Chapter 3: Health Care is Not Convenient

Every American who uses health care has run into the problem of not being able to get an appointment with their doctor. Doctor’s offices are open only limited hours and these hours are not convenient to the working adult or school-aged child.

The use of the medical home is a critical aspect to getting great health care. One doctor caring for all of your needs improves the quality of care in many ways. Unfortunately, it is not convenient.

A medical home is a patient centered health care setting where patients receive the majority of their medical care. This care is accessible, continuous and affordable. In this model there is relationship between patient and provider. Easy access to multiple services are available within this system.

While the medical home is an ideal theoretical concept, it is not a reality. People live busy lives and often do not have time to see their doctor on a regular or urgent basis. The use of urgent care centers, emergency rooms and retail clinics improve convenience but get away from the concept of the medical home.

In today’s society, people do not have a lot of time. They need to have easy access to primary care. Because of this the medical home has not become a reality.

American health care falls behind many other countries in hours in which care is available. I recently took care of a family from Canada. This family had just moved here a couple of weeks before I saw them. I first met them on a Sunday when they came into my clinic. They were absolutely applauded that they could not get into to see their primary health care provider on Sunday.

America is far behind many countries including Australia, Germany, Canada and New Zealand when it comes to evening hours. We also fall far behind many other countries on getting same day appointments. One study reported that only 30% of Americans are able to get same day appointments with their health care provider (1).




Many people have to resort to going to the emergency room, where care is very expensive.

As a direct result of the inconvenience of care, the retail health care concept was developed. These services get away from the medial home concept, but are convenient.

The emergency of retail health care centers are improving the access to care, but it has some drawbacks. Today there are over 600 retail health clinics and this number continues to grow. MinuteClinic, Take Care Clinics and RediClinics are three major clinics and many are found in drug stores.

These centers are open 7-12 hours a day and most are open 7 days a week. Visits are usually only 15 minutes, but some services may take significantly longer. Services are provided on a first come first service basis.

These centers are staffed with nurse practitioners and physician assistants and typically handle common health care problems such as strep throat, sinus infections and ear infections. Many of the clinics are adding more services such as management of some chronic diseases such as acne, asthma and diabetes.

These centers provide convenient and affordable health care. Unfortunately, these center often have to refer away patients, as there are many situations that are beyond the scope of their service. The convenience factor is even greater when you realize that you can walk across the store or the aisle and pick up your prescription.

Some clinics are able to do physicals, screenings and immunizations. Prices are below 100 dollars for most services and most clinics have a price list displayed at the check in center. Most accept insurances and therefore patients are only responsible for their co-pay or deductible.

Some physician organizations are trying to impede the growth of these retail health clinics. Physician groups are powerful and are working to make it harder for these retail health clinics to operate. While retail health clinics do provide a service they take money out of the hands of physicians and their practices.

One example of how this happens is that people will go into these clinics on a Sunday instead of waiting until Monday morning to call their doctor.

The future may see a melding of the retail health care clinic with the traditional health care clinic as a way to improve access to care while at the same time allow better use of health care services. Physicians need to work with the clinics to improve the health care system as a whole.

Retail health care clinics fill many needs in today’s health care setting. They allow the health care consumer to get convenient, high quality, affordable care for many problems.