My primary concern is care continuity and clinical fragmentation. I’ve experienced it for myself, my husband, my family members, and friends. Personally, I prefer to have a physician with whom I have an established trust relationship.

I actually prefer to work with a concierge physician. I am willing to pay more per encounter and a membership fee with the right physician operating a concierge medical practice that offers the extra amenities I want to purchase even if my insurance won’t cover the costs of the membership fee.  Some people simply don’t care. They want what’s cheapest and convenient – to them.

In the concierge business model that’s right for me (they aren’t all the same) the doctor limits their practice to a maximum number of patients they feel they can manage at a certain service and quality level and that physician and his/her/their staff become my “medical home” to coordinate care continuity for me with other diagnostic and specialist services.

Because of my clinical training and experience, I am an excellent diagnostician for a non-physician. Paired with the right clinician, and with trust established between us, my concierge physician can manage my care via email, text, phone, webchat or in their office during extended hours, on a weekend or during regular office hours.

By selecting a concierge physician, I have avoided the use of an emergency room (and its associated costs) for the past 10 years. They trust me when I describe symptoms and I trust them. They have access to my medical history on their phone, tablet or computer anytime, anywhere. I don’t have to reiterate everything for them each time I speak with them.

In contrast, if I use a walk-in or urgent care outlet for a first time, all that care coordination is absent. There’s little if any care coordination, I have to describe symptoms, allergies and past medical history right there on the spot. At 62, with my complex medical history and chronic conditions, that takes time. When one is unwell, often patience is in short supply. The care I receive from a concierge physician versus a retail clinic is incomparable.

I’ve used retail clinics since about 2005 when it was appropriate to do so.  For example, I visited a Walgreen’s outlet for travel vaccines prior to traveling to Africa for a consultation in Nigeria.  They had to order the vaccines I needed, but the price was cheaper than my doctor’s office and they could get them sooner. I had to provide proof of the vaccines to obtain my VISA for Nigeria. Time was of the essence. But it was up to me to provide all the medical records of each vaccine to my concierge physician – which I was able to do by fax with a scan of all my documentation and receipts.

In another instance, in Minneapolis, several speakers at an event all became ill with some virus that left us hoarse and miserable. We walked across the street from the multi-day event venue and came back to the hotel with what we needed to relieve our symptoms so we could carry on with what we were hired to do.

In Florida, I woke up in a hotel in the middle of the night with renal colic associated with a kidney infection and passage of a kidney stone. I have had them in the past and knew exactly what was happening. The retail clinic was open at 8am, and between pain medication that I had with me and a check with the nurse practitioner on duty and some prescription medication for the infection, I made do without having to present unaccompanied in an out of state emergency room or make a claim through my annual executive travel  insurance policy with  Allianz. Once the stone passes, the majority of the pain is diminished and the crises is not as bad.

Again, I gathered up all the receipts and prescription stubs from the bag, faxed them to my primary care physician with a note of explanation, and I manually ensured that the care continuity dots were connected.  If one doesn’t do this, retail clinics won’t do it for you, so care continuity is in jeopardy. In some instances, that’s no big deal, but in other instances, it is critical. What if I had an allergic reaction to the medication that the nurse practitioner described? How would my personal physician be informed? It isn’t fair to blindside my physician with gaps in care or information. But many laypersons simply don’t realize how important care continuity can be. This is especially true if they are rarely ill or see a doctor infrequently.

Should physicians and investors be worried about competition?

Competition is complex and tricky. Any of the models, be they retail, urgent, freestanding ER, concierge practice, traditional practice, direct primary care, (DPC) can compete with one another at certain levels. But when properly marketed and branded, and with adequate  consumer education through marketing, web design and content, and proper branding, each can “teach” consumers when and how it is most appropriate to use their services to the patients’ best advantage.

As for physician competition with one another and between traditional, concierge, and DPC practices, competitive traditional clinics will need to evolve to be quicker, better, affordable, transparently priced with no more surprises and easier to get an appointment for more consumers to be satisfied with their services. No one can relegate them to be a commodity brand without their express consent. 

Traditional medical practices who offer “drive through, bum’s rush” service like what I saw in Cary, North Carolina when my sister lived there where the signs throughout the practice waiting room and lobby that read, “Please note: We must limit patients to no more than three symptoms per visit. Please schedule another appointment to address additional symptoms, if necessary. A separate visit fee and copayment will apply.” is as absurd as it is bad medicine.

For information on starting, strategizing, branding assistance, or accreditation preparation for a retail model clinic, or if you are a reporter covering a story on retail health options, please contact Maria Todd for an interview.