The other day a patient presented for evaluation with left arm and chest pain. She was immediately sent to the emergency department. There have been many instances when patients have presented with that same complaint and other acute emergencies like abdominal pain, severe headache or severe cellulitis, to name a few (they were also referred to the ED). We also have patients requesting medication refills for their chronic conditions; many have been out of them for a long time.

I appreciate the confidence these patients have in us. We could take care of them in the correct setting of course. But, as we know, presenting in an office setting of any type with these inappropriate conditions can be potentially detrimental to patients' health.

I believe that most people are aware that we are here for nonurgent episodic care. But now in this time of high unemployment and no health coverage, people are desperate and not always thinking clearly about their best health interests. For example, they hope that we can look at them and tell them they are not having a heart attack.

Some of the stories people convey about their circumstances will tear your heart out. They've been out of work for a long time, or they've just lost their house. It takes a lot of talking and convincing to persuade some of them to go to the emergency room or urgent care. We keep lists of local health departments, physicians, local indigent clinics, etc. We also try to keep a working knowledge of other types of programs available for people who are underinsured or have no insurance at all. For example, we have a program in Georgia called Breast Test and More for women 40 years old and over who are uninsured which enables them to get their pap and mammogram at reduced or no cost to them.

Educating people about the things we can do in this setting is a very important part of our job. Educating people about how to access appropriate care is a vital part of our job and one of the things we do best.

I have thought about what it could mean if we as the professional healthcare providers spoke more with a united voice. Most of the time, it is when I get frustrated with others telling us how to practice our profession. The reality is that as employees of corporations, we do not have as much autonomy over our practice as we would if we practice independently. This is one reality a person who chooses to work in retail healthcare generally needs to accept.

But that is just one part of why, I think we, as retail healthcare providers need a larger voice in how retail healthcare develops. As a clinician, as a nurse, I have always known that I am the patient advocate. I speak for patients when they cannot speak for themselves. When my patients were in ICU, dying or on ventilators, I have been the one with them for hours. I knew their body, I saw them suffer or saw them prosper. And it has been my voice that has called the doctor, my actions that moved the legs, turned the body, and sometimes my eyes that cried a few tears. When I was an oncology nurse, with other oncology nurses, we were the ones who organized ourselves and taught ourselves and sometimes the doctors about patient care. It was nurses who pushed for ports and central lines for oncology patients in Georgia. I know because I was one of them. And it was nurses who set the standards for what oncology nurses should be.

Now, I am a provider in a retail clinic, where people come to feel better about their sore throats and earaches and urinary tract infections and, oh, their sinuses. But we are still their advocates. To do this, I believe we must first be educators. We need to teach them about how they can help themselves feel better and be healthier. To do this we need to advocate for more health education in our practices. For greater attention spent on educating our patients about their conditions.  What kind of educational materials do you have in your clinics about skin care, sinus infections, colds and fevers? What is the quality of our patient education materials?

We can be advocates for healthcare resources. Are the products we are marketing necessary? Are there products we could provide that could meet more patient needs?  Is there a place for clinicians in establishing pricing?

The ANA standards call for involvement of the NP in the heart of our companies. Our voices need to be there, where decisions are made. Are they there? I don't know. I think this can happen if it is not, but I think it needs to be a collective voice. I speak loudly but one voice is a nag or a complainer, many voices bring consensus and I think wisdom.

We have a medical directorand this medical directoris a physician. Now I have a lot of friends who are doctors. It is OK to be a doctor. And I respect a lot of doctors. And in our society I understand why an MD has to be in the role of the medical director. But where does this leave the nurse practitioner? We talk about autonomy but do we practice it? Should we be autonomous? I know where I live it just "ain't so" but where does it leave us as professionals?

I am a talker and I need the help of some of the doers. So, let's exchange cards and maybe network while we are in Florida and perhaps get together over a nice glass of iced tea. And maybe learn to become a better voice to advocate for our patients in the retail healthcare setting. I believe that it is possible to work with the corporate world that employs us. I believe our voices will make retail healthcare stronger and a better bet for our patients.

