Unbiased Analysis of Today's Healthcare Issues

Minute Clinics come to San Diego

Written By: Jason Shafrin - Nov• 08•07

Looks like the convenience clinic trend is coming to my neck of the woods in Southern California.  According to the San Diego Union-Tribune (“Are retail clinics a healthy choice?“) six Minute Clinics are opening in San Diego county with ten more on the way before year’s end.

These clinics likely will lower the cost of obtaining a flu shot.  Not only will providing the flu shot be less expensive for the provider, the patient will have fewer time costs waiting for a doctor or driving to an inconvenient physician location.  These clinics are likely just as safe as a physician’s office if the patient is healthy.  However, if a patient has multiple diseases and needs a more in depth check-up, these convenience clinics will be poor substitutes in terms of quality.  There is always a tradeoff.

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  1. Vieng says:

    Wow, that’s pretty cool. I haven’t heard of these. Here are some thoughts from my limited med-student perspective.

    I think these clinics could be a great idea, after all, how often have you had to make a doctors appointment for things that could easily be done by a physician assistant or nurse practitioner (vaccination, screening tests, med refills-only if you’re on stable medications for a chronic illness, of course). It will be very important for the clinics to realize what they can do (take out stitches) verses what they cannot do (debride infected lacerations).

    “In California, public officials and insurers have been unable to solve skyrocketing health care costs and the ballooning ranks of the uninsured. Retail clinics are one potential answer from the private sector.”

    These clinics could fill a very important role for a growing population of Californians – those that are covered by medicare/mediCal (and thus ineligible for care at most free clinics) but still cannot easily afford regular medical care. This could cut costs in several ways: for the patient (cheaper procedures and decreases time-off from work), for the health care system (people no longer using the ER as their primary care clinic and hopefully seeking care before it turns into a medical emergency), and for the doctors themselves (they would triage the ‘easy stuff’ to these clinics and be able to more effectively deal with complex patients).

    In order for it to work successfully, the current medical system must embrace these clinics and incorporate them into the health-care heirachy (triage triage triage). We (as health-care providers) shouldn’t look at these clinics as an ‘intrusion’ or as ‘competition’ but work to ensure that they only handle situations they are equipped to and refer everything else to a licensed doctor.

    “California rules require at least one supervising physician for every four nurse practitioners or one for every two physician assistants. The supervising doctor typically works off-site and is consulted by telephone.”

    To be honest, I’d be more comfortable if the physician was actually on-site instead of on-line. Though I’m sure that it is cheaper to have an MD on-line as then it’s also possible to outsource to other countries where the docs are just as knowledgeable but don’t charge as much for their consulting services.

    “Our concern is not with the concept (of retail clinics) but with the execution,â€? Gehring said. “Physician oversight of allied health professionals must be maintained. If you want to be a doctor, go to med school.â€?

    Yes and no. Honestly, how much of medical school is memorizing algorithms and how much of 3rd year (clinical year of medschool) is spent referring to uptodate/google/epocrates (on-line resources). You don’t have to be a rocket scientist to be a doctor, and the smartest people don’t often make the best doctors. I’m not trying to minimize the profession or the training required. I think physicians must be an integral part of these clinics if they are to work at all. I mean, there is a very good reason that medical training is so long…there is a lot to learn and there is a lot at stake; I’m just not sure that doctors being elitist are the right stance to take. On the other hand, there is something to be said for the idea that primary care docs are the ‘first line’ … meaning that they are responsible for identifying potentially life-threatening conditions that parade around as something milder. It will be interesting to see how this works in SD.

    My (possibly more than) two cents.