The American Association of Family Practitioners has revised it’s position on retail health clinics from mildly concerned to oppositional. This is in response to what the association sees as expanding scope of services offered by the clinics, which are small health care outlets typically located in pharmacies, grocery stores, and other retail locations that have historically focused on treating a handful of very standard illnesses like strep throat, bronchitis, ear infections, and pink eye.
These clinics have always represented a threat to the AAFP, since they primarily staff physicians assistants and nurse practitioners and are an obvious substitute for their members. This is not the first organization of health professionals to object to the retail clinic model. The American Academy of Pediatrics has previously issued a policy statement listing their concerns about quality of care and safety and officially opposing the use of retail health clinics for infants, children, and adolescents. The AMA, and the American Academy of Family Physicians have called for increased regulation.
A symposium last year in Health Affairs on retail clinics included articles showing that 90.3% of visits to retail clinics were for clinics typically served 10 common and simple illnesses. Furthermore, clinics treated these patients at lower cost than traditional health providers, specifically, $50-$60 cheaper per treatment, and they serve a population that is currently underserved by primary care providers. Other studies, which I can’t find right now, have shown no difference in treatment quality between retail clinics and traditional caregivers. So if retail clinics are treating common illnesses, at lower cost, with the same quality, what is the problem?
The AAFP is worried that clinics are expanding the scope of services they offer. According to a 2008 interview with an industry expert by the AAFP, clinics have the following expansion of scope in mind:
You can see the expansion with things like camp physicals, screenings and preventive care. Consumers need a health care provider; they want something done quickly, simply and conveniently. That core brand promise is now being applied to a whole new range of services, including injections, vaccinations and weight loss counseling….
This is supported by a recent study from Health-Leaders InterStudy, which confirms that in some markets retail clinics are expanding the services they offer. The more services these clinics provide the more they are competing with the AAFP’s members, so this move represents an increasing threat to them.
The expansion of scope is not surprising either, while retail clinics are popular and growing in numbers, there have long been concerns about clinics profitability. In recent years have been several incidents where large retailers, including Wal-Mart and CVS, will close several clinics at once. The issue appears to be that clinics have to serve a lot of customers a day in order to be profitable, and one easy way to overcome this would be to expand the scope of services.
Entrenched industry groups have been successful in the past in getting states to impose burdensome regulations on retail clinics, and this increasingly oppositional stance by the AAFP may add to that.