Pediatrics Group Balks at Rise of Retail Health Clinics

Medical Outposts Don't Provide Pediatricians' Continuity of Care

Melinda Beck and Timothy W. Martin Feb. 24, 2014 12:09 a.m. ET

A customer fills out a health-information form at a Walgreen's health clinic in Illinois last September. Getty Images

Retail health clinics that are popping up in drugstores and other outlets shouldn't be used for children's primary-care needs, the American Academy of Pediatrics said, arguing that such facilities don't provide the continuity of care that pediatricians do.

While retail clinics may be more convenient and less costly, the AAP said they are detrimental to the concept of a "medical home," where patients have a personal physician who knows them well and coordinates all their care.

"We want to do all we can to support the concept of 'medical home' for kids," said James Laughlin, lead author of the statement, published in the journal Pediatrics Monday.

Set in drugstores, supermarkets and big-box stores, retail health clinics are playing a bigger role in the delivery of health care. Some have expanded beyond treating sore throats and giving flu shots to offer sports and school physicals and treat chronic diseases, setting up more direct competition with doctors.

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Retail clinics also are generally open seven days a week, don't require an appointment, accept more types of insurance than doctors do and charge 30% to 40% less for similar services, studies show. Costs vary widely by region and service offered, but getting a common ailment treated at a retail clinic, without insurance, typically runs between $50 and $75.

After plateauing in recent years, the numbers of these outlets are once again expanding, as retailers bet that the Affordable Care Act will bring longer waits at doctors' offices and drive more patients their way.

CVS Caremark Corp. , the largest player, wants to double its MinuteClinic locations in CVS stores to 1,500 by 2017. Walgreen Co. plans to add 100 more clinics this year, bringing its total to 500. Consulting firm Accenture estimates the total number could grow to 2,800 by next year from about 1,400 in 2012.

The Convenient Care Association, the national trade group, said retail clinics are responding to consumer demand. "They are a more convenient option for parents with sick children than the alternative, which is often waiting for an appointment or spending hours in a high-cost emergency room for a minor pediatric complaint," Tine Hansen-Turton, the group's executive director, said in a statement.

Half of visits to CVS's clinics, for instance, are at night or on weekends, said Andrew Sussman, MinuteClinic's president. "We're filling in the gaps," he said.

Most retail clinics are run by nurse practitioners, not physicians, but some health systems are creating alliances with retailers. CVS has 30 partnerships with hospital systems, including Emory Healthcare in Atlanta and the Cleveland Clinic, where doctors review electronic medical charts, off-site.

The AAP said it supports partnerships where clinics refer patients back to their pediatricians and share all pertinent information, but Dr. Laughlin said those are rare. With most clinics, he said, "The tendency to work collaboratively has not been there."

Studies show that people who use retail health clinics tend to be younger, healthier and more affluent than average. As many as 70% of parents who use them have a pediatrician but say they can't wait for an appointment or take time off work when the doctor's office is open, said AteevMehrotra, a policy analyst at RAND Corp., who has studied the clinics for years.

And some parents say they don't want to bother their doctors. Karen Ide, mother of two boys in Park Ridge, Ill., said their pediatrician is their main health-care provider. "But for the little things that come up, like sore throats, eye infections, ear infections, Walgreen's is my go-to," she said.

The AAP statement, which updates a 2006 policy, said seemingly simple complaints may have serious underlying causes. Pediatricians also use routine visits to monitor and discuss other issues, such as mental health and obesity.

Dr. Laughlin also said, however, that pediatricians should be more accessible: "That's an issue that we as a profession need to address." By including a large group of doctors who work staggered shifts, he said his practice in Bloomington, Ind., is available 365 days a year, and 8 a.m. to 8 p.m. on weekdays.

With demands on their time likely to increase, Dr. Mehrotra said pediatricians should accept that patients will use retail clinics for some services and focus on improving communication and cooperation. But he fears the AAP's position may create more animosity instead. "Some pediatric practices say they won't see you if you go to a retail clinic," he said. "And we've heard that some patents tell retail clinics, 'Please don't tell the pediatrician that I'm here.' "

Write to Melinda Beck at and Timothy W. Martin at

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