Retail Based Clinics and the Future of Pediatrics
By Dennis Cooley, MD, FAAP
Within the last week the AAP has come out with an updated policy statement on Retail Based Clinics (RBCs). I encourage all of you to read this document which is included in the March issue of the journal Pediatrics. In it, the AAP strongly discourages children being seen in these clinics and supports the concept of the medical home. The policy statement reaffirms the problems with using RBCs including fragmented care and incomplete medical records. Children make up only 15% of the patients seen in these clinics but there is concern that these numbers will rise.
Unfortunately we all know that these clinics are here to stay mainly because they are driven by consumers’ (we used to call them patients) desire for convenience. This has led to some disagreement amongst pediatricians about how we should deal with the RBCs. Some pediatricians I have talked to want to take a hard line while others want to incorporate them into the health care system and work with them to provide better care. I frankly see both sides but tend to be more on the side of the hard liners. While I understand they are not going away, I do think we should actively discourage usage by competing with them. That’s correct… we need to compete.
For one thing we need to be more accessible to our patients. Not only will this make us competitive, but we owe it to our patients. In my office we have a walk-in clinic Monday thru Friday mornings where patients can check in from from 7:30 to 8:30 a.m. We also have after-hours appointments available Monday thru Thursday. During the weekend we are open Saturday morning by appointments and Sunday from 12 p.m. to 2 p.m. for walk-in patients. Does this keep all of our patients from going to an RBC or a free standing Urgent Care Clinic? Of course not, but it does cut down on the numbers. Do I like to work these extended hours? No, but I also didn’t like making trips into the hospital at 2 a.m. but understood it was part of the job. The feedback from our patients has been very positive. We have even been told many parents choose our practice because of our extended hours. Other methods of increasing accessibility need to be considered. Smaller practices may join together for sharing extended hours coverage. Pediatricians may consider forming their own urgent care clinics as is being done in some larger cities. I realize not every practice will be able to do these things but increasing accessibility in some manner is no longer an option but a must.
I believe we should also be more aggressive in marketing ourselves. Educate parents on the benefits of seeing us in our office. Let’s quit telling parents why the RBCs are bad (which I am afraid rings hollow to their ears) and instead tell them why we are better.
I am fully aware that even with increasing our availability we cannot have 24/7 office hours and we are going to have to accept the fact that someone else may be seeing our patients. So where are our patients going to go after hours for non-emergencies that can’t wait until the next day? Emergency Rooms are expensive and tend to over treat. Some form of urgent care clinics may have to be utilized. Here is where I agree with the argument of working with them to provide better care. How this is done will depend on your community but I think it makes sense to improve communications and strive to improve the quality of care they provide children.
Pediatricians provide the best care to children. We owe it to our children to continue to be leaders in their care. We shouldn’t roll over and let other groups assume this role, but we also have to be realistic and understand we can’t be everything for everybody. The health care milieu is changing rapidly and it is important that we be flexible and understand we have to change with the times.