When one of Hilario Aguirre’s three daughters gets the flu or an earache, the heavy equipment operator says he no longer tries to get “squeezed in” at the family doctor’s office. Instead, he or his wife Raquel takes the sick girl to a Rite Aid retail pharmacy about a 10-minute drive from their West Sacramento, California home. In the back of the store, just beyond shelves stocked with pet food and antifreeze, sits a new kind of doctor’s office where the Aguirres can walk in seven days a week, and on most holidays, without an appointment. Like fast-food outlets, the clinic conspicuously posts a “menu of services” along with its flat fees: $63 for most visits, $25 for a flu vaccination, and $35 for a cholesterol screening, to mention a few. “Quick, convenient healthcare” reads a sign. Typical visits last 20 to 30 minutes and patients get pagers if they want to shop while they wait.

But there’s a twist. This “Express Care” outlet is not the brainchild of some healthcare upstart but rather one of six such clinics opened by Aguirre’s healthcare provider Sacramento-based Sutter Health, one of the state’s largest health systems with roots going back more than a hundred years. Because a visit to Express Care is considered “in network,” Aguirre’s insurance requires him only to come up with the $25 co-pay when he comes in. “You are always going to get in on the same day and you never have to wait more than 15 minutes,” says the 35-year-old. “I’d hate to have to go to the emergency room and wait there for hours.”

The doc-in-a-box concept, as it’s called, is nothing new. The first retail-based clinic QuickMedx (now MinuteClinic) opened some eight years ago in the Minneapolis-St. Paul area. What is new, however, is the dramatic expansion of these clinics. In the last two years, their numbers have more than tripled to 1,104 clinics as of November 1, from 343 in the beginning of 2007, according to the research and consulting firm Merchant Medicine in Shoreview, Minnesota. The growth comes as a faltering economy coupled with always-on-the-go lifestyles lead Americans to seek basic care that is cheaper and more convenient. “The reality is, many patients in the U.S. have difficulty accessing care from their primary care physician,” says RAND Policy Analyst Dr. Ateev Mehrotra, who is also a professor at the University of Pittsburgh and has studied the emergence of retail clinics. “When they have something that is urgent but relatively minor, these retail clinics are trying to fill that niche.”

Today, the market leader MinuteClinic is owned by CVS, but many clinics are owned by some two dozen independent operators, including The Little Clinic in Brentwood, Tennessee, RediClinic in Houston, and QuickHealth in San Mateo, California (See “Healthcare on the Go,” p. TK). These clinics tend to be situated in high-traffic locations such as Wal-Mart, Kroger, Duane Reade, and Target stores. Growing particularly fast are clinics such as Express Care that are affiliated with large healthcare providers. That segment has more than tripled, going from 30 clinics in the beginning of 2007 to 108 as of November 1.“It is a defensive play,” says Tom Charland, Merchant Medicine’s CEO. “The hospital systems would like to neutralize competition in their markets by getting in before the big clinic operators get there. Secondly, they want to generate visibility for their brand out in the community, and as a result, bring new patients into their system.”