The New York Times reports today 43.6 million people in the United States — more than 14 percent of our population — do not have health insurance. Minute Clinic is a for-profit medical office staffed by nurse practitioners and they are located in malls and at places like Wal-Mart and pharmacies like CVS. There are some entities — mainly the American Medical Association — that thinks healthcare options like Minute Clinic are dangerous to your health.

Here’s how places like Minute Clinic serve their patients:

The clinics, staffed by nurse practitioners and physicians’ assistants, usually charge $50 or less and treat patients without an appointment. Many of the clients are uninsured. Nearly half of those who have used retail clinics went for a vaccination, and “one-third received treatment for ear infections, colds, strep throat, skin rashes or sinus infections,” according to Grace-Marie Turner, director of the Galen Institute, a free-market-oriented health policy shop.  The clinics are spreading rapidly (Wal-Mart plans to open 2,000 in the next five to seven years) and getting some push-back from the medical establishment, with some doctors arguing that the clinics may threaten quality of care.

Here’s how the in-power medical majority establishment plans to shut down the threat of access to cheap, quick-and-easy, healthcare:

Insurance companies are beginning to cover care at the clinics, which also provide services to the uninsured. And though doctors supervise the clinics, many physicians see them as a threat.  “What is going to happen to the future of family medicine … Do people want corporate-style medicine?” a family doc told the Tribune.

The Illinois State Medical Society is pushing a state bill that would require permits for clinics. The doctors are also calling for closer physician supervision of the clinics and for more regulation of their marketing. The group plans to rally support for a similar federal law at a meeting of the American Medical Association next month.

Here’s how nurse practitioners define their role:

A nurse practitioner (NP) is a registered nurse (RN) who has completed advanced education (a minimum of a master’s degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a broad range of health care services. They provide some of the same care provided by physicians and maintain close working relationships with physicians. An NP can serve as a patient’s regular health care provider.

Is the AMA more concerned about the rise of nurse practitioners or places like Minute Clinic?

Is the fact that insurance companies are now beginning to pay for services at Minute Clinic too much of a threat to the status quo of healthcare where referrals are required and Primary Care Physicians can lock in patients while making them waits days and weeks for appointments and service?

Isn’t the AMA’s involvement in this matter a clear indication of the threat to their power and influence in the marketplace of American healthcare and yet another bare-faced blow against those who are not “appropriately credentialed?”

Is the popularity of places like Minute Clinic a clear indication that the American public are now ready to support a fair and uniform National Healthcare system?

22 Comments

  1. Hi David,
    Good point about the Minute Clinics alleviating Emergency Room traffic.
    Maybe if we had viable health alternatives for common illnesses, those who needed ER help could get it without being declared dead first. That recent story about the woman who died in the ER after waiting hours to see a doctor and it was something like the third time she had been to the ER for help is frightening!
    Donna

  2. I’m glad to see the UK is making some positive movement toward affordable healthcare coverage for all citizens.
    In the USA the poor wait in Emergency Rooms or, sometimes, free clinics while the middleclass worry about what is covered and what is not and what needs pre-approval or pre-determination before services are rendered or not.
    In Southern California there is an epidemic of emergency rooms births from foreign nationals. The women race over the border to give birth in an American hospital so their baby is born as an American citizen and then the parents have a landed citizen in which to gain a foothold into citizenship for the entire family.
    Hospitals are not allowed to check passports before providing service — even if the person is indigent and cannot pay, they cannot refuse service — and so this “Immigration Scam via Emergency Room” perpetuates into a population explosion in California of American babies with Mexican parents stuck in Mexico.

  3. Donna!
    Right! If you’re going to pay the ER waiting game — even if you have money and good insurance — means you better be ready for a real brawl to get seen in a timely fashion.
    I read in Newsweek this week that a woman dies every minute from childbirth somewhere in the world. In Africa the death rate is 1 in 16. In America it is 1 in 2,800.

  4. Hi David, NBC nighlty news had a feature on this a couple of weeks back. I was startled that the MD’s were not screaming “FOUL!” until they stated that the NP sends a record of treatment to the Doctor listed on the screening form AND they also instruct the patient to see their Doctor as a follow up. The feature showed a young boy taken to the local drug store with suspected strep which was confirmed by the NP. In and out in 20 minutes. The scary thing to me is, what may I become infected with while doing shopping and sick people are in the store brathing the same air as me? I don’t need the flu or worse.

  5. Rich!
    It’s good to see you again!
    It was on the news here recently too. The new AMA class-action suit against these clinics — they want them inspected and certified and a bunch of other legalistic mumbo jumbo so they can keep their medical monopolies in place — and it outraged me so much that I had to write this article.
    Those sick people are all around you anyway, Rich. They’re sneezing on your grapes and wiping their noses on your fresh bread. At least if they have access to a clinic in your grocery store or pharmacy — that they can afford — they might get quick faster and lessen the likelihood of spreading their viruses to the innocent unsuspecting.

