MDs the Right Medicine for Reade’s Clinic Biz
Most in-store health clinics in the U.S. are
staffed by nurse practitioners. Duane Reade in New York has taken another tact and partnered with companies to offer in-store clinics manned by doctors.
"I strongly believe that having our
clinics staffed with physicians — not physician assistants or nurse practitioners
like they use in other drugstores — is a big reason for our success," Adam
Henick, senior vice president for ambulatory care at Continuum Health Partners,
told Crain’s
New York.
Continuum, the parent company of Beth
Israel Medical Center and St. Luke’s-Roosevelt Hospital Center in Manhattan,
has partnered with Duane Reade to offer patients at clinics the ability to
go to its facilities for follow-up care. Actual care at the in-store clinics
is handled by physicians employed by the Duane Reade Walk-In Medical Group
and Consumer Health Services.
The chain currently
has two clinics operating with plans to add another 20 by year’s end. The
reason for expansion is because both Duane Reade and Continuum have seen
benefits.
“We are absolutely seeing a flow of new patients,” said Mr Henick.
The
drugstore chain is looking to open a new clinic at its store at 135th St.
and St. Nicholas Ave. in Harlem. It is the first clinic to open in a lower
income area.
Mr. Henick said, “We are working with Medicaid managed care
companies to come up with reasonable payments.”
The clinic should benefit
insurers and get their support, said Mr. Henick, because it “will drive
people who don’t need to be in the ER out of the ER.”
Discussion Questions:
Is there a competitive advantage for retailers using doctors instead of nurse
practitioners to operate in-store clinics? Does Duane Reade operating stores
in densely populated New York have more of an opportunity to succeed with
in-store clinics than those in more suburban locations? Will the chain be
successful with the concept as it moves into lower-income areas?
Using docs instead of nurse practitioners may in fact drive greater adoption of retail clinics, and I agree it will drive re-routing of patients from ERs to a more appropriate setting for various conditions. I think the key is to solve for the payment issue, and to socialize the key differences in “why would a shopper chose a doc staffed option” over a Walgreens clinic staffed by a nurse?
I also think it returns nursing care to its roots and adds to the diagnostic competency most docs are trained for.
There may be some slight advantage but nurse practitioners are becoming a fixture in many doctors’ offices so an increasing number of patients are learning to trust them as much (or possibly more) than regular physicians. In the end, it is the quality of the care, not the degree that will build loyalty. That’s why people trust their pharmacists more than their doctors.
A Nurse Practitioner or Physician’s Assistant in most states can do anything a physician can do in a clinic setting. The real measure of whether the clinic should be staffed with a NP (or PA) versus an MD is the extent of care the clinic offers.
If it is a substitute for an emergency room, a physician is required. If it is taking the place of a simple doctor’s office visit, the NP is all that is needed. Under the current model, the chain drug stores don’t need a physician. Further, they would be foolish to offer services that require a physicians’ attendance, and all the complications and liabilities that go with it.
You may get a very different answer from the above if you are surveying potential patients. Today the natural answer would be that patients want a doctor. But, as clinics expand and more people use them, more will realize that the physician is unnecessary in most cases. They will also realize that the NP may actually provide better and more personal care than one receives at the doctor’s office.
Pharmacy associated clinics will not only expand, but will boom. The convenience alone will provide the impetus. It will make no difference if the clinic is located in middle class or lower-income areas.
I have found that in-store clinics are useless without doctors. Nurses are not allowed to do anything for a patient that the patient couldn’t do for themselves. Seems to me the nurse’s primary job is to refer patients to doctors. Having the doctor on-site would seem to solve this problem.
It is going to make a difference where you have the population density to support a doctor and as long as you keep the fees at the same price point. Everything we keep reading is price, price, price and the person using an in-store clinic is going to want convenience and price. If the price goes up and they have an alternative place to go even if the service is different, they will give the price point location the first try.
It’s all about perception. I agree that a nurse practitioner or physician’s assistant in most states can do anything a doctor can do in a clinic setting. In fact, I would even guess they could hire a highly experienced nurse practitioner for less money than any doctor. The patients may even get better care. However, this isn’t necessarily about care, it’s about profit. And if advertising the fact that they have actual doctors brings in more traffic, then you can’t argue with success. Based on their initial success, their customers do perceive more value.
Why have so many of the clinics with nurse practitioners closed? Was it traffic? Was it liability? Was it an issue of what nurse practitioners could and could not do? Without knowing what the problems and issues were in that situation, how can you know whether using doctors will work better?
Knowing the consumer in a specific location is really the key. For example–if the area around the retail location is Korean; the professional in the location should have an understanding of Korean.
If the retail location is in a Hispanic area, the professional should be fluent in Spanish.
This ethnic “understanding” of the geography is really key.
I wouldn’t say it’s a competitive advantage to have a doc in the box rather than a nurse practitioner. Having a doc will instill a sense of confidence and trust in some consumers, such as seniors who naturally look for a more traditional doc/patient relationship. For others who may simply need to get a minor finger burn tended to or a flu shot, the nurse practitioner works well. It’s really going to depend on the customer base the chain hopes to serve. And keep in mind, it needn’t be one or the other. The ability to staff the clinic with a nurse practitioner and have the doc be available via remote monitoring technology is a distinct possibility.
Re: the potential for convenience clinic success, I don’t think access to quality, affordable healthcare is an urban/suburban issue. Consumers across demographics want the same thing when it comes to healthcare. Duane Reade and the plenty other chains that have entered the convenience clinic industry are responding to the consumer’s desire for more convenient, accessible healthcare. These clinics, much like the retailers that put the clinics in their stores, come in a variety of stripes. Smart chains will do their homework and figure out the best clinic offering to suit their customers.