With an increase in medical clinics operating out of establishments such as CVS, Wal-Mart and Walgreens, consumers of medical services are taking note of promises of convenience, lower costs and speedy service. Studies on PubMed dating back as far as three decades support and anticipated the current high level of interest of families with children in these walk-in clinics, given the services they offer and the highly convenient hours that are usually outside of a physician’s office hours.
Most walk-in clinics are staffed with nurse practitioners and physician assistants, addressing the most pressing issues for which worried parents may not want to wait for an appointment with a pediatrician. However, the AAP has identified a series of concerns with walk-in clinics, specifically:
- Symptomatic-only treatment: Access to a child’s health record is likely not readily available, thus the clinic can only treating the prevailing symptoms.
- Lack of Pediatric-specific knowledge: Family practice knowledge cannot be equated to pediatric knowledge
- Inability for follow-up: The ‘convenience’ visits usually serve an immediate need and, though follow-up with a pediatrician is always recommended, in many instances the clinic may not be able to cover the complete health needs if symptoms worsen.
- Clinical setting: Not all retail clinics offer the level of exam room privacy that pediatric offices provide.
- No Support for the Medical Home: The medical home is the optimal standard of care for pediatric patients, yet it is understood that the services of these clinics may be used for acute care outside of the medical home.
Armed with such knowledge, pediatricians will need to determine how to best serve their patients and families, while maintaining an appropriate work/life balance. What could you consider?
- Offer the same and more: The best way to counter the potential impact on a pediatric patient’s longitudinal health is to understand in detail how any nearby competing walk-in clinics work, what services they offer, what office hours they keep, how they are staffed and where the discrepancy lies and determine how, as a pediatric practice, these services could be added to your practice.
- Educate parents: As part of patient communication practices, it is highly desirable to educate parents on the potential pitfalls of walk-in clinics, the sacrifices made in quality long-term patient care in exchange for convenience, and to impress upon parents that these clinics cannot provide pediatric patients with the preventative care needed. If they choose to use a retail clinic, parents need to ask if the clinic has a formal relationship with their Pediatrician and whether a process is in place to communicate visit findings to the pediatric office.
The decrease in primary care physicians and pediatricians in favor of more lucrative specialties, along with the Affordable Care Act (ACA), is driving the expansion of retail clinics. In addition, the price transparency often drives patients to a walk-in clinics, as costs for services can be up to 40% less. Ultimately, clear education and diligence about offering convenient services will assure that pediatricians can continue to offer complete and appropriate care for pediatric patients and their families, while maintaining the concept of the medical home – the location for all medical care records and complete care coordination.