(p. A3) My wife and I both work. When one of our children wakes up complaining of a sore throat, we could begin a ritual stare-down to determine which of us is going to have to wait for the doctor’s office to open, make the phone call, wait on hold, schedule an appointment (which will inevitably be in the middle of the day), take off work, pick up the child from school, sit in the waiting room (surrounded by other sick children), get the rapid strep test, find out if the child is infected and then go to the pharmacy or back to school, before returning to work.
Or, one of us could just take the child to a retail clinic on the way to work and be done in 30 minutes. Strep throat is incredibly easy to treat (Penicillin still works great!). There’s a simple and very fast test for it. Moreover, physicians are really bad at diagnosing some of these common illnesses clinically; a study found that a doctor’s guess as to whether a respiratory infection is bacterial or viral is right about 50 percent of the time — no better than flipping a coin. The point is, you need to get the rapid strep test every time regardless, whether at your doctor’s office or at a clinic.
Aimee and I choose the retail clinic every time.
Why? Convenience is the biggest reason. Many doctors’ offices are open only on weekdays and during business hours. This also happens to be when most adults work and when children attend school. A 2010 survey of 11 countries found that Americans seek out after-hours care or care in a hospital’s emergency room more often than citizens of almost any other industrialized nation. More than two-thirds of Americans with a below-average income did so. But this isn’t just a problem for the poor. About 55 percent of those with an above-average income did so as well.
We complain all the time that people use the emergency room for primary care. But that’s not always about lack of insurance. It’s about access. The emergency room is open when people can actually go. Emergency room use has gone up, not down, since the passage of the Affordable Care Act. More people have insurance, and now can afford care when they need it.
That care is also coming from retail clinics, usually found either in stand-alone storefronts or inside pharmacies. Between 2007 and 2009, retail clinic use increased 10-fold. It turns out that my wife and I represent America pretty well. About 35 percent of retail visits for children are for pharyngitis — sore throats. Add in ear infections and upper respiratory infections, and you’ve accounted for more than three-quarters of visits for children. Parents bring their children to retail clinics to take care of quick, acute problems. Swap ear infections for immunizations, and you’ve got the main reasons adults use retail clinics, too.
Researchers for a study published in the American Journal of Medical Quality talked to patients who sought out care at retail clinics. Patients who had a primary care physician, but still went to a retail clinic, did so because their primary care doctors were not available in a timely manner. A quarter of them said that if the retail clinic weren’t available, they’d go to the emergency room.
For the full commentary, see:
Aaron E. Carroll. “The Hidden Cost of Retail Health Clinics.” The New York Times (Thurs., APRIL 14, 2016): A3.
(Note: the online version of the commentary has the date APRIL 12, 2016, and has the title “The Undeniable Convenience and Reliability of Retail Health Clinics.” Where the two versions differ, the quoted passages above follow the online version.)
The research on patient motivation for using retail clinics, is:
Wang, Margaret C., Gery Ryan, Elizabeth A. McGlynn, and Ateev Mehrotra. “Why Do Patients Seek Care at Retail Clinics, and What Alternatives Did They Consider?” American Journal of Medical Quality 25, no. 2 (March/April 2010): 128-34.