Retail Clinics Continue Explosive Growth

Arizona Republic
Ken Alltucker
December 28, 2007

Worried parents, a sick infant and a crowded hospital emergency room. Instead of frustration over a seven-hour wait to have their son treated for a common respiratory infection, Rob and Debra Tofil sensed a business opportunity.

Today, the Tofils own and run MediMin, a Goodyear, Az.-based retail health clinic with locations in three Bashas' and Food City stores in the Valley. MediMin is one of a handful of retail health clinic chains opening locations inside grocery and drug stores across Arizona. These in-store clinics promise convenient health care for common ailments such as strep throat, skin conditions or vaccinations. Patients don't need an appointment, and care is administered by a licensed nurse practitioner or physician's assistant instead of a staff physician.

Backers of these in-store clinics say they provide an inexpensive option for people in need of quick treatment for minor health issues. These clinics, which typically charge a small fee for each service, also provide an option for people who lack health insurance. "We view ourselves as an alternative to urgent-care or an emergency-room visit," said Dr. Joshua Holland, MediMin's chief medical officer. He added that retail clinics help a strained health-care system pare unnecessary visits to those facilities. "It is prohibitively expensive to take care of a sore throat or a urinary-tract infection at an ER," Holland said. "We can do that here."

Retail clinics are rapidly expanding in Arizona with clinic operators planning new locations at retailers such as CVS and Fry's and Bashas' supermarkets. The Minute Clinic has been the most aggressive retail clinic in Arizona, with locations in 13 Phoenix-area CVS stores and another three clinics in or near Tucson. Minneapolis-based the Minute Clinic, a subsidiary of

CVS/Caremark, plans to open locations in 2,500 CVS stores nationwide. The Brentwood, Tenn.-based Little Clinic recently opened clinics at two Fry's stores in Phoenix and a third Fry's location in Peoria. The clinic plans another five Valley locations in 2008. MediMin, too, plans to open new locations in the Phoenix area, but no new sites have been announced. Wal-Mart operates retail health clinics in 12 states, but not Arizona.

The rapid growth of these clinics has caught the attention of some doctors' groups. The American Medical Association this year urged federal and state regulatory agencies to take a hard look at the growth of retail health clinics. The AMA said such clinics may pose a health risk to consumers by quickly treating patients for minor conditions that may be symptoms of larger health problems.

The Arizona Medical Association is among the groups that believe retail health clinics need regulatory oversight to ensure patient safety. "I think they need to be watched carefully in the same way we (doctors) watch ourselves," said Chic Older, executive vice president of the Arizona Medical Association. "Will the public be assured that they are competent enough to know what they don't know?"

The Arizona Medical Board provides some oversight to retail clinics that employ physicians' assistants. The state requires an Arizona licensed physician to oversee all physician assistants. That oversight requires weekly meetings between the doctors and the physician assistants to review matters such as patient charts and treatments. So far, the Arizona Medical Board has received no complaints about retail health clinics, according to a medical board spokesman.
Retail clinic representatives insist they do not intend to replace primary-care doctors. They offer a menu of health-care services that vary from chain to chain, along with fixed prices charged for these services.

Customers of The Little Clinic can get a cholesterol test for $20, a pre-employment physical for $45 or a flu vaccine for $30. And the process is quick, with most customers typically in and out within15 to 20 minutes, said Lisa Loscalzo, The Little Clinic's executive vice president of business development. "We are not out there doing surgery, just minor ailments," Loscalzo said. "We treat a very narrow scope of services."

Clinic representatives say they do not pretend to offer services they cannot handle. The clinics usually do not have sophisticated equipment such as X-Ray or MRI machines that are needed to diagnose and treat more complicated medical problems. If a doctor is needed, the clinics say they provide patients with names of licensed physicians. They also encourage their customers to maintain a primary care physician. Thing is, clinic representatives say they are tapping a demographic that conventional health providers often miss. At least 30 percent of customers who seek care at The Little Clinic don't have a primary care physician. MediMin counts the uninsured among its biggest customer groups. That can be fertile ground in Arizona, where one in five residents did not have health insurance in 2006, according to the Census Bureau.
Phoenix resident Audrey Villa admits she was initially skeptical about the idea of a health clinic inside a grocery store, but she has used retail clinics for routine care such as flu shots. "It is a weird combination, but it's convenient," said Villa, at a Fry's store on W. Bell Road near Interstate 17, the site of a new The Little Clinic.

Some retail clinic representatives expect the medical community will become more comfortable with these clinics once they learn more. Kevin L. Smith, director of clinical services for the Minute Clinic, believes retail health clinics represent an evolution of health care service. He compares the trend to the introduction of urgent care clinics more than a decade ago. Doctors and hospitals initially balked at those facilities, too, he said, "Both have been disruptive innovations," Smith said. "We are providing a niche of services. We have no intention of becoming the primary-care provider for the patient."