Doctors: The ‘Mall-ification’ of Medical Care ~NY TIMES

October 29, 2015 1:00 pm

Last week I was dashing through O’Hare International Airport in Chicago to catch a flight back to New York. Fifty feet before my gate I noticed a stand offering flu shots. I’d been considering getting a coffee before the flight, but maybe I should get a flu shot instead?

It sure looked tempting. I’d been meaning to get my flu shot at work, but whenever I had a moment the nurse was busy with patients, and whenever she was available I was locked in mortal combat with the electronic medical record system. The pleasant young woman at the airport clinic offered to check my insurance plan to see if it would be covered, and I was about to pull out my insurance card when the paperwork logistics gave me pause.

Because I’m a doctor and am required to get vaccinated, I’d have to get documentation from the airport kiosk, remember to bring it to my hospital, and figure out how to get it incorporated into my official medical record. And who was this white-coated person anyway, I wondered. Was she a nurse, a pharmacist, an airport employee? Who was certifying this kiosk? Were they storing the vaccine in the proper manner? Did they have equipment available to handle allergic reactions?

When retail health clinics started springing up in the early 2000’s, many thought it was a passing fad. But these clinics have exploded over the last 10 years, and now it seems like every other big-box store, supermarket and shopping mall has its own clinic. Apparently airports are now getting in on the action.

Between 2007 and 2009, the number of visits to retail clinics quadrupled. Almost half the visits were after hours — on evenings and weekends when doctors’ offices are usually closed. Most were for minor acute conditions like flu symptoms, ear infections and back pain, or for simple preventive care like vaccinations and sports physicals.

There are nearly 2,000 retail clinics in the United States. Typically they are staffed with nurse practitioners or physician assistants. For patients, the convenience of easy location, after-hours availability and walk-right-in policies are appealing. It’s hard to argue with this, since traditional doctors’ offices fail miserably on these measures.

There’s also an actual price list. When a patient asks me in my office how much her CT scan is going to cost, I can’t even give her a ballpark figure, nor can my finance department. My patient will have no idea what the cost will be, and she certainly can’t comparison shop with any another hospital. But two clicks online and you can see that the hepatitis B vaccine for kids costs $60 at Walgreens but $79 at Target.

Many physicians worry about the quality of care these clinics provide, and perhaps the competition they pose. Dr. Ateev Mehrotra, an associate professor of medicine at Harvard University, has researched the topic extensively and has concluded that for the minor conditions treated by retail clinics, the quality is generally “as good as the care at regular doctors’ offices. Or should I say ‘as poor as’ because these clinics overprescribe antibiotics as much as doctors do.”

But the patients he interviewed at retail clinics love the convenience, easy access and clear pricing. They also love the standardization. “Just like Starbucks is the same in Seattle and in New York, so is CVS’s Minute Clinic,” he said.



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