Retail store NPs: good or bad idea?

VivaRN · Jan 17, 2008

NP-run retail based clinics have caught on in my area and are fairly prevalent. They have a very narrow scope of practice: primarily mild episodic complaints, which allows for quick visits and not a lot of paperwork. To my knowledge they don't have lab capability (other than perhaps a rapid strep) because they don't do follow up. They don't do chronic disease management. It is very limited compared to your standard urgent care.

From what I've heard, the NP's are well paid (>75K). I'm not sure about your scenerio of turning people away but my guess would be these clinics don't have the capacity to handle such complaints. 911 would be the best, and fastest way to evaluate these patients.

While at first I was skeptical about the role of an NP being put in such a narrow box, my colleagues in the ER have told me these clinics have helped reduce ER overcrowding. Patients without insurance can go to these clinics and pay a flat fee for common complaints, such as URI's, peds ear infections, etc. instead of going to (and paying for!) the ER.

Ideally, everyone would have a "medical home" with organized primary care and ease of access.

But until that day comes... it seems like these clinics have tapped into a niche. They are making bank and are spreading like wildfire.

Jolie, BSN · Jan 17, 2008

I'm not an NP, so I can't address the practice questions you asked, but I have had positive experiences with our local NP-in-the-box, housed within a grocery store.

We have a high-deductible insurance plan, and almost never meet the yearly deductible. So with the exception of preventive care (which is covered 100% without regard to deductible) we pay out of pocket for most expenses. We have primary physicians (internist and pediatrician) who we see for yearly preventive visits, prescriptions and serious problems, but for the occasional sore throat or minor injury, the NP clinic is more convenient and less costly.

We've been there for sinus infections and tetorifice shots, and have been well-cared-for. We live near a military base, and almost all of the NPs that staff the clinic are former military with impressive experience and credentials. The waiting time has never been more than a few minutes, and follow-up forms are always sent to our primary doctors. For the services we've utilized, the cost was about half what we would pay at the doctor's office. Works well for us, and offers a nice alternative on weekends and evenings.

westcoastgirl · Jan 18, 2008

the clinics sound like a good idea for consumers, especially if it reduces ER visits for minor ailments that is very good for patients and ER alike.

if you are asking about working at a clinic as a NP, I think you need consider your professional needs. Personally I wouldn't do it even if it's pretty easy like some of my NP friends have told me. This is because as a recent graduate I feel strongly about working in an environment where I can maximize my learning, manage a variety of conditions, and having MD backup in case I am stumped about anything.

If I were an experienced NP looking to pick up some good money doing part time work in a low stress environment then such clinics may be an attractive option.

joy09 · Jan 19, 2008

sounds like it isn't such a bad idea after all. that's why i asked. thanks for the feedback.

DutchgirlRN, ASN, RN · Jan 19, 2008

I visited a doc in a box a couple of weeks ago and found it very unsatisfactory. Now maybe for very simple complaints it might be fine but otherwise forget it. 99% of the people I saw there appeared to be very sick and no one came out with a script, including me, and it turns out I had pneumonia. I was told to take Delsym and drink alot of fluids. :angryfire

birdgardner · Jan 23, 2008

A neighbor of mine is a FNP at a local retail outlet. She told me they had 35 different diagnoses they could make and treat. I asked her if she felt limited at all, and she said that at one time she would have, but now she likes a place within a five minute drive, with fixed hours, that pays her well and treats her well, with respect.

butch228 · Jan 23, 2008

Up here in Boston..the clinics in the drug stores are about to enter the market. Our mayor..acted like chicken little about the upcoming clinics. In Boston, with the dominant physician presence ..they have also acted like alarmists. The bottom line is NPs will be practicing in specific niche..minor ailments..providing more access to health care. I haven't seen any hard evidence that these clinics are detrimental to people's quality of healthcare. Just trying to find a PCP up here..is about a month or two wait.

Here's an interesting article in the Boston Globe..

http://www.boston.com/news/local/connecticut/articles/2008/01/22/upbeat_diagnosis_for_clinics/

n_g · Jan 23, 2008

Is this the impression that NP's want to give to the public? If you have something simple like sore throat, go to an NP who can't screw up because they basically read off a company approved template. When you have something more serious, then go to a doctor. In the long run, I think this will hurt the NP image more than help it.

ICRN2008, BSN, RN · Jan 30, 2008

I think that working in this type of environment might be good for NPs who wish to work in a place with limited liability, set hours, good salary, etc. I do not see it as damaging to the image of nurse practitioners. There are PTs, SLPs, pharmacists and many other providers practicing in a wide variety of settings. For instance, some pharmacists are highly specialized transplant pharmacists in tertiary care hospitals, while others work the night shift at Walgreens. Both play an important role in providing care to patients where they need it most, whether it be in the community or in a more complex setting.

n_g · Jan 30, 2008

But people aren't confused by the differences between PT's, pharms, and doctors. They all practice different areas of healthcare. However, they get confused with NP's and doctors because NP's are practicing medicine. My vote is it hurts the image long-run.

VivaRN · Jan 31, 2008

I have to disagree about the recognition... because the retail based clinics have flooded the radio with ads telling people about NP's. For example, a mom voice saying something like:

When I have a problem, I go to the nurse practitioner at Walgreen's because I trust her education and experience. She listens and cares about making sure I'm healthy.

Another one had kids yelling out who they see when they are sick. "A scientist!" "A doctor!" "A nurse practitioner!"

It's like the law of unintended consequences. Their bottom line depends on people seeking care from NP's. As a result they are getting us a lot of recognition - more than AANP could do. It'll be interesting to see where this goes.