Disruptive Issues in Healthcare: Retailers as Primary Care physicians

“Retail health clinics like CVS Health aim to provide patients with acute care services at a lower cost, eliminating the need to visit the typical hospital for primary care, Ms. Buckley said. The shift in care delivery has caused traditional hospitals and health systems to re-evaluate how they use PCPs and has led many systems to focus more resources on the development of their urgent care facilities. While the downfall of such urgent care clinics is that they typically are not able to provide care for patients’ long-term health issues, retail clinics have begun to partner with PCPs and larger hospital organizations to begin providing those services.”         

https://www.beckershospitalreview.com/hospital-management-administration/these-are-the-8-most-disruptive-issues-in-healthcare.html

I’ll admit it, I used a CVS Minute Clinic for something typically done in the primary care office. However, I was in a bind and needed a PPD placed and read by the end of the week and my usual primary care clinic wasn’t able to do it. I decided to go to the Minute Clinic where I saw a nice physician’s assistant. I got it done. It was convenient and though the cost was out of pocket, it was reasonable. Is this bad? Not sure. Perhaps this is good utilization of such a clinic, but for primary care, I don’t think it it is good for primary care management. The downfall in utilization of these retail clinics is cited above as “that they typically are not able to provide care for patients’ long-term health issues.”These clinics are not set up as PCP offices with support staff etc to be able to follow, refer, track primary care issues. As such, while it was convenient in my case and appropriate, I don’t believe it is appropriate to manage primary care from within one of these clinics. Doing routine health care items as an adjunct to the primary care office as in my case, or when acute minor needs make it not feasible to be seen in the PCP office sure, but as the full time primary care manager role, not good nor safe. Safety is an issue because in primary care, patient issues are often complex with multiple co-morbidities and polypharmacy. These clinics are staffed by mid-level providers (NPs or Pas) with no physician oversight and this could be a safety issue. Perhaps as the article cites, the way forward is for an evaluation overall of the primary care model and how it is best accomplished given the apparent shortage of primary care physicians and current financial and IT constraints. But for sure, the retail clinics are not cut out to function as primary care offices. For now, I’ll leave it up to each to decide their opinion. For me on this day, the clinic served a purpose for an acute need, but I wouldn’t get my true primary care here

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams