Customers leave a CVS Minute Clinic inside a CVS in West Hartford, Conn. MinuteClinics provide quick care for minor health problems. A nurse practitioner makes the diagnosis and writes a prescription, if needed.

The Providence Journal / Steve Szydlowski

If clinics that treat minor problems open up in local stores, one thing seems certain: people will go to them. Lots of people.

But whether that’s a good thing remains open to debate. And that debate is heating up again in Rhode Island.

Last week, the two top officials of MinuteClinic, the biggest company offering the store-based, nurse-provided care that has become popular around the country, went head-to-head with the folks who helped fight them off in Rhode Island two years ago: the doctors.

Michael C. Howe, chief executive officer, and Dr. Glen D. Nelson, chairman, made the case for MinuteClinic to the Health Department’s Primary Care Physician Advisory Committee. If the executives’ purpose was to win over the primary-care doctors, they did not succeed. But they don’t need the doctors’ approval — just a license from the Health Department — and the discussion that ensued provided a glimpse of what MinuteClinic would mean for Rhode Island.

“MinuteClinic provides access to health care seven days a week in convenient locations,” Howe explained. Typically this location is a CVS drugstore; CVS bought MinuteClinic last year.

Staffed by nurse practitioners, the clinics are open seven days a week, till 8 on weeknights. They require no appointments, and waits are brief. The nurse practitioner, guided by a checklist, diagnoses and treats a limited menu of simple health problems, such as sore throats, urinary tract infections, ear infections, and rashes, typically for $59 a visit. Most health insurers will cover these visits, and uninsured people often find them affordable.

If the problem looks serious or complicated, the patient is referred elsewhere. Otherwise, the patient gets a prescription if needed, a diagnostic record, educational materials, a bill, and a toll-free number for after-hours questions. If the patient has a primary-care provider, a record of the visit is immediately sent to that provider. If not, MinuteClinic refers the patient to a local doctor.

Dr. Elizabeth B. Lange, vice president of the Rhode Island chapter of American Academy of Pediatrics, spoke in rebuttal. No medical visit is simple, she declared. When a child has a bladder infection, for example, that could indicate anything from sexual abuse to a need for circumcision. And even if the infection is uncomplicated, these visits provide an invaluable opportunity to review the medical chart, see whether vaccines are up to date, and ask how the child is doing in school.

“Medicine is a relationship,” Lange said. “It is not a business transaction.”

She also accused MinuteClinic of “frank conflict of interest” when its nurses prescribe medications that can be purchased in the same store.

Lange acknowledged that the doctors’ objections are financial as well. The kind of quick, easy care provided at MinuteClinics is the bread and butter of primary-care practices, which in Rhode Island are reimbursed at lower rates than in most other states. Pay is so low in Rhode Island that many primary care practices report difficulty recruiting new doctors. If MinuteClinic “skims off” those services, doctors are left doing the harder, slower work that pays little, such as managing chronic illnesses or interacting with schools. “We need the reimbursement to keep our doors open,” she said.

Responding to the accusation of conflict of interest, Nelson, the MinuteClinic chairman, said that MinuteClinic has documented that its nurse practitioners do not prescribe antibiotics when they’re not needed; in fact they do a better job at that than doctors. “Physicians overprescribe because the mother insists,” Nelson said.

Furthermore, Nelson said, doctors can’t deny that MinuteClinic fills a need. “There isn’t access to care. The primary-care system is not addressing the needs of patients,” he said. “You need to take a look at yourselves and ask ‘Is MinuteClinic the problem or is it what we’re providing?’ ”

Howe said that in other states MinuteClinics have had little financial effect on doctors. The clinics don’t compete with the doctor’s office, but serve as an adjunct to it, he said.

Doctors at the meeting said that just means more fragmentation of care, giving doctors new responsibilities while draining away their income.

MinuteClinic, said Dr. Albert J. Puerini, a Cranston family doctor, “provides something that McDonald’s and Burger King provide. Patients don’t see that. They don’t understand that’s not the way to get medical care, just like going to McDonald’s is not the way to eat.”

Donald C. Williams, the Health Department’s chief of health services regulation, told the doctors that some of their comments were “fairly paternalistic” and that patients often do know what they need. He noted that the MinuteClinic faces “no legal impediment” to opening as long as it meets the terms of a Health Department license. “There’s a demand for this service,” Williams said. “It’s not going to work to put blinders on.”

Indeed, MinuteClinic may be unstoppable. Launched in Minnesota in 2000, the company has recently been growing at an astounding rate. In the middle of last year, it had 86 clinics in 10 states; today there are 321 in 25 states, with plans to raise the number to 450 before year’s end.

Slower to get a foothold in the more heavily regulated Northeast, MinuteClinic now has 15 clinics in Connecticut. The Massachusetts Department of Public Health is considering its proposal to open 20 to 30 MinuteClinics in the Boston area. The department is first drafting regulations that may include such requirements as limiting the number of repeat visits by a patient, establishing policies to ensure the clinics “do not promote the use of services provided by the host retail location” and posting a sign alerting patients that they can fill prescriptions anywhere, not just at the host store.

MinuteClinic first approached Rhode Island regulators in 2005, seeking a license to open clinics in CVS stores in five upper-middle-class communities. But doctors raised objections, the Health Department showed reluctance to waive its requirements for sinks and toilets in the clinics, and it became clear that the regulatory process would be lengthy. MinuteClinic withdrew its application, promising to return.

The company has not yet reapplied for a Rhode Island license, and Howe would not say when that application would be filed. But his appearance at the Health Department last week suggests it will be soon.

While doctors worry about MinuteClinic, another group remains sanguine: nurses.

“This is all about power and control. This is not about access,” Donna Policastro, executive director of the Rhode Island State Nurses Association, said in a phone interview. “This is about the doctors not being in direct control of MinuteClinics. This is a nurse-driven model. I don’t think they like that.”

Policastro predicted that parents would continue to take children to their pediatricians, would use the MinuteClinic only when their doctor isn’t available, and would then go back to the doctor.

“We’re a team,” Policastro said. “This should be a team effort.”

ffreyer@projo.com