Pediatricians: Competing for kids

At 5 every weekday afternoon, after the last feverish child has been treated and the last sucker handed out, Central Pediatrics in Woodbury goes dark and a nurse locks the front door.

Another door opens right next to it. Priority Pediatrics Urgent Care is open for business.

Both lobbies lead to the same clinic. And the same doctors.

The unorthodox business model has kept Central Pediatrics, with two locations in the east-metro area, ahead of the latest competitive challenge in health care: "retail" clinics.

Even as a number of small pediatric practices have closed around the Twin Cities, Central Peds has expanded to 14 pediatricians and just opened a location in Falcon Heights, also with an urgent-care clinic attached.

"We've been able to be successful when other groups are going under," said Dr. Shelly Strong, the clinic's managing partner.

Central Peds isn't the only group making it easier for patients to see doctors as quick clinics such as MinuteClinic and Target Clinic spread. Many pediatric practices now have evening and weekend hours. Others are accepting walk-ins and a few are starting to allow parents to schedule appointments for their kids online.

All are worried about the same thing: retail clinics skimming off care for common ailments such as ear infections and pink eye. Such simple services give clinics a stable income stream so they are able to do less frequent, more complex and higher-cost care.

"When you take the bread and butter off the table, what's left is harder to provide," said Terri Hyduke, chief executive of Children's Physician Network, which represents Twin Cities pediatricians.

Cost pressures on practices

Central Peds isn't the first to offer urgent care for kids. South Lake Pediatrics, with six metro-area locations, did that 15 years ago at an Eden Prairie clinic that later moved to St. Louis Park. But the stakes are much higher now.

Pediatrics no longer is just about sore throats and immunizations. These days, there are more children with conditions such as obesity, diabetes and attention deficit hyperactivity disorder that require more involved, continuing care. Better medicine has meant more sick kids are surviving far longer than in the past.

For example, Strong said, she is caring for a child who has had a bone marrow transplant, two 27-week premies and a child with brittle-bone disease.

Pediatric practices are also struggling to keep up with technology. Electronic medical records are becoming a standard in health care but are too expensive for many small practices to afford.

Add growing competition from retail clinics, and it's all coming to a head, say those in the field. In the past 18 months, four small pediatric clinics have closed and one group closed a single location. Another four clinics closed sites only to open elsewhere.

"It's the most movement we've seen in 10 years," said Hyduke of the Children's Physician Network, which represents about 200 primary-care doctors in more than 20 pediatric practices.

Evolving as a business

Central Pediatrics has been around since 1936. For years, it was housed in the Central Medical Building off Interstate 94 and Lexington Avenue in St. Paul. In the 1990s, it opened a second clinic in Woodbury.

Central Peds doctors knew that a few of their patients were popping into retail clinics because those clinics sent them medical reports afterward.

When a day care next to the Woodbury clinic closed in 2004, the clinic took it over and opened the first Priority Peds Urgent Care. That allowed the staff not only to see the regular patients, but also those who go to other doctors for primary care and get reimbursed by insurers. Those patients now make up about a quarter of urgent-care patients.

Central Peds also hired a public relations firm to market its services. Its walk-in policy, introduced years before, was rebranded with a snappy name: FlexCare. "We've had to become more of a business," Strong said. "Before, we didn't need to. Patients were just coming in the door."

Last year, Central Peds moved from its other longtime office, in the Central Medical Building in St. Paul, to Falcon Heights. By moving out of a high-rise building to a ground-floor lot in a commercial strip, it was able to add another urgent care and hire four doctors to staff the extra hours.

Emphasizing differences

One of the hires is Sandy Sackett, who used to be part of a now-defunct three-physician practice in nearby Roseville. "It's increasingly obvious that small practices aren't going to be around," Sackett said.

Still, she's happy with where she landed. Her patients, most of whom followed her to Central Peds, now have access to an X-ray machine on site, a lab and, of course, urgent care.

On a recent weekend, Denise Kauth took her daughter Valerie to the Falcon Heights clinic after the 4-year-old developed a bad cough. In the past, Kauth headed to an urgent-care chain, Now Care, when her kids got sick on weekends.

"It's a wonderful option being a working parent," Kauth said. "Things don't always happen during the weekdays."

Even while competing on convenience, Priority Peds emphasizes how it differs. Brochures stress that kids will see a pediatrician -- a dig at retail clinics, which employ nurse practitioners.

That has big appeal for families such as the Kulseths of St. Paul. After a sleepless night with Aanen, 15 months old, as his cold developed into croup and he began wheezing, his parents took him in one recent Saturday.

They said they picked Central Peds because of multiple recommendations from friends. In a phone interview, Radd Kulseth said he himself used a MinuteClinic close to work, but probably wouldn't take the baby there. In the background, his wife, Laurie, yelled: "Absolutely not!"

Chen May Yee • 612-673-7434