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Does California have Retail clinics or not???


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Hi guys, could I get some clarification on whether or not CA has retail clinics that use PA's? I have read two different articles one of which says that CA prohibits them in the state and another article listing 84 active retail clinics in CA!

 

Out in texas we have them in CVS, Walgreens and HEB's just to name a few. They all use PA's. Thanks for any insights!

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There's a clinic at the Albertson's in Huntington Beach off of Main St. Their sign outside says they do physicals, immunizations, and a couple other general items. I'm not sure if it's a PA, MD/DO or what operating it or really the extent of their practice. It looked very limited though.

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why the interest? do you really want to do this kind of work?(if so, why?)

 

 

Well most of the retail clinic organizations in Texas are very PA friendly. I find it interesting that the same business structure is so different state to state. Do I really want to do that kind of work? Perhaps? I try not to turn up my nose at any aspect of medicine in which PA's are welcome. Like it or not retail clinics are here to stay and PA's need to plant a flag in the ground in these emerging medical fields or we are going to be NP'ed right out the market. Anyway, after 18 years of practice in EM and Urgent Care I don't have anything left to prove :)

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I can see retail medicine as a good part time or semi-retirement job but after doing this full time for 5 years one would likely not be employable in any other field. as you know this is fairly cookbook/algorithmic medicine....I know I am likely in the minority when I say this but I am ok with np's having this market and becoming known as the "quickie mart provider of choice" while pa's work in more traditional roles..after years in another field if you are looking for a comfortable 9-5 m-f no nights/holidays, etc job I can see the allure. I can't see this ever being a job for a new grad however(and all the ones near me are staffed by new grad pa's who were unwilling to relocate to find other jobs....)

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I can see retail medicine as a good part time or semi-retirement job but after doing this full time for 5 years one would likely not be employable in any other field. as you know this is fairly cookbook/algorithmic medicine....I know I am likely in the minority when I say this but I am ok with np's having this market and becoming known as the "quickie mart provider of choice" while pa's work in more traditional roles..after years in another field if you are looking for a comfortable 9-5 m-f no nights/holidays, etc job I can see the allure. I can't see this ever being a job for a new grad however(and all the ones near me are staffed by new grad pa's who were unwilling to relocate to find other jobs....)

 

 

I think you are selling our base training very short by assuming someone who does retail med or another hyper-focused sub specialty would not be able to get a job in another field. I have many friends who have made lateral career pivots such has CV surgery after 10 years to IM with little difficulty. I would agree that a new grad would not grow much if they entered this field right out of school, but to say they would be unemployable is a bit much.

 

Btw, what exactly is a "traditional PA role"? When i started in EM I was the first PA several of the hospitals I worked at had ever seen. That was only 15 years ago? There is no traditional role for a field such as ours. We are used wherever and whenever a provider is needed in every specialty including emerging medical markets. "Traditional"? We are PA's! The very definition of our career field screams untraditional. The one attribute we can't have as PA's though is arrogance. Looking down our nose at any aspect of medicine willing to use PA's is ill advised.

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The walgreens and Publix(supermarket) have "clinics"...run by NP's. The Publix one shut down. the Walgreens one isn't utilized much. I remember each time being in Publix and walking by the clinic, seeing the clinician sitting and reading...no clue about what thy are paid.

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The reason I "look down my nose at these places" is our training is wasted here.

it's 100% algorithmic. it's not a specialty at all. a medical asst with 3 mo training could do this:

sore throat: check step: if + give pcn or clinda

I want a pregnancy test. ok.

I think I have a uti. you do. give macrobid or septra.

I need a td. ok, here it is.

waste of an education. treating 10 problems, and only ten problems in only 1 way means you forget how to practice medicine. I would NEVER hire someone to work in the er or primary care whose prior experience was "convenient care".

I say we should leave it to the np's and continue practicing traditional roles/ real medicine(anything else) elsewhere.

that being said if this is your last job/bridge to retirement/easy 2nd job on the weekend for quick cash, that's fine. my problem is with doing this early in ones career as it is career death for anything else. switching surgery to IM is very different then convenient care to anything else. your example doesn't have merit. convenient care is basically "unskilled labor". surgery and IM are not. imagine trying to pass panre if your job experience was 10 problems and 10 treatments. good luck.

