CVS IS TRYING TO OPEN small clinics in its drugstores staffed by nurse practitioners to treat simple problems according to established protocols. Physicians think that this plan is a bad idea for reasons to be discussed below. The Journal published on Feb. 27 a lead editorial (“Handy local clinics”) saying that store-based clinics would be a good idea because of consumer convenience and lower costs.

Although we are enthusiastic about nurse practitioners in primary care, we physicians oppose placing medical facilities in drug stores.

The reasons are threefold: professional, ethical and financial.

When our patients get occasional care without our knowledge or consent, it often leads to bad results. It is hard enough to render a correct diagnosis and treatment even when you know a patient’s history, including allergies to medicines and the like. There are pitfalls in prescribing medicines, even simple medicines. For example, sulfa-based antibiotics can lead to fatal hemorrhages in patients already on the anticoagulant Coumadin as well as allergic reactions.

Secondly, there is an unethical aspect to selling medical care and drugs under the same roof. How does a patient know that a drug prescribed by a “MinuteClinic” nurse practitioner is the best one and not the one with the highest profit margin for the store? I will not refer patients to a physician who sells drugs in his office nor to a pharmacy that tries to practice medicine.

The final objection relates to the financial impact on our practices. To put it frankly, simple visits make us money. The work required by the time-consuming complex patient, on the other hand, is poorly reimbursed by Blue Cross, United Health Care and Medicare.

We understand that calls of poverty by physicians play poorly to the public. However, the fees of Rhode Island physicians are historically 20 percent less than fees in Connecticut and Massachusetts. It is hard to attract and retain primary-care physicians (as well as specialists) in Rhode Island. Managers of practices often joke that applicants to primary-care positions in this state have boats, sick parents or psychiatric problems. (In fact, it is essential to check references on these applicants because misfits who can’t find better will try to come here.)

The good news is that we work long hours for relatively little pay and provide an excellent value for our patients. The bad news is that our financial condition is precarious. An increase in expenses or a sudden drop in profitability may close your doctor’s practice. That is why we will fight CVS on the MinuteClinics. Since they leave us no choice we will fight with whatever crude instruments we have in our hands.

As to the issue of consumer convenience, the concept of the Urgent Care Center first arose in Rhode Island in 1975. According to the Web site of the Urgent Care Association of Rhode Island (urgentcareri.com) there are 20 Urgent Care Centers in Rhode Island, at most a 15-minute drive from anywhere in the state. Also, around the state, there are five Walk In Clinics that offer similar if simpler facilities with extended hours for the working sick who can’t get an appointment with their primary-care practice.

With competition from store-based clinics, Urgent Care Clinics, which have often sophisticated diagnostic facilities, will be forced to cut back hours of operation because it is too costly to pay a registered nurse, lab technician and X-ray technologist to stay on duty if there are no visits.

The above are the principal reasons why we are asking the protection of the legislature and the state Department of Health to exclude MinuteClinic. Hooray to Barrington, which blocked the MinuteClinic on the basis of inadequate parking spaces. And good for the Department of Health for giving them grief for not having a public bathroom for leaving a urine sample, for example.

As for fighting CVS, I call upon all of my colleagues and, as many patients as wish, to transfer their family traffic away from CVS and go across the street. If CVS leadership cannot recognize and avoid the appearance of wrongdoing, how can we from the outside know about actual wrongdoing itself?

I believe that even a small boycott with the threat of adverse publicity and bad will toward the store will change their minds. I bear Tom Ryan, the CVS chief executive, and the dedicated employees of CVS in general no ill will.

We need more such great and successful national corporations like CVS in our state. In this case, however, they are crossing the ethical line but, most objectionably, trying to work my side of the street.

Sorry, Tom, nothing personal; it’s business, you know. And we are really saving you from yourself. This is not about ruined one-hour photos for which you can give a store credit! Just think of the prospect of the inevitable fatal reaction to an antibiotic prescribed on the basis of a flimsy rationale. You will see that you don’t want to do what we do. The filling of prescriptions is your core business and it is liability enough. As Benjamin Franklin’s Poor Richard’s Almanack advised, “Take care of the store and the store will take care of you.”

Allen Dennison, M.D., is a primary-care physician, vice president of Medical Associates of Rhode Island and chairman of the Urgent Access Committee of Rhode Island Primary Care, an association of independent primary-care physicians.