White Coat, Black Art

See the doctor & go shopping all under one roof

Why are walk-in medical clinics showing up in big box retail stores? In his weekly House Doctor column, Dr. Brian Goldman (@NightshiftMD) looks at whether they might save you a trip to your GP or the ER.
Thanks to the growth in retail clnics, you may be able to shop and see a doctor in the same place. (Jeff Gritchen /The Orange County Register via AP)

You're in the local big box retail store buying groceries and some holiday gifts, and a sore back from too much snow shovelling has left you in pain. You can't get a same-day appointment with your GP and you dread a trip to the ER.. So you decide to head to the nearby retail medical clinic.

You're not alone. More and more of us are doing just that. 

The grocery retailer Loblaw's now has scores of medical clinics at many of its Loblaw's and Real Canadian Superstores. There are retail medical clinics at some Zehr's and No Frills stores as well. The clinics at those stores are staffed by MDs; the clinic is managed by Primacy - a property management firm. Wal-Mart was late adding medical clinics, but it's catching up; its 64 clinics operate on space rented out by Jack Nathan Health.  Shopper's Drug Mart was the first to open such clinics. The first one opened in 2002, and it has hundreds of them at pharmacies across Canada. The result is that many people are able to get medical advice right inside the big box store. 

The level of care you receive depends on where you go. In general, they are staffed by MD, although there's no reason why they couldn't be staffed by nurse practitioners. The clinics affiliated with Shopper's Drug Mart offer walk-in service as well as family practice. Some of the retail clinics may offer walk in services only, so check first. Clinics at Loblaw's and other retailers may be under the same roof but are managed separately, yet they work synergistically with the retailer.

One of the key aims of retail clinics is customer convenience - which is code for "keep shopping please." When you sign in to clinics operated by Jack Nathan Health (Loblaw's, Zehr's and No Frills), you get a pager so you can continue browsing the store aisles. You're paged five minutes before your appointment. There are no surcharges. The doctor bills the province. If needed, the doctor can refer you for lab tests, x-rays, plus referrals to a physiotherapist or a specialist.

Health care consumers seem to like them. For what it's worth, they've been packed during the holiday shopping season. Convenience is the main attraction. If you injure your ankle and are looking for a quick assessment and (if necessary) a referral for x-rays, this sort of place is right up your alley. 

A young mother wrote about the experience of being at the cottage when her child developed a fever and a skin rash. It was pointless to return home since the pediatrician wasn't in the office that day. The ER was a 45-minute drive away, and the local walk-in clinic had long wait times. Instead, she took her child to the clinic at the Wal-Mart pharmacy, and was in and out within 30 minutes. Mom was happy, but would have felt differently had the doctor on duty advised her to take her child to the ER. 

Customers love the fact that retail clinics are cleaner and have more up-to-date equipment than many walk-in clinics or ERs.

But how good are retail clinics at helping avoid trips to the ER? That question was the subject of a study by researchers with the RAND Corporation, Truven Health Analytics, Harvard Medical School and the U.S. government's Agency for Healthcare Research and Quality. The researchers looked at the rate of visits to the ER for minor illnesses and injuries. They found that the presence of retail clinics near the ER had no impact whatsoever on the rate of visits to the ER for minor ailments. 

The study is based on the experience in the U.S., but my sense is that the results would be the same in Canada. My fear is that retail clinics will actually contribute to an increase in health care costs by duplicating services without improving the health of Canadians. 

Family doctors would argue (correctly in my opinion) that retails clinics do not offer the kind of continuity of care that is part-and-parcel of family medicine.

Still, long term, myself and others see a pretty compelling trend here. Patients are tired of being herded like cattle to the ER. They're looking for a different kind of entry point into the healthcare system – one that is conveniently located and operates during convenient hours. It may not be retail clinics alone, but perhaps retail clinics plus walk-ins plus teledoctors and mobile apps all working seamlessly. 

The trend is new, and many are unfamiliar with it. In the U.S., which is several years ahead of Canada, a 2013 Consumer Survey found that a third of Americans were unfamiliar with retail clinics. But that is changing rapidly, and the same will likely happen in Canada. Based on surveys, a lot of Canadians might be tempted to try a retail clinic if it were affiliated with a patient's local hospital, doctor or nurse practitioner.

Have you been to a retail clinic?  If so, what did you like about it?  What didn't you like about it?  Post your comments here - or to whitecoat@cbc.ca.  We'll be working on this story next season on White Coat, Black Art.

Brian Goldman is host of White Coat, Black Art on CBC Radio One, and the house doctor on afternoon radio shows across Canada. This item airs on CBC Radio afternoon programs. Dr. Goldman's latest book - The Secret Language of Doctors - is published by HarperCollins Canada Ltd.