Letters to the Editor
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If Only the Insurance Companies Saw It This Way
I'm a doctor. I would love to be in a situation where a nurse practitioner picked up all the easy cases and left me with the complex ones, giving me more time with each patient. The problem with this is that insurance companies don't let me bill that way.
You can bill more for more time spent in the exam room, but the range is rather limited. Insurance companies routinely pay well for procedures, and not nearly as well for talking and throughful examining.
Minute clinics could be OK if doctors were really reimbursed for doing what they do best -- cracking harder cases. Insurance companies seem to want to outsource patients to cheaper and cheaper providers and thus kill the practices of the skilled generalist.
Maybe the solution is for doctors to convert to cash only, and then charge by the minute.
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Retail clinics in Alberta
In Alberta, where family doctors are retiring in droves and very few graduates are lining up to replace them, the drop-in clinic has become essential in filling the gap.
I recently became pregnant before I had found a family doctor. The drop-in clinic arranged my referral to an OB, labs, ultrasounds, and offered to care for me in the interim--drop-in pre-natal exams.
When I did find a family doc, my plan of care didn't change.
The main difference I see between the family doc and the drop-in clinic, is that the work load is clearly spread out among a larger staff than typically mans a family practice. Doctors at the drop-in clinic, even on a Saturday evening, have a sense of professional detachment that I do not see among docs in private practice, even when I lived in the U.S.
I don't care to hear about how insurance/rent/shortage/something else is killing a doctor's business. I like a doctor who appears fresh and ready to listen to me.
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Horrible
I had a horrible experience at a Doc in a Box about eight years ago that still leaves me angry and bitter. My brother-in-law almost died when another Doc in a Box misgiagnosed a heart problem. I don't trust the quality of the people they employ and I wouldn't go near one again unless I had an arterial bleed on the highway -- if even then.
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@knotadocpac
You're assuming that a doctor will actually dispense appropriate care, at a price (both monetary and time-wise) the patient can afford. Doctors also prescribe unnecessary antibiotics; most of my friends and family have had at least one experience like that. Doctors also misdiagnose things at an alarming rate. Presumably, these walk-in clinics will have a nurse practitioner on staff? That's about the level of care one can expect at a doctor's office, anyway.
And really - much of the population has no meaningful access to a doctor, so it's irrelevant just how wonderful some doctors may be. If your alternatives are "toughing it out" at home or going to see the doc-in-the-box, it may indeed be a better idea to go see the doc-in-the-box.
(I'm speaking as someone who, when uninsured, had to apply butterfly sutures to my own thumb because I could not afford to go see a doctor or to go to the ER... it doesn't matter how well a doctor I couldn't afford would have done that job, if I couldn't afford him)
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Addendum to knotadoc comment
In the likely event that others will also not read my previous comment very closely, please accept this addendum, prompted by 565656565's comments.
A main assertion I intended to make was that most visits to the Doc-in-a-box/minute clinic (and for that matter primary care clinics in general) are NOT NECESSARY in the first place. I did not (do not) assert that doctors/PAs/NPs in the office setting are all "wonderful" or will dispense appropriate, cost effective care...merely that the doc-in-the-box is far less likely to do so. (and more likely to perpetuate the hideous overuse of antibiotics).
"Toughing it out at home" is indeed the the best (and cheapest!) way to handle most minor health care issues (and most are minor) unless you are mentally unable to examine and be aware of the fact that humans get ill and have pain...and get better! (regardless of someone patting you on the back, giving you unnecessary medicine, and charging you money)
As a case in point... How's your thumb? I bet it's fine. (ie proven lack of need for medical care in retrospect) I do credit you highly with considering cost when going to the ER, and feel badly if you did not receive care there if necessary. Most people do not have this compunction. I have personally evaluated someone in the ER who arrived by ambulance who had..a hangnail. Really. In most ERs, the proportion of people who pay ANYTHING is about 50%. ER physicians (and PAs/NPs) are functioning under unbelievable pressures, and are largely responsible for propping up a teetering health care system.
On another but related topic, let me first say that the UK health system (National Health Service) has many flaws, and I look forward to going back to the US system...however, since practicing here, my antibiotic prescription per respiratory infection rate has fallen to...at a conservative guess 5% of my US total. Guess what? Makes no difference. People get ill, get better, same amount of time, no difference. Granted only a subjective opinion from myself on my experience, but...in this case there are hundreds of studies to back it up. The US system is just too geared toward placating what people BELIEVE is necessary.
Thus, to bring it back to the general thread of this discussion, the "Doc-in-the-box/minute clinic" concept will exacerbate this problem to a high degree.
Cheers,
Jim
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Okay
...then what? They've had these walk-in type places for years now. And until recently, they were affordable places when you could not get in to see your normal doctor - or didn't have one. Now, they are over $100 a visit, and that's if you are a repeat customer. Other down-sides: Sitting around and waiting, as they are first come-first served.
These new places will start off with a low price, and within two years be right up there with the established walk-ins. I doubt the existing walk-ins will lower their prices.