AAP Principles Concerning Retail-Based Clinics

Has anyone read the recent policy statement issued by the American Academy of Pediatrics regarding retail-based clinics that was issued in December? You can find the complete paper at www.pediatrics.org/cgi/doi/10.1542/peds.2006-2681 .

From the AAP’s policy statement: "The American Academy of Pediatrics (AAP) opposes retail-based clinics (RBCs) as an appropriate source of medical care for infants, children, and adolescents and strongly discourages their use, because the AAP is committed to the medical home model." Some of the concerns outlined include "the fragmentation of care, possible effects on quality of care and the use of tests for the purposes of diagnosis without proper follow-up."

The AAP’s Retail-based Policy Work Group recognizes that RBCs will continue to exist and expand and lists the following principles that should guide their growth: 1) RBCs should support the medical home model by referring the patient back to the pediatrician or other primary care physician for all future care, 2) Communication with the patient’s pediatrician or PCP should occur within 24 hours of the visit, 3) The use of evidence-based medicine, 4) RBCs should be subject to and comply with all health care facility standards, and 5) The AAP is opposed to waiving or lowering copays or offering financial incentives for visits to RBCs in lieu of visits to pediatricians’ or other primary care physicians’ offices.

Well, here's my response:

Dear Membership of the AAP:

Nurse Practitioners and Physician Assistants working in RBCs have as much of a professional interest in providing patients with quality care as pediatricians. We understand the need for continuity of care. We provide referrals to physicians when a patient does not have a "medical home". We have supervising physicians who collaborate closely with us on the development of our guidelines. We comply with health care facility standards. We communicate with our patients’ physicians when they are seen in our offices. We refer patients to physicians when their health warrants a referral and when their presenting condition exceeds our scope of practice as defined by our company – which is, by the way, much more restrictive than when we, as NP’s or PA’s, worked for you in your offices.

Reatil-based clinics are a new phenomenon. There is not enough research to substantiate many of the claims made in the AAP's policy paper. Furthermore, to say that providers in retail-based clinics perform diagnostic tests without proper follow-up is an insult to our professional standards. To say that we, as professional healthcare providers, contribute to the fragmentation of healthcare without acknowledging the essential role we play in providing access to care for thousands of uninsured children is irresponsible. And finally, to suggest that our presence in a retail setting provides more of a public health risk than a pediatrician’s office is absurd.

We strongly encourage the AAP to research and revise its recommendations on the use of retail-based clinics for children and adolescents. As this model of healthcare evolves there will be increasing opportunity for collaboration between the NPs and PAs that staff these clinics and community-based physicians. We want to work with you, as colleagues and continue to make a positive contribution to the healthcare needs of children in this country.

Convenient Care Association

Some folks have recently pointed out that there already is a Convenient Care Association. Visit their website at www.convenientcareassociation.org and look at the membership directory for 2007; it is apparent that their interests are those of the convenient care businesses they represent. Not the providers on the front lines. If you were a hospital-employed mid-level provider would you belong to the American Hospital Association? While I don’t think that would be a bad idea, PA’s or NP’s do not necessarily share the same goals as the hospitals that employ them. Especially when it comes to issues related to their work performance and compensation! (That’s obvious!)

We are grateful that some courageous entrepreneurs have taken the financial risks to bring this model of healthcare to the public and by so doing, provided us with great jobs. That should not be an invitation to complacency. Nor should it be a muzzle that quiets our dissent. After all, without us, where would they be?

At no other time in the history of Nurse Practitioners and Physician Assistants have we had such a prominent public role in increasing access to healthcare. What do you want the public to know about who you are, what you believe and what you know? What type of input would you like to have regarding the direction of Retail Clinics? Time to speak up!

NARCP or NARCP?

A really smart guy once said "Ideas have consequences". I happen to agree with this smart guy, but I would take it one step further. Words have consequences. We all know that the words we say and how we say them can have a profound influence on where we are heading. In light of that fact, I would like to pose a question. Yes. Another question. Would it be better to call this association the "National Association of Retail Clinic Providers"? Could the word "practitioner" alienate our physician and physician assistant colleagues? If that possibility exists, I think the word needs to be eliminated. Stat. What are your thoughts?

How to post a comment on this site

For the folks who have asked. It's simple. No, really - it is. Click on the word "comments" at the end of a specific post that has inspired or peeved you and leave your two cents. You may have to create an account, but hey - that's free. And simple. The only identifying info you allow the public (and me) to see is what you want us to see.

Now that doesn't mean you can be ugly. Well, you may be ugly; what I mean is - constructive criticism and intelligent debate/discussion is what we are after (and capable of - imagine that!)

Pharmacy Representatives and Retail Clinics

So, you have been approached by an eager pharmacy rep saying "I didn't know you guys were here! Want some samples?"

Is there any benefit to obtaining samples in a retail clinic setting? Have you ever, in another setting felt obligated to sample?

I see many patients who are self-pay, no insurance, even struggling to purchase OTC medications. A physician I worked for saved samples for just these folks. Our unwritten policy was: if they are self-pay, give 'em the samples.

What kinds of problems would this pose in a retail clinical setting?

Statement of Purpose

Sounds so formal - "Statement of Purpose". Why have yet another National Association of Anything? Well, there are a few reasons why I think laying the foundation for a coalition of mid-level providers who work in retail clinics is essential.

Isolation - personal or professional is not good. In order to protect our interests as professionals we need to look beyond the boundaries of our employers. For example, if you worked in Dr. X's office for 10 years did you confine your professional relationships to just those people who worked in Dr. X's office? Or did you belong to a group(s) outside of Dr. X's office who could offer insight into your own practice?

If your answer is yes but you still have your doubts - how 'bout this question? If you were employed by X hospital did you confine your professional relationships to just employees of X hospital? I hope not.

Hospital X and Dr. X and Retail Clinic X may be just the most darndest best place/employer in the whole world (give me a break!) - but if you isolate yourself from your colleagues in different offices, hospitals, and retail clinics, in my opinion you are committing professional suicide.

Retail clinic practice is new, uncharted professional territory for most of us. This means two things: opportunities and innovation are still welcome and unknown hazards may lay ahead.

I understand that some retail clinics have specific rules about what you are allowed to discuss or not discuss outside of the company. Let's face it, when Wal-Mart gets into the game - you know this is Big Business. So protect yourself. Do not post anything that could get you into trouble! We do not want to share company secrets here. We want to share personal professional experiences.

So, with that being said, share your experiences, questions, frustrations and innovations as a practitioner working in a retail clinic - start posting!

Welcome!

Welcome to a blog designed specifically for Retail Clinic Practitioners - Nurse Practitioners and Physician Assistants welcome!