Healthcare reform is very much on the forefront of our minds. I recently have been reviewing different perspectives on the subject and have become better informed, somewhat more accepting of the idea - and probably more confused by all the issues involved. There is little doubt that we need some changes to occur, with our healthcare spending topping out at twice what other developed nations spend!

Health care reform has different meanings to different people. Some feel we need to simply reform the present way we are doing things. This can mean cut the staggering administrative costs that insurance companies have, which has been quoted to be up to 30% of all total healthcare costs. Others feel a national health plan where everyone has insurance coverage is the key. This is a great premise and many other countries have done this successfully without sacrificing quality, which is a concern for the United States. The quality of the U.S. healthcare system is not what it should be for the amount of money we spend per capita.

I am torn between the two options... I very much would like to see increased access for all, but I am not convinced that a universal plan would accomplish this as we continue to see decreasing numbers of primary care physicians. I also agree that the insurance companies and pharmaceutical companies have outrageous overhead and I think they could run a leaner ship and not have such fat pockets. Hopefully, a combination will emerge that will accomplish the goals we all want without sending us into greater debt.

Retail clinics have demonstrated that quality health care can be lean!  Retail clinics run a tight ship; we have bare staffing with an NP or PA and perhaps a medical assistant in clinic. We meet the patient, answer questions, room them and see them, making a satisfying visit, providing quality care that is affordable and convenient. 

Currently many retail clinics contract with numerous insurance companies, which increases access for patients. Secondly with retail health visits being much less costly than urgent care, emergency care or primary care, the insurers are saving money by contracting with us. It would be my hope that they would pass this savings on to their participants, improving the overall landscape of health care costs.

I think retail clinics will continue to thrive if or when we get a nationalized plan. The government has been very receptive to their concept and will see the benefits to them, the patients and the country as a qualified provider of excellent health care. I am proud to be working in a new area of health care that makes a difference!

One example that comes to mind happened on a day that I was in my office seeing a client when a host staff member knocked on the door and said that someone hurt them self in the store. I asked if the person was bleeding or not breathing, the response was no. I explained to that person that I could not respond because I was with a patient. The host staff member was a little upset with this reply. I finish taking care of my patient and then followed up in regard to the emergency. A child bumped his head on the shelf when bending down, there was no blood, no open wound, and as far as I am concerned, no emergency. This type of injury did not meet the requirement of a medical emergency.

Another example that comes to mind is that the host store has an employee that has medical issues that occur frequently. Sometimes the complaints may appear legitimate and other times the person appears to be faking. I have also noticed that if an employee states that he or she is sick the host staff will come and get the practitioner to assess the employee. However, neither of these persons wants to pay to be treated in the clinic. Should the retail clinic respond or attend to the host employees? These examples are truly not life-threatening events.

Now, I have responded to several real emergencies such as a man who was on blood thinner and cut his leg, bleeding heavily in the isles. I responded and controlled the bleeding until EMS arrived. On another occasion, a woman slumped over in the store and appeared to have experienced a TIA or stroke. I responded to these emergencies without any hesitation. However, I am still cloudy in regard to responding if I had a patient in my office. Would it be appropriate to refuse or should I leave my paying customer to attend to the host store emergency? 

I have had several conversations with my colleagues regarding this matter and our opinions differ slightly. Nevertheless, we all agree that what constitutes an emergency for the host facility may not be considered a medical emergency by the retail practitioner's definition. Handling these issues is a delicate task because retail practitioners want to maintain a positive relationship with the host without inconveniencing their clients for unnecessary reasons. Prior to the retail clinic present in these facilities, the host facilities were trained to handle and respond to their own emergencies. Should the host rely on the retail clinic now for support or should they be required to continue as if the clinic is not present? This question continues to plague the retail practitioner. What are your opinions on this situation?

Service expansion in retail health has created great concern for some members of the medical community. New service rollouts in retail health are not synonymous with new skill acquisition for nurse practitioners. Retail clinicians are highly trained nationally certified family nurse practitioners whose commendable evidence-based practice has been well established in the literature.

The convenient care model of health care delivery is primarily consumer driven which speaks volumes for the high quality and affordable services provided by retail health clinicians. Let's take a glance at the proposed new services ... infusion therapy for the treatment of postmenopausal osteoporosis is currently being piloted in some retail health clinics. These medications are safe efficacious treatments that are proven to improve patient outcomes and are commonly administered by nurses in various outpatient settings.

