The Advance of the Retail Health Clinic Market: The Liability Risk physicians May potentially Face when supervising or Collaborating With Other Professionals

Abstract

The first retail health clinic opened in Minnesota in 2001 after the frustration a father, and future MinuteClinic cofounder, experienced during a long wait at an urgent care center for treatment of his son’s strep throat.1 CVS Caremark Corporation, the largest retail pharmacy in the United States, acquired MinuteClinic in 2006, further strengthening the foothold of retail health care clinics throughout the country. During the first 5 years, the industry added only 29 clinics before rapidly increasing by more than 10-fold between 2006 and 2008.2 By 2008, the world’s largest retailer, Wal-Mart, had also entered the retail clinic market, adding to the almost 1000 clinics at that time.1 This accelerated trend reversed in 2009, reflected by the industry closing approximately 5% of outlets that year.2 As early as 2007, significant future growth in the market was expected, with predictions of up to 6000 clinics by the end of 2012.3 Despite this early optimism, as of June 2011, only a total of 1227 retail clinics are now in operation, slightly up from 1197 reported in February 2010.2-5 Although the overall profitability of these clinics has been questioned, recent health care reform efforts are forecast to increase consumer demand for retail health clinic services well into the future.2,3,6 A combination of newly insured individuals after implementation of the Patient Protection and Affordable Care Act (PPACA) with an ongoing shortage of primary care physicians may lead to increased retail clinic use.3 The difficulty in access to health care practitioners that the newly insured may experience has raised fears that they will seek future care in expensive emergency department settings.2 A 2010 report exploring ways to reduce future health care costs in New York State argued that expanding access to retail health clinics could help reduce health care expenditures by $350 million between 2011 and 2020.2 To sustain economic viability, retail health clinic practice models largely rely on nonphysician practitioners to provide care. State regulations vary on the degree of physician oversight these practitioners require. With the predicted increased demand for care provided by retail clinics, the number of physicians who may be involved with supervising or collaborating with these practitioners will likely increase as well. Although no reported malpractice liability claim has been filed against a retail health clinic or their practitioners to date, physicians may find themselves at greater risk in the future. This commentary first describes the current financial and practice models in today’s retail health clinic environment. This sets the foundation for exploring the potential future liability risk impacting physicians contracted to oversee the care provided in the retail health clinic sector.