Why Boston and Mass. need more walk-in clinics
After nearly a decade of opposition, Boston may be on the verge of getting its first for-profit walk-in clinic. Although it’s not yet official, it appears the city’s Zoning Board of Appeals has approved an urgent-care center application in West Roxbury.
Almost 3,000 “convenience” clinics in 41 states have served 10 million people. They fall into two categories — retail and urgent-care clinics. The former are typically staffed by nurse practitioners, the latter by a doctor.
In Massachusetts, there are well over 100 such clinics, including six in Cambridge alone. But if you put a Christmas light on every convenience clinic in the region and observed from an airplane, Boston would look like a black hole.
It’s not hard to understand why the clinics are increasingly popular. As the name suggests, patients don’t need an appointment, and the majority of Massachusetts clinics are open seven days a week. They’re conveniently located in drug stores and neighborhood strip malls. It generally takes significantly less time to be seen by a nurse practitioner at these walk-in clinics than it does to see a medical professional at the local emergency room.
Research shows that the quality of care at walk-in clinics is as good as or better than when the same services are provided in doctors’ offices or at the ER.
As clinics have proliferated, so have their partnerships, allowing for easy referrals and follow-up by area hospitals and health systems when patients present conditions too severe to be addressed at a walk-in facility.
Clinics also provide a number of systemic benefits, such as taking the pressure off emergency rooms. A critical goal of the 2006 Massachusetts health care reform law that provided near-universal insurance coverage was to cut down on costly emergency room use for less serious conditions. We have made little progress toward that objective.
Annually, more than a million Massachusetts emergency room admissions — nearly 400,000 of which involve Medicaid patients— are preventable. The costs to the overall system and to public programs are staggering. Shifting patients to less expensive urgent-care centers saves money without compromising quality of care.
No community needs the clinics more than Boston. A recent survey of 15 metropolitan markets found that Boston patients experience the longest average wait to get a doctor’s appointment — 45.4 days. It took city residents an average of 66 days just to get an appointment with a family physician. Is it any wonder that they turn to emergency rooms for treatment?
Despite all the benefits of walk-in clinics, there is opposition. As is the case with new ride-hailing companies, it comes from existing providers. Thus far, Boston’s 26 community health centers and 12 teaching hospitals have succeeded in locking walk-in clinics out of the city.
Their arguments are predictable. Some doctor and hospital groups say clinics increase fragmentation by adding to the number of providers and hand-offs within the health system. They say walk-in facilities with limited services should be subject to the same regulations as larger providers when it comes to things like examination room size and separate patient entrances. Unsurprisingly, physicians’ organizations don’t like that many of these clinics are not staffed by doctors.
They’re missing the point. Typical walk-in visits are for immunizations and conditions like ear infections and strep throat. The clinics aren’t designed to compete with doctors and emergency rooms; they are meant to provide routine care that frees larger health institutions to focus on more serious conditions.
Simply put, many traditional institutions and players don’t want competition — even if it is good for patients.
The evidence shows that walk-in clinics provide treatment for routine conditions more cheaply and conveniently than doctors’ offices and emergency rooms do, without sacrificing quality of care. They are long overdue in Boston.
Jim Stergios is executive director of Pioneer Institute, a Boston-based think tank.