Memo From the Staff

It's probably no surprise to many of you, but retail clinics are spreading rapidly. There are only about 280 of them today, but Walgreens alone plans to open another 200 this year, and at least 1,500 retail clinics are expected to be in operation by the end of 2008.

If you doubt that these nurse-in-a-boxes will become a major force, just consider who's behind them: CVS Corp., with 6,200 outlets, has purchased MinuteClinic; Steve Case, the billionaire former chairman of AOL-Time Warner, is backing RediClinic, whose units are popping up in Wal-Marts; and Take Care Health Systems has raised $77 million in venture capital.

Investors and mass merchants are putting money into retail clinics because there's a market for them. The reasons are obvious: Retail clinics are convenient and cheap. They're open every day, and 12 hours a day during the week, so patients can get to them when they're off work and their doctor's office is closed. Seeing a nurse practitioner in a retail clinic costs the consumer only half of what an average doctor visit would cost if they had to pay out of pocket. If their insurance covers it, they usually have the same copay they'd have in your office.

Their unrelenting onslaught is somewhat chilling. But there are ways to protect yourself.

First, do what you can to minimize the competitive threat by making it easier for patients to see you. If you're not already offering evening and weekend hours, start now.

Be sure that patients can make appointments easily. Do an informal survey to find out how much trouble they have getting through to a receptionist on the phone. If it's a problem, improve your phone system and your front-desk response. In addition, consider switching to same-day scheduling so that everyone can come in when they want. Your patients will be happier and less likely to go to a retail clinic.

You'll also benefit by making yourself an ally of retail clinics and working with them to maintain continuity of care. Go in and introduce yourself. Since many retail clinics use electronic health records, it should be easy for them to fax you encounter notes or even send them online to your EHR. They could also refer new patients to you.

Finally, take the long view of how these clinics will change your practice: Even if you see fewer patients who have routine problems, you'll have more time to spend with those who have complex issues. If you document and code properly for those visits, you should end up earning as much as you do now.

In the end, it's not your reaction to retail clinics that counts; it's how you adapt to the new business environment that they're going to create.