"Drugstore Clinics Spread, and Scrutiny Grows", (c) Sarah Kershaw, The New York Times, 8/23/7

The concept has been called urgent care “lite”: Patients who are tired of waiting days to see a doctor for bronchitis, pinkeye or a sprained ankle can instead walk into a nearby drugstore and, at lower cost, with brief waits, see a doctor or a nurse and then fill a prescription on the spot.

With demand for primary care doctors surpassing the supply in many parts of the country, the number of these retail clinics in drugstores has exploded over the past two years, and several companies operating them are now aggressively seeking to open clinics in New York City.

But with their increasing popularity, the clinics are drawing mounting scrutiny. Several states including New York, New Jersey, Rhode Island, Massachusetts and California are examining ways to more closely monitor the clinics, which are overseen by a hodgepodge of state agencies applying a wide and inconsistent range of regulations.

More than 700 clinics are operating across the country at chain stores including Wal-Mart, CVS, Walgreens and Duane Reade.

New York State regulators are investigating the business relationships between drugstore companies and medical providers to determine whether the clinics are being used improperly to increase business or steer patients to the pharmacies in which the clinics are located.

And doctors’ groups, whose members stand to lose business from the clinics, are citing concerns about standards of care, safety and hygiene, and they have urged the federal and state governments to step in to more rigorously regulate the new businesses.

“We’ve got big problems in health care, and this is not the answer,” said Dr. Rick Kellerman, president of the American Academy of Family Physicians. “They are a response, they are a niche market and an economic opportunity, but we still have an underlying primary care crisis in this country.”

Patients, however, have flocked to the clinics, according to a new industry group, the Convenient Care Association.

“I think it’s great you don’t have to make an appointment. That could take weeks,” said Ezequiel Strachan, 33, who lives in Manhattan and walked into the clinic at the Duane Reade store at 50th Street and Broadway on a recent morning for treatment of a sore throat. “People here value their time a lot.”

The average waiting time for an exam at such clinics nationwide is 15 to 25 minutes, according to the Convenient Care Association.

The association estimated that 70 percent of clinic patients have health insurance and are using the clinics because of convenience. For them, costs may not be much different from those at doctors’ offices, because the same insurance co-payments apply. But uninsured patients could reap substantial savings.

In New York City, one in five residents lacks a regular doctor and one in six is uninsured, according to a recent survey by the city’s Department of Health and Mental Hygiene, and overcrowded emergency rooms are often their first resort for routine care.

State officials acknowledged the clinics’ appeal. But they said they were looking into possible violations of state law prohibiting unauthorized corporations like pharmacies, which are licensed only to provide pharmaceutical services, from delivering medical care.

“If we determine the business corporations are practicing medicine, then they are illegally practicing the profession and we have the authority to investigate,” said Frank Munoz, associate commissioner of the State Education Department’s Office of the Professions.

MinuteClinic, a wholly owned subsidiary of CVS Caremark, the drug chain’s formal name, and the largest of more than a dozen clinic operators nationwide, manages seven clinics at drugstores in New York state, including one on Staten Island, and 20 others in New Jersey and Connecticut. The company said it hoped to open as many as 150 more clinics in the New York area, which would be staffed by nurse practitioners and physician assistants.

New York law requires that nurse practitioners work closely with a physician, who oversees the practice but is not required to be at the clinic, and that the clinics operate as independent practices or professional corporations. In other states, the medical providers can work directly for a drugstore company, a practice that has touched off concern that the providers might place the interests of their employers above those of patients.

MinuteClinic officials insisted that there was nothing improper in the relationships between providers and the drugstores and that medical care is not being compromised.