Consumers, especially younger consumers, are increasingly driven by convenience in seeking health care. This has contributed to the rise of medical clinics in the workplace and in retail settings, such as grocery stores and pharmacies, and to the growth of stand-alone urgent care centers and even emergency rooms. These settings also typically provide less expensive care and are often staffed by nurse practitioners or physician assistants. As might be expected, the primary care physician community has been less than thrilled with these developments and now the American Academy of Family physicians has issued a patently anticompetitive statement on conditions that retail clinics should meet. (AAFP Statement) The statement bows to the reality that the clinics are here to stay, but attempts to assert the primacy of family physicians in treating patients.
Here are a few of the conditions that the AAFP sets forth. Employ local supervising physicians; support coordination of care; always refer patients back to their primary care physician for ongoing care; utilize EHRs to transfer medical records regarding care to the primary care physician; only deliver chronic disease care in coordination and at the direction of the primary care physician; and help patients find a family doctor. You get the drift–“these poor patients who are misguided in seeking care at a retail clinic need to be directed back to a real doctor as soon possible and any care they do get should be closely overseen by someone who really knows what they are doing.”
Fortunately, no one is going to pay much attention to the AAFP’s conditions, least of all the patients who visit retail clinics. Coordination of care is undoubtedly important, but for many consumers, the retail clinics are now their source of primary care. The statement is another doctor-directed slap at professionals like nurse practitioners and physician assistants, whom research suggests are every bit as capable as physicians at delivering quality care and who don’t need physician assistance or oversight to render most of the care patients seek from them. And of course, given the discontinuity of care rendered by many primary care doctors, AAFP might want to get its own house in order before giving advice to others. And primary care practices might want to figure out how they can deliver care as inexpensively and conveniently as retail clinics and other alternatives do.