Convenience and quality of pediatric care at retail-based clinics versus traditional practices: Where will you choose to take your kids?

The Pediatric Insider

© 2015 Roy Benaroch, MD

Clinics in drug stores and big-box retailers are here to stay. Often staffed by nurse-practitioners working alone, they’re much cheaper to set up and run than a traditional practice. They need only a little corner of real-estate in the back of the store, and rely on centralized billing to further reduce costs. These clinics can provide “one-stop shopping” for customers who’d like to get their prescriptions and fill them at the same place. So it’s a win-win for the retailer. They’re cheap, they generate income, and—bonus!—they drive store traffic and support the sale of prescription and non-prescription medications from a counter only a few feet away.

But are these places a win for kids and families?

A recent JAMA Pediatrics study interviewed about 1500 parents who brought children to retail-based clinics in the St. Louis area. The parents were recruited from the waiting rooms of their pediatricians. Among the findings:

Reasons for going to the retail clinic included: more convenient hours (37%), no office appointment was available (25%), didn’t want to bother the pediatrician (15%), or because parents thought the problem wasn’t serious enough to warrant a doctor visit (13%). About 50% of these pediatric visits occurred when their own pediatrician’s office was open.

About half of visits entailed a 30-60 minute wait; about 10% waited more than an hour. (BTW: Data from Kids Health First, an Atlanta-area consortium of dozens of pediatric practices, showed that overall our practices have similar wait times.)

There was striking evidence for over-prescribing of antibiotics at the retail-based clinics. 68% of colds and flu were prescribed antibiotics, as were 29% of sore throats with a negative strep test. These antibiotics were not needed. To be fair, these surveys relied only on parental recall. We also don’t know the antibiotic prescribing practices of local pediatricians. Other studies of quality of care at retail chains have not shown a big difference in antibiotic prescribing rates. Still, the numbers from this study are way out of line with national statistics and good medical practice.

Can traditional pediatric practices like mine compete on location and convenience? We  can’t open up satellites in every neighborhood. We’ve got after-hours clinics, but not as many as the retail clinics. But perhaps we can demonstrate that we’re worth a few minutes extra time to make the appointment and drive over:

• Care at our office is by genuine, board-certified pediatricians. Yes, many simple things can probably be addressed by adult-trained advanced-practice nurses at a drug store. But how often does something that seems simple turn out to be something else?
• We’re here for emergency phone follow-up, and we’ll be here to reexamine and help when your child isn’t recovering as expected.
• Our office is happy to handle many medical issues over the phone—we don’t charge for this service, it’s just part of what we do for our patients. (Obviously we cannot keep doing that if our patients use us for free phone service but actually pay someone else for care.)
• We’ve got all of your records, and we’re here to coordinate care with specialists. Labs, x-rays, consultations—you need it, we can arrange it.
• We’re here to get to know you and your family. Your children will get to know us, and get to feel safe knowing that their own doctor is there to help.

Are these services from traditional pediatric practices worth the trade-off in “convenience” at the local retail clinic? Wal-mart and other huge chains have decimated many small businesses. Time will tell if private practices can continue to succeed.

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