Blog Post

Why APPs are the perfect fit for retail clinics

October 28, 2017

    An Advisory Board survey found that being able to walk in without an appointment and be seen within 30 minutes is the top consumer preference for a primary care provider. But physician shortages, appointment backlogs, and maxed-out physician panels make meeting this demand nearly impossible for most primary care clinics.

    To meet the growing demand for timely access, many groups are opening retail clinics. These clinics provide convenient locations with extended hours—and the opportunity for medical groups to compete with the nearly 2,800 retail clinics nationwide.

    However, retail clinics see mostly low-acuity, low-margin cases, which makes breaking even a challenge. Financial sustainability depends on strong patient throughput and lean staffing models. Given these constraints, the most successful clinics are staffed exclusively by advanced practice providers (APPs) instead of physicians.

    A closer look at Sparrow Health System's retail staffing model

    Sparrow Health System owns and operates three "FastCare" clinics, which are open seven days a week from 8 a.m. to 8 p.m. Monday through Friday and 9 a.m. to 6 p.m. Saturday, Sundays, and most holidays (they're closed on Christmas Day). These clinics are staffed by APPs and medical assistants. Eight full-time APPs (mostly nurse practitioners) practice across the FastCare sites, and each site is staffed daily by one APP and one medical assistant.

    While planning for these sites, Sparrow FastCare's Medical Director, Dr. Patricia Crowe, spent time shadowing various retail clinics and quickly learned that the most successful models employ APPs instead of physicians. APPs provide high-quality care at a much lower cost than physicians, which is ideal for the retail setting. In fact, our employed medical group benchmarks indicate that family medicine physicians are compensated 48% higher than physician assistants—even though researchers found similar clinical outcomes and patient satisfaction scores for both provider types.

    Not only does staffing retail clinics with APPs improve the financial viability of a retail clinic, but these positions give APPs—who are often more independent and entrepreneurial—the opportunity to manage their own patients.

    In fact, Dr. Crowe told us, "APPs thrive in this model given their desire to have relationships with patients and their ability to figure out a way to do everything well—showing empathy, looking people in the eye, welcoming patients."

    The sustainability of this retail model hinges on APPs who crave autonomy and function efficiently at top-of-license, which led Sparrow to create explicit hiring criteria. Dr. Crowe even delayed opening one site by four months, foregoing potential revenue, because she hadn't found the right APPs to staff it.

    Sparrow FastCare's hiring criteria include that an applicant:

    1. Has at least one year of experience working in a primary care setting;
    2. Exhibits excellent interpersonal skills, such as friendliness, diligence, and listening, in behavioral interviews and scenarios;
    3. Articulates Sparrow's ICARE (Innovation, Compassion, Accountability, Respect, Excellence) values and how they plan to incorporate these values in patient care;
    4. Demonstrates eagerness to meet patients' expectations regarding price transparency (e.g. willingness to discuss prices with patients); and
    5. Understands the importance of exceeding patients' expectations by providing high quality, compassionate care to every patient, every time.

    Achieving financial stability

    The Medical Group Strategy Council estimates that retail clinics need at least 20 visits per day to break even within four years. By that metric, Sparrow's initial FastCare site, which opened in June 2015, has been a resounding success: It currently sees an average of 30 patients per day. This visit load, in combination with Sparrow's lean APP-based staffing model, positions Sparrow for a positive ROI for the organization.

    In addition to the straightforward financial viability of the retail clinics, Sparrow has also leveraged their FastCare clinics to actually build system loyalty. Approximately 70% of FastCare patients are established Sparrow patients. For the other 30%, when these new patients come into a Sparrow FastCare location, the APP offers to pair the patient with a Sparrow Medical Group PCP. This way, the clinics are able to meet patient demand for immediate access while further contributing to system growth and supporting population health initiatives.


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