Yesterday I walked into my local Dillions Grocery store to pick up a few things, and I was surprised to see new lettering on the outside of the building indicating that the store had expanded its offers. It was now not only a grocery store/pharmacy/restaurant/Starbucks/general goods store…it was now also a Little Clinic. Most people living in the US are by now familiar with the concept of the all-in-one shopping experience. Retailers like Walmart, Target and Kroger are building and opening what they often refer to as Marketplace stores. These are stores where you can do your grocery shopping, get your hair/nails done, do your banking (and let me tell you from working in the financial services sector there is a HUGE uproar about that within the industry!), get your prescriptions refilled, get your car worked on and everything else under the sun all from within location. These are marketed as being the ultimate convenience, after all you can get everything done in one stop instead of driving all around town to ten different places! Those of you who tend towards the cynical can also identify it as ways for these institutions to increase profit even after you have already killed your competition in one location by going after related services and taking them out.
Whether or not this business model is good for the economy as a whole is a question for another day. But I was intrigued with the idea of Little Clinics. Pharmacies have been incorporated with these larger stores for more than a decade, but this was the first full-fledged medical facility I had ever seen in a store. The Little Clinics at the Dillions locations are affiliated with Via Christi, a large health care provider based in Wichita, and as the article explains if a shopper comes into one of these Little Clinics and needs a referral, they are going to be referred to a Via Christi location or Via Christi affiliated practice. Of course this is genius from the marketing side…most people don’t really shop around for their healthcare providers and tend to pick based on location and whether or not the facility takes your health insurance or is in your preferred provider network. This is a good way to get your name out there get people to have experience with you…people who may be convinced to switch after the experience. And the services offered by these Little Clinics is pretty expansive. The local Little Clinic alone offers everything from school physicals to full lab work (everything from diagnostics to full lipid panels and blood glucose screenings) to vaccines (everything from flu shots to HPV) and treatment for all sorts of conditions including ear infections, bronchitis and any of the other things that most of us whine about having to make an appointment for because we know we just need an antibiotic. It’s basically a general/family practice clinic right in the store.
The reason this idea intrigued me is for a couple of reasons. The first reason is because of the much publicized shortage in primary care physicians in the US. Thanks to general population growth, the aging of the Baby Boomers and the expansion of healthcare to those who could not previously access it under the Affordable Care Act, one estimate indicates the US will need an additional 52,000 primary care physicians by 2025, just to keep pace. One driver behind this shortage is simply that fewer medical students are interested in primary care, choosing instead to pursue specialty care. My guess is that one of the big reasons behind this is reimbursement rates. Student loan debt is already astronomically huge in the US (mark my word…it will be the next bubble to burst), but for those who are going to medical school the average student loan debt is north of 160K, which is enough to guarantee that you will have an IOU printed on your tombstone. If you have that much debt, you would be far better off to go into a specialty because the reimbursement rates for a specialist far exceed what you will earn as an ordinary primary care doctor. Even if you have to take out more in loans to become a specialist, if you can double your salary by doing so you have a much better chance of paying it back. Given this looming shortage, there has already been a vast expansion in the role of nurse practitioners and physician assistants who can help fill in the gaps that are created in treatment. Opening up new spaces for primary care physicians, nurse practitioners or physician assistants to operate in improves access to healthcare, which is one of the major challenges facing healthcare in the US.
The second reason this intrigued me was because of a Ted Talk from 2009 called Take Healthcare Off the Mainframe. In the talk Eric Dishman makes a thoroughly convincing argument that the current US healthcare system is operating just like the old mainframe computers. Hospitals serve as the central hub, and everything else (clinics, nursing homes, etc.) branches out from them and must connect to them in order to work. Hospitals are large, unwieldy complex systems that are not good at adapting to the changes in the population that are driving future changes in healthcare, like the aging of the Baby Boomers. Eric argues, very convincingly I might add, that in order for medical care to survive, we need a systemic shift in how its delivered. We need to take it off of this unwieldy mainframe and re-organize it in a way that more closely resembles a modern networked system which is faster and easier to adapt.
The opening of these Little Clinics is definitely a step in that direction. Is this a sign that the healthcare industry is beginning to try to adapt itself by trying to break away from the old mainframe idea? Is it an attempt to deal with increasing demands for healthcare and the looming primary care physician shortage? Is it a cynical attempt to make more money in a sector not known for being economically stable? My guess is that it’s a combination of all three of these factors and more. But if in the end we get a more accessible and responsive health care system out of it, the ends may justify the means.