IRA FLATOW, host:
You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.
A couple of years ago, I was killing time at O'Hare airport in Chicago. You know how it is flying these days. You hang up forever in the airports. That's something else for another day.
But in this day, when I saw a sign with a big red arrow on it that said flu shots, 20 bucks, this way. Of course, before you could say roll up your sleeves, I was vaccinated. Well, times have changed. And people are doing more than rolling up their sleeves at airports, shopping centers and malls. Home medical clinics are springing up in places where people find themselves spending time.
And with the extra time on their hands, the grocery store, the airport, maybe the local discount store - the interesting term for them is retail clinics. And they are a rapidly growing part of the medical landscape. But what kinds of things should you trust to a clinic at the corner market? Are these clinics a good choice for patients?
Joining me now is Larry Fields. He's a family physician in Ashland, Kentucky and chair of the board of the American Academy of Family Physicians. Welcome to the program, Dr. Fields.
Dr. LARRY FIELDS (Board Chairman, American Academy of Family Physicians): Thank you, Ira. I'm a big fan. I love your show.
FLATOW: Thank you. These are very popular now, aren't they?
Dr. FIELDS: Well, they seem to be growing. I'm not sure how popular they are. But they certainly are a phenomenon that has taken off recently, over the last three years I would say, even though they've been around in parts of the country for somewhat longer. But I do want to point out that they're not complete medical clinics. They're there to serve as a very small number of self-limited type problems, you know, colds, maybe flu, minor injury, that sort of thing.
They do not want - and to their credit - generally, don't try to take care of things that are more properly taken care of in the patient's medical home, where all their, you know, in their family doctor's office.
FLATOW: Yeah. I'd like to get - let's talk more about this. Our number is 1-800-989-8255, 1-800-989-TALK. So you're saying that they do have their place for certain kinds of problems, for certain kinds of functions?
Dr. FIELDS: They have a business model, which says that we'll take care of a limited number, 18, 19 - depends on which one - of self-limited type illnesses and maybe small injuries, and we might give some flu shots. But we are not there to treat your high blood pressure or your diabetes, complicated medical problems. We're not there for follow-up visits. We're just there to provide a convenient, fairly quick, fix for a problem that's probably going to get well on its own given time but that you may need some symptomatic relief or it may be after hours or on a holiday weekend like coming up where most physician offices are closed.
CONAN: Right. So if your kid is trying out for the chess team and he needs a physical, that would be okay, something like that, just to - pro forma sort of thing?
Dr. FIELDS: Yes. Some of them do do that. But, you know, physical examinations are not just pro forma. They serve a purpose and that's to get people into the medical system, to detect problems that are not obvious on the surface. And therefore, chess team physical I could see. Football physical on the other hand, you know, what about the heart murmur that was undetected previously and all that. So I would be cautious about that kind of thing.
CONAN: Are these places regulated?
Dr. FIELDS: They're not really regulated. Some states, like Massachusetts, have started to look at regulations. And like Rhode Island - I mean, I think they tried to put some in Rhode Island that didn't have sinks(ph), and so that didn't quite fly. But I think most of those problems have been corrected. But there's no overall state regulation or federal regulation of retail clinics.
CONAN: So what kinds of people run them and staff them?
Dr. FIELDS: They're generally staffed by mid-level providers, which are generally advanced registered nurse practitioners. Some, they have physicians' assistants and some even have physicians.
CONAN: How many different kinds of - or different types of clinics are out there?
Dr. FIELDS: There are about 50 different varieties. Most of which are small, either regional or local-type things. There are two or three big nationwide chains and those are all staffed by nurse practitioners.
CONAN: We've seen in the past - in the last few years, these places that offer full body scans, things like that.
Dr. FIELDS: Yeah.
CONAN: But they're at the mall.
Dr. FIELDS: Yeah. At the mall, right. And, you know, it's like what sense does that make? Because what are you going to do with the results. You know, the most precious thing that a patient can have these days - because we have a very complicated, highly technologically advanced medical system - is a personal medical home with their family physician where all your medical history resides, where you can always come back to get advice, get 80 to 90 percent of your problems taken care of. And we try to make sure that these retail clinics are at least linked in some way with the medical home where they act as a funnel to get patients who don't have family doctors into the system. But the point about the CT scan or the MRI at the mall is - so you get the result -who's going to take care of that result if you don't have a family doctor?
Dr. FIELDS: Certainly, not the person that owns the CT scan or the MRI. And the other question would be - so you find something, what do you do then?
CONAN: Mm-hmm. 1-800-989-8255 is our number. Martha(ph) in Baton Rouge. Hi, Martha(ph).
MARTHA (Caller): Hi.
CONAN: Hi. Go ahead. Thank you.
