Say you've got a sore throat and you've heard that strep is going around. You're really busy at the office and want a quick answer on your health.

Then imagine you could just stop at the drugstore, where within minutes a nurse practitioner could give you a strep test -- and, if it's positive, a prescription for antibiotics. Which you could then buy at the selfsame drugstore.

Such convenience has obvious appeal for consumers.

But last year, when a for-profit company, MinuteClinic (now owned by CVS/pharmacy), proposed setting up clinics like that in several Rhode Island CVS drugstores, doctors around the state got up in arms. In letters, newspaper columns and hearings at the Health Department, they raised concerns about unfair competition and disruption of the doctor-patient relationship.

And MinuteClinic retreated -- temporarily.

But even as the furor over MinuteClinic died down, many in the medical community recognized what it meant.

"MinuteClinic has exposed an Achilles' heel of office-based practice," Dr. Fredric V. Christian, a cardiologist who is immediate past president of the Rhode Island Medical Society, wrote in a message on the society's Web site. "There is an ACCESS problem."

MinuteClinic, Christian wrote, appealed to consumers "who perceive that their primary-care provider or pediatrician is unavailable or unable to meet their immediate needs."

Michael Howe, MinuteClinic's chief executive officer, said his company has definite plans to reapply for a Rhode Island license -- but he wouldn't reveal when it would act.

Based in Minnesota, MinuteClinic is part of a trend sweeping the country. With 86 clinics in 10 states, it's the biggest of several companies that offer "retail" medical care in stores and supermarkets. CVS approached MinuteClinic in November 2004, seeking a partnership, and within a year opened MinuteClinics in 69 CVS stores in 10 states. But in Rhode Island, the process proved more arduous.

MinuteClinic needed a license from the Health Department, and proceedings dragged on for months. The company proposed to open clinics in CVS stores in Barrington, East Greenwich, Cranston, Providence and South Kingstown.

Each clinic would be staffed by a nurse practitioner who would diagnose and treat common, minor ailments such as sore throats, urinary tract infections, ear infections, skin infections, allergies and bronchitis, as well as providing vaccinations. Prices would range from $25 to $78 per service; people could pay out of pocket or use their insurance.

"This is about being patient-centric," said Howe, the MinuteClinic CEO and former head of the Arby's restaurant chain. "Medical services are just that -- a service industry. This about providing service to the patient."

But doctors had many concerns. A top one was financial. They feared that the MinuteClinic would grab the "lowhanging fruit" -- those quick, easy, lucrative services that primary-care doctors depend on to make ends meet. Doctors would be left with follow-up visits, physicals and chronic-illness care, all time-consuming services that are not well reimbursed.

This was coming at a time when primary-care doctors are seeing their incomes decline (a recent analysis found a 10.2-percent drop in income nationwide from 1995 to 2003) and having difficulty recruiting young partners interested in general medicine rather than specialties.

Doctors also questioned whether MinuteClinic would draw patients away from primary care; patients seeking quick help for minor problems in the MinuteClinic would see their doctors less and miss opportunities to deal with bigger health issues and prevention. Some also worried that with its focus on simple things, MinuteClinic would overlook serious problems. A seemingly minor illness could be a sign of more serious trouble in a patient with complex or chronic problems, they said.

The Health Department also had some issues. The MinuteClinics would not have sinks; they wanted a variance that would allow them to use alcohol-based hand sanitizers instead. Health officials also had concerns because the clinics would not have restrooms. And several members of the Health Services Council, the advisory group that would rule on the license, questioned whether MinuteClinic would provide its share of charity care. They noted that the four clinics would be in upper-middle-class neighborhoods.

But MinuteClinic had at least one big fan: Blue Cross & Blue Shield of Rhode Island, which said that retail clinics would fill a need, at lower cost than emergency rooms.

IN DECEMBER, MinuteClinic abruptly withdrew its license application, offering no explanation. Howe, MinuteClinic CEO, said recently that the company had "other priorities" but would return. "MinuteClinics will open in Rhode Island," he said.

