On-call goes retail: Defining the doctors' role

Ambulatory health clinics are springing up in stores throughout the country. While these clinics generally are staffed by nurse practitioners, physicians are being tapped to supervise. Here's how it works.

By Tyler Chin, AMNews staff. Sept. 11, 2006.

When the country's largest operator of retail-based health clinics approached Christopher Thompson, MD, about supervising nurse practitioners, he had questions about the clinics' quality of care, about how continuity of care would be ensured and about who would cover liability.

The Nashville, Tenn., family physician learned that MinuteClinic pays for liability insurance, that its nurse practitioners use evidence-based referral protocols and treatment guidelines, and that it asks patients to OK automatic sending of visit documentation to their regular physicians. So he signed up as a part-time independent contractor for the Minneapolis-based company.

There are approximately 150 retail-based health clinics operating inside supermarkets, pharmacies, shopping malls and other retail-based locations. They are staffed by nurse practitioners or physician assistants who treat non-urgent conditions. Market watchers predict industry growth, fueled in part by a looming physician shortage and an increasing popularity of consumer-driven care. Some experts estimate that 2,000 clinics will be operating by 2009.

Those clinics will need physicians -- not for on-site staffing, but in a supervisory role for the extenders. Although no one knows how many doctors will be hired, every clinic is expected to have a supervising physician. All states require physician extenders to have collaborative practice agreements with physicians.

Collaborative practice is consistent with AMA policy. Acknowledging that store-based clinics are expected to proliferate, despite some physicians' misgivings, the House of Delegates during its 2006 Annual Meeting pledged to ensure that physicians stay involved.