California doctor behind latest store-based clinics

A Walnut Creek, Calif., occupational medicine physician is leading an effort to bring compact, no-appointments-necessary medical clinics to retail outlets on the West Coast.

Wesley P. Chan, MD, MPH, the president of WellnessExpress Clinic, said the opening in April of the new company's first clinic inside a Longs Drug Store in Davis, Calif., is a prelude to expansion throughout the West: sites that offer quick, inexpensive medical treatment supplied by nurse practitioners and physician assistants who can handle a variety of basic problems, from eye and ear infections to superficial wounds. WellnessExpress is following the lead of MinuteClinic, a chain of similar medical offices in the Minneapolis and Baltimore areas, which was founded in 2000.

Here are excerpts from an AMNews conversation with Dr. Chan:

Question: What led you to form WellnessExpress?

Answer: We were aware of the concept because of what MinuteClinic was doing back East. [We knew about] the access-to-care problems and long wait times in emergency rooms and problems getting in to see primary care physicians. There is a large uninsured population in California, and I think this service would serve that patient population very well because of its affordability and its access. It's also great for working parents who want convenience, and for patients who are traveling who don't have access to their primary care physician right away.

Q: How profitable of a business do you think this will be, and what will determine that?

A: Obviously since we have such a limited scope, being able to run the practice efficiently and keep the overhead low is key, and that's one reason for using mid-level practitioners.

Q: What are your expansion plans?

A: Our immediate plans are to open up another clinic in Sonoma, Calif., and Salinas, Calif., within the next month or so, and we do plan to expand after that into all of California and possibly Hawaii. We'd like to be fairly aggressive and open up between six and 10 clinics by the end of the year. ... We're not committed to just Longs. We're looking at other retail chains as well.

Q: Would most existing drug stores have room for this type of clinic?

A: Not all drug stores, [but] we don't need a lot of space. Each clinic only requires about 100 square feet. We typically don't need a waiting room or large administrative area. The store is the waiting room, essentially.

Q: What's the supervisory relationship between the physician extenders and your doctors?

A: Physicians have to be available, and we make them available at all times [by telephone]. They are not on-site on a regular basis. We are on-site periodically to review the charts.

Q: How does the clinic staff know what types of problems they can handle and when to call a physician or send patients to a physician?

A: With each of the [extenders] we have a supervisory agreement that details what role the collaborating physician has, what drugs [the staff] can prescribe, what conditions we have agreed that they will see. We've also developed clinical guidelines for each item on our scope of service, and the guidelines outline standard-of-care treatment, including what medication to prescribe and when to refer that patient out for a higher level of care. It's a 200-plus-page document. Obviously if someone comes in with chest pain, they're not appropriate to be seen at a WellnessExpress clinic.

Q: What's your relationship with insurance companies?

A: Right now we do not bill insurance companies directly. We are not a Medi-Cal or Medicare provider. We are strictly cash, credit card or check. At the price point we set [$20 to $98], I think even people who do have insurance would be willing to pay for the convenience.

Q: Have you heard whether any physicians in your region have any qualms about the debut of your clinics?

A: We've had [some area doctors] call us and ask if they could send some patients over after hours. We don't view ourselves competitive [with traditional practices].