Is It OK if Our Residency Graduates Work for Walmart?

Joseph Scherger, MD, MPH

I attended a health care forecast conference recently and learned a sobering new reality. In the near future, Americans will be getting their primary care services in many different locations.

Walmart has announced that it soon will be offering comprehensive primary care in many of its stores. Walgreens, already the largest provider of immunizations outside the government, will expand its Take Care clinics and manage four common chronic diseases: diabetes, hypertension, hyperlipidemia, and asthma. A longtime colleague and family medicine educator recently went to work for Kroger’s new clinic system, The Little Clinic. Large employers are setting up workplace clinics to provide common health services while keeping their employees on the job.

Discount department stores have already started to dominate certain areas of health care. The most convenient place to have hearing and vision testing and treatment in our area is at Costco.  The pharmacies in Walmart, Target, and Costco are gaining market share rapidly over the traditional pharmacy providers. What is to stop these institutions from offering primary care?

All of these nontraditional primary care services are likely to be at lower cost than through traditional providers and be delivered in most cases by mid-level providers. How will a patient’s medical record be kept whole? What is the future of the traditional family physicians’ office?  How many of our residency graduates will take positions as medical directors or providers in these nontraditional settings?

There has always been a distinction between a primary care physician and primary care services.  The primary care physician, especially a family physician, provides continuity of care through a relationship. Primary care services include preventive services, common acute problems, and chronic disease management. Ever since the emergence of Urgent Care centers in the 1980s, primary care services have expanded beyond the primary care physicians’ offices. Increasingly, the family physician has had to gather information from the patient about what and where they have received various services such as immunizations and procedures. The decentralization of receiving primary care services is likely to explode in the drive to deliver care faster and cheaper.

There are not many answers to this new reality of primary care. Only the patient will be able to keep an intact medical record. One thing that trumps care in a discount store is being available to patients online anytime from anywhere. Calling for the next available appointment will not suffice. The role of the family physician increasingly will be that of a health coach and advisor rather than the mandatory provider of primary care services.

Medical societies will fight against the expansion of primary care and other medical services to different providers, but it is likely that many new physicians will find that joining these convenience care teams is satisfying work. It may turn your stomach now, but your residency program may be giving out a Walmart award at a future graduation. How does family medicine education prepare us for this future?