American Medical Association Goes After Walmart-Style Retail Clinics

The American Medical Association is going after in-store clinics being opened by retail giants such as Walmart and Walgreens, according to the Chicago Tribune. The AMA is concerned about potential conflicts of interest between the nurse-practitioners who prescribe the drugs and the pharmacists who fill them.

“Our primary focus is patient safety and patient care, and the retail clinics have a different mission of selling products and prescriptions,” said Dr. Rodney Osborn, a Peoria anesthesiologist who is president of the Illinois State Medical Society, an AMA delegation among the most outspoken on scrutiny of retail clinics. “We want these clinics to be accountable.”

The AMA says it will advocate for increased regulation of the retail clinics. The clinics usually operate 7 days a week and do not require an appointment. There is usually no doctor on site. Patients are charged about $60, even without health insurance. Some clinics waive a patient’s copay, in a move that doctor’s say encourages consumers to avoid seeing a physician.

Walgreens responded:

“If the AMA is going to push this agenda, they may find that legislators and their constituents have been demanding accessible and affordable health care for years,” said Walgreens spokesman Michael Polzin. “And that is exactly what retailers are delivering as a supplement to the primary care physician. As they push back against retail clinics, it would result in higher health-care costs and prevent some patients from receiving care that they are receiving.”

Have you tried these clinics? Were you happy with the level of care you received?

Doctors, retailers square off [Chicago Tribune]

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  1. gibbersome says:

    I wish for the old days when the AMA hadn’t sold out to health insurance companies and big Pharm.

  2. QuirkyRachel says:

    I’ve never been to one, but the idea sounds great as long as they have good boundaries about what they can treat and what they can’t. Still, if you’ve got certain issues that can escalate quickly, but start out small, this could be great.

  3. SaveMeJeebus says:

    Geek Squad expose… Now!

  4. dbeahn says:

    I have a friend that’s been to one several times. I’ve gone with for support. Great experiences every time.

    I can see why Doctors would be worried – these places are affordable, you don’t have to wait for 90 minutes to go in the back and wait another hour before seeing the doc, and for almost all of the common reasons you go to the doctor, these places are more than able to handle it.

  5. bnet41 says:

    I think overall these are a good idea. It’ll take some time to iron out the kinks though, and many may find they will need a doctor on staff.

  6. Dangerdog says:

    @SaveMeJeebus: Seriously. What’s the hold up?

  7. mrmysterious says:

    This is no more of a conflict of interest than pharmaceutical reps pimping their pills to doctors and pharmacist.

    I’m all for people with the common problems (flu, vaccines, etc) to go to these clinics to free up the real doctor offices for real problems.

  8. dvddesign says:

    These are great. My doctor decided to be a dick and not prescribe me antibiotics when I was 2500 miles out of town and sick with a sinus infection. I get them every year in Feb. But my doctor, despite my priors, refused to fill my prescription out of state and told me to come in a WEEK LATER for a checkup.

    I went to the doc-in-a-box at the nearest CVS to the Opryland Hotel and had the drugs I needed 45 minutes later. I was over the infection before I left town. Screw AMA for trying to shut down a legitimate need in emergency situations.

  9. strandist says:

    On the other side, I could also see these places being used just like payday lending places. People who have serious problems (with health instead of their budgeting) go in frequently to continue getting stopgaps to problems rather than admitting that they need real treatment beyond the simple prescription and getting it taken care of.

  10. lamorevincera says:

    I agree completely with everyone else who’s saying that these places are great. I went once for a sinus infection. I felt more listened to by that PA than I have in years, and I had my medication in 30 minutes. They read you a statement saying you do not have to use the pharmacy that you’re in, and even offer to call it in to another store if you want them to, so nobody’s ever pushing you.

    Doctors are just threatened – they’re gonna lose their precious money due to these clinics. Maybe it’ll teach ‘em a lesson in patient care, specifically the “don’t make us wait for 2 hours” and the “don’t make us pay out the nose” lessons.

