Is 'Quick' Enough?

James Woodburn, chief medical officer of MinuteClinic, emphatically disagrees:

"We've been around for nearly seven years now . . . with almost no adverse events," he says. "We have a long track record of quality medical care," he continues, expressing pride "with our ability to provide convenient and extremely high-quality and cost-effective care."

Rockville parent Meredith Salamon is inclined to agree. Dropping into a MinuteClinic in a nearby CVS pharmacy last month to get flu shots for four of her five children, she says she was in and out in 15 minutes. "The cost was good, and the location was good, so it was easy and quick," she said. By contrast, she says, the family's more expensive traditional doctor "kept running out" of flu vaccine and keeps inconvenient hours.

From a business point of view, RBCs look like a success story. Five years after the first RBC was founded by a Minnesota doctor, there are now about 200 nationwide. A survey last summer by the California HealthCare Foundation projected the number will reach several thousand by the end of 2007.

Filling a Need

Fueling this growth, says Anne Pohnert, MinuteClinic's manager of operations for the Washington area, is the appeal of lower cost, speed, convenience and after-hours availability.

"Many patients would like to get in to see their primary care physician, but when they call, there is no appointment available," she says. Choosing an urgent care center or emergency facility may involve "a long wait and considerably more cost," she adds. "We believe that a visit to MinuteClinic instead of an ER on a Friday evening for a five-minute strep test is a win-win for patients and insurers trying to save time and health-care costs."

To contain costs, the typical retail clinic is a bare-bones affair, usually a small room with a few chairs, a cabinet or two and perhaps, but not always, an examining table.

On-site medical staff usually consists of a single nurse practitioner or physician assistant. A doctor is generally available for phone consults only. Prices are posted for all to see. Some typical fees in Maryland's MinuteClinics: $30 for a flu shot, $59 for a strep test, $49 to diagnose and prescribe treatment for an ear infection. Also posted prominently are ad slogans that capture the concept: "You're Sick, We're Quick," "Get Well, Stay Well -- Fast," "On the spot relief," "Great Care, Fast, and Fair."

MinuteClinic, which began operating here two years ago, now runs a dozen clinics in Maryland and 146 nationally, making it the industry leader. In the Washington area, it has recorded about 80,000 patient visits, according to its chief executive, Michael Howe. (CVS acquired MinuteClinic in September and operates it as a wholly owned subsidiary.)

Even their critics concede the clinics are tapping public frustration with traditional delivery of health care.

"The retail clinics are sending physicians a message that our current model of care is not always easy to access," says Rick Kellerman, president of the American Academy of Family Physicians.

This summer the nine partners of Spring Valley Pediatrics, a District-based practice founded 80 years ago, huddled to develop their response to RBCs.