by Craig Klugman Ph.D.
Where do you get your medical care? Recently I was feeling under the weather and when I tried to get an appointment with my primary care physician, I was told that he could see me in 3 weeks. Figuring I would be either better or dead by then, I went down to my local pharmacy and was able to see a nurse practitioner in their quick clinic. I was examined, given a prescription and was feeling better in no time.
The national pharmacy chains have jumped on this opportunity. Walgreens has 360 clinics and CVS has 640. Each clinic is staffed by a nurse practitioner or a physicians’ assistant who can write prescriptions.
The popularity of such drugstore-based clinics is gaining. In a January report, nearly ¼ of surveyed Americans surveyed had visited such a clinic because of convenience—no appointment is necessary, waiting times are short and office hours are extended. For the 30-40 percent of patients who do not have a regular doctor, such clinics are a place to get the medical care they need. And considering that 34 million previously uninsured people will be joining the health care system in a few months time and that there is a physician shortage projected to reach 50,000 doctors by 2025, such clinics fill a very real need.
Opponents say that these clinics pose a health threat to patients. For example, clinic patients are less likely to have a medical home—a primary care practice that coordinates and reviews the patient’s comprehensive care—where one’s health is known in conjunction with medical history, lab tests, and all prescriptions. Even when patients do have a medical home, the quick clinics may not share lab results, diagnoses, and prescriptions with that home, compromising a patient’s medical record that may become important in their later care. With a variety of health care professionals working different shifts, a patient is less likely to see the same person each time and to have continuity of care—something that is important for chronic disease. There is also no real data on the quality of care patients receive at such clinics and whether there is any real harm.
The reality is that physician training is expensive and takes an enormous investment of time. With health care reform more people will be entering the health care system. There are fewer physicians and getting appointments to see them has become more difficult. Only about 40 percent of graduating U.S. medical students choose primary care residencies, and many of those will not practice in primary care. Why? Many medical students cannot afford to choose primary care if they have significant student loan debt.
When the supply cannot meet the demand, creative solutions have to be found. These clinics fill that need. This is more of a story of professional turf wars than about serving patients. In the traditional story, the physicians control medical care. In the new reality, physicians cannot meet the demand. Well trained nurse practitioners and physicians’ assistants can add resources to help meet this need. Making sure all health care professionals are well trained, have the knowledge necessary to take care of patients, and that they can work together for the benefit of the patient is of the utmost important.
What often gets lost in these turf wars is the patient. And the patient is the real reason the health professions exist in the first place.