Retail medical clinics are a welcomed addition to our current medical delivery model

Implications: Retail clinics are health care centers of limited low risk services staffed most commonly by masters in primary care level nationally certificated Nurse Practioners who have provided primary care to millions of Americans for 40 years without issues of Quality by all evidence based studies. This is serving the uninsured who have difficulty finding a "medical home" and those Americans who wish a more accessable, convenient, lower cost per per episode  ) for minor low risk issues well within the training, education, and experience of licensed health care professionals.  This is only a "turf issue" and where money may flow cloaked in the cloths of "Quality."  Dr. Nosrati should study the model before commenting on Quality.

Analysis: Care by Advance Registered Nurse Practioners for primary care is not new or revolutionary.  Nurse practioner care centers sponsored by the federal government initially for the under served have been a tremendous success and all federal and academic Quality and Outcomes of care studies have shown equivalency with traditional primary care.  High quality of these Primary care or adult/pediatric certificated healers is unquestioned by evidence based studies.

Sarah Kershaw's article in the NY Times says cost is near equal to primary care--that is not true.  It is true that the transparent per episode of care is near a visit payment level for primary care, but billings above their professional bill cause the entire episode to be in nearly all geographical environments double the cost for a traditional primary care physician.

However, this model complements the primary care dilemma we have in America by not competing with the full scope of practice of nurse practioners that is regulated, but by seeing patients for single episodes when patient's (if they have one and 30% of the insured do not) primary care physicians are not available--after 5pm and weekends.  Continuity of care is maintained by copies of the care episode made available to the primary care physician.

In the days of HSA's and HRA's and any high deductible health plans, these clinics offer a more convenient, lower cost quality venue than an Emergency room which is 10X-15X's more costly--This will not set well with consumers with their primary care for minor illnesses and a understandable lack of their primary care physician availability (studies show Primary care physicians work nearly 60 hours per week already).

The reality is, we could double the number of dwindling primary care physicians we have now and not meet the needs and expectations of consumers for minor medical issues in a low cost, convenient, in their neighborhood venue.  This greatly simplifies the complexity that is often surrounded by taking time off from work or managing children while seeking minor care evaluation.

All health care providers can and will make mistakes.  Yes it will happen in this model setting no doubt.  If this model truly serves the best interests of American consumers, it will survive such expected incidents as has traditional medicine.

Affordable (especially for the uninsured), convenient, high quality, accessible care is enhanced to all Americans with this model--embrace it and integrate it proactively to complement the critical shortage of primary care physicians (that is predicted to only get worse).  Having primary care physicians manage higher acuity and complex patients to their level of education and experience only makes rational sense. 

Consumers must be our first priority and let us not act reflexively out of "turf issues."