Common office dermatological procedures such as wart and skin tag removal using approved portable cryosurgical techniques are also proposed new service soon to be rolled out in the retail health setting. These simple low risk procedures are approved for administration by any licensed healthcare professional in outpatient settings.

Skin closure with topical skin adhesives is another common outpatient procedure performed by healthcare professional including nurse practitioners. This method of skin closure is comparable to suturing and is best suitable for small superficial lacerations. Again, the procedure is of low complexity, commonly used by many licensed healthcare professional and is preferred over suturing by patients especially children.

Now, let's take a closer look at the proposed new service roll outs for retail health. They have all been approved by the FDA as safe highly effective alternative methods of treatment in outpatient settings, they are preferred over traditional methods by most patients which means that there is a high demand for the service. Why not give patients what they want in a convenient affordable setting? Coincidently, they are all "procedures" that are reimbursed by most commercial insurers ... could this be the real basis of concern? Surely not ... so I'll dismiss that thought...

Will the scope of services expand in retail health?

Yes, for many reasons.

First, we all know that as nurse practitioners, our knowledge and skills are not being utilized to even a fraction of our capabilities in this setting.  It has been established that nurse practitioners have the ability to provide high levels of care in many settings. Numerous studies have confirmed this. Satisfaction surveys and studies show that patients enjoy seeing nurse practitioners in many arenas of healthcare.

Second, the patients enjoy utilizing this model of care for the convenience it offers. Patients have the advantage of being able to walk into these clinics at their convenience without missing work, etc. If it seems too busy to the patient at the time they present to the clinic, why they can shop or come back later to be seen and evaluated since the hours are very flexible. For this reason, patients value this model of healthcare and express interest in other services that may be offered.

Third, our increasingly unstable economy in which many patients are having to take on all or most of their healthcare costs will drive the ability for retail health to expand its scope of services. From what I read these days, about a quarter of Americans are not insured. The patients really appreciate knowing how much the visit will cost them up front. I have noticed that even when a patient is insured, most of the time they take an interest in how much their insurance is being billed so they can understand the actual cost. Patients in these settings reap the benefits of one on one attention and receive their evaluation and treatment as well as education regarding their condition from a highly trained healthcare professional. As patients become more educated regarding healthcare, they recognize the value of this more and more.

Fourth, retail health will have to expand the services in order to continue to thrive as a business. Historically, as businesses start out they seem to become successful as they begin with a menu of services that is small and clear cut and then expand.  It makes sense that if patients enjoy the convenience of episodic care in this setting, they will really appreciate the convenience of chronic and well care. We must expand our services to maintain a steady number of patients that is not dependent upon seasons.

It will be interesting to watch this evolution of retail health and I think we are up for it.

What I dislike about my job:

(OK, folks, this topic was a suggestion from someone. So, if you happen to be my boss reading this, please understand I truly mean every word I say. Including the fact that I know I work for a great company that does its best to respond to what we need. And considering some of the things that could happen - layoffs, cookbooks, etc. - I think I made a good choice working where I work. End of caveat.)

I hate getting up in the morning and coming to work. I do not like alarm clocks or one of my multiple cats screeching that it is another day of joy and I need to get up and earn the money for their kitty litter.

That I now have to drive many, many miles to different clinics since I, temporarily (please Lord), don't have a home clinic right now, is torture. This morning I was thinking about all the wear and tear on my poor old car and how there is no way I can afford to get a new one. And how I wish I could afford a new air conditioner since mine chose to break at the beginning of summer!

Opening up the clinic with people waiting on me makes me nervous. I like to be ready to see patients.

I HATE our electronic medical record. If Mr. Obama thinks EMRs are going to help the health care system, I wish he had to use the piece of... well, you get the idea. I noticed today that the AMA has a copyright on this thing. That explains EVERYTHING.

I hate equipment that breaks down. Computers that have been used 12-14 hours daily for over 2 years, with sticky keys, being replaced with another computer with a different sticky key. Printers that don't print, scanners that fail to scan, voicemail that sends you your messages a day after you get them, shredders that get stuck in reverse, cholesterol checking machines!! People who tell me what to do who are not my boss (any people who tell me what to do) and the biggie: people who have little or no clinical experience trying to tell me how to treat my patients.

