The New York Times carries a front-page feature on the explosion of convenient clinics in America’s largest city. The Times counts 600 clinics nationwide, and Duane Reade alone plans to roll out 60 more in New York City in the next 18 months.

The city claims that one in five New Yorkers lack a regular doctor and one in six is uninsured, and they often use hospital ERs for routine care. Convenient clinics, often located in drugstores and staffed by nurse practitioners, or (sometimes) physicians, are one way entrepreneurs are addressing their needs.

But not if Frank Muñoz, Associate Commissioner of New York State Department of Education’s Office of the Professions has anything to say about it: “If we determine the business corporations are practicing medicine, then they are illegally practicing this profession and we have the authority to investigate.”

As I’ve already noted, Mr. Muñoz and his ilk are backed up by some primary care practitioners, who “stand to lose business from the clinics”. Dr. Rick Kellerman of the American Academy of Family Physicians admits that convenient clinics are a “niche market” but adds that “this is not the answer” to “big problems in health care”.

No sir, but there is not one answer. Health reform is about lots of different answers to serve the needs of patients who often do not have access to primary care physicians (who increasingly seem to keep bankers’ hours); not waiting for the New York State Department of Education’s Office of the Professions to give you permission to get the health care of your choice, with your own money.

Another “problem”? That the clinics (sometimes owned by pharmacies) inappropriately refer their patients to the host drugstore to fill prescriptions. According to one study, a visit to a convenient clinic cost, on average, $18 less than a visit to a primary care practitioner, but prescription costs were $4 higher per patient.

To me, that adds up to $14 of savings, but not to the busy-bodies. That $4 is evidence of self-dealing. Not so fast: physicians often give patients sample medicines, and I haven’t heard of convenient clinics getting free samples from drug companies, so that might explain a lot of the $4 difference.

There is also the well observed (but not fully understood) fact that many patients who get prescriptions from their family doctors do not fill them: over one fifth of patients in a recent study, for whom lack of transportation was a major reason (Wroth & Pathman 2006).

So, if part of the business case for convenient clinics is that they increase revenues to their host pharmacies, that's a benefit for patients – not a problem.

…Which would explain why they’re not sprouting up in Mr. Lube, J.C. Penney, or Virgin Records Megastores.

Reference:

Wroth, T.H., & Pathman, D.E. (2006), “Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care,” Journal of the American Board of Family Medicine, 19, 5: 478-486.