Doctors Not Happy About Express Clinics

Chris Frazier looks sick. His head aches, he's congested and he's decided to get help. A woman in a white coat directs him to an exam table and asks about his symptoms. It seems like a normal trip to the doctor—except that just 15 feet away, cash registers are ringing up Cheerios and Tater Tots. Instead of wasting an hour in his doctor's waiting room, Frazier is at a RediClinic located inside an H-E-B superstore in Katy, Texas, where a nurse practitioner quickly diagnoses his sinus infection and prescribes an antibiotic. The visit costs a fraction of what his doctor charges—and the next time he's sick, Frazier says, he'll be back.

It's a scene playing out in stores across the country—and it may change the way Americans think about health care. Seeking treatment for a bladder infection at the same place you buy dinner may feel strange (and if it doesn't, wait until you're asked to produce a urine sample not far from the produce aisle). But by offering patients quicker, cheaper alternatives to doctors, so-called convenience-care clinics—staffed by nurse practitioners who offer low-cost treatment for easy-to-diagnose conditions—are spreading faster than a cold in a kindergarten. Two years ago there were just a handful of these clinics; now there are more than 500. As health insurers have embraced the concept, some forecasters say there could be 5,000 clinics operating by 2012; Wal-Mart alone says it could have 2,000 clinics in its stores within seven years. Among the concept's boosters is Steve Case, the founder of America Online, who bought a stake in Houston-based RediClinic two years ago. "Most people thought these clinics would never get off the ground," Case says. "But we've seen an acceleration of interest, and it's happened faster than we thought it would."

The clinic model has two simple premises: that physicians are overqualified to treat many everyday maladies, and their waiting rooms are often intolerably jammed. The clinics offer a solution by using nurse practitioners to treat a very limited set of common illnesses that can be confirmed by simple exams and tests. Most clinic customers have strep throat, ear infections or urinary-tract infections. Some clinics offer basic physicals or blood tests, but they won't treat anything very complicated (no X-rays or stitches) or see patients with chronic conditions (like diabetes) that require follow-up care. Due to the limited scope of treatment, patients are in and out in 15 minutes, eliminating the need for appointments. Another big benefit: unlike many doctors' offices, the clinics are open during evenings and weekends. Monica Castillo used to drag her four children to a pediatrician whenever one was sick, but since Sutter Express Care opened inside a Rite Aid near her Sacramento, Calif., home, she now waits for her husband to get home from work and takes only the sick kid to see the nurse. Having a pharmacy right there "makes it even more convenient," Castillo says.

Some doctors applaud the concept—but not everyone is a fan. Critics complain that the clinics lead to "fragmentation" of care and incomplete medical records. Some doctors fear having to clean up messes left when clinics misdiagnose conditions (though so far no one can cite a single malpractice claim). Last month the American Medical Association called for an investigation into the clinics, based partly on the potential conflict of interest regarding drug sales. Since 2006, CVS and Walgreens have bought the two biggest clinic chains, MinuteClinic and Take Care—leading some critics to believe the clinics may overprescribe to boost drugstore sales. The clinics point to data showing its nurse practitioners write scripts less frequently than doctors, but skepticism remains. "The clinics need to be careful that they're not just a place to ... sell drugs to people," says David Dale, president of the American College of Physicians.

For policy experts, the clinics' big attraction is the low cost: most charge less than $65 per visit. In some neighborhoods, up to two thirds of patients lack health insurance; many don't even have a primary-care physician. Free-market advocates say there's a lesson here: as political candidates debate ambitious plans to reform health care, the biggest innovations are coming not from Washington but from for-profit businesses catering to impatient Americans just beyond the checkout aisles.

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