Doing things that make no sense, just to follow rules that are not in the least designed for retail care drives me insane. It is necessary to have standards but retail clinics are sometimes square pegs that are trying to be fitted into round holes. We are still too new and I think what might be appropriate for some areas of healthcare is stupid for us. Case in point: having to label a specimen cup with the patients' name and DOB, when they are the only ones to handle the specimen and you are the only one to whom they are going to hand it back. It is not like there are going to be multiple urine specimens hanging around the store. However, the government asks, we have to do.

I do not like being the janitor, especially when my co-worker from the night before was human enough to forget to empty her cup of ice. I looked at the floor this AM and saw a half filled cup of melted tea and almost freaked. It looked like... well, you guess. It wasn't and I remember when I accidently rushed out and left a real specimen. My co-worker forgave me.

Sitting in a clinic for hours with no patients until it is time to go to lunch and getting three in a row.

Not seeing patients until all of the sudden at closing time they show up. And if they have been sick for a week, I have to remember not to flinch. Insult to injury is if I have to come back the next day. I am a wreck. I am too old to work 30 hours in a 48 hour period.

Again, no patients until 3 or 4 show up simultaneously. And all of them are "in too much of a hurry" to wait.

• Patients who come in with a "sinus infection" (after one day of symptoms) and NEED an antibiotic.
• Patients who are rude and condescending.
• Patients who don't have time to be sick.
• Patients who are going on vacation and need to feel well immediately.

I don't hate these people; I just am frustrated with our society that teaches us that if you feel bad, take a pill. Where does it say that you are not going to feel bad sometime and if you are sick, someone should fix it immediately? And for all those who don't have the time to be sick, guess what, your body says: too bad, take the time.

I dislike dealing with Insurance and people's ignorance about it. Some people don't even know the name of their insurance company. I hate that healthcare is a business but that's life as we know it. I don't like insurance companies but I think you have to put some of the blame on the people who use it (and misuse it). And when I tell someone how much we cost and they can not afford to have their child seen, a little part of me curls up and dies. When people come in with major stuff going on and want me to fix it because we don't cost as much as an emergency room, I feel bad. But not bad enough to not refer them on to a higher level of care. I am not stupid, just filled with angst. 

And that leads me to what I like about my job:

#1 My supervisor

#2 Seeing kids

#3 Acute (minor) versus chronic care, episodic versus long-term care

#4 My paycheck (even though it is not enough)

There are more things that I like about my job, but I will save those for another time. Like any other job, there are days when everything works wonderfully and I am glad I do what I do. And there are days when I plot my revenge and think working anywhere else would be a step up. I am not sure how much longer I will want to keep on doing what I do now. I have been here for two years. I may retire from this job or something else may come along. But I do know I am glad I have had this experience and there is nothing in the world like knowing you have helped someone. In this position, I have educated, treated and listened to many people. I feel that for that period of time I have intervened positively in their lives. For me, that is what being a nurse is about: caring and helping (sentimental but true).

As healthcare continues to present challenges for the United States, I am excited to work for a retail organization that is so attentive to the needs of both patients and providers.

In late June, 2009 we will be expanding our services to include a wider variety of skin treatments and conditions. We will be able to provide procedures like Dermabond for minor lacerations, skin tag removals and wart treatments! In addition, we will have a broader focus on recognition and treatment for other dermatological issues, while keeping strong ties with the local medical community and referring to specialists, as needed.

These new services were developed with our core strategies in mind - providing high-quality, affordable and accessible care. Prices are affordable and clearly posted at the clinic, and can be provided in a timely fashion where patients can walk-in without and appointment to receive care. 

All new services result from provider input -- what we as NPs think we can and should be providing -- as well as patient need and what makes good sense from a business and practice standpoint.  I am impressed at the amount of education and support we have been given around these new services prior to their unveiling.  The leadership in our organization recognizes the importance of providing proper education and training for the providers prior to offering a new service, something you don't find often in today's clinical practices.  The providers in our organization are extremely diverse in their experiences and years of practice, so providing continual professional development when a new service is offered is extremely important not only so the providers all feel confident, but also so we provide a quality service that retail health can be proud of. 

Not unlike NPs in the physician-dominated health field, retail health seems to have to prove their worthiness in comparison to the traditional health care settings of primary care. I look at this as an opportunity to shine and prove that we are competent professionals in an innovative setting, and instead of a threat, NPs and retail clinics complement today's current health care options. 

I believe that because retail health is responsive to consumers and providers, they have something special, and that has been a key to their initial success.  Retail health will continue to expand their locations and their services as they strive to meet the needs of the health care consumer and by doing so continue to secure their place in health care today.

I am sure that everyone is aware of the swing flu scare that took place a few weeks ago. This was an uncertain time for everyone in the medical and public health arena. However, after working in a retail health clinic during this time, I realized that the public turns to retail clinic providers to help them understand and process public health announcements and actions. Although we responded swiftly and kept the communication lines open, I feel more was needed and not just from the staff in the organization.

I want to take a few minutes and talk about a few points of concern. I will start by telling you a little about my course of events. I must say, by coincidence, my sister and I were talking on the phone when she ran across an article that read something like "Swine flu epidemic started in Mexico 16 deaths." Of course, this did exactly what the media expected; my sister, as well as many others, dropped everything and went into a panic mode. What is an epidemic? What should we do? Swine flu, what is that? My sister and I then read further and discovered that the symptoms consist of persons who had a sore throat, fever and flu-like muscle aches.

I relaxed because I had not been to Mexico and I did not have any cold symptoms; however, I could only imagine how many people just "realized" that they have the swine flu because of their sore throat or cold symptoms. I began to read more to better understand this disease process because I knew that a lot of people would be looking for answers. I did a lot of research by reading different newspaper articles, visiting the CDC website. I felt that I was abreast of the situation and now know about as much as everyone else on this new emerging infectious disease.

On the way to work, the radio that yesterday was blaring music was now talking about the swine flu and the potential for becoming a pandemic. Once in the office, I immediately signed onto my email to get directions on how to handle situations at the clinic concerning the swine flu, only to find no emails. I then checked the cabinet and realized that I only had a few flu test kits. Shortly after arriving, I began to meet the confused and panic-stricken public with questions about the swine flu; I was thankful for the prior research. I then began to receive calls from a few other providers wondering how we should address the public. Some time later that morning we finally received directions from the organization.

To be clear, considering this was the first emergency preparedness situation, my retail clinic organization did an excellent job in handling this public health matter. My mind keeps wondering, however, what would have happened if I had not had the opportunity to research? Would the outcome have been successful? Should retail health providers have emergency preparedness training?

I was very impressed with the organization when the ball began to roll. The thing that impressed me the most were the daily phone conferences updating the providers on the new findings and course of actions. This conference also gave the provider an opportunity to get questions answered. However, we ran into a few problems in following through with the plan of action.

One of the problems identified was if a provider suspects swine flu but the person does not have health insurance or a PCP, where does the provider sends the person to be tested? I know most of you would say the health department; however; the health department in GA was not providing these tests. The only other answer was the ER but this can be an unnecessary burden on the emergency room. This could have been a disaster for everyone and valuable cases may have been omitted. I think that public health needs to make provision and plans for retail clinics as responders in emergent situations. There need to be a protocol ensuring adequate support from the local health department or the Center for Disease Control and Prevention. What do you think? Did you witness any excellent actions from your organization in handling this matter? Do retail health clinics have a viable emergency preparedness plan? How involved should the public health arena become in supporting the retail clinics?

Our clinic is fairly new, open less than a year. We have been steadily seeing patients. Of course we would always like to be busier. We are at the point that even though we see new patients everyday we are seeing repeat patients as well. It is interesting to watch our clinic grow and to try to figure out patterns of what to expect each day as far as what we will see.

I thought that we may slow down as the weather improved but we seem to be seeing a consistent number of patients daily. In Georgia, many people are plagued with seasonal allergies as well as asthma which is really aggravated by the pollen in the spring. We are also seeing more sport exams now that spring football practice is beginning. I think that the recent outbreak of the swine flu also increased our patient visits. We didn’t have any patients with the swine flu of course, but we did see patients with concerns regarding that illness.

