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Fast-Medicine Nation

Retail health clinics are all the rage these days, but not everyone sees their popularity as a positive

In a world where dinner comes in a paper bag handed through a drive-thru window at McDonald’s and ATM’s man virtually every street corner, retail medical centers are giving new meaning to one-stop shopping. In addition to bread, orange juice and toilet paper, people can add flu shots, routine blood tests and treatments for a variety of other everyday ailments to their grocery lists.

With hair and nail salons, vision centers, restaurants and banks already opening shop right inside big box stores like Wal-Mart, it should come as no surprise that the health industry would be next in line, but the thought of retail clinics is a little unnerving to many primary care physicians. In Colorado alone, there are 15 SmartCare Family Medical Centers in Wal-Mart Supercenters, including ones in Loveland, Greeley and Brighton.

“SmartCare is another option for access to health care for the community located where people live, work and shop,” said Rebeca Imgrund, chief nurse practitioner from SmartCare Family Medical Centers. “It’s very convenient when you have an acute condition.”

The first SmartCare clinics opened in 2006 and the Greeley and Loveland clinics have been open just over a year. The clinics, which are staffed by nurse practitioners, require no appointment and charge about $65 for an average visit. By not having physicians on staff, the clinics are able to keep the cost down and do not require as much expensive medical equipment. Common things like the stomach flu, coughs, sore throats and physicals are the types of things these retail clinics treat. For more complicated things, patients are referred to primary care physicians.

“Our goal is to refer them to the level of care that is appropriate,” said Dr. Brian Erling, SmartCare’s National Medical Director.

Erling, who has a background working in emergency rooms, said he would see people come into the hospital and rack up a $400 bill for a soar throat because of a lack of access. Though retail clinics attempt to address this issue, many physicians do not necessarily think it’s the best solution.

Dr. John Bender, Larimer County Medical Society president and medical director of Miramont Family Practice in Fort Collins, said there is a concern that these retail clinics will negatively impact primary care physicians.

“Considering we have had 16 primary care physicians go bankrupt, prematurely retire or close their doors and no solo clinics left in Fort Collins, the concern is that 10 years from now, when our neighbors get sick they will go to a retail clinic and when they are really sick, they will try to go to the emergency room and everyone will try to send a report back to the primary care physician who no longer exists,” Bender said. “This will adversely impact the longitudinal and continuity which is the foundation of a healthy society.”

Others, like Dr. Ken Olds of the Family Physicians of Greeley, feel that retail clinics lack the personal information needed to take care of patients.

“As a family doctor, I believe that continuity is a good idea,” Olds said. “Our physicians will take care of an entire family over a long period of time. They know about your allergies and your past health. I don’t see how a retail clinic could offer that.”

Erling said that it isn’t about taking patients from primary care physicians, but improving access for people who may not have it and making it more convenient. Imgrund agreed, adding that about 30 percent of the people who visit the clinics do not have a primary care provider and might otherwise end up at the emergency room door.

SmartCare is but one of many retail health companies that is continuing to expand across the nation with talks of expanding into Fort Collins and Colorado Springs. According to the Convenient Care Association, there are more than 200 clinics operated by over a dozen companies across America.

“The reality is there is going to be more of them,” Bender said. “The question is whether they will delay people from getting the preventative services they need from a primary care physician.”

As the retail clinic industry has continued to grow, it has also caught the eye of many lawmakers. In early December, GOP lawmakers purposefully selected a SmartCare center as the site to announce their version of health care reform.

Sen. Steve Johnson, R-Fort Collins, said when they rolled out their agenda, the retail clinic was a perfect fit because it makes health care more affordable and is also a great avenue for education on health-related issues.

“I think it’s a good development as long as the quality is good.” he said. “A lot of people, if they didn’t have this option would go without care.”

Dr. Edward Norman, president of Big Medical Group, met with SmartCare officials before the clinic opened in Loveland. He said the emergent medical clinic and pediatric at Skyline Center for Health, which is located next to the Wal-Mart Supercenter, has not been impacted by the retail clinic.

“If you have good doctors and well-run clinics, then you don’t have a problem,” he said.

He said that retail clinics serve a small niche right now, but could be a benefit for a city where there is poor access to primary care services. However, he doesn’t think they will be a dominant force in the medical market.

“The only emotional feeling I have is I don’t think it provides very good continuous care,” Norman said. “I think this is a form of medicine does not even attempt to do this. Medicine is more than just going to McDonald’s and getting a hamburger. You need to find a physician you trust.”

By Erin Frustaci