This study assesses why patients seek care at retail clinics and their experience with the care provided. We find that patients are attracted to retail clinics by the convenient location, prompt care provision, and reasonable, fixed, and transparent pricing. In general patients were very satisfied with their care. This is consistent with results from proprietary patient satisfaction surveys conducted by retail clinic operators such as MinuteClinic, RediClinic, TakeCare, and The Little Clinic, as well as a 2007 healthcare poll and a 2008 health care consumer survey conducted by private firms.1,3,17
There are several lessons from this study that can help inform the current debate on retail clinics. First, our analyses help distinguish between two decision-making models, not always exclusive, that describe why patients seek ambulatory care at retail clinics. The first model conceptualizes the retail clinic as a complement to services provided by the patient’s existing PCP. This model was mostly used by the insured and those with a PCP and was driven by the lack of a timely PCP appointment. If retail clinics were not an option, these patients would have waited to be seen by their PCPs. During the follow-up phone call some patients noted they either had already seen or planned to contact their PCP. For patients without health insurance and/or a regular source of health care, retail clinics offered a superior substitute for urgent care centers and EDs which they found to be overcrowded, with long wait times, and high (and uncertain) pricing. Retail clinics were considered to be more accessible, logistically easier (e.g., less forms to fill out), and more affordable. Without retail clinics as an option, these patients would have no choice but to seek care at urgent care centers and EDs, try to find a provider that would see them, or delay seeking care.
There have been concerns that retail clinic visits would replace visits to PCPs and disrupt patient-provider relationships.6,7
A recent proprietary study of retail clinic users and potential users found that 12% of retail clinic patients with a PCP agreed with the statement “retail clinics have mostly or completely replaced my primary care physician for the type of treatments offered at retail clinics.”18
Our analyses of patient interviews revealed that patients did not wish to replace their PCPs. Rather they used retail clinics as a back-up or alternative for minor health care needs. For more serious issues or chronic illnesses they would continue to see their PCPs. Although retail clinic visits could potentially undermine provider-patient relationship, patients with PCPs mentioned that retail clinics helped them avoid unnecessary visits to the ED when their PCPs were not available. For patients without regular PCPs, there was no provider-patient relationship or care continuity to disrupt.
The operating model for retail clinics makes the assumption that patients are capable of triaging themselves for appropriate care. In other words, patients will not go to retail clinics for life-threatening complaints or those that require complex health assessment and care.6,7
Our study found that patients understood the differences between what problems retail clinics and EDs or urgent care centers could handle. Whether patients can always make the appropriate triage decision is unknown though a recent study found that only 2.3% of retail clinic visits were judged to be outside the scope of care for a retail clinic and triaged out to an ED or PCP.19
Our study lends credence to the potential for retail clinics to serve as a mechanism to deter unnecessary ED visits and thereby help alleviate ED over-crowding.8,9
Patients shared during the interviews that they were willing to pay out-of-pocket for the retail clinic visit in order to avoid long wait times and high prices charged at the ED. With many public health facilities and safety net hospitals facing budgetary constraints, retail clinics may offer a market-based solution to provide health care at a price that is sensitive to patients’ willingness and ability to pay.
This study has several limitations. First, this study had a small sample size and a low follow-up rate. Though our use of qualitative methods provides contextual insights on why patients seek care at retail clinics, we recognize that our findings may have limited generalizability to a larger population. Despite the small sample size, we found consistent themes that repeatedly emerged from interviews with patients at the same clinic and across different clinic locations. This suggests that we have identified the common underlying appeals of retail clinics. Second, this study was conducted at six retail clinics located in California and the two retail clinic operators in this study, Sutter Express Care and QuickHealth, do not represent the typical retail clinic operating model. Sutter Express Care is part of an integrated healthcare delivery system while most retail clinics are independent companies (though recent growing trend of retail clinics has been among well-established integrated delivery systems). QuickHealth employs physicians whereas the predominant model for retail clinics is the NP-model. This might limit our ability to generalize our findings to other geographic regions and to other retail clinic chains. However, these two retail clinic operators share the core elements of all retail clinics—they offer a convenient location in a retail store, walk-in model, extended hours, limited scope of care, and fixed prices. The fact that our study’s findings echo those from proprietary patient surveys conducted by other retail clinics and polls across the country suggests that the basic model and attractiveness of retail clinics are more universal than variant. Also, our study population was composed mostly of young adults who were frequently uninsured and only one-third report having a PCP. They visited the clinics primarily for simple acute reasons and immunizations. This socio-demographic mix and reason-for-visit mix is remarkably similar to the patients seen in a national sample of retail clinic visits and therefore suggests that the patient population attracted to these clinics and care provided is consistent across regions and retail clinic chains.19
Future research should use a structured survey approach with a larger sample across different geographical areas to confirm these qualitative findings and test hypotheses on how patient socioeconomic and health condition influence their choice and experience with retail clinics.
In summary we find that patients are generally satisfied with the care they received at retail clinics. The primary attraction of retail clinics is their convenience and their reasonable, fixed, and transparent pricing. Patients with primary care providers (PCPs) sought care at these clinics primarily because their PCPs were not available in a timely manner. A significant fraction of patients, in particular the uninsured, reported they would have visited an ED if the retail clinic was not available. Retail clinics appear to be responding to a need for convenient, affordable, and consumer-centered care.