Our clinic is also providing different free screenings each month which has increased our patient contact and visibility in the community. I have really enjoyed doing the screenings especially when we are not very busy. I like to talk to people and learn about them and this gives me that opportunity. As a result of the screenings some of those people or their neighbors have returned as patients.

The patients do like the convenience and the care they receive and many inquire about possible expansion of our services. People drop by or call to see if we do lab work, routine health maintenance, manage chronic conditions, as well as other services. I’m sure that over time, there will be an increase in our scope of services. It will be interesting to see.

What is up with retail clinics in May?

Well, I have been out of action for most of the moth of April so I have missed the end of flu season and the push of sport physical exams that seem to come with spring.

Living in Atlanta, the "wanna-be" capitol of allergies, I know sinus problems and other allergy problems are a big part of the patient population. About 80 per cent of my patients have been allergic rhinitis or sinus pain and the rest strep throat.

It amazes me that people know so little about allergy and sinus medications. We are beginning a series of educational sessions and one of the topics will be about allergy and cold OTC meds. I am not sure there is enough time to properly discuss all the meds simply for colds, heaven help, if we start in on the homeopathic meds. People come in and say they have taken a cold and sinus medicine and it has not helped. They have no idea what the medication has in it! Does it even treat the symptoms they are having and if they are taking it frequently enough or too frequently. Many double up on meds and overdose on one ingredient in the many they take. They give them to their children. I understand how it feels to be miserable with a cold or sinus pain. But I can not really understand taking some medication without knowing what it is. You know I am a nurse. And I have seen people pop the pills they are told to take and know nothing but the color. Even after forty years, it still amazes me the blind trust people have in pills and doctors and the idea of medicine.

I am so old-fashioned it is sad. Instead of the latest in multisymptom medications, my patients get information about salt water nasal rinses and lemon and honey for cough suppression. Sometimes I feel like one of those "granny docs."

Seriously, I believe in getting back to basics and avoiding drugs. I do write for new meds, when they work better than old and while I try to avoid antibiotics, I use them. Last week, I even wrote for singulair for someone whose life has been miserable with her allergies. I did refer her back to her allergist but, yes, I gave her a trial of singulair.

My first information session is going to be on H1N1. I feel like we have been very lucky with this outbreak of influenza so far. I personally think the information the CDC has given has been on spot. I don’t think this situation has been over or under sold. The company I work for has been very good about keeping us up to date on issues. We have had a daily briefing and while I don’t know how long this will last, it has bee supportive for me as a clinician. Unfortunately, the public health departments have not seemed to be as on the ball as I would have hoped. None of the public health departments that are in my area are offering cultures if we need them. So far, it hasn’t been a problem. I hope this episode of H1N1 scare will help to see needed areas of improvement. If this flu became epidemic, the public health department would not have been the place to go. Someone asked me about free flu tests and as far as I know there aren’t any. I would think that the health department would be the place to go, if there were. And who pays for those antiviral medications the government released? I have read that they become the property of the state and local government to do with as they choose. I wonder what they have chosen to do with the amount send to my state? Needless to say, I don’t know as much about the public health system as I should.

What does all this have to do with retail clinics?

Well, my frustration with OTC cold and sinus (and don’t forget allergy medications) has got to be common with most retail clinicians. If it isn’t let me know how you do it. This frustration has led to a need to educate my patients and others. This idea of education fits right in with "marketing" our clinics. So we are doing something good. At least I think it is good. I will let you all know if other people think it is a good idea as well. We are doing a series of information sessions in the venue where we practice. And one of the topics is OTC Cold and Allergy Meds. The other thing that talking about the H1N1 virus situation does for me is to highlight how central retail clinics can be in times of public emergencies. I believe we need to take ourselves seriously and develop a real position in this area.

