NURSE-DRIVEN CONVENIENT CARE MOVES PAST 'TREND'
Nurses and nurse practitioners have a growing field of opportunity as walk-in clinics become 'Doc in a BIG box'
By Doug Childers

Karen Frye provides health care in what five years ago would have seemed like an unusual setting.  Each workday, the nurse practitioner with 27 years' experience as a nurse drives to a Wal-Mart in central Virginia and cares for patients at a RediClinic there.

At first, it felt strange to work as a nurse in a retail store, she said.  "But honestly, this is absolutely what the market is asking for."

As patients grow tired of crowded waiting rooms and long waits for an appointment in traditional doctors' offices, medical concerns that offer convenient care in retail settings are growing. They boast quick service, extended hours and transparent pricing, and some of them, such as Houston-based RediClinic, operate inside retail stores with a pharmacy onsite.

"We're practicing convenient care, and a part of that convenience is getting access to diagnosis, treatment and a prescription quickly and easily," said Kevin Riley, RediClinic's vice president of business development.

Currently, there are more than 400 retail-based convenient-care clinics across the U.S., operating in places such as Wal-Mart, CVS and Walgreen's.  And Riley expects the industrywide number to grow considerably.

PATIENT FIRST in Mechanicsville

"We're past 'trend,' " Riley said.  "Some day, there will be convenient care in every market."

Among the retailers looking to play a larger role in the emerging retail clinic field is Wal-Mart, which plans to open as many as 2,000 convenient-care clinics inside its stores through partnerships with retail clinic companies in the next five to seven years.

The services offered by retail walk-in clinics like RediClinic and Minneapolis-based MinuteClinic are similar to what you would find in a primary care physician's office, if slightly more limited.

"We treat 80 percent of what a primary care office might see," said Anne M. Pohnert, MSN, FNP, MinuteClinic's manager of operations for Northern Virginia and Washington, D.C.

Among the common medical conditions treated at retail clinics are strep throat, ear infections, urinary tract infections and skin rashes.  Some retail clinics also offer preventive services, including screenings and blood tests, immunizations and basic physical exams.  RediClinic recently started a smoking cessation program in response to patients' requests.

"It's such a proactive organization that they're willing to look at things the community is asking for," Frye said.  "And there's a lot of nurse practitioner input.  We know what makes a difference with patients, and we are a part of the change here."

The number of patients a retail clinic sees in a day varies widely.  During flu shot season, daily traffic can be as high as 140 patients at MinuteClinic sites, but they typically see 20 to 30 patients a day, Pohnert said.  Likewise, a typical RediClinic averages 20 to 30 patients per day, although the number is higher during flu shot season.

MinuteClinic first opened inside a Minnesota grocery store in 2000.   It became a subsidiary of CVS Caremark in 2006 and now leads the industry with nearly 350 clinics in 24 states.  Some of the clinics are located in malls, but 90 percent of them are inside CVS stores.  The company operates two locations in Virginia, and it will soon add another nine retail clinics in Northern Virginia and four in Richmond.

RediClinic has 37 retail clinics across the United States and operates clinics inside nine Wal-Mart stores in the Richmond area.

Patient First is a pioneer in the convenient-health-care field.  Founded in Richmond in 1981 with headquarters today in Glen Allen, the company operates 21 neighborhood medical centers in Virginia and Maryland.  Eight of them are in Richmond, and seven are in Hampton Roads.

Like MinuteClinic and RediClinic, Patient First's walk-in centers offer extended hours and one-stop convenience, but its range of services is wider.

"We offer primary and urgent care at each of our medical centers with digital X-rays, a CLIA (Clinical Laboratory Improvement Amendments)-approved lab and prescription drugs also available at each location," said James E. Schulenberg, Patient First's director of marketing and public relations.  "The cost to patients for urgent care is around 25 percent of what comparable service would cost in an emergency room." 

Since the company accepts all major insurance plans, patients are responsible only for the co-pay when insurance is involved. This applies to a patient's primary and/or urgent care.

While nurse practitioners provide medical services at RediClinic and MinuteClinic locations, Patient First's patients can see a physician regardless of their needs, and physicians are available at all times.

The growth of convenient-care providers offers expanded employment opportunities for nurses and nurse practitioners.  Patient First employs 242 nurses companywide, with 12 to 21 nurses at each of its locations. MinuteClinic employs more than 1,600 family nurse practitioners across the U.S. Two full-time nurse practitioners work separate shifts at each RediClinic location, along with part-time nurses who cover holidays and vacations and serve as support staff.

"We couldn't do it without nurse practitioners," said Susan Wadsworth, district manager for RediClinic's Richmond locations.  "They're what our company is based on."

And with nurses and nurse practitioners in many management and training positions, retail clinics offer nurses and nurse practitioners great opportunities for growth and promotion, as well.

"If you want to have input in changing our new health-care industry, this is the wave of the future," Frye said.