From Our 2014 Archives
Retail Clinics for Kids: No Sub for Pediatricians
By Rita Rubin
Reviewed by Hansa D. Bhargava, MD
Feb. 25, 2014 -- Like many busy parents, Ellen Hoffman likes the convenience of the MinuteClinic, a handful of which can be found in CVS pharmacies within a few miles of her home in Bethesda, MD.
Her two daughters, 14 and 12, often get ear infections or colds that are going around. "I used to take them [to MinuteClinic] all the time because my pediatrician's office was a pain in the neck," Hoffman says. "I could never get in there."
Eventually, though, her local MinuteClinics became so popular that their wait times were as long as those at the pediatrician's office. Still, Hoffman says, she takes her girls to MinuteClinics in Florida when they come down with something while visiting their grandparents.
"It's better than not having that resource, but it doesn't replace having your own doctor," Hoffman says.
That's the message the American Academy of Pediatrics (AAP) is trying to get through to parents in a new update of its 2006 policy statement about retail-based clinics in pharmacies, supermarkets, and "big box" stores. The group continues to oppose the retail clinics, calling them "an inappropriate source of primary care for pediatric patients."
Compared to 2006, "there's a lot more of them, and our patients are using them," says Geoffrey Simon, MD, a pediatrician in Wilmington, DE. He chairs the AAP's Committee on Practice and Ambulatory Medicine, which issued the updated statement.
While most retail clinic patients are adults, polls cited in the policy statement found that 15% of children were likely to be taken to one.
Advice for Parents
Consider these tips if you take your child to a retail clinic:
According to CVS, MinuteClinic is the largest and fastest-growing retail clinic provider in the country, with more than 800 locations inside CVS pharmacies in 28 states and the District of Columbia. They're staffed by nurse practitioners and physician assistants -- they are not doctors but are licensed to practice medicine.
Walgreens runs about 400 Healthcare Clinics staffed by nurse practitioners in 20 states and the District of Columbia. And nearly 100 Walmart stores in 20 states offer clinics that are owned and run by independent companies.
Convenience, Convenience, Convenience
As Hoffman noted, convenience seems to be the main selling point of the clinics. A recent study of nearly 1,500 parents at 19 Midwestern pediatric practices found that almost 1 in 4 had taken their children to a MinuteClinic or a similar place. Three-quarters of the parents who took their children to a retail clinic had first considered going to their pediatrician but dropped that idea. The main reasons were that the clinic had more convenient hours or they couldn't get an appointment at the doctor's office, according to the study, published in September 2013 in JAMA Pediatrics.
Simon says the AAP's opposition to retail clinics isn't part of a turf war. "We're offering a different type of service and a different level of expertise," he says. "It really hasn't hit anybody's revenue."
He says that when he practiced in Atlanta, he used to tell patients to go to a particular MinuteClinic instead of an emergency room for minor complaints when his office was closed. He had talked with the chain's medical director and felt comfortable with the care at that MinuteClinic.
Question of Care
The AAP's main concern with retail clinics is that the care they provide is "fragmented, episodic, and not coordinated," the group's policy statement says. Health-care providers who staff the retail clinics "lack pediatric training equivalent to pediatricians and do not provide after-hours coverage for patient/family questions or complications," the statement says.
A child's family pediatrician is also better able to see patterns that might point to a larger health problem.
Spokespeople for the two largest retail clinic chains say they are not trying to replace primary care doctors.
"We strongly encourage all patients to have a relationship with a primary care physician," Walgreens spokeswoman Emily Hartwig says. "Our objective as part of the health care team is to support and complement physicians' care plans."
Andrew J. Sussman, MD, president of MinuteClinic, says staff members at his clinics are in constant touch with young patients' doctors. "With patient permission, thousands of visit summaries are sent to pediatricians every week via fax or electronic medical record systems within 24 hours of the child's visit," he says. "This ensures continuity of care and provides doctors an opportunity to follow up with patients should they choose to do so."
Pediatricians could collaborate with retail clinics, the policy statement says. That should include such things as prompt communication and referral of all patients who see a retail clinic doctor back to their pediatrician. Also, pediatricians can try to make their practices more convenient for parents by having "extended hours, open scheduling, and same-day appointments for even 'minor' acute illness," the statement says.
Many pediatricians already do that, Simon says, noting that his practice sees patients Saturday and Sunday mornings as well as on weekdays. Scheduling isn't everything, though, he says. "A lot of parents go [to the retail clinic] when the pediatrician's office is open because they feel it's more convenient."
SOURCES: Garbutt, M. JAMA Pediatrics, 2013. Ellen Hoffman, Bethesda, MD. AAP. Pediatrics, published online Feb. 24, 2014. Geoffrey Simon MD, chair, AAP Committee on Practice and Ambulatory Medicine. Emily Hartwig, spokeswoman, Walgreens. Andrew Sussman, MD, president, MinuteClinic. Walmart.com.