MARTHA: I just wanted to say, in the past, if I developed an ear infection or something, it'll always - you could call the ENT doctor and they say, oh, we can't see you for two weeks, you know? These walk-in clinics, I think, they have a really a good function for the people because, you know, lately, I've been having infection and I was able to go to a walk-in clinic in Baton Rouge and get treated for it. And I don't have to wait to see an ENT doctor. It really serves the purpose for what I needed it for.
CONAN: Was the clinic in the mall or a shopping center? Was it a separate clinic…
MARTHA: No. This was a freestanding clinic that's affiliated with one of the local hospitals here.
CONAN: Now, Dr. Fields, that's a different thing, it sounds like.
Dr. FIELDS: Yeah. That's a whole different animal(ph). And I don't know if Martha is still on line, you might tell us if she was seen by a nurse practitioner or a PA or a physician?
MARTHA: I was seen by a physician.
Dr. FIELDS: Right. Now, that's a whole different ball game. Most hospitals or big hospitals do have what we call outreach clinics that are physician-staffed. And essentially, they're staffed by family doctors, general type internists, maybe pediatricians. They do function in some ways as a medical home. So that's exactly what we've been trying to get our 94,000 members to do, is to make their office more convenient to patients, longer hours, faster appointments, same-day-type things, in order to provide what patients want, which is convenience. But, you know, you don't need to be seen by an ENT for an ear infection, you know, but you do need to be seen by your family doctor. So it sounds like she has a medical home that she can certainly rely on.
MARTHA: Yeah. I see my primary care physician every six months.
Dr. FIELDS: Right.
MARTHA: And she's still located in New Orleans.
MARTHA: Although, I moved here from New Orleans after the storm. But I still see her every six months.
CONAN: Oh, good for you. Thanks for calling, Martha.
MARTHA: Okay. Bye-bye.
CONAN: Have a good weekend. 1-800-989-8255. Let's go to Conrad(ph) in Hampton, Virginia. Hi, Conrad(ph).
CONRAD (Caller): Hello, there. Thank you very much for having me on your show. I think this is a wonderful development for what, I guess, I would call the enlargement of our medical footprint. Our emergency rooms are so overtaxed that they are just not - I've been - I've spent a lot of time in emergency rooms. Believe me. But my family doctor is now in one of these outline clinics and they handle things very well for me. I had once some stitches put in when I slashed my hand open at the so-called doc-in-a-box, the urgent care center. Well, now, we have this other thing, this other toll, I guess, on the footprint for people who don't have to go to the emergency room for flu or a headache or - and will get a proper referral. But we need publicity. I mean who handles what? See what I mean?
CONAN: Yeah. Dr. Fields?
Dr. FIELDS: Well, that's true. You do have to know what these things are capable of handling. And the problem with 50 different varieties is they handle 50 different sets of things. And so you don't always know. And if you have other medical problems, if you're elderly, if you're taking a lot of medications, these things are not appropriate for you because of the complicated nature of your problem.
For instance - take example, headache, well, I don't know that you'd actually go to one of these things for a headache because you don't know whether that's a migraine or a sinus infection, which can cause headaches, whether it's a muscle contraction headache, and these things are not set up to make a differential diagnosis and do diagnostic testing in general.
Now, the ones affiliated with hospitals that are staffed by doctors are. The ones that are in the grocery stores and the pharmacies in general aren't. He mentioned referral. He mentioned appropriate referral. You know, we have certainly tried to work with the industry to make sure that there are family doctors in these towns that will see these patients in follow-ups so that the appropriate steps can be taken.
FLATOW: Do they take insurance, by and large?
Dr. FIELDS: Sometimes they do, sometimes they don't. That, again, is variable. There have been some developments in that area. They first started with the business model that said, you know, cash only. You're sick. We're quick. And that pretty much went out the window and their charges started to go up. And then some of them do take insurance. Some of the insurance companies have tried to negotiate whether they should pay co-pays or not there. And certainly that can come into a contentious situation in the given state. It's a region-by-region thing.
FLATOW: Mm-hmm. Anna(ph) in Miami. Hi. Welcome to Science Friday.
ANNA (Caller): Hi. I just completed a survey online for a grocery store that's apparently considering putting these clinics in. And I've got to tell you, I honestly was grossed out by the idea of really sick people being around produce and food that I'm eating or being in an area where I usually take my kids. So I don't know what the thought is by putting these clinics in highly, you know, public places that have a lot of traffic if we're so concerned about contagious diseases.
FLATOW: Interesting question, Doc.
Dr. FIELDS: Yeah. That's a brilliant point. And I made a previous interview with a print magazine that, do you really want to take sick people and mix them in with the general public? That's - I realize these places have several waiting areas and things like that. But, you know, what - the reason these things are in the retail stores is to generate more traffic in the store and so you buy things there and you fill prescriptions there.
