Wednesday, May 02, 2007

On the Proposed CVS Med Clinics

One of today's big stories in the Globe is a proposal by CVS to create upwards of 20-30 "MinuteClinics" across the state. The clinics could do the basic things;

They are trained to treat 20 or so common conditions, such as bladder infections, strep throat, and poison ivy, give pregnancy tests and vaccines, remove stitches, and write prescriptions.
The best part is they're supposedly quick and cheap, with an average 15 minute wait (without an appointment) and $59 visit, which would likely be covered by most insurances (they're in negotiations with Blue Cross and Blue Shield, Harvard Pilgram and Tufts).

Of course, doctors aren't thrilled by the idea.

Dr. Allan Goroll, an internist at Massachusetts General Hospital, said the opening of clinics in CVS stores and in Walmarts in other states reflects "the sorry state of primary care in America." He said insurers underpay primary care doctors, leading to a physician shortage. One answer, he said, is more investment by payers in primary care practices.
So, the real answer - according to doctors - is to pay them more. Err.... okay? No offense to Dr. Goroll, but these MinuteClinics sound almost exactly like a University Health Clinic - something any college student is well versed in. Are they perfect? Of course not, but they're not supposed to be either. They have their uses - such as when I got my stitches out, but I wouldn't go there for everything. It's just a convenient way to avoid going to the doctors if I don't really need that visit. If all someone needs is a vaccine, to have basic stitches removed or basic treatment of poison ivy, a nurse practitioner (or even nurse, in many instances) is fine. In fact, I've had nurse practitioners who were far and away better than doctors in terms of treating the same condition (I've had two warts in my life; the doctor who treated one left a nasty scar; the nurse practitioner who treated the other didn't).

Furthermore, there are some added bonuses to a MinuteClinic. For example, there are people who avoid treatment because of other time commitments - how many people forgo going to the doctors because they can't take a day off? Meanwhile, conditions worsen till a doctor's office becomes necessary. By that point, people just suffer more and disease spreads. Another example would be an older patient who doesn't want to visit the doctor - but, perhaps, could be coaxed into a "MinuteClinic" by a son, daughter or grand child?

With that said, these MinuteClinics will have to be open and honest in what they treat. They shouldn't think twice about redirecting anyone they're treating to a doctor if the occasion arrives. However, especially because of liability reasons, I think the fact that they would do that is obvious. It's my humble opinion that people tend to be decent human beings and thus would recommend a doctor's visit if their clinic weren't equipped or capable of treating a specific problem.

So, really, there is no inherent reason I can see to not have a MinuteClinic. They may treat people who would otherwise go untreated. They are faster and cheaper than most traditional methods. Hopefully, they'll keep people who don't need to be there out of emergency rooms. It's one time where the free-market comes up with a good idea. Though, like I've mentioned several times, the idea is far from unique. If what's akin to MinuteClinics is good enough for college students, it should be good enough for everyone who's willing to go.

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