Retail Clinic Recoil


More retail clinics in more chains with more store sites are inevitable. Changes to observe:
  • MegaRetail versus MegaInsurance Deny, Delay, etc.
  • Success or Failure with Loss Leader Marketing
  • Epidemic Victims Crowding in with MegaRetail Customers
  • Will Highest Turnover Clinicians (13%) reach 20% or More? 
  • Least Experienced Clinician Care 
  • Protection of protected health information?
  • Further shrinkage of primary care workforce
  • Best retail avoids sites where health services are most needed

Who Wins in Insurance Versus MegaRetail?

What if insurance companies attempt the usual delay or deny tactics? As with all who supply goods or services for MegaRetail, resistance is futile.

Insurance companies would lose if they chose to fight this battle, which they won’t. But do not shed tears over this situation, after all insurance companies are powerful in their own right. Their losses dealing with MegaRetail will just be passed on to the rest of us (higher premiums, out of pocket). Insurance companies, like all good corporations, will just find other ways to make up the profits that MegaRetail shifts there way. Of course, Megaretail could choose the Direct Primary Care way and not take private insurance. 

The United States Supreme Court has granted corporations much the same status as persons - and in some cases better status. So don't look for court relief for any side effects.

As health designs add more new big and bigger players such as Big Software and Big Retail, the focus can be diverted from health care delivery.  

The call of 18% of GDP spent on health care is powerful, especially with flattening economy. MegaRetail has the power to structure designs their way. If that helps drive health spending to 20%, well such is the changing health care design.

There is a common problem at MegaRetail and other retailers - do you really need what you buy? Does convenient ready access at $4 with more paid by someone else, actually result in needed services delivered? As care becomes more convenient with fewer barriers, the care may mean even less.

Will MegaRetail actually profit from their health care efforts?


Loss Leader Marketing

Findings from Hayden in 2009 - “Less than a decade old, the retail health care clinic business is in the midst of significant consolidation, with CVS Caremark and Walgreens emerging as the key players. Still a loss-leader, the business stands to gain from several structural changes underway in the American healthcare industry, discussed in the paper. Benefiting from those changes, however,will require a significant increase in foot traffic into the host stores, i.e.to the clinics themselves and also for ancillary shopping. Until then, the economic viability of the clinics remains unclear.”

Athletic physicals at MegaRetail sites are just $10. Immunizations and other simple services offer additional opportunities. Can health care loss leader pricing compete with other MegaRetail loss leader successes? 

Is MegaRetail Health Care - Healthy?

Successes in convenience care, urgent care, and retail care are about high people volume. Is it a good idea to concentrate flu victims into high traffic retail centers? The new Norovirus strain will love retail expansions. Will stores close entire aisles after a vomiting episode? Will Megaretail staff immediately quarantine patients with recent travel from China, or Africa, or the Arabian peninsula, depending upon the origin of the latest epidemic? Will Megaretail give up precious retail space and profits to construct and have a quarantine room or ventilation redesigned for protecting customers?

How will Megaretail deal with the potential negative publicity of having concentrations of contagious disease entering their doors?

The New MegaClinicians

Will MegaRetail clinicians retain the respect that clinicians have long appreciated? Will MegaClinicians get fed up with low pay, long hours, high volume, high turnover, and minimal support? An attempt to organize or unionize would likely be squashed as with other past attempts by employees. 

 Having discussions about the consequences of lost motivation might be better before rather than after.


Will health information regarding MegaRetail employees be kept safe from prying MegaRetail eyes - time off, injuries, or other care provided under the same roof?

 Would clinicians be in a position to keep information safe or succeed in changing clinic operations or policy for better health care?

 Health Access

Will MegaClinics be found in locations in need of workforce? This is not likely as closures of MegaRetail are seen in these less profitable locations. Current retail clinics are only in some locations. The states, the cities, and the neighborhoods in need of workforce are commonly not a part of the plan.

 The rapidly increasing MegaClinician workforce will be supplied from primary care - resulting in even fewer continuity primary care clinicians available from each class year of graduates. 


Clinician Limitations in Experience

Nurse practitioners will be utilized – the least experienced clinicians due to fewest years in a career, fewest years prior to an encounter,lowest volume, and highest turnover. The MegaClinicians would likely have less experience and higher turnover and would continue to move away from lower pay and poor support, taking their experience with them as seen in primary care.

Addendum - Strategy and Consequences:

 A focus upon primary care and rural sites may seem to be helpful, but…

  • Walmart chose rural sites at the start of its massive growth. Walmart had a clear advantage in lower prices and lesser competition. Eventually as Walmart had greater market share, they did not need to worry about competition and were free to do what they wanted. They left behind many rural sites in favor of consolidations into super centers  This  forced rural customers to drive to nearby larger towns for their purchases, leaving small towns and their economics further behind as noted in national media articles of the time period.
  • There is little reason not to suspect the same pattern. There is less competition in rural areas. The retail primary care would potentially drive off other local primary care for a result of no increase in local access. Then consolidation into larger sites would potentially collapse local rural care.
  • Of course MegaHealth systems have been doing much the same - acting in their best monetary interest. Big health systems have branched out to funnel referrals of patients into their system for highly reimbursed hospital and specialty services. One system grabbed a rural hospital and rapidly converted it into a referral clinic - the reason for a recent March on Washington by a small town major. Blessed is the site in the middle of two or three large systems vying for services, a situation unlikely to last.


To Follow the Money Is to Follow the Workforce and Vice Versa

Recent Works

Global Fails Local But Local Focus Succeeds Globally

What Veterans Need Is Family Practice

Domino Decline By Design

Declines in Health Care Delivery Despite Increases in Health Spending

Perverse Health Payment Dividing US

How To Resolve Health Access for 40 States Behind By Design

Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...

Overcoming Barriers to Health Access Including ACA

Will Teaching CHC Sites Deliver on the Promise of Health Access?

How Bad Medicine is Sweeping The Country.

Preventing Rural Workforce By Design

Best of Basic Health Access

Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

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