In-house clinics can be an attractive option for providing more cost-efficient and high-quality health care for patients with particular medical conditions. Creating such clinics need not require a large capital investment. In fact, all that is needed is likely already in the practice setting.

“I encourage the creation of subspecialty type of clinics,” said Daniel Elliott, MD, Associate Professor of Urology at Mayo Clinic in Rochester, Minn. “The volume of knowledge out there is increasing rapidly. You cannot provide high-quality, efficient care in all types of urology. There is too much to know. These [subspecialty clinics] save money for the system, provide better care for patients, and create fewer complications.”

Mayo started its Female Urology and Incontinence Clinic in the early 2000s. The clinic is run by a highly specialized group of urologists and was created to provide more efficient, higher quality care for patients coming in from all over the country with female urological problems.  The clinic has a streamlined system for screening, evaluation and funneling to subspecialists for treatment.

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The backing, funding, marketing, and reputation of Mayo help get patients to the clinic, but all of these factors are not necessary, Dr. Elliott said. In fact, many clinics can be created with very little capital investment.

It is important that clinicians have expansive knowledge of the subspecialty, particularly if there isn’t a lot of training available in that subspecialty.

“You do not need to have a female urologic fellowship and credentialing in female surgery,” he said. “It is nice … but what is important is a passion for taking care of these [conditions] and a willingness to think and solve problems.”

Andrew Portis, MD, Chair and Medical Director of the HealthEast Kidney Stone Institute in St. Paul, Minn., said the interest of a physician is an important component of establishing a clinic. “If you are not going to be a physician champion, forget it,” Dr. Portis said. “If you don’t invest time and energy, it won’t succeed.”


One of the major factors in deciding whether to start a clinic is the need in the community, Dr. Elliott said. To determine need, a practice’s business office can generate reports that provide insight into the types of diagnoses a practice sees during the course of a year. If there are a large number of patients coming in with complex stone cases, for example, then a clinic focuses on such cases may make sense. If one patient a month comes in for a sexual problem, a sexual health clinic would be hard to justify.

Jeffrey Albaugh, PhD, an advanced practice clinical urology nurse and Director of Sexual Health at the William D. and Pamela Hutul Ross Clinic for Sexual Health at NorthShore University Health System in Illinois, said it was apparent in his practice that there was a dearth of providers treating sexual dysfunction. He was getting patients who were bouncing around, seeing five to seven providers to no avail before they got to him.

“I was treating men, and women would say, ‘What about us?’” he said. “I would tell them to talk to their gynecologist about it and they said it was not something a gynecologist could help them with. We found there are not a lot of people out there trained in this.”

So he and his group decided to focus on a multidisciplinary approach to sexual health for women, men, and couples.

Another option is to talk to the primary care doctors who provide a lot of referrals to the office, asking them if they see a lot of patients who need treatment for a particular condition and if there are enough local specialists to treat those patients.