I hope that our companies and our government see it this way as well. I, again, have been pleased with the way my company has looked at the flu situation. It has been from a medical perspective and not from the idea of see as many people as possible and rake in the dollars. We have been educated by daily updates from our medical people, provided with guidelines for what to do with our patients and supported by our supervisors. We have provided free information from the CDC and seem to be handling this in a calm, professional manner. That is what I have seen about the swine flu and I hope this has been the outlook of other companies. I give retail clinics an A in this H1N1 situation. Now, if it were to really become as serious as it could become, I am not sure what would have happened. But if the virulence of the flu stays as it is, I hope we use this to teach us what we need for a health disaster.

Health care providers are faced with more and more issues on a daily basis. First the economy seemed to grab our attention with numerous layoffs, people losing their jobs and their insurance and their homes. This was disturbing to all of us and I was proud to work in retail health because I knew people wouldn’t have to sacrifice getting good care even if they had no insurance, no job or were down on their luck. Retail clinics offer a benefit to patients that do have insurance by charging their regular co-pay or even lower “retail-health” copays. For those uninsured, pricing transparency has allowed uninsured and underinsured people to be informed, aware and in agreement with the costs of the services they request from a retail health clinic. Not only are retail clinics making a difference in the health care economy, but in the lives of patients, which is the most important for me.

More recently we have been overwhelmed with “swine flu” or H1N1 Influenza A. Reports and information about this new strain of influenza has literally taken over our entire country, with new information presenting almost hourly. Once again I am proud to be working in a retail clinic at this time. The providers in retail health are able to provide front line information, education, testing and medications to assist in managing this outbreak. The response from the retail health community to this urgent issue, reinforcing the faith I have in the retail clinics, the providers that work in them and the administrative forces guiding them. No time was wasted before the retail health clinics responded to initial and subsequent news regarding H1N1, providing clinical policies, providing personal protective gear, educating the staff, etc. I have never worked in a primary clinic that was so well organized and responded so meticulously in an organized fashion. I am impressed. I think our colleagues in primary care should take note of this response.

We may follow a certain scope of services, but our care is full service! We know when, how and who to refer our patients to, we know the communities we work in and all the available resources to our patients. We work closely with public health, HMO’s, and Urgent care or emergency rooms to ensure “high quality” evidence based care. That is what all NP’s want for their patients and their practices. So no matter what is thrown at retail health, we can respond and succeed.

Over the past couple of days, there has been pandemonium in our community. Shortly after announcement of the 1st local probable case of H1N1, our community went into a downward spiral of panic. Several school closings contributed to mass hysteria … face mask, hand sanitizer and grocery items quickly left store shelves. It’s like Swine Flu Christmas in May for most retail pharmacies and grocery store chains …What a way to stimulate the economy! On a different front, emergency rooms, urgent care centers and to a lesser extent retail health clinics have been bombarded with asymptomatic people seeking testing and chemoprophylaxis prescriptions for antiviral medications…

Early this morning, I received a startling phone call from a colleague informing me that a local radio station announced that our retail partner was providing free testing and treatment for Swine Flu resulting in a surge of people expecting to receive free related services… Incidentally, a couple of days earlier, our company was featured in the local newspaper announcing an offer to provide limited free healthcare services for our current patients who had suffered a job lost on or before a specific date… Needless to say, the radio announcer misinterpreted that offer to include free testing and treatment for all unemployed persons in the county… Well, this triggered the domino effect that lead to a day of near chaos. In one of our clinics, an asymptomatic person presented requesting a signature on a voucher issued to him by his employer so that he can purchase Tamiflu from the pharmacy. Reportedly, one of our pharmacists received a prescription from a local physician for 40 doses of Tamiflu for personal use. Still in another clinic people presented with handwritten notes (taken from news reports) feverishly looking in the OTC section for Tamiflu.

Through it all, the providers in our clinics managed to hold it together and presented the facts to frantic patients based on CDC and our local health authority recommendations. Our company was proactive in implementing polices to address the public health threat in the retail setting. Fortunately, we have started to receive some of our personal protective equipment and are expected to receive our testing supplies any day now. I’m more convinced now than ever that retail health is a viable part of the healthcare solution. If we were not open, most of our patients would have presented to over crowded emergency departments looking for answers more so than healthcare services.