As a matter of fact, according to some of their own research, particularly in the grocery stores, they have four goals, you know, some to gain more control in their industry, utilize their space better with increasing their foot traffic, compete better in their industry and advance their brand. But it doesn't say anything about health care. And if you go into one of these things with the flu, you're going to share that with hundreds of your fellow citizens. And that's really not something that we promote. I mean, it would be like if I sold apples in my office. I mean, who would want to buy an apple from me?
FLATOW: Thanks for calling, Anna. 1-800-989-8255 is our number.
We're talking with Larry Fields who is a family physician and chair of the board of the American Academy of Family Physicians this hour on TALK OF THE NATION: SCIENCE FRIDAY from NPR News.
We're talking about these clinics that are springing up in food stores and places all over the country and some of the things to be wary about.
CONAN: Rodney(ph) in Kansas City, M.O. Hi, Rodney.
RODNEY (Caller): Hi. Yeah. I'm totally in favor of the clinics. We've got a -we have four kids. And, you know, kids have always got the step over(ph). They've got a fever. They've got something like that. And it is just so convenient and it is - it's staffed by a nurse practitioner. And the convenience of being able to go there after school, get the kids in, find out what's wrong. And, you know - and this is just an ear infection or strep throat, I mean, the simple things is when we use that for. And it has been a definite help to us.
FLATOW: Where is the clinic in your case?
RODNEY: It's in a retail pharmacy.
FLATOW: Uh-huh. Doctor?
Dr. FIELDS: Yes. Well, Kansas City is where our headquarters is and one of the early adopters of this model. And the reason that he can get in and out quickly there and the reason they take care of appropriate things is that our academy have started working with, I believe, it's Minute Clinic that's in - been owned by CVS…
RODNEY: That's where we go.
D. FIELDS: …in the Kansas City Market. And we developed a set along with them and others in the industry of what we called desired attributes, which were for patient protection. And it's had a limited list of things, affiliation with a referring physician that will see patients in follow-up, electronic health records, communications both ways. So I'm not surprised that the ones in Kansas City work real well. Those were some of the first. And we worked very closely to try to get the business model and the care model with them adopted nationwide.
FLATOW: Thanks for calling. I will see if I can get one quick phone call in from Dr. Seth Levy(ph) in Palm Beach. Hi, Doctor.
Dr. SETH LEVY (Caller): Hey. How are you guys doing today?
FLATOW: Hi. Quickly.
Dr. LEVY: Okay. I just wanted to find out how they deal with the Medicare population. We are actually a group of doctors that do nothing but house calls to Medicare recipients.
FLATOW: Oh, good for you.
Dr. FIELDS: That's a great - especially in Florida, that's a great, great way to take care directly to patients.
Dr. LEVY: Yes, sir.
Dr. FIELDS: And these things deal with Medicare pretty much like an office would, you know, there are still a co-pay and the deductible. And then they would pay a fee for service or these places would have to file Medicare. So most of them don't do that and it's just cash out of the patient's pocket.
Dr. LEVY: Okay. Are you also able to do diagnostics? For instance, we're able to do everything at the bedside from (unintelligible), sonogram, echo, blood draws, X-rays, everything.
Dr. FIELDS: Oh, I - no. I'm not - I don't' work for a retail health clinic. I'm a family doctor.
Dr. LEVY: Oh, okay.
Dr. FIELDS: I'm the chair of the board of the American Academy of Family Physicians.
Mr. FLATOW: But can you expect them to do those things?
Dr. FIELDS. No. Absolutely not. Now, some do. And that are, again, associated with hospitals or that are physician-run. But, most…
Dr. LEVY: Okay. But because today, everything is mobile, we literally bring that right to the bedside. And we are also on EMR, electronic medical record. Yeah.
FLATOW: Well, thank you, Dr. Levy, for calling.
Dr. LEVY: Thank you.
FLATOW: You have a good weekend. So quickly, Dr. Fields, what did you look for if you want to shop for one and then get a good one? What are some of the things to look for?
Dr. FIELDS: Well, you want to makes sure that it's probably one of the big national chains. And if it's located in a CVS or a Rite Aid or wherever it probably is, you want to make sure that they have separate facilities, that you're not exposed to the general population - more for the population's, you know, health and yours. If you have an infectious disease, don't go running around the store after you get seen because you'll just be spreading problems. Make sure they have hand-washing facilities, and make sure that they can connect with your family doctor. That is the most important thing.
FLATOW: For a follow-up.
Dr. FIELDS: Connect with your family doctor, your medical home.
FLATOW: Dr. Fields, thank you.
Dr. FIELDS: Thank you, Ira. It's a pleasure.
FLATOW: Thank you. You're welcome. Dr. Larry Fields, a family physician in Ashland, Kentucky and chair of the board of the American Academy of Family Physicians.
We're going to take a short break. And talk about something totally different, as Monty Python used to say, much ado about nothing. So stay with us. We'll be right back after this break.
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