Wednesday, July 18, 2007

In-Store Health Clinics

The July 5, 2007 Rocky Mountain News had a good OpEd favoring in-store health clinics. Here are some excerpts:
Experts who study health-care finance agree that a significant way to contain costs would be to encourage more patients who aren't suffering acute or life-threatening ailments to visit facilities that provide routine care and not occupy scarce and expensive emergency-room beds.

An ER visit to treat strep throat on average costs $329, the Rocky's Joyzelle Davis found, more than three times the cost of a trip to an urgent-care center; doctors' offices routinely charge at least $100 for such a visit.

Enter in-store health clinics, now opening at retail pharmacies and department stores. Over the past couple of years, hundreds of these clinics have sprung up across the country and thousands more are in the works. They're staffed by nurse practitioners or physician's assistants, accept patients without appointments and can write prescriptions, treat infections and perform a host of other routine procedures. Many are open seven days a week.

Physicians are available on-call if a patient requires more-extensive care and needs to be sent to a doctor's office or emergency room.

You'd hope the American Medical Association would support the concept, but you'd be wrong. The medical association claims the clinics are not safe alternatives for many patients, because they provide only limited services. It also worries that a clinic located, say, in a Walgreens might push patients to buy their prescriptions at that store rather than at another pharmacy.

...What's really going on here is protectionism, pure and simple. The association would deny patients this convenient, cost-saving alternative rather than surrender turf to innovative rivals.

The professionals who staff in-store clinics are doing nothing illegal, and they're providing patients with a service they value - affordable health care with hours that fit their desires.

On July 12 and July 13, 2007, the Rocky Mountain News printed two responses. One was from me, supporting their position and one was from Dr. Jeremy Lazarus of the AMA opposing their position.

Here is my response:
In-store health clinics

As a physician, I wholeheartedly agree with the RMN position favoring in-store health clinics ("The Cheaper Option", July 5, 2007), and I disagree with the AMA position against them. If a nurse practitioner or a physician’s assistant in a clinic is offering an honest service for a good price, and the patients find that acceptable, then nobody should interfere with their right to trade according to their best rational judgment.

Such in-store clinics are especially good at providing affordable quality health care to those without insurance and those with Health Savings Accounts, as noted by Grace-Marie Turner in the 5/14/2007 Wall Street Journal.

If the AMA truly wants what's best for patients, it should support such free-market medicine, rather than oppose it.

For more information on free market medicine, go to

Paul Hsieh, MD of Sedalia
Here is Dr. Lazarus' response:
Health clinics need physician oversight

The American Medical Association is committed to ensuring that all patients have access to high quality health care, which is why we support the safe and responsible operation of in-store health clinics.

The AMA understands and appreciates that innovative and alternative strategies may be needed to ensure all patients get the health care services they need in a timely fashion. However, we do not agree with the Rocky's July 5 editorial ("The cheaper option/AMA should stop looking down nose at in-store health clinics"). We do not accept that in-store health clinics should be held to a lesser standard than the local physician's office down the street. The AMA has put forth principles these clinics should comply with to ensure patient safety, and continuity of care when necessary.

These principles include reasonable measures such as making sure these clinics establish appropriate sanitation and hygienic guidelines; protocols to ensure appropriate physician oversight; and advanced communication with patients to ensure patients know the qualifications of the health professional providing their care.

The AMA was founded 160 years ago to promote the highest standards of medical care in this country. History shows that patient care and medical practice have benefited from these efforts. The AMA remains committed to promoting these high standards of care whether it's delivered at your doctor’s office or at an in-store clinic.

Dr. Jeremy A. Lazarus of Greenwood Village is a board member of the American Medical Association.