Last month, CVS, based in Woonsocket, announced that it had purchased MinuteClinic, making the return seem all the more likely.

Jim Maritan, vice president of strategy and business development of CVS/pharmacy, made it clear that MinuteClinic -- which expects to have 250 clinics operating by the end of October -- wanted to focus on places where there was less trouble. "Going to hearings costs money," he said.

In a recent interview, Howe offered a rebuttal to objections raised before the Health Department. He asserted that hand sanitizers actually work better than hand-washing with soap and water, and the lack of bathrooms within the clinic hasn't been a problem in other places.

The nurse practitioners at MinuteClinics follow computer-based protocols that are like "a preflight checklist," preventing them from moving forward with a diagnosis until every question is answered, he said. Five to seven percent of patients who appear at MinuteClinics are found to have problems that the clinic cannot handle, and are referred elsewhere.

MinuteClinics, he said, abide by all the guidelines for in-store clinics established by the American Medical Association and the American Academy of Family Physicians.

As for threatening primary care, Howe insisted that MinuteClinic does the opposite. MinuteClinic transmits a summary of every encounter to the patient's primary-care doctor, and also offers after-hours telephone follow-up.

About a third of patients say they don't have a primary-care doctor -- and MinuteClinic refers them to one. "We can be a portal into the medical community," Howe said.

Howe acknowledged that MinuteClinic chose wealthier neighborhoods; that's where people were most likely to have the education to use the clinics appropriately, he said.

And finally, Howe asserted, doctors' worries about the financial impact were exaggerated.

"It's not the financial death knell of primary care," he said. "We've been practicing in Minnesota for six years. There hasn't been bankruptcy declared by Minnesota medical practices."

BUT DR. David Luehr, president of the Minnesota Medical Association, tells a different story. "A fair number" of smaller medical offices have been hurt financially by the MinuteClinics, he said. "What is happening is that many of the individual clinics are having to sell out to larger groups," Luehr said.

Luehr said there have also been anecdotal reports that MinuteClinics overprescribe antibiotics, something that doctors attribute to the desire to drum up business for the store pharmacy.

But Luehr sees one positive effect of MinuteClinic in Minnesota: "It has encouraged primary-care offices to be more accessible to their patients," he said. Luehr, a family doctor, has changed his own practice so that half his appointment slots are open each day to meet patient needs on short notice. He now offers free blood-pressure checks, and patients who want a flu vaccine or strep test can drop in without seeing the doctor.

In Rhode Island, Dr. Kathleen Fitzgerald, the current medical society president, said the access problem runs deeper than doctors' scheduling practices, and points to problems in the system as a whole.

In other states, MinuteClinics' busiest times are Friday night through Monday morning, when most doctors offices are closed, and the same would probably be true in Rhode Island. The state needs to develop a well-organized and well-regulated system of after-hours and urgent care to fill this gap, Fitzgerald said.

Around the state, many people find quick care at urgent-care centers or walk-in clinics, which offer a wider array of services than MinuteClinics. But these centers are loosely regulated and vary in quality; in the eyes of some patients, they are not a trustworthy alternative to the emergency room, said Dr. Daniel H. Halpren-Ruder, an urgent-care center owner who has called for tougher regulations of urgent care.

Christopher F. Koller, the state health-insurance commissioner, has convened a work group examining ways to change the reimbursement system to better support primary care. One of the possibilities under discussion, he said, is for insurers to pay consistently higher fees for after-hours care, creating the means and incentive for doctors to provide more evening and weekend care -- as well as rewarding the pediatricians who are already doing that.

"If an upshot of the MinuteClinic is that it allows people to be more responsive to the needs of patients, that's a good thing," Koller said. "If an upshot is that people avoid or don't understand the routine preventive stuff, then it's not a good thing."

All in all, with the tight regulations in Rhode Island, Koller said he is not worried about the MinuteClinics. "We can integrate them into the medical system," he said.

ffreyer@projo.com / (401) 277-7397