Over the 20 years Mark Taylor has been a pharmacist, he's seen customers come into his store and pull their pants down or yank their shoes off to see if he could identify a swelling or a rash.
That sort of behavior is likely on the rise: While the economy remains in a slump and people continue to lose health benefits, it's becoming more common for them to turn to their pharmacists rather than their doctors to address minor health problems.
"It's definitely more prevalent now than ever before," said Taylor, who owns Jersey Shore Pharmacy in Egg Harbor Township.
To meet the needs of their customers, pharmacists today provide services that were once the province of primary care physicians. Many offer a battery of vaccinations, from the more common, like those for influenza and pneumonia, to the more specialized, like tetanus, diphtheria, and meningitis. And some of the chain drugstores like Walgreens and CVS now have walk-in clinics staffed with nurse practitioners who can diagnose, treat and write prescriptions for common illnesses like strep throat, bladder infections, pink eye, and ear infections.
This trend isn't just about health and healing, however.
"We're always looking to offer more services," Taylor said. "You're always looking for ways to get people into your store."
New Jersey was actually one of the last states to allow pharmacists to offer vaccinations. The Pharmacy Practice Act was signed into law in 2005, but lobbyists for the physician community requested that any rules regarding immunization be approved by both the New Jersey Board of Pharmacists and the state Board of Medical Examiners, a process that took about four years.
Some drugstores began offering vaccinations seven or eight years ago by bringing in nursing agencies that were already licensed to give them, but it wasn't until 2009 that pharmacists were authorized to offer them -- for people over the age of 18. They are still prohibited from vaccinating minors.
"It was a concession [to the physicians' lobby] that these protocols be approved by both boards," said Laurie Clark, legislative counsel for the New Jersey Pharmacists Association, the industry's trade group. "The intent wasn't to take business away from physicians. The intent was to make immunizations more available."
In fact, fears of a pandemic may be what prompted New Jersey to finally pass the legislation, according to Kristen Binaso, a spokeswoman for the American Pharmacists Association and a practicing pharmacist in New Jersey.
"If you traveled to the West Coast, pharmacies there have been immunizing for at least 10 years. For some reason, the East Coast lagged behind," Binaso said. "It wasn't until New York had a champion in the New York City health department, who warned about a pandemic if vaccines weren't readily available, that New York got legislation passed."
New Jersey followed suit shortly thereafter, she said.
Since pharmacies began offering immunizations, the number of people vaccinated in the state has gone up, and that's a good thing, said Linda Gooen, president of the New Jersey Pharmacists Association.
That trend comes as no surprise to pharmacists, who argue that they have more contact with patients than doctors do, so it makes sense that they should be the ones to take care of inoculations.
"Because we see them more often than they would go to their doctor, we have a relationship with them, and we can provide them with immunizations more promptly than a physician would," said Joseph Tarallo, who owns Park Plaza Pharmacy in Matawan. "But if we have patients who are compromised, we will refer the person back to their physician for a follow-up to the vaccination."
But immunizations are just part of a pharmacy's expanded role.
"Pharmacies are really changing from community drugstores to community health destinations," said John Colaizzi Jr., chairman of the New Jersey Pharmacists Association and a manager at Walgreens, where four of its stores have walk-in clinics. "If there's anything severe, we would refer you to a physician or emergency room, but most visits to the ER are for minor illnesses, and those are things that our nurse practitioners can treat."
The pharmacists growing role is making some doctors take pause. While they acknowledge that making immunization more accessible is good for society at large, they also argue that people are doing themselves a disservice if they're turning to a drug store for healthcare and are no longer seeing a doctor. At-risk patients, such as those with diabetes or other chronic illnesses, for instance, need to see a doctor on a regular basis for monitoring and preventative care, said Lawrence Downs, CEO and general counsel for the Medical Society of New Jersey, which represents the state's physicians.
"Clearly there's a public health benefit for getting the most people vaccinated. That's not disputed. But for at risk people, people with chronic conditions, those folks can benefit from having their vaccinations in a doctor's office because there are underlying conditions that can be treated at the same time," Downs said. "We want to make sure those people aren't forgoing their physician visit just because they can get their vaccine at Walmart."
How many people getting their vaccinations at a drugstore rather than a doctor's office? Figures for New Jersey aren't available, but the Center for Disease Control and Prevention (CDC) publishes statistics for the entire country -- and they offer some guidance.
According to the CDC, "For adults overall, a doctor's office was the most common place (39.8 percent) for receipt of the 2010-11 influenza vaccine, with stores (e.g., supermarkets or drugstores) (18.4 percent) and workplaces (17.4 percent) the next most common."
The federal agency continues, "The proportion of adults vaccinated in stores (18.4%) during the 2010-11 season increased in each age group compared with the 1998-99 and 2006-07 influenza seasons, when 5% and 7% of adults, respectively, were vaccinated in stores. This increase likely resulted partly from changes in state laws allowing pharmacists to administer influenza vaccinations to adults."
Dr. Martin Neilan, a primary care physician in Wayne, says getting your healthcare in a drugstore is cutting corners.
"There's nothing more important than establishing a relationship with your primary care provider or doctor," he said. "To run in and run out of a pharmacy and get your shots is not a proper way to obtain healthcare."
Neilan says if patients no longer see their doctors for vaccinations or when they get sick, they may no longer go in for their wellness visits either, which is where they talk to the doctor about other health issues that may have come up and where the doctor may catch something before it gets worse.
" We haven't discovered some rare disease in someone through a well visit, but they do give people an opportunity to raise other health issues for us to discuss," he said.
If the new system is working properly, pharmacists should be encouraging their patients to go for their checkups, said Clark of the Pharmacists Association.