  11. hc5duke says:

    Typical AMA bullshit…

  12. Hawk07 says:

    @dvddesign:

    But who ultimately is held responsible if you get the medicine and your condition worsens?

    Yeah, if he was your family doctor for the last 10 years, maybe he was being a dick, but at the same time, he has a lot more to lose than you do. The tables could very easily be turned when some jackass lawyer says, “how do you adequately diagnose a medical condition when the patient is 2,500 miles?”

  13. Red_Eye says:

    My wife and i recently found our primary medical care group had lost their contract with Cigna (our ins provider) while they were in hurried negotiations for 5 months we did wind up needing some medical care. So my wife and I have both used these Walgreens clinics for sinusitis and conjunctivitis and have been very happy. In and out with the nurse practitioner in under 22 mins and just wait for the scrip.

    The AMA can go hang, they aren’t protecting us but the big medicine doctors.

  14. Red_Eye says:

    @mrmysterious: EXACTLY! How many doctors get their free promos for promoting drugs being pushed by the big pharma? People seem to overlook this angle the fact the DR has 200 tissue boxes with diagra ED medication doesnt hit home that they are scratching his back saving him supplies money so that he can spend more time promoting their drug.

  15. Vinny says:

    God knows it’s much better to get your treatment from a bought and paid for doctor than it is to get advice from a bought and paid for pharmacist.

    Are they for real?

  16. savvy9999 says:

    Doctors complain that expensive emergency rooms are filled with sniffly noses. The sniffly noses go somewhere faster, cheaper, and more appropriate to their condition. The doctors complain again.

    These clinics– properly run and staffed– are a wonderful solution to a huge gap in the US health care system.

    Combine these places with an employer-sposored (and pre-tax) Health Savings Account, and you’d see a significant drop in the cost of health care for your average consumer.

  17. Hawk07 says:

    @savvy9999:

    Well that and a lot of people thing ER and Primary Care physicians are the same thing.

  18. TSS says:

    I’m with everyone else – I’ve had great experiences at these places. The AMA is just plain wrong here.

  19. bendersae says:

    This is just fear-mongering from the AMA. They are worried because NP’s and PA’s provide better patient care than they can. I’m sure if WalMart or Walgreens had MD’s sitting in their stores, there would be no conflict of interest. But, that would be below them.

  20. @savvy9999: I hate our local emergency room for this very reason. I’d love a very simple clinic for the aches and pains and colds and flus.

    You figure these places will scope people out, so if they keep going back for stopgaps they will/should eventually tell them “go to the emergency room.”

    Oh, and I was at a nice resturant the other night when some Pharma rep was buying dinner for a dozen doctors and their spouses. And we’re talking $30 a $30 entree place. There is where your drug profits go!!

  21. remthewanderer says:

    With a Fiance 10 months away from her medical degree and a father who has been a drug rep for almost 30 years I have to say that I love the idea of these clinics.

    I recenly had pink eye. I woke up on a sunday with it. My PCP would not see me until wednesday. I went to a CVS clinic and had the eye drops I needed in about an hour.

    I agree with Savvy9999, these clinics represent a solution to the most common of ailments.

    I equate PAs and Doctors like this: PAs are the computer repair people of the human body. They know how to fix you but they have no idea why what they are doing works. Just like I know that to cure a spyware infection the first thing I should do is run ad aware but I have no clue how a piece of spyware is coded.

    A doctor is more like a computer engineer. They can tell you why you got spyware. How spyware is coded. They can go into extensive detail about the security holes in windows that allow for the kernel.dll to exploit the blah blah blah. They can tell you how to build a hard drive from the first transistor up. But in the end, you end up with the same eye drops that the PA prescribed.


    PS: Doctors may get dinner from a drug rep every once and a while but, crappy pens and boxes of tissues do not sway any Doc into prescribing one drug over another. My Dad’s job is to lay out the facts about why a drug he sells is better than the competition. If the Doc agrees he/she may prescribe it more but thinking about a free dinner or pens will not make a difference 99% of the time.

