Companies like MinuteClinic, which employ nurse-practitioners in pharmacy chains, threaten to disrupt physicians' practices with convenient lower-cost care for consumers.
CVS, America's second-biggest pharmacy chain, recently bought the MinuteClinic chain and now plans to double the number of clinics in its stores to perhaps 300 this year.
Put that notion to MinuteClinic's Mr Howe, who as it happens used to be the chief executive of Arby's (another American fast-food chain), and he rejects the analogy.