Doc-staffed clinics set new standards

NEW YORK —Take a typical physician’s office, drop it into a big-box retailer or drug store and you essentially have the next growing trend within the convenient care clinic landscape.

While the nurse practitioner-staffed clinic model continues to garner most of the news headlines, there’s no doubt that the newer trend of physician-staffed clinics is rising to the surface to meet the health care needs of Americans. Of the 600-plus retail clinics in operation nationwide, a small portion is the physician-staffed model. But there’s no doubt the number is growing.

“When we looked at the status of health care in the country, one of the greatest issues for us was the problem of access to physicians,” said Ken Richmond, vice president and chief medical officer of Medical Marts, which has partnered with select Meijer, Kmart/Sears and ShopKo stores. Given that mass-market retailers are open seven days a week, including evenings, such a partnership made perfect sense.

The concept comes at an important time for the convenient care clinic industry. It is no secret that some in the medical community are concerned with retail-based clinics, which typically staff nurse practitioners to diagnose and treat patients suffering from acute ailments. Some opponents have cited a lack of continuity of care and a risk that the clinics will replace a doctor-patient relationship. Furthermore, in June, the American Medical Association announced that it would push for state and federal agencies to conduct investigations of convenient care clinics for potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy retailers.

Having a physician-staffed model—like those operated by Medical Marts, Solantic, QuickHealth and Consumer Health Services—could help operators escape the criticism and scrutiny.

As with the nurse practitioner-staffed model, there are some differences between the various brands. For example, one operator may have X-ray equipment, while another may not, and the prices vary.

Richmond of Las Vegas-based Medical Marts said of its clinics, “We are full-service physicians. Anything you would associate with visiting physicians is who we are.”

Medical Marts, which opened its first clinic last November, currently operates 10 clinic locations within certain Meijer and ShopKo units in Utah and Illinois. The company also is working on opening clinics within select Kmart/Sears stores in such states as Virginia, Illinois and Hawaii—a move that will go a long way as it works toward its goal of 400 to 450 clinics by the end of 2009.

Each clinic generally has four exam rooms and two full-time physicians on staff at a time. There also are two medical assistants or licensed practical nurses on staff to support the physicians.

“We are building full-service primary-care practices.“ Richmond said. “We are a physician office, but we just happen to be in a location that is more accessible.”

Richmond didn’t elaborate on pricing, but he said that the least-level visit is comparable in price to the same-level service at a nurse practitioner-staffed model. However, the charges are typically in-line with any other physician’s office.

Since opening its first clinic in California in August 2005 adjacent to Longs Drug Stores, QuickHealth has been on a growth track.

Currently partnered with select Longs Drug Stores, Wal-Mart and Farmacia Remedios in the San Francisco, Fresno, Sacramento and Los Angeles markets, Quick-Health has 10 clinics and expects to have 15 in operation by the end of November. By mid-2008, the Burlingame, Calif.-based company hopes to have up to 30 facilities. While it remains largely focused on California, it does believe the model will prove successful elsewhere and is looking to eventually expand outside of the state.

“We view ourselves as a family practice medical office, but are in retail units,” said Dave Mandelkern, president and chief executive officer of QuickHealth. He added that the main difference is that its in-store clinics do not have X-ray equipment.

As with most retail-based clinics, prices for QuickHealth’s services are displayed on a menu board. A basic visit costs $49, lab tests start at $19 and immunizations $19.

Following the quiet closure of its two RediClinic in-store health clinics, Duane Reade earlier this year teamed up with newcomer Consumer Health Services and opened four physician-staffed clinics called DR Walk-in Medical Care.

In an interview earlier this year, James D’Orta, chairman and chief executive officer of Consumer Health Services, told Drug Store News that when patients walk in, they are greeted by a physician extender (could be a nurse practitioner, physician assistant or medical technician). They are then placed into the exam room where they are seen by a doctor, not unlike an urgent-care center, but without the diagnostics and radiology.

He also said the scope of services is broader than a nurse-staffing model inside a retail location. For example, services at a DR Walk-in Medical Care include treating sprains, minor lacerations and abscess drainage. Prices generally range from $95 for basic care to $199 for advanced care.

The company is licensed for just more than 60 clinics in the New York area with Duane Reade and is working toward that goal. In addition, over the next 18 months it will be working with another unnamed retailer to expand to other markets including Baltimore, Washington and Charlotte, N.C.

There’s also Solantic, which operates 13 clinics, including three in Wal-Mart supercenters in Florida. The remaining are free-standing units. It opened its first Wal-Mart location in October 2005. According to Karen Bowling, chief executive officer of Solantic, the company is looking to double by mid-2008; however, none of the additional locations are expected to be within a retail setting.

Bowling said the model does not compete with primary-care physicians because its niche is urgent care, and it works with local physicians on a referral basis.

The company has X-ray equipment and lab facilities in all of its clinics, and there’s at least one physician on staff at a time. The physician is supported by nurse practitioners. Pricing ranges between $59 and $169.