Do Retail Clinics Support the Provision of Primary Care?

Article Outline

• Support for Retail Clinics as Primary Care
• Rationale Against Retail Clinics as Primary Care
• Copyright

Monica Kohler, RN, MSN, FNP-C, is a graduate of the University of Cincinnati and has been in health care for 25 years. Her background as a nurse practitioner includes family practice, geriatrics, and retail care. She is the lead nurse practitioner for Take Care Health Services in Cincinnati, Ohio.

Tracy Klein is a family nurse practitioner practicing in a Tigard, Oregon, primary care clinic. She also serves as the Oregon State Board of Nursing's advanced practice consultant and was recently named by the AANP as the Oregon NP Advocate of the Year. She is a doctoral student in public policy/nursing at Washington State University.

Frequently staffed by nurse practitioners (NPs), retail clinics have emerged as an accessible, affordable, high quality, and convenient option to seeking episodic care. With the growing shortage of primary care physicians, the need for retail clinics is expected to dramatically increase. Compared to a primary care practice, retail clinics traditionally have offered a more limited scope of services. As the need for primary care expands, however, will retail clinics be compelled to expand their current limited scope of services to a broader option? And if so, how would expansion of retail clinic services impact our current system of providing primary care?

What do you think? Contact Section Editor Janet Selway at janet.selway@gmail.com if you would like to comment on this matter.

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Support for Retail Clinics as Primary Care 

Monica Kohler

Retail clinics, although innovative, are no longer considered a new model of care. For patients and providers alike, these clinics have established themselves as an integral part of the health care community. Increased utilization, recognition from the health care community, and increased attention from government and reform leaders all illustrate a need for additional high-quality, convenient, and low-cost health care access points.

By necessity, consumers have become savvy shoppers and close managers of their health care dollar. Recent changes in the economic environment, resulting in a greater number of uninsured or underinsured persons and increased financial strains on individuals and families, have hindered patients' desire to be proactive in seeking consistent health care. In addition, clinic providers frequently acknowledge and address patients' lack of or limited access to a medical home. Those who do have primary care providers often do not consistently maintain that relationship or, furthermore, are in need of access points that not only meet their needs of convenience and cost but also deliver a great experience.

As convenient care clinic operators consider recent trends and determine how best to meet patients' needs in the future, it is not a question of whether clinics support the provision of primary care, it is that they must. Retail clinics are convenient, literally and figuratively positioned to integrate with other health care providers. The utilization of an EMR system also enables, with patient consent, the sharing and integration of health care information to ensure continuity. More and more patients are seeking nurse practitioners' and physician assistants' comprehensive health and wellness expertise. Overall, clinics need to continue to function as a bridge to primary care and entry point into the health care system as the medical home concept and health care industry as a whole evolve.

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Rationale Against Retail Clinics as Primary Care 

Tracy Klein

Retail clinics provide many consumer-focused services: quick visits, evening and weekend appointments, transparent pricing, and proximity to medication dispensing or OTC treatment options. Because they provide safe and appropriate care, consumers and insurers overwhelmingly approve of retail clinics in spite of sometimes heated physician opposition and rhetoric. Unfortunately, proponents of the retail health model themselves engage in rhetoric that promotes the retail model as an “allied primary care” provider.

The retail home is not a medical home or a health care home. Primary care relies on ongoing assessment, evaluation, and planning within the context of an established patient/provider relationship. Primary care is costly and poorly reimbursed, requiring consistent and routine follow-up. Retail clinics by intentional design offer profitable episodic care. Although NPs providing care within them are capable by education and licensure to do primary care, they are asked by most clinics to refer patients to a primary care physician in the community.

Many clinics closed in the past year as a result of an inability to exist financially on episodic care. Despite the fact that minorities and uninsured people use retail clinics at a higher rate, many clinics are not geographically accessible to them. A recent analysis of census tract data found that clinics are located in areas with “more white residents, fewer black and Hispanic residents, higher rates of home ownership, higher median incomes, and lower rates of poverty” compared to stores without retail clinics. However, neither the retail clinic nor the primary care practice in town is prepared to accept them for their long-term primary care needs. Retail clinics do many things well—but they do not provide allied primary care.