I see disaster bounce backs from these places regularly. just because your strep test is neg. doesn't mean you don't have a peritonsilar abscess requiring stat ent consult, etc.

there is a reason organized medicine hates these places.....no continuity of care and questionable quality at many places.

marijuana dispensing clinics are an "emerging market" too. should pa's strive to work there....?

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EMEDPA,

 

I know exactly what you are saying, and while there are parts of it I agree with I also know your mentality as an ER guy :) I've done enough emergency medicine and acute care to know exactly how non-ED facilities are viewed by the career ER guys like yourself. I get it, ED's are the dumping ground for all things difficult whether medically necessary or not. This breeds a somewhat cynical <putting it very lightly> attitude which tends to taint ER providers view of others. The reality is that while Docs can get away with this attitude, PA's can't. We can't afford to begin disparaging any field of medicine that PA's are welcomed into and this includes retail clinics.

 

Btw, if medical Marijuana prescribing is legal and studies show it effective in treating things like the nausea associated with chemo therapy, then I would ABSOLUTELY be in favor of Physician Assistants being able to prescribe it consistent with proper supervising Physician delegation. Would I go into the field or clinic doing it? Nope, but pain management is not my thing. One thing I would not do though is disparage any PA's that decided to do it.

 

Anyway...this thread was not meant to be a debate about which fields of Medicine you feel are "worthy" of PA's. So lets keep it on topic please :)

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on topic. I spent a few minutes looking for pa jobs in convenient care in california and could not find any.

(last off topic diversion: when I talked about MJ clinics I was not speaking about legitimate MJ use for cancer, HIV, etc, I was speaking of the places that rubber stamp free marijuana use cards for $$$ for indications like "asthma"-I've seen it. end of off topic diatribe).

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The reason I "look down my nose at these places" is our training is wasted here.

it's 100% algorithmic. it's not a specialty at all. a medical asst with 3 mo training could do this:

sore throat: check step: if + give pcn or clinda

I want a pregnancy test. ok.

I think I have a uti. you do. give macrobid or septra.

I need a td. ok, here it is.

 

Sorry to disagree but you're way off base. A medical assistant will never be able to do this no matter how much training they receive because they don't have a license to practice medicine.

 

What you are also saying is it doesn't matter what other sx Strep Throat Man has, any prudent practitioner, new grad or otherwise is not going to do a review of systems, is not going to investigate further if Strep Throat Man had LAD of all nodes known to man, is not going to investigate further if STM had 102 fever, is not going to investigate further if STM has nuchal rigidity?

 

My assertion is that any prudent PA is going to treat any complaint in the usual way. This means working up or referring anything that needs it.

 

Is this type of medicine beneath you? Apparently. Judging by this criteria you probably don't like Urgent Care's either.

 

Do you have a right to feel this way? Sure. It's a free country.

 

However, just because you don't like it, doesn't mean it's not an option for others.

 

It's another choice in the long line of choices that any PA has.

 

And at 50 bones an hour hmmm....Where did you say those clinics were?

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Even if they wanted to work it up, they do not have the facilities to do so. Anything outside of their 10 or so diseases, they refer out. It would not take long for a new grad (in emeds example) to lose significant skills quickly. If they squatted in this "specialty" for too long, it would be very difficult to train them in another. An experienced provider who has solidified what they learned in school I'm sure would have more constitution.

 

Sorry to disagree but you're way off base. A medical assistant will never be able to do this no matter how much training they receive because they don't have a license to practice medicine.

 

What you are also saying is it doesn't matter what other sx Strep Throat Man has, any prudent practitioner, new grad or otherwise is not going to do a review of systems, is not going to investigate further if Strep Throat Man had LAD of all nodes known to man, is not going to investigate further if STM had 102 fever, is not going to investigate further if STM has nuchal rigidity?

 

My assertion is that any prudent PA is going to treat any complaint in the usual way. This means working up or referring anything that needs it.

 

Is this type of medicine beneath you? Apparently. Judging by this criteria you probably don't like Urgent Care's either.

 

Do you have a right to feel this way? Sure. It's a free country.

 

However, just because you don't like it, doesn't mean it's not an option for others.

 

It's another choice in the long line of choices that any PA has.

