The number of walk-in health clinics in supermarkets, big box retailers and drugstores has nearly tripled in the past year, leading physicians to wring their hands over quality-of-care issues and bemoan the increased competition for medical services.
But physicians at the Greater Baltimore Medical Center have taken a different tack: If you can't beat 'em, join 'em.
GBMC, a Towson hospital, agreed to allow physicians it employs to act as off-site medical directors of four such clinics, all newly opened within Target Corp. stores in the region, the organizations announced yesterday. A fifth clinic is set to launch this fall in Aberdeen.
"It's a way to give people in our community better care and a way to introduce us to future patients," said Dr. Sarah Whiteford, a GBMC physician who oversees the Target Clinic in Towson, which opened earlier this month.
The clinics - also in Bel Air, Ellicott City and Timonium - offer weekend and evening hours and often instant access to a health care provider.
They're staffed by nurse practitioners, who are licensed to write prescriptions and diagnose certain minor ailments, such as strep throat, ear infections and skin rashes.
Medical directors such as Whiteford oversee the nurse practitioners and are available for telephone consultation if a case is perplexing. Patients are referred to physicians for advanced care. "Our clinics are complementary to primary care, they are not intended to replace the doctor-patient relationship," said Target spokeswoman Lena Michaud.
Last year, the big box Minnesota chain had to close its store clinics, then located only in the company's home state and Maryland, when former partner MinuteClinic abandoned it for CVS.
A new Minnesota medical partner led to fresh clinics in Target's home state about a year ago, in a setup similar to that with GBMC.
Several quick care clinics have partnerships with regional health providers, said Ann Ritter, policy director of the Convenient Care Association, an industry trade organization. And she expects to see more.
"I think it makes sense for both sides in a lot of different ways," Ritter said. Clinics get the prestige of having a formal partnership with established physicians, and the medical centers get a chance to grab new patients who may not have primary care contacts.
There are roughly 700 quick care clinics in the United States, up from about 250 at the end of last year.
Few have physicians on site, which has caused concern among medical organizations and doctors, who have increasingly lost business to the stand-alone clinics.
This summer, the American Medical Association called for legislation to regulate such store-based clinics.
The American Academy of Family Physicians has created a set of guidelines - suggesting that the clinics limit the scope of their services, have a team-based approach and maintain electronic records - in the hopes of boosting the quality of care.
The Target clinics comply with the guidelines, but for some critics that's not enough.
"The guidelines ... are forced by a less than adequate situation," said Dr. Martin P. Wasserman, executive director of MedChi, the Maryland state medical association. "There are a lot of these [clinics], they're well-financed and I don't think we can stop them. Should they have been started? I think not."
Wasserman worries that such clinics open the door for mistakes and missed opportunities for diagnosing diseases that a physician could recognize, but not necessarily a nurse practitioner.
"Something could be missed," Wasserman said.