positioned to help address these concerns and can be a significant part of the solution to increase access to high-quality, affordable medical care.”