EclectEcon

I posted last week about the shortage of primary-care physicians in both the US and Canada. Since then, Brian Ferguson has sent me an article from the NYTimes that tells how increasingly major pharmacy chains are creating in-store clinics that many people are using for primary care.

The concept has been called urgent care “lite”: Patients who are tired of waiting days to see a doctor for bronchitis, pinkeye or a sprained ankle can instead walk into a nearby drugstore and, at lower cost, with brief waits, see a doctor or a nurse and then fill a prescription on the spot.

With demand for primary care doctors surpassing the supply in many parts of the country, the number of these retail clinics in drugstores has exploded over the past two years...

Patients ... have flocked to the clinics, according to a new industry group, the Convenient Care Association.

“I think it’s great you don’t have to make an appointment. That could take weeks,” said Ezequiel Strachan, 33, who lives in Manhattan and walked into the clinic at the Duane Reade store at 50th Street and Broadway on a recent morning for treatment of a sore throat. “People here value their time a lot.”

The average waiting time for an exam at such clinics nationwide is 15 to 25 minutes, according to the Convenient Care Association.

The association estimated that 70 percent of clinic patients have health insurance and are using the clinics because of convenience. For them, costs may not be much different from those at doctors’ offices, because the same insurance co-payments apply. But uninsured patients could reap substantial savings....

New York law requires that nurse practitioners work closely with a physician, who oversees the practice but is not required to be at the clinic, and that the clinics operate as independent practices or professional corporations. In other states, the medical providers can work directly for a drugstore company, a practice that has touched off concern that the providers might place the interests of their employers above those of patients.

This looks like a classic setting for someone to be accused of engaging in illegal tie-in sales. The argument, though, would have to come from other pharmacies, alleging that having an in-store clinic ties patients to the pharmacy and blocks other pharmacies from the ability to compete fairly with those that have clinics.

But that is not what is happening. Rather, the objections are coming from medical associations, who object to the increased competition for their services (presumably the objection comes primarily in areas not suffering from a shortage of GPs). Nurse practitioners might not be as well-educated as GPs, but people are willing to take a chance with them for the sake of convenience -- short waits and no required appointments. This is an understandable reaction to the artificial shortages of GPs.