Retail health has made a monumental step toward reforming our current health care system… Not the usual rhetoric from broken campaign promises, but measurable actions in the form of service delivery designed to provide immediate aide to families who are affected by the downward spiral of economic malady… March 31, 2009 is recorded as the day that retail health rolled out the red carpet of limited free healthcare for patients and their families who suffered a job lost and became uninsured as the result of that lost… As with most offers there are terms and conditions that must be satisfied and the offer is not intended to be an offer of insurance replacement or a safety net program for all uninsured members of a community… It’s just a step in the right direction.

Arguably, the long term effects of this offer can be interpreted as a step toward social reform or the impetus for healthcare equality for all Americans... I know that’s a long shot and I should be crucified for even entertaining the thought, but if you expand the invisible borders of your mind; you’re free to explore the world of impossibilities… We call it “possibility thinking”… After all, who would have imagined that the convenient care model would become a viable alternative system of healthcare delivery? Certainly not those of us you spent years researching ways to fix the current system… No, the convenient care model is consumer driven and will continue to evolve based on consumer demands.

As consumers become more informed, providers of retail healthcare will need to become innovative in our efforts to deliver quality affordable healthcare and simultaneously maintain high customer satisfaction ratings. Effective marketing strategies including promotional offers are crucial to sustaining the model and have proven successful over the years for our retail partners. This is not an advertisement for “drive through” healthcare… Just an opportunity to explore possibility thinking...

Retail Clinics can become a key player in maintaining health and wellness for many Americans during this economic crisis.

As the financial system continues to plunge in a downward spiral, I often sit in my clinic wondering what the future holds for retail clinics. I often hear clients taking about the closing of businesses, the loss of employment and the inability to afford health insurance. In addition, I hear retail practitioners voicing their concerns regarding whether they have a secure job in the changing economy. Many retail practitioners are trying to decide whether to stay or change their specialty. These conversations may be stimulated by the media but bring about valid concerns and many unanswered questions.

We all have read statements such as this one written in the Kansas City Business Journal, “Eight in 10 Americans say they fear that the ongoing global financial meltdown might affect their ability to pay their medical bills” or results from the Harrison’s poll which states, that women report cutting back of health care due to cost. The media continue to report on the negative effects of this economical crisis on the health of many Americans. No one knows what the outcome will be for many Americans but lawmakers, economists and others are speculating that the cost of healthcare will continue to rise, people will continue to lose their insurance and the lack of accessibility and affordability to healthcare will continue to widen. Many small practices are feeling the impact of the economy and are closing their doors and making accessibility a problem for many people.

Initially, retail clinics might feel the pinch of seeing fewer patients because people are using their capital to buy food and keep shelter over their head. We all know that Maslow’s hierarchy of needs states that physiological needs must be filled prior to meeting safety needs. Maslow defines physiological needs as food, water, sex, breathing, sleep and homeostasis. He defines safety needs as security of body, of employment, of resources, of health, of family and of prosperity. Nevertheless, when a family member becomes sick and needs treatment, delaying care because of lack of finance can lead to a bigger expense. In addition, decrease immunizing children, people not filling their medications and delaying needed treatment will increase the mortality and morbidity rates in the United States. This opens the door for retail clinics to provide needed services and care during a time of hardship. Many retail clinics are in the infancy stage of development and decreasing their cost may not be a viable solution but staying around will give people a place to obtain medical care.

Let's look at the advantages of retail clinics in helping to bridge the gap of providing healthcare in this deteriorating economical state of affairs. Retail clinics offer affordable care to persons with insurance and persons without insurance. Retail clinics are also located in many neighborhoods with multiple locations, which improve accessibility. The major role for retail clinics now is to ensure the public that retail clinics will continue to provide affordable and convenient care for them as more and more people struggle to make decisions regarding obtaining food, shelter or healthcare. This also brings about the need for service expansion to ensure that the health of Americans do not worsen during this economical crisis.

I do not know about what other retail practitioners think, but I think retail clinics will be a key player in helping to maintain the health and wellness of many Americans. I have had several clients who are victims of the economic crisis and voiced that if retail clinics were not available they would not be able to afford healthcare. If retail clinics can find ways to survive the storm of this economic meltdown, the future of retail clinics can only look brighter. What do other practitioners think about the economical condition and retail clinic? Do you have any suggestions on what could improve retail clinics viability?