I noticed that there are several PharmD applying or are in medical school. Besides the reason that you are interested in medicine are there any other reasons to switch from PharmD --> Med?

I know some medical students who are going from Med -> PharmD since they find it is a better less stressful lifestyle.

I was just curious as to know if the PharmD occupation is going down a slope? Was PharmD now offering as many opportunities or was the workload too stressful?

- Thanks

I left pharmacy school because it was not right for me on many levels. Other than the fact that I feel medicine is my calling, there were aspects of pharmacy school that turned me off tremendously. Perhaps first and foremost were the teachers (a minority, but a very vocal one) that CONSTANTLY took stabs at the medical profession, finding every chance they could to belittle physicicians and nurses. I found this distastefull for a number of reasons on a personal and professional level. Also, as you enter pharmacy school and work in a pharmacy, you will find a HUGE difference in the way you are TAUGHT to practice pharmacy and the way things actually are. I heard several of the pharmacists I used to work for state that "there is just no way to practice pharmacy the way they teach you in school." It is infinitely frustrating, but MUCH of what you are taught in school you will never use, ESPECIALLY if you work in retail. Retail pharmacists with PharmD's have much more training than they need to adequately do the job. Don't believe me? Pharmacists with BS's do just fine.

Pharmacy always has and always be largely a REACTIVE profession when it comes to dealing with patient's health. There are advances being made, but pharmacy will never, ever be anywhere near as proactive in dealing with a patient's health as medicine. I heard several professors state that physicians should not be allowed to prescribe medications; they should leave that to pharmacists. Physisicians will never, ever ever give up the right to prescribe.

Basically, I want the most proactive approach possible to treating patients; medicine is the only choice for me.

Those that leave pharmacy often do it b/c of the often TEDIOUS work and the irregular hours. Do NOT worry about the job market; pharmacists have a killer job market now and for the next ten years or so.

hope this helps

I became interested in pharmacy because of an unfortunate situation with the wrong medication.I honestly felt learning a little more about drugs could definitely do no harm.i plan to work as a pharmtech over the summer.I am presently in a pre-health science program and have not ruled pharmacy out.However i really like the idea of 'procedural medicine' and prefer direct patient contact.
Altho my situation was one in a million it is a 100% for you if you are the *one*.i just would not want what happened to me to happen to one of my (future) patients.

I find pharmacology, OMC (organic medicinal chemistry), and therapeutics EXTREMELY interesting. I don't think I could have chosen a better pre-med curriculum. Pharmacists can make excellent doctors.

Originally posted by LSUMED2006
I find pharmacology, OMC (organic medicinal chemistry), and therapeutics EXTREMELY interesting. I don't think I could have chosen a better pre-med curriculum. Pharmacists can make excellent doctors.
Exactly.
My school no longer offered the BS in pharm.I would have probably done that if they had.I am looking forward to medical chemistry.(Just remind me that i said that when the class rolls around next fall or spring 2004 :D )

Originally posted by LSUMED2006

Pharmacy always has and always be largely a REACTIVE profession when it comes to dealing with patient's health. There are advances being made, but pharmacy will never, ever be anywhere near as proactive in dealing with a patient's health as medicine. I heard several professors state that physicians should not be allowed to prescribe medications; they should leave that to pharmacists. Physisicians will never, ever ever give up the right to prescribe.

Basically, I want the most proactive approach possible to treating patients; medicine is the only choice for me.



How can somebody suggest that physicians not prescribe if they were the ones who first prescribed meds in the first place? The prescribing should be left to those who make the diagnosis.

Good question. The "ideal" situation, as suggested by some would be to allow physicians to diagnose and pharmacists to prescribe. The rational behind this absurd idea is that pharmacists are drug experts, know much more about medications than physicians, physicians just aren't capable of keeping up with the new medications that emerge, yada yada yada. These statements, amounting to little more than propaganda, demonstrate professional envy and ignorance. Physicians usually know (MUCH) more about the drugs THEY prescribe than do pharmacists. (There are exceptions, especially in a clinical setting, where there are some really sharp pharmacists. However, this statement usually holds true for retail and non clinical hospital pharmacists). Case in point, take a cardiologist and pharmacist. The cardiologist will know much, much more about heart medications than will a pharmacist. Now, the pharmacist MAY know the names of more skin ointments than the cardiologist, but does that mean the pharmacist is more competent to prescribe than the cardiologist? The physicians I have spoken with are infinitely more knowledgeable about the medications they prescribe than the average pharmacist.

Another school of thought is to give pharmacists limited prescribing powers. This, I believe, is already being done in some places. I would be in favor of this only for certain medications, and only if there was some national standard of accredidation to do so. The range of quality of students and faculty within pharmacy schools ranges tremendously. Are there some pharmacists I would feel 100% comfortable with them prescribing medicine? Yes! Would I feel comfortable with every pharmacist prescribing