  22. ancientsociety says:

    Hmmmm, between this and the AMA attempting to classify “excessive” video game playing as a psychiatric addiction, it looks like they are seriously out of step with modern American society.

  23. medcat2010 says:

    I am a medical student and my husband is a resident. I actually think these sorts of clinics are a great idea as it pains me that financing or receiving health care for even things like ear infections can be a pain in the ass. There’s a clinic my school has that is run by the students with supervising physicians, and it serves a large uninsured population. There is a growing shortage of primary care docs as people going through med school are more interested in specializing . So anything that can help abate the shortage I see as positive.

    However, I feel better about clinics are not affliated with any retail companies. While I don’t believe patients will necessarily receive inferior care at retail clinics, I do think there is potential for treatment bias. But you get the same with a private primary care doc sometimes. Anyways, just my thoughts. By all means, some treatment is better than none at all.

  24. @strandist: “People who have serious problems (with health instead of their budgeting) go in frequently to continue getting stopgaps to problems rather than admitting that they need real treatment beyond the simple prescription and getting it taken care of.”

    Still better than them doing that at the local ER.

    I’m teaching medical ethics this semester so my students (mostly nurses & EMTs doing continuing ed) are talking about it a LOT. The one point the Trib article made that I think is probably valid is that very young children (under 3) need to see a pediatric specialist because diagnositics are very difficult (they can’t tell you what hurts and how it hurts) and many serious childhood illnesses look like or start like a common cold or ear infection or whatever.

    Still, I’d rather someone take their toddler to a drug-store clinic and see an LPN who says, “take that child to urgent care!” or “You MUST see a pediatrician with this!” than to have that toddler never seen at all because of cost.

    I’m generally in favor. Most of my students are generally in favor. But most of my nurses in particular think doctors have a pretty high opinion of themselves and believe they are the ONLY medical professionals able to diagnose and treat, at which my nurses scoff. ;)

  25. Frank Grimes says:

    Just want to be a bit nitpicky. The professionals staffing these are NOT PA’s (physician’s assistants) they are Nurse Practitioners. Is there a difference, yes. In most cases a PA has to work under a physicians license, in most cases NP’s do not (varies a bit by state), making it far easier to prescribe medications. PA’s also come out of school as one size fits all. In the NP world there are Pediatric, Adult, Geriatric, and Family (can see anyone). In the big picture they don’t work all that differently but these clinics could only really function with FNP’s. Not to diminish what PA’s do (you’ll find many of them assisting in the OR) it’s just a different type of gig.

  26. ronaldscott says:

    Doctors: Oh noes, they are learning that you don’t need a fancy medical degree for like, 50% of what we actually do! The secret is out! Help us AMA!

    AMA: Those clinics are bad because… ummm… yeah because their reasonable prices and instant availability encourage people not to go to doctors!

  27. magic8ball says:

    I like the urgent-care-type clinics for when my regular Dr’s office is closed (evenings, weekends) and I have generally gotten OK service from them. But how is it not a conflict of interest to have the clinic and the pharmacy in the same facility, owned by the same company? They have more motivation to prescribe something for me. Clearly if I’m going into the clinic, then I’m not feeling well, but that doesn’t always mean that I need a prescription. And even though I could take my prescription elsewhere to get it filled, chances are that I will go ahead and fill it where I got it, because it’s more convenient. This is why I don’t get my safety/emissions tests for my car at a place where they also do car repairs – they are more motivated to find something wrong that they can fix.

  28. @magic8ball: “But how is it not a conflict of interest to have the clinic and the pharmacy in the same facility, owned by the same company?”

    It will depend on corporate structure and how well they do separating the two functions. Doubtless there will be lawsuits. But hospitals provide in-house pharmacies, and many rural doctors’ offices do as well, and it is limitedly permissible within the ethical canons of the profession.