 

And at 50 bones an hour hmmm....Where did you say those clinics were?

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And if STM has a raw peritonsillar abscess, he is referred to where? The retail ENT? Or if that LAD is lymphoma? Or..... Just playing devils advocate. I think the prob w/ retail clinics are no continuity of care for the more complicated cases.

 

Another caveat: 50 bones/ hour "looks" good but chasing that paper sometimes comes with things we don't think about until we've signed that binding contract (found out the hard way w/ my first job outta school paying MORE than 50/hr. Money ain't errythang)

 

Sent from my myTouch_4G_Slide using Tapatalk

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Sorry to disagree but you're way off base. A medical assistant will never be able to do this no matter how much training they receive because they don't have a license to practice medicine.

 

What you are also saying is it doesn't matter what other sx Strep Throat Man has, any prudent practitioner, new grad or otherwise is not going to do a review of systems, is not going to investigate further if Strep Throat Man had LAD of all nodes known to man, is not going to investigate further if STM had 102 fever, is not going to investigate further if STM has nuchal rigidity?

 

My assertion is that any prudent PA is going to treat any complaint in the usual way. This means working up or referring anything that needs it.

 

 

my point was that at these places you pay 15 dollars for a strep test and that is all you get. you don't get someone "practicing medicine". you get an algorithm: burning with urination, check ua. if leuks give abx a. if allergic give abx b. they don't get a pelvic to r/o chlamydia, etc. you don't get a hx beyond " I have a sore throat today". you don't get a ROS/exam. you get a strep swab. period. I see these folks as bounce backs in the ER and not because they were referred but because they got worse. sure, a skilled clinician would pick up the bad stuff but too many of these places are staffed by new grads who have never seen lymphoma, peritonsilar abscess, retropharyngeal abscess, epiglottitis, etc. if we considered this "practicing medicine solo"(as you are there alone) like a rural clinic or rural er they would only accept experienced folks but they call it " retail medicine" or "convenience care" which somehow means no one potentially sick will ever go there(?)

all of these jobs in my town are filled by new grads who want to stay in town and can't get jobs in the fields they actually want to practice in.

if they required 5 yrs of experience to get these jobs I would have more respect for the work done there.

now, by the op's request let's turn back to the question of these jobs in CA.

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Back on topic. I remember that our former Gov had mentioned the use of midlevels in retail Pharmacys as part of his healthcare plan. I think that plan went out the window when the office changed hands. I have not heard of any PAs doing this kind of work in California, but I don't get out much anymore. I have heard of NPs doing it, but don't know any. You might contact the CAPA office and see if they have any current information on this. Ph (714) 427-0321; Fax: (714) 427-0324, Email: capa@capanet.org .

Good luck

LesH

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Ok thanks for the input guys. I found it weird that something so prevalent out here in Texas was coming up with a big /Whiff when I goggled similar California clinics. It's definitely interesting to see the varying job markets from state to state. I guess the good news is California is still ahead of Mississippi when it comes to jobs and PA restrictions. lol

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Long story short........retail clinics are usually owned by large corporate organizations and hire PAs/NPs/MDs. However, California law forbids the corporate practice of medicine, so retail clinics in California must be under the umbrella of a larger health organization with an independent medical staff in order to hire anyone or provide medical services. Sutter, Catholic Healthcare West (Dignity Health now) in NorCal are all examples that sub-contract from Walgreens, etc. for that type of clinic. That undermines the profit motive for the larger corporation so retail clinics are not as popular in Cali. However, the medical staff organization (Sutter Physicians, etc.) can hire whoever it wants....MDs, DOs, PAs, NPs for the clinic. Walgreens or Walmart cannot, in california, hire a doctor or a PA, or an NP that practices medicine (they could hire a nurse for nursing services only). This has nothing to do with whether these clinics are good or bad for PAs, that’s entirely another question.

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Ok thanks for the input guys. I found it weird that something so prevalent out here in Texas was coming up with a big /Whiff when I goggled similar California clinics. It's definitely interesting to see the varying job markets from state to state. I guess the good news is California is still ahead of Mississippi when it comes to jobs and PA restrictions. lol

 

To locate retail clinics in California, try this: Healthcare 311

 

You're welcome

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