Healthcare Part I: Milk, Tires, Primary Care

The first of a series of posts on the US health care system. Some will focus on narrow issues, other posts will take a macro look at the system.

For now I will be posting under two assumptions, namely 1) the US healthcare system needs reform, and 2) single payer in NOT on the near horizon.

* * * * * * * *

Wal-Mart, Target and CVS Pharmacies, among others, are starting in-store clinics, to be staffed by Family Nurse Practitioners (FNPs), who are specially trained RNs. Wal-Mart is apparently contracting with existing companies for many of their clinics.

Wal-Mart has already made great inroads in pharmacy and optometry services, and certainly has the traffic (optometry is low risk and no-blood).

I have hired and supervised FNPs and many of them are really terrific.

I have no great feelings on this one way or the other, but it does deserve some discussion.
This is my list of pros and cons.

Improved access, which is always good
Lower cost, at least for the initial fee
Immediate access to pharmacy services
FNPS are generally very skilled at triaging minor ailments
FNPs are usually good at picking up and referring major problems
This could relieve FPs of evening and weekend calls
This could relieve traffic in Emergency Departments
Good for routine vaccinations

Patients may think they don’t need a relationship with a physician
Patients have a procrastination tendency, this may encourage that tendency
Not all FNPs are experienced enough to staff such a clinic, hard to evaluate
In most states there has to be a supervisory relationship with an MD, I’m not certain
how well that will work, or how loose it will be
The tie to the pharmacy could cause conflicts of interest
This could stretch the pool of FNPs very thin
Will the FNPs miss issues an FP would find?
The economics of family practice already stink, this could hurt some FPs

I pulled up some FNP cost studies and I think it will be very difficult to make any money, but I don’t have full data. If this service is offered as a “loss leader,” what are the ethical considerations?

For those of you who resent the profits of health insurance companies, would Wal-Mart healthcare profits be something different?

Does this program make sense? Would you use the service? Do the ethical concerns bother any of you?

More info at: