So, I work in one of the clinics at Walgreens and feel I can therefore address this topic. First. walgreens is just beginning to delve into chronic care management and it is not something they have done without a lot of thought. Yes, we do emergency refills etc but the chronic care management is beyond this, obviously. As we all know, nurse practitioners are well trained to manage chronic conditions. Just because it is being offered in a convenient care setting does not mean the standards change. NPs at Walgreens have the capability to order labs, order EKGs, make referrals, do POC testing in addition to outpatient labs etc. I am not limited in my ability to appropriately manage a chronic care pt because I work there (I cannot speak for other convenient care companies). Also, my patients can make appointments and they can choose to see me or my coworker. Our clinic is managed by 2 NPs and we rotate days. So, there is consistency in providers for our patients. We are there EVERY day of the year except Christmas and Thanksgiving so we are very available. Our patients have a call center to call if they need to talk to a provider and they get a call back the same day from the NP working. Also, the particular clinic I work at is the most busy (for Walgreens) in our area and I still feel this is manageable.
Keep in mind that, despite the ACA, there are still a lot of uninsured or underinsured patients out there and we are often a more affordable option for patients that will not go to a physician practice because they cannot afford it. In addition, because we work in the community, a lot of people get used to us and feel comfortable coming to us instead of a physician practice. Obviously, if a patient is beyond what I feel comfortable managing, I do encourage them to get hooked up with a PCP. We are NEVER trying to take patients from their PCP, we simply are offering another option for those who would otherwise not go anywhere.
Having said all of that, I feel like I should "confess" that when I first took this job out of convenience a few months back (got married, moved an hr away from my previous practice) I felt like I was taking a "lesser" job because it was located in a store. I could not have been more wrong. Again, I can only speak for Walgreens, but I will say that they really, really push evidence based practice and guidelines, following HEDIS guidelines, appropriate billing and coding etc. I get weekly chart reviews from my collaborating physician, quarterly peer reviews, weekly reviews of my billing practices etc. In addition, Walgreens does NOT use algorithms to tell the NP what to prescribe, labs to order etc like some other companies do. I decide how to manage my patients, no one else tells me what to order, pressures me to order antibiotics etc (in fact quite the opposite). I'm actually glad I made the change and work here!