  29. TechnoDestructo says:

    How is this (fundamentally) any worse than an independent clinic having a pharmacy?

    Well, I guess I trust a local doctor over Walmart not to push unnecessary drugs. If the clinics were just tenants, it would be a whole lot easier to get behind. (But then their rents might depend on how much business they send the way of the pharmacy)

  30. Thrust says:

    Somebody call Dr. House, there’s a new place for him to get his Vicadin without Cutty’s meddling.

  31. britne says:

    I just had an amazing experience at one of these clinics. I’d been having a pretty persistent condition (not getting into details here!) – saw my primary doc, he couldn’t figure it out, sent me to a specialist, nope. Last week it started driving me batty and I needed some relief. The specialist was booked for 2 months, so I went to a clinic. Well, what do you know? What the NP gave me fixed it. Really. I felt so bad for the poor girl, dumping this chronic problem on her, but she came up with something the other docs didn’t, and now I feel great. My $0.02.

  32. Hawk07 says:

    @remthewanderer:

    but PA’s work under a physician. Also, guess who gets the axe when SHTF?

    The reason it’s cheaper to go to nurse practitioners or PAs is the fact that they don’t hold a medical degree. They’re not paying malpractice insurance premiums more than some people make in a year and ultimately, they’re not held responsible when something goes wrong (as in the same degree as a physician would be).

    Another problem is people think they can self diagnose using sites like WebMD and the Mayo Clinic Online, and then shop pharms online from Canada.

  33. StrawberryOChoi says:

    So typical of the AMA! They’re not worried about patient safety. They’re worried about their dwindling pay checks. Take away treatment of simple ear infections, sinusitis, UTIs, and upper respiratory infections, and the primary care doctor isn’t left with many patients in the office on a day to day basis. NPs and PAs are more than qualified to diagnose and treat the simple ailments for which people come into the quick clinics. Anything more complex is referred to a physician for examination. As a nurse, I’m confident that a patient at the quick clinic would get the same examination and treatment as he would get in a private office. I’ve yet to hear of a patient who receives a comprehensive, full-body examination when he comes in complaining of a sore throat. A five minute exam for sinusitis is the same regardless of location or degree of the health care professional doing it. Perhaps the wide availablility of these clinics will force docs to give patients more for their money and begin practicing real primary care medicine again. A little competition never hurt anyone, but the AMA is doing all it can to maintain their monopoly on health care.

  34. kostia says:

    I saw an actual MD in a walk-in clinic inside a Duane Reade in Manhattan on Sunday. There was no wait, no line, and I was completely satisfied with the medical care I received. However, because it was Sunday, I went to four pharmacies (and walked about 15 blocks) before finding one that was open at all, and another two before finding one that could fill ONE of the two prescriptions I’d just been written. No one in midtown could fill the other on a Sunday. I WISH there’d been a relationship–improper or not–between the clinic and the Duane Reade. I might have actually gotten the medicine I needed that day, instead of a day later. He might have known to prescribe only what Duane Reade actually stocks. And so on.

  35. Lkbardo says:

    I’m a physician assistant, and I want to respond to many of the things said here in the comments, as well as the overall article. Here goes:

    To HAWK07: I agree with most of your most recent comment, but I take slight issue with your assertion that NPs and PAs “don’t hold a medical degree.” In point of fact, PAs are specifically trained in medicine (just like doctors), whereas NPs are trained in advanced nursing.

    To FRANK GRIMES: Contrary to your statement, primary care is the specialty in which most physician assistants (note the lack of an apostrophe) work. Only about 20% work in surgery (myself included). Unlike NPs, who are not trained in medicine, PAs can work with any doctor in any specialty-including primary care. It is odd that you would characterize this versatility as a negative (“one size fits all?”), rather than a positive. It certainly isn’t a negative in the case of these clinics.

