Care & Convenience

Convenient care has had its ups and downs in the eyes of the professions that make the industry tick - nurse practitioners and, more recently, physician assistants. Until now, few have put much thought into the role NPs and PAs play in the overall success of convenient care. But those shaping the industry are wise to do some research on the convenient care workforce in order to advise groups that want to open clinics.

Tom Charland, CEO of Merchant Medicine, a consulting company that tracks the convenient care industry, agrees. Merchant Medicine and ADVANCE for NPs & PAs joined forces in 2011 to survey NPs and PAs about their attitudes toward convenient care. The informal survey asked about respondents' willingness to work in convenient care and their general impression of the industry relative to their own careers.

The Yeasayers

Responses were generally positive. Nearly 60% of the 309 NPs and PAs agreed or strongly agreed that they'd be willing to work in a convenient care clinic. Almost 70% agreed or strongly agreed that they view retail clinics positively. Most disagreed that working in convenient care is stressful, and most agreed that the clinics are viewed favorably by the public. Seventy-nine percent of respondents agreed or strongly agreed that convenient care clinics make treatment of some conditions easier for patients. Most (67%) agreed or strongly agreed that convenient care clinics reduce healthcare costs.

Write-in responses skewed slightly in support of the retail clinic concept, with many noting ways the industry could improve. A few examples:

• "From the interview process, credentialing, clinical practice, professional development and growth, electronic medical record, staff communication, interactions with management to the high level of customer satisfaction, this has been an eye-opening experience. I would recommend this position and my employer highly, as well as the services offered to patients."
• "The public is beginning to trust retail clinics, and most find their experience to be positive with regard to our expertise, compassion, little wait time and value for the money."
• "Retail clinics are great, but the problem is that they reinforce the public's misperception that NPs (and PAs) are not able to manage chronic diseases and/or more complex patient presentations, which is not true."

The Naysayers

The survey respondents weren't as positive about how convenient care fits into their career trajectory. NPs and PAs did not respond favorably about their perception of pay: 42% answered "neutral" when asked if those working in convenient care were compensated fairly. However, the 2010 National Salary Survey of Nurse Practitioners and Physician Assistants (www.advanceweb.com/NPPAsalary) showed that salaries in convenient care averaged $90,170 for NPs and $91,188 for PAs, squarely in the middle of the range for both professions.

Respondents also reported that their colleagues viewed the clinics less favorably than other settings. Less than 10% agreed that NPs and PAs in convenient care have more opportunity for career advancement than those in other settings. Most said the clinics don't provide a broad range of services. And, less than 24% responded that they would be most likely to work in a convenient care clinic in the future. Complete survey responses are available here.

Many respondents - even those who fully supported the convenient care concept - stated in the write-in area that they disliked the fact that the scope of services is limited. Some feared a conflict of interest when a convenient care clinic operated next to a pharmacy. Others were concerned that new graduates wouldn't adequately develop their skills while working in the convenient care setting. A few said they noticed that turnover was high. Some comments were as follows:

• "Working at McDonald's is nicer than working at a retail clinic. At least you get support while you work as a team."
• "As the client based has increased, retail health owners have failed to meet the requirements of the NP."
• "They rob the patient of the advantages of continuity and a medical home, putting them at risk of inadequate care of their chronic problems."
• "I am interested in working in a retail clinic but would miss the relationship that is formed in primary care practice."

The Final Say

The takeaway message is that NPs and PAs appreciate the benefit and convenience of the clinics to the public, but to attract NPs and PAs, operators should look at improving pay, advancement opportunity and scope of service. I will present these results to hospital executives and clinic operators at the ConvUrgentCare Symposium later this month; sharing this with them will be invaluable.

Jennifer Ford is the senior associate editor and convenient care columnist. Reach her at http://jford@advanceweb.com.

By the Numbers

60% willing to work in convenient care

24% likely to choose it as their next job