Not many things raise the blood pressure of a good pediatrician more than a conversation about retail-based clinics. Before we get to a recent study that looked at the reasons why parents choose to take their kids to a retail “doc-in-the-box” clinic rather than their board certified pediatric medical doctor, let’s get a few things out of the way:
- Retail-based clinics exist for one reason and one reason only: to make money.
- Pediatric practices like Pediatric Alliance exist for two reasons: to make money AND to provide expert, specialized pediatric care to benefit children, their parents, and the community. (And not necessarily in that order. If pediatricians wanted to get rich, we’d become neurosurgeons!)
- Retail-based clinics are almost always staffed by non-pediatric doctors, non-pediatric physician assistants, and non-pediatric nurse practitioners. It’s important to make a distinction about pediatric providers and non-pediatric providers. All PA’s and NP’s serve a vital role in caring for patients, especially in private offices. However, pediatricians would hire a pediatric PA or Certified Pediatric Nurse Practitioner (CPNP) to care for your children, as we have in my office. Parents would also be well-advised to hire pediatric providers to care for their kids. (Believe me, you don’t want me diagnosing and treating grandpa’s chest pain, just like you don’t want his cardiologist diagnosing and treating your child’s viral exanthem (rash)).
- Retail-based clinics don’t know you from Adam. And they don’t care to know you. They hold none of your medical history, including chronic conditions, medications lists, immunization status, and allergy history, and they have no access to it. The largest doc-in-the-box in our area (MedExpress) refuses — REFUSES! — to communicate with primary care doctors after our patients are seen there. And retail-based clinics that do acknowledge that communication enhances patient care often provide us with very little in the way of useful information.
So why do parents take their kids to doc-in-the-boxes? Alexandra Sifferlin tells us:
In a study published in JAMA Pediatrics, researchers from Washington University School of Medicine, St. Louis report that even families with well-established relationships with a pediatrician take advantage of pediatric retail clinics to take care of their children’s minor health issues, even if they are staffed with non-pediatric health care personnel.
Why? The researchers surveyed 1,484 parents from 19 Midwestern pediatric practices who said that they took their kids to the clinics out of convenience…
Of the parents who took their children to a retail-based clinic:
- 74% thought of calling the pediatrician’s office first. 26% went right to the retail-based clinic without considering their own pediatrician.
- 37% of retail-based clinic attendees cited more convenient hours as the reason for their choice; 25% said their pediatricians had no open appointments; 15% didn’t want to bother their pediatrician after hours; 13% felt the problem wasn’t serious enough for their pediatrician.
- Nearly half (47%) of child visits to retail-based clinics occurred during most pediatricians’ regular office hours! (8 AM – 4 PM weekdays, 8 AM – noon weekends).
- Most visits (80%) were due to upper respiratory infections: sore throats (34%), ear infections (26%) and colds/flu (19%).
- 13% of pediatric visits to a retail-based clinic were for a physical exam. By a provider who is not a pediatric specialist. At a place that knows nothing about you, your family, and your child. Where immunizations cannot be discussed or given, past medical history reviewed, or medication lists updated because there is no access to the medical record.
You can see why this is more than just a minor concern for pediatricians. The American Academy of Pediatrics takes this very seriously:
“The AAP supports that concept of the medical home, a place where all care records are kept and where care is coordinated. Retail-based clinics don’t fit well in that model,” says Dr. Anne Francis, a clinical professor of pediatrics at the University of Rochester School of Medicine and Dentistry and co-author of the AAP Principles Concerning Retail-Based Clinics. “Retail-based clinics have established a niche for quick convenient care. They are poor choices for evaluating sick children, especially younger children. [They] are not the place for children and adolescents to get ongoing care for chronic conditions and not the place to have physicals for school or sports. The lack of access to the complete medical record and appropriate screening surveys and tools make this a poor choice for pediatric care.”
Pediatric Alliance has addressed the convenience issue in many different ways. Most of our offices have expanded office hours to include evenings and weekends. Some offices even have a morning “walk-in” clinic, no appointment necessary for simple sick visits. We’ve hired more doctors and pediatric providers (Kelly Dreisch is our new certified pediatric nurse practitioner and she is terrific!) and more trained staff to help answer your phone calls, fill out your forms, and schedule your children’s check ups (which can now be done online at some (and soon to be all) of our offices, through NextMD, our patient portal. Call us if you are not yet signed up!) We’ve allotted extra time during certain check ups, allowing us to thoroughly address chronic health issues as well as acute concerns.
We know your child and your family. We are wired to keep their medical records complete, legible, and secure. In the near future, we will be one of the first primary care practices to exchange health care information (with parental permission, of course) with other appropriate providers of care for your children. We are also connected closely to the community-at-large, and to the schools that we all share. All for the sake of our children.
As pediatricians, this is what we do.
Pediatric health care is not generic. It’s not the same whether you go to a retail-based clinic, an emergency room, or the office of your own board-certified pediatrician. It may well be more convenient for parents to choose a retail-based clinic some times, but it also very well may turn out to be a major inconvenience for your child when your pediatrician has to pick up the pieces.
More on The PediaBlog on retail-based clinics here.