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Alan Stolier, MD/

“The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care”

There are currently over 12,000 urgent care centers and retail healthcare clinics in the US. The number is growing. This movement away from the personal primary care physician has clearly arisen from a need. What exactly that need is, is not totally understood; but is likely related to difficulty in booking appointments on nights and weekends as well as a change in the need for a more personal doctor-patient relationship by the younger generations. This movement has not gone unnoticed by large corporations. Walmart, CVS Health, and others are looking to make deals with health insurance carriers to open retail clinics.


In many instances, simple health needs can be met by a nurse practitioner or physician assistant much cheaper than in the doctor’s office or clinic. According to an article in the New York Times by Reed Abelson and Julie Creswell (NY Times), office visits have declined 18% from 2012-2016! Furthermore, long hours and low pay have also made pediatrics and primary care specialties unattractive.

Abelson and Creswell note that corporate deals are currently in the works which would offer the opportunity for one-stop medical care. A deal between Walmart and Humana is one example. For instance, one idea is to expand Humana’s 19 clinics to offering one-stop medical care in many of Walmart stores. Walmart already offers pharmacy services attracting many elderly patients. Another potential merger between CVS Health and Aetna is in response to the United Health Group which employs over 30,000 physicians. Moreover, United operates the country’s largest urgent care group (MediExpress) as well as a chain of surgery centers. As noted in a previous post on the BCN Website, Amazon, JP Morgan and Berkshire Hathaway are also trying to enter this busy field. Apple has also decided to open its own clinics and other companies are offering healthcare via cellphone, Skype, and Facetime.

Although a retail clinic may charge less, there is no evidence that overall healthcare cost is lower. There are also claims that these clinics adversely impact the quality of care but yet there is no evidence supporting such a claim. There is no end in sight. If the CVS Health merger with Aetna goes through, CVS will enter markets where Aetna has high penetration. United Health is similarly increasing their doctor employment to 75 markets in the US. Large hospitals are also joining the fray. Currently, hospitals employ 43% of primary care doctors, up from 23% in 2010. Many are opening urgent care centers. “Those physicians still holding on too their practices stress the importance of continuity of care and gaining patient trust. Unfortunately, these claims are falling on deaf ears.”

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