  6. Hi David,
    When my eldest son was younger, he jumped off the couch while flipping and jammed his arm as he landed. He was crying and we were concerned that he might have injured his limb, so we took him to the emergency room at our local hospital.
    My wife saw a doctor she knows walking by and he asked what we were doing at the hospital. We gave him a five second explanation of what had happened. He touched my son’s shoulder in a couple of spots and said if it was broken, my son wouldn’t have tolerated any pressure, so he was probably okay. He said we’d have to wait for hours in the ER, so we should run our son by the little prompt care place that doesn’t require an appointment to get an x-ray to make sure everything was okay.
    The trip to the little medical clinic place was quick and cheap and our insurance even paid part of the bill. 🙂
    When I was working in South Bend, I remember calling my doctor’s office to get an appointment because I had a bad sinus headache. The receptionist told me that the doctor was all booked up, but also suggested a similar urgent care clinic that was conveniently located right in their office building because there wouldn’t be a wait.
    These places are the future of medical care because they can take care of the routine things while freeing up the doctors for more serious matters.

  7. Chris!
    You left out the best part: WAS THE DR. RIGHT ABOUT YOUR SON OR NOT? 😀
    I agree these “in-and-out” medical shops are wonderful. They can heal the immediate need while the real life-threatening work is done properly by the emergency rooms.
    The long wait to see an MD — my eye doctor has a one-month wait for any appointment — really pushes people away from seeking preventative care and then they only go when they are in dire need. Of course, insurance companies like it that way because they don’t have to pay for the wondering appointments.

  8. Hi David,
    This is an interesting trend; I remember having a terrible shoulder pain once and called the Student Health Service only to find out that the doctor was booked for the whole week. I went to the stop-by clinic and got an instant help!
    I needed a prescription medicine instead of the regular off-the counter. Though my student health insurance didn’t pay for it, but still it was cheap and worked great!

  9. I’m so glad you were able to find the help you needed, Katha. Nurse practitioners are experience and smart and they’re frankly just as good as doctors and they have a much better bedside manner.
    Did you have stop-in medical clinics in India?

  10. Hi David,
    The doctor was right! (A wing of the hospital is named after him, so I trust his opinions).
    The last time I went to check in with my doctor he was bringing medical students from IU around with him as part of their training, so he’s molding the minds of future doctors as well!

  11. Oh wow! That’s great, Chris! I’m glad your son did get broken.
    I hope your MD has a good bedside manner and listens to his patients. I read an article the other day that said doctors and patients spend too much time chatting and not enough time talking about specifics and preventative plans. It’s “I hurt here,” get a prescription and go home!

  12. Yes, but most of the time it is not well equipped with qualified medical/nurse practitioners though.
    The poor has no other options to be exposed to the “quacks” – the scenario is a bit bleak there, you are one of those lucky few to get a proper treatment in case you live in a remote area.
    http://timesofindia.indiatimes.com/articleshow/2099186081.cms
    http://student.bmj.com/issues/06/11/life/430.php
    http://www.taipeitimes.com/News/feat/archives/2004/08/25/2003200104

  13. Hi David,
    I have to check in with the doctor fairly regularly because I have high blood pressure and can’t go for too long before needing to check in to make sure my medication is working properly. It’s something that runs in the family, so it’s nothing major — unless it isn’t treated.
    When I was working in South Bend, I went to a doctor in that city and his manner was fairly cool and focused on the clinical results. He always told me of the latest medical research and studies.
    Before that doctor, I went to a local doctor who was younger than most. He’d always give me a pep talk and talk about doing certain things to prevent problems at a later date. He reminded me of a sports coach.
    My latest doctor likes to talk about my line of work in between asking me questions about how I feel, etc. Having experienced a couple of different styles, I like my latest doctor’s manner the best, although the “coach” was always good at keeping me motivated to work out and do things like that. (I was somewhat afraid he might yell at me if I hadn’t achieved specific results on the next visit, i.e. lowering my BP).

  14. It’s hard to find the right doctor, Chris.
    Many people just pick a name they like out of a book and head in to see the MD. They don’t usually switch doctors unless they move or are treated completely unfairly. If you ask MDs about their schooling and associations they get VERY defensive. 😀

  15. David Boles:
    How can a NP be equal to an MD if they receive at minimum 6 fewer years of post-college education?
    When your minor medical complaints segue into serious or multiple chronic illnesses, which happens to all of us with age, you will discover the gap in your NP’s knowledge and ability to provide adequate care. At that point, you will be waiting even longer than you do now for an appointment with a physician, as GPs become more scarce due to the competition.
    To those bemoaning the AMA and its “medical monopoly”:
    If it wasn’t for the AMA, you wouldn’t have any idea which doctors had received real medical education and which had just decided to hang a shingle. This notion that the AMA ONLY serves the interests of physicians is misguided. However, the AMA does have an interest in protecting physicians’ place in the medical community–doctors go through the most intensive training of any profession out there, at least twelve years of their early lives in the United States. Did you know that work hours for medical residents were recently LIMITED to 80 hours a week? Can you imagine working 50 to 100 hours a week for 7 years of medical school plus residency, after 4 years of busting your butt to be near the top of your class in college, being responsible for the lives of your patients, constantly worried about that malpractice shark lurking in the shadows, and then hearing people complain that you are overcompensated and that an NP with 2 years of training is ‘just as good?’