As the economy hits the skids, how are retail clinics faring? Better than you might think. May Hang, an NP and manager with CVS Caremark MinuteClinic in Detroit, said patient visits are holding steady there, despite the downturn in the auto industry. Even so, more people, especially those without insurance, are postponing care and are presenting with more serious conditions.

Take, for instance, a woman suffering an asthma attack, who recently sought treatment in a suburban Detroit clinic where Hang was working. The patient needed more help than the clinic and Hang could provide, but the woman resisted a call to 911 for assistance. "People are reluctant to go to the emergency room because they're afraid of the cost," Hang said.

Robolino and her husband, Dominick, after receiving flu shots at a CVS MinuteClinic in New Milford, New Jersey, in 2006. CVS Caremark recently announced it would be closing 90 of its MinuteClinics until the flu season of 2009-2010, leaving some wondering whether low-income families will have adequate access to health care. Photo by Chris Pedota /

In March CVS Caremark, the largest operator of in-store clinics, said it would temporarily shutter 90 of its more than 500 MinuteClinics until the fall, when business picks up because of cold and flu season. The cutback reflected a mismatch between clinic locations and patient demand, the company said. "We had clinics that were closer together than was necessary for the seasons that are not as busy," said Donna Haugland, chief nursing officer at MinuteClinic. Overall, she said, patient volumes have been good, and the proportion of people not using insurance to pay for care is about 20%, which is in line with past patterns.

CVS Caremark's decision to scale back goes beyond seasonal slowness or an ailing economy, said Tom Charland, chief executive of Merchant Medicine, a consulting firm specializing in retail clinics. Instead, he said, new management at MinuteClinic decided rightly to trim in specific areas, such as Chicago, where the company had overbuilt. Nonetheless, Charland expects the ranks of retail clinics to keep growing, more than doubling to 2,500 in 2012 from about 1,100 today. Retail clinics will continue to appeal to the rising number of people who are uninsured or covered by high-deductible plans, he said.

Adding new services to the in-store clinics may also spur demand. MinuteClinic's Haugland said the chain is pilot testing care of minor wounds, tuberculosis testing, and administration of the live herpes zoster vaccine (Zostavax) against shingles for patients on Medicare.

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