Back in the 1980s, freestsnding walk in clinics were “hot” – Wall Street, always so insightful into health care policcy and operations, poured millions into a range of start ups. I put a few dollars into Doctors OfficeCenters, but that one collapsed. I got a few dollars out from the subsequent lawsuit.
As I wrote in my November 4 2005 post (pre- All Business) how these clinics can fill a real need. In the 1980s, the walk in centers were often place in freestanding buildings. In 2006, the model is to put them in high traffic “big box” merchandisers such as Wal-mart (ironic, is it not?), Target and CVS. Secondly, they typically use nurse practitioners, who command lower salaries than physicians, and thirdly, they need less space to operate since they are integral to the stores. The focus of these clinics is routine, non-emergent care. An article in today’s New York Times (free registration required) reviews some of the history and where the four major companies in the business are now. All have grandiose claims (of course). One, Jacksonville, FL bases Solantic, is headed by none other than Richard Scott, who single handedly ravaged HCA and handed the stockholders, employees and physicians the embarassment of over $1 billilon in fines. Stephen Case, founder and former chair of AOL, has a revelation when he took his daughter to an ER one night for an ear infection. Here we have a reasonably intelligent person, with – one presumes – a private practice pediatrician – and he took his daughter to the ER for a possible ear infection? Why not call the pediatrician? On the other hand, that’s why these clinics are opening – people get sick after hours, and most practices are geared for the 9-5 day.
My thoughts at this point – monitor what is going on in your community. Emphasize to your patients that they should call you after hours if they’re sick. Give all patients a handout with your after hours policies. If you have a relationship with an after hours clinic (not necessarily a bad idea), you can offer that as one option, and make sure that the clinic knows to call you as warranted. You may want to consider using a telephone nurse service, who can screen calls and provide reassurance and some guidance after hours (particularly good in pediatrics). The objective here is for your patients to have access to competent, reasonably priced care after hours, avoiding the ER, and for you to be there for them.