If Retail Clinics Keep Growing, We May Lose More Primary-Care Doctors

(MoneyWatch)  As cash-strapped consumers seek less expensive forms of healthcare, CVS Caremark's (CVS) MinuteClinic chain reported a 36 percent second-quarter pickup in traffic. That doesn't necessarily mean that retail clinics as a whole will rebound from their current stagnation; but if they do, and if they take on more of the functions of primary care, the nurse practitioner-run clinics could further erode in primary care doctors' incomes. As a result, even fewer young physicians will enter primary care just when it's needed most.

Retail clinics, once viewed as a rising force in the market, have plateaued in the past year or two. Currently, there are 1,179 retail clinics across the country, of which 455, or nearly 40 percent, are MinuteClinics. The total number is about the same as it was a year or two ago. However, CVS plans to double the size of its MinuteClinic chain within five years. Other major operators include Walgreens, Target, Kroger, and Shopko. Some retail clinic chains are partnering with big healthcare systems to accelerate their expansion. The Deloitte Center forecasts that the industry could hit 3,200 outlets by 2014, but Merchant Medicine predicts a more modest 2,050 clinics.

If the recession were the only reason for the increased traffic at MinuteClinics, retail clinics would have have been on the upswing long before this. But much of the impetus for people to seek care at in-store clinics is related not to the recession, but to increased out of pocket expenses: even if they're insured, consumers are bearing much more of the cost of healthcare. For example, the percentage of Americans enrolled in high-deductible plans rose 25 percent this year to 10 million. While that's still a small percentage of the overall market, the average deductible of health plans is also on the rise.

From that viewpoint, the growth of retail clinics, which charge less than doctors do for treating minor health problems, is a good thing for consumers. But it's not going to be such a rosy scenario for primary care doctors. One reason is that MinuteClinics, Walgreens' (WAG) TakeCare chain, and some other retail outlets are expanding into chronic disease care, which is primary care physicians' bread and butter. MinuteClinic, for example, recently introduced a new service called Monitoring Made Easy. The stated goal of the service is "to help patients previously diagnosed with diabetes, asthma, high cholesterol and high blood pressure overcome the challenges of living with their conditions."

Of course, MinuteClinic hastened to add that it was offering these services to patients between primary care visits or if they didn't have a primary care physician. That could be helpful to patients who have trouble finding a doctor or getting a timely appointment. But it could also hurt primary-care doctors' business.

On the other hand, it has been widely reported that we don't have enough primary-care physicians. In shortage areas, generalist doctors are probably going to be as busy as they want to be even if more people go to retail clinics. The real problem that could arise, however, is economic: Beset by competition from retail, urgent-care, and worksite clinics, will primary-care doctors find their rates beaten down even further than health plans have already done? If so, fewer young physicians than ever will enter primary care.

That will come back to bite us a few years hence, when millions of newly insured people seek personal physicians. They may be able to find relatively inexpensive care at retail outlets; but if they have serious health problems, it may be far harder to locate a primary care doctor with the capacity to take on new patients.

Image supplied courtesy of Wikimedia Commons.
Related:

• Retail Clinics Have Hit a Wall-But May Have a Way Over it
• Nurse Practitioners: We Need More of Them, But Not in Place of Physicians
• Right-Sizing the Physician Workforce
• Primary Care Is a Key Issue For Healthcare Reform