Retail Health Clinics: Convenience With Caveats

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What are retail-based clinics like? Think of McDonald's. As business school professors have pointed out, the organizing principles behind retail health clinics are taken right from the fast food industry: convenient locations, quick service, long opening hours, limited menu, low prices and consistent quality. Anything that can be done by nurse practitioners using well-accepted guidelines is in. Anything that involves too much judgment, ongoing chronic care or serious consequences is referred out.

Most patients really like them. A recent national poll found that between 80 and 90 percent of users were satisfied with the quality of care, convenience and costs of these clinics. They especially liked the no-appointment-necessary policy and short waiting times.

No surprise that most doctors really don't like them. Medical societies around the country have expressed concerns about the quality of care and the lack of continuity of care provided by these clinics. But maybe that's just sour grapes.

If you go to a retail health clinic, it will probably be like the one I recently visited. It was in the back of a suburban drug store: There was a small waiting area with a sign saying that the nurse practitioner was in one of the two examination rooms with a patient. I signed in and sat down.

While I waited, a large flat-screen video display flashed promotional material alternating with the "menu": ear infection, $59; flu shot, $39; camp physical, $59; and so on. The clinic took cash, credit cards and many health insurance plans, though not mine. After about five minutes, a smiling nurse practitioner came out and greeted me.

So, should you go to one of these clinics? They are designed for people who have a simple, well-defined problem or need a shot or another offered service. Perfect for a child's recurrent ear infection on a Sunday or an assessment of a sore throat in the evening. Quick exam, diagnosis, treatment and, of course, your prescription can be filled before you leave the store. Also, they've been very popular with uninsured people because of their low charges. Or if you're on vacation and develop conjunctivitis or a sinus infection, nothing could be more convenient.

But legitimate clinical questions exist. Who assures quality of care? Where's the medical backup and follow-up? What do they do when an emergency walks in? And how do retail health clinics differentiate a simple, minor problem from a serious one?

The clinics say that they hire experienced, certified nurse practitioners who know what they're doing and when to get help. They follow recognized guidelines for diagnosis and treatment. They'll refer you out if your problem is too complicated, and they'll tell your doctor about your visit. All the clinics have telephone backup from a doctor, although sometimes that doctor is in another state. As for emergencies, they say they really don't see many.

Bottom line? I think these clinics are providing a very useful service, from which conventional doctors' practices could learn a thing or two about speed and convenience of care. Would I go to one? No, if it were for a complicated problem or related to lots of other ongoing problems I had. Yes, if I were out of town or I couldn't get in to see my doctor for what I knew was a simple, quick problem. But in either case, I'd make sure to subsequently let my primary care doctor know what the problem was and how I was treated.

Family physician Douglas Kamerow, a former assistant surgeon general, is a researcher at Research Triangle Institute. He lives in Maryland.



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