Retail Clinics for Kids: No Sub for Pediatricians
Convenience, Convenience, Convenience
As Hoffman noted, convenience seems to be the main selling point of the clinics. A recent study of nearly 1,500 parents at 19 Midwestern pediatric practices found that almost 1 in 4 had taken their children to a MinuteClinic or a similar place. Three-quarters of the parents who took their children to a retail clinic had first considered going to their pediatrician but dropped that idea. The main reasons were that the clinic had more convenient hours or they couldn’t get an appointment at the doctor’s office, according to the study, published in September 2013 in JAMA Pediatrics.
Simon says the AAP’s opposition to retail clinics isn’t part of a turf war. “We’re offering a different type of service and a different level of expertise,” he says. “It really hasn’t hit anybody’s revenue.”
He says that when he practiced in Atlanta, he used to tell patients to go to a particular MinuteClinic instead of an emergency room for minor complaints when his office was closed. He had talked with the chain’s medical director and felt comfortable with the care at that MinuteClinic.
Question of Care
The AAP's main concern with retail clinics is that the care they provide is “fragmented, episodic, and not coordinated,” the group's policy statement says. Health-care providers who staff the retail clinics “lack pediatric training equivalent to pediatricians and do not provide after-hours coverage for patient/family questions or complications,” the statement says.
A child’s family pediatrician is also better able to see patterns that might point to a larger health problem.
Spokespeople for the two largest retail clinic chains say they are not trying to replace primary care doctors.
“We strongly encourage all patients to have a relationship with a primary care physician,” Walgreens spokeswoman Emily Hartwig says. “Our objective as part of the health care team is to support and complement physicians’ care plans.”
Andrew J. Sussman, MD, president of MinuteClinic, says staff members at his clinics are in constant touch with young patients’ doctors. “With patient permission, thousands of visit summaries are sent to pediatricians every week via fax or electronic medical record systems within 24 hours of the child’s visit,” he says. “This ensures continuity of care and provides doctors an opportunity to follow up with patients should they choose to do so.”
Pediatricians could collaborate with retail clinics, the policy statement says. That should include such things as prompt communication and referral of all patients who see a retail clinic doctor back to their pediatrician. Also, pediatricians can try to make their practices more convenient for parents by having “extended hours, open scheduling, and same-day appointments for even ‘minor’ acute illness,” the statement says.
Many pediatricians already do that, Simon says, noting that his practice sees patients Saturday and Sunday mornings as well as on weekdays. Scheduling isn’t everything, though, he says. “A lot of parents go [to the retail clinic] when the pediatrician’s office is open because they feel it’s more convenient.”