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Whether doctors like it or not, retail-based health clinics in pharmacies are catching on like wildfire.

Case in point, in November, Walgreens subsidiary, Take Care Health Systems, opened 11 new clinics in Florida – four each in Tampa and Orlando suburbs and three in Miami.

The new clinics, along with others in Tucson, Az., mark a milestone for Take Care, having now expanded to 11 states with more than 100 clinics. By 2008, it plans to run more than 400 nationwide, said Rochelle Latkanich, regional nurse practitioner for Take Care, covering the eastern and southeastern United States.

“It’s an incredibly exciting time,” Latkanich said. “The main focus is to be able to provide healthcare services that are affordable and accessible. When you look at it, for patients outside the city, there is an access need.”

Take Care’s substantial growth coincides with equal expansion by its larger rival MinuteClinic, which runs 43 clinics in Florida – including seven in Tampa and nine in Orlando – within CVS Pharmacies, its parent company.

That Take Care and other retail-based clinics mainly choose to establish themselves in the suburbs rather than the inner city is one thing doctors worry about.

In 2006, the American Medical Association (AMA) passed a resolution in its House of Delegates urging greater oversight of retail-based clinics, mainly those staffed by nurse practitioners, such as Take Care. MinuteClinic also uses nurse practitioners or physician assistants. In some states, a doctor is required to be on site, but not in Florida.

Doctors worry that retail-based clinics staffed by nurse practitioners stand the chance of inappropriately replacing a primary care doctor and in effect providing substandard care, said Melanie Boscan, executive director of the Orange County Medical Society in Orlando.

“That’s certainly something physicians are always opposed to,” Boscan said. “We really feel the starting point of care should be with the physician.”

Latkanich counters that argument by saying Take Care has worked hard to establish a referral network of area doctors. Nurse practitioners work entirely within their scope, she pointed out, handling common conditions such as strep throat and administering vaccines. They do not manage, for instance, high blood pressure or diabetes. But they do perform an overall exam to see if a patient needs to be referred, she said.

“We’re not replacing a patient’s primary care provider but we want to network within the healthcare delivery system so that patients have somewhere to go to follow up with care,” Latkanich said

Another concern the AMA cited was that the clinics would not share the burden of caring for the uninsured and Medicaid patients, therefore cherry picking the paying patients in affluent suburbs. Both Take Care and Doctors Walk-In accept most major insurance carriers and Medicare, but not Medicaid. For this reason, Boscan views the retail-brand clinics as moneymaking enterprises. “They’re trying to get in on the action,” she said.

Boscan does concede there might be an access issue for urgent care, something retail-based clinics have grasped onto as a means for existence.

However, there are other urgent care clinics staffed by physicians who are available without an appointment. Dr. Stephen Dickey founded Doctors Walk-In Clinic 27 years ago in the Tampa area as a way to address long waiting times at doctors’ offices. The company now has seven clinics staffed by doctors that treat common emergent conditions, perform x-rays, and include a full laboratory. As the case with Take Care and MinuteClinic, they do not treat chronic illnesses.

Dickey said he doesn’t fault retail-based clinics, including others that exist in Wal-Mart, Osco Drug and Target. After all, he said, doctors criticized his model of urgent care when it first started that bragged no appointment necessary.

“It (the retail-based health clinic) is just another level of care,” he said.

“Anything that brings easier access to healthcare you can’t fault.”

Dickey does see a problem, however, in some of the advertising. He spotted a recent television ad for a MinuteClinic that claimed patients would see a board-certified practitioner without specifying that it was a nurse practitioner and not a doctor. “I think they’re being a little deceiving,” Dickey said.



January 2008

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