'Welcome, slightly sick shoppers'

John Taylor: June 26, 20070 Comments

It's the biggest controversy in health care -- in-store medical clinics. Really, it is.

The American Medical Association this week said it intends to ask state and federal agencies to investigate health and liability risks and potential conflicts of interest posed by retail clinics now operating in stores like Wal-Mart, Walgreens, Rite Aid, CVS/Caremark and Target. There's something like 400 such clinics nationwide, but this regulatory uproar may slow expansion.

The clinics typically are run by a nurse practitioner or physician assistant, under supervision of physicians who are usually off-site. No appointments are needed. Those without insurance usually pay $60. And treatment is provided only for minor ailments like sinus infections, coughs or athlete's foot.

Clinic operators say their health care is affordable and accessible. Now the AMA wants to add "accountability" to the mix. One AMA official told the Chicago Tribune that physicians focus on patient safety and patient care, while clinics sell products and prescriptions.

Clinics say doctors are putting personal greed ahead of the greater good. They say clinics are a supplement, not a replacement for visits to doctors' offices, where appointments are often limited and insurance is expected. The Wall Street Journal has reported that 22% of clinic visitors were uninsured; Wal-Mart says half of those it sees are uninsured.

In the arguments, there is more than a little hint that doctors fear competition.

As always, California is in an unusual position. State law requires that clinics be part of a doctor-owned medical corporation. The doctor then directly hires the staff; by contrast, other states allow clinic companies to directly hire staff.

Another California twist: nonprofit Sutter Health operates six clinics in the Sacramento area. Sutter is the first health system in the state to enter the clinic arena, with an eye toward steering those it treats into its hospitals or physicians' offices.

So the next time you're hunting for dental floss, Kelly Clarkson CDs or a DVD of "Sicko,", just remember that "nurse in a box" in your department store is actually a warrior in another weird battlefield of health care.