    To REMTHEWANDERER: Your analogy greatly underestimates the level of care delivered by both NPs and PAs. We are professionals with large funds of knowledge about not only collections of symptoms, but also advanced anatomy, physiology, biochemistry, and pharmacology-i.e., we have MORE than just “an idea [of] why what [we] are doing works.” I personally have corrected doctors (and not just residents and interns) on medical issues, and I am far, far from alone.

    In response to the actual article, I’ll only remind people that the AMA is NOT a patient advocacy group, it is a professional organization that serves the needs of its members. The AMA has opposed anything that would lower the income of their doctors, including HMOs and public funding of healthcare, and now they are opposing retail clinics. They are out of step with the public and most American doctors on this issue. In fact, only about 1/3 of practicing physicians in the US even belong to the AMA, and that number is decreasing.

  36. Red_Eye says:

    @magic8ball: While its true many will simply opt to get the prescription in house as I have (my prescription coverage works fine there too) in the case of Walgreens I believe I have read that the in house medical staff is not owned by Walgreens, but a separate company who leases the space from the store. And every visit we have made (4 total) they offer to call the scrip wherever we want and even on one occasion warned me of a substantial wait.

  37. bohemian says:

    Our hospital/clinic/PPO has an NP at our local clinic. We pay a lower copay. We can also usually get right in during the day without any wait or an appointment. They built the clinic anticipating the area to grow so for now it just has an NP. It works great for basic things like sinus or eye infections, the flu, vaccinations or needing something basic like prescription allergy meds in the spring.

    We also use the NP for follow up blood draws rather than having the nurse at the specialist draw it.

    If we go to the family practice doctor it costs us $15 more and there is usually a week to get an appointment along with at least an hour wait to get into a room.

    Our local grocery chain also has one of these retail clinics that is being operated by the same hosptial/clinic group.

    The urgent care clinics are also a much better option than the ER unless your potentially dying.

  38. hop says:

    got the medicos upset,have they??????looks like someone is trying to snatch a piece of their golden goose……..

  39. nardo218 says:

    @remthewanderer: Yes, product recognition does influence what you prescribe. If there’s three antidepressants you can try prescribing to a patient, and you’ve been using Lexapro office supplies all day, what’s the drug that’ll pop into your mind first?

    Further, it’s been established by research in the social psychology sector that name recognition = trust. The more you see something, the more ‘real’ it seems to you. That’s why political campaigns put up those cardboard signs in every yard they can.

  40. nardo218 says:

    It bugs me that this ‘ethical’ issue is basing itself on the idea that people mindlessly follow what doctors tell them. Yes, some people do, but that’s increasingly rare as the generations who were taught to follow authority are dying out and also as society becomes more medically aware and generally less gullible.

    When you go into a CVS clinic, you know it isn’t a real hospital; you know you’re not getting as good a care as with a doctor. Further, people know when doctors are ignoring their symptoms or giving them nonrelevant advice because they’re not receptive and/or are giving out medical advice based on the 100 other patients they’ve had that month whose symptoms are kinda-sorta like yours. Most people have some level of bullshit detector. Not everyone, no, but I think this sky-is-falling assumption that we’ll have legions of poorly diagnosed patients is a bit over the top.

  41. medcat2010 says:

    By the way, this isn’t all that threatening for specialists. Accessible clinics may only help them receive a few more referrals.

  42. synergy says:

    I’m all for getting all the people out of my doctor’s office who just have the sniffles, often by a virus and can’t be cured. That’ll free up the doctor for those of us who go once a year for a check-up or if we’re on death’s door.

    On the other hand, if they think they have a problem with overprescribed antibiotics and creation of Superbugs, wait until everyone is getting them at the local CVS/Walgreens/Walmart.

  43. notebook says:

    Micheal Moore should’ve seen this.

    I’d go to the smaller clinics, especially after hearing good reviews from some of the comments here. I don’t even go to my ‘regular’ doctor anymore, because the wait is too long. I just go to a stop in place, and usually have to pay 20$. I’m in and out pretty quick, and I /do/ feel like I’ve been taken care of.
    Seems like the large retailers have done something right, for once. ;D