Minute medicine: examining retail clinic legal issues and legislative challenges.

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Minute medicine: examining retail clinic legal issues and legislative challenges.

INTRODUCTION

In the back of the local CVS drug store, behind aisles stocked with shampoo, painkillers, soda, and holiday decorations, sits a clinic examination room. The exam room is located next to the pharmacy. The couple of chairs between them do the double duty of seating patients who are waiting to be seen and customers waiting for prescriptions. A small touch screen display outside of the closed door permits those wishing to see the nurse to tap out their name and browse the menu of services that the clinic provides. Services range from pre-summer camp physicals and strep throat tests to diabetes testing and meningitis immunizations. Within fifteen minutes, a patient's name is called, and he or she is ushered into the exam room set up as a smaller-scale physician's examination room. When the exam is completed, the patient will leave the exam room with either a prescription for the pharmacy next door or with an answer to his or her medical problem, all without having to wait in an urgent care clinic, or needing a prescheduled doctor's appointment.

By summer 2009, the Convenient Care Association, a trade group for the retail clinic industry, estimated that 1,200 retail-based health clinics operated in the United States. (1) With such operations in place, any patient who is eighteen months or older (2) can enter a drug store or supermarket that contains a clinic and can be seen and assisted, usually within fifteen minutes of arrival. (3) Each patient of a retail clinic takes part in what critics and proponents alike agree is a major change in the manner in which Americans receive healthcare. (4) Doctors, nurses, politicians, and patients are closely following the spread of retail clinics. These groups hold diverse views on the retail clinics' growth, ranging from deeming the clinics as a solution to the crisis of healthcare coverage, to condemning the clinics as the complete undoing of the doctor-patient relationship in America. (5)

The American public has enjoyed an immense increase in consumer power in every area of commerce. (6) No longer are consumers willing to enter a store and rely completely on the salesman to tell them what products to purchase. As the balance of power shifts from salesman to consumer, so too does the balance shift in the U.S. medical community, with patients increasingly demanding more information and more choices when it comes to their healthcare. The idea that a patient is a retail consumer and healthcare is the product has negative implications within the medical community. The medical community has relied historically on its advanced training and position of power to guide patients in making health-related decisions. (7) To say that a patient could enter into a doctor's office and purchase a strep throat test sounds strange, and yet, as fewer and fewer Americans have access to the traditional primary care provider relationship, shopping becomes a more apt analogy. Accordingly, retail clinics have responded to consumers' demands for convenience, control, and value throughout the United States.

In 2008, spending on healthcare in the United States represented sixteen percent of gross domestic product at $2.3 trillion. (8) As healthcare costs continue to rise, nearly forty-five million Americans remain uninsured and without adequate access to necessary health services. (9) The spread of retail clinics is not a panacea to the healthcare problems facing the United States. It is too early to accurately judge the impact which retail clinics may have on healthcare in the United States, but many groups both for and against, are tracking these clinics' development. Implemented correctly, and controlled appropriately, the increased access to healthcare and preventative focus which retail clinics can provide may help extend healthcare to more Americans when they need it, creating a healthier society. Retail clinics can achieve these goals because of their innovative use of non-physician providers as well as technological and medical innovations. Retail clinic expansion shoul...

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