I got home from a trip late at night last week, and found my daughter up with a fever. This was still going on the next morning, and I feared she might need to go see the doctor. Although I’m a pediatrician, I’m forbidden from diagnosing my own children for reasons I’ve previously discussed. Taking one of our children is a big deal. My wife and I both work, and it’s often difficult to get an appointment at a time that doesn’t require one of us to take time off. In an ideal world, we’d be able to get to the doctor early in the morning, but these days we’re just happy to get a sick-visit appointment the same day we call. Part of the reason for this is the fact that we have a doctor shortage in the United States. There are too many people for the number of physicians we have. That makes it hard to offer a lot of flexibility in scheduling. More people in the United States report having trouble getting medical help on nights, weekends, and holidays than any other comparable country. Luckily, my daughter was much better in the morning. But on other occasions, we’ve solved the problem with a different solution. We’ve gone to a retail clinic. It turns out we’re not alone:
When Emily Auerswald and her children need care for minor illnesses or injuries, they head to a shopping center near Annapolis, Md. that has a Starbucks, a Five Guys hamburger joint and an urgent care center. Doctors Express in Edgewater is open nights and weekends, and accepts walk-ins without an appointment. "I have a doctor, and my kids' pediatricians are great, but we'd prefer not to have the long wait in the office. So we come here and everything seems so much faster," said Auerswald, 36, who was having a doctor remove the stitches he had put in her foot after a weekend boating accident. Such centers treat the most common injuries and illnesses - including colds, ear infections, cuts and back pain - in addition to taking X-rays and performing simple blood, urine and drug tests. And they are booming: An estimated 3 million patients visit them each week, according to the Urgent Care Association of America.Physicians are understandably uneasy about this development. More and more, we’ve seen a drive to more coordinated care. The idea of a medical home incorporates a view of care where physicians are responsible and intimately involved in numerous aspects of their patient’s lives. If they are fragmenting their own care by seeing multiple providers without connection to the medical home, such coordinated care becomes difficult. It’s going to be harder for doctors to win this argument in the future. Visits to retail clinics can be significantly cheaper than a trip to the emergency department or even the doctor’s office. Retail clinics also pride themselves on their efficiency, with shorter wait times and more availability in difficult hours. And, for some issues, it’s hard to argue that they can’t provide comparable quality. For a long time, physicians have resisted changes to practice that might improve some of the factors that are noted here. We’ve been terrible at reducing the price of care. We’ve been lax in increasing the numbers of people in our profession, and in allowing mid-level practitioners to alleviate some of the stress of the physician shortage. Finally, we’ve been ineffective in providing patients with hours and appointment slots that fit into their busy schedules. Retail clinics are filling the void. If physicians want to change this, it won’t be by fighting them. It will be by doing what they do better. Dr. Aaron E. Carroll is an associate professor and vice chair of health policy and outcomes research in the department of pediatrics at the Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll. [Editor's note: AcademyHealth is assisting the Agency for Healthcare Research and Quality with its Evidence Based Care Challenge, which invites teams to translate existing AHRQ research reports into innovative, provider-friendly resources that can be easily adopted for use in retail clinics by nurse practitioners (NPs) and physician assistants (PAs).]