Interview (Page 2): Dr. Steve Cooley

FH: What penetration do you need to achieve in a marketplace to be successful?

SC: To get the right numbers, you can work backwards from healthcare stats, including for emergency departments and urgent care, and back into a national volume. By doing that you can come up to anything from 1 per 50,000 to one per 125,000. But we don’t know yet which is the right number.

Atlanta is the first market to have a concentration in this range, and I think its going to take 2 years to see if Atlanta works. That’s the generally accepted amount of time that it takes to generate enough value to cover expenses.

FH: What do you think of the concerns critics have raised about retail clinic safety?

SC:There are a number of theoretical concerns which have been raised by certain physician groups, such as the possibility of infection due to the way clinics are run or the lack of a sink or whatever. But as scientists, physicians should be operating on evidence. Rather than assuming that there will be a disproportionate amount of infections, it’s better to observe and see whether there are.

For example, in Minnesota, where MinuteClinic has had 20 to 25 locations for six or seven years, I’m unaware of concerns with the Minnesota Department of Health.

In short, while I think all the concerns are legitimate, I haven’t heard any specific objections or complaints that I think are dealbreakers.

FH: What are your goals for the next year or two?

SC: For one thing, we’re looking at performance metrics for clinical outcomes to be published in refereed journals.
Also, we want to continue to improve the efficiency of the way we deliver the care. What that means explicitly to us is trying to consistently achieve low waiting times and low overall throughput times. That is cornerstone of early success of these clinics.

FH: How will competition with private physicians shake out?

SC: Back in 1980, there was no urgent care centers, and now there are 17,000-odd centers. At the beginning, there was lots of discussion about how they’d be competing, and how physicians might react. The most common answer was physicians could offer weekend hours or extended hours using nurse practitioners. It didn’t happen though.

Today, patients still seek care which is appropriate for what they need. In an era where over the next 10 to 20 years we’re going to have a declining supply of primary care physicians per capita, what should really be happening is that doctors should work with NPs or PAs to see whether they can work together. Otherwise, as a system we’re not going to be able to meet the needs of the population. It’s about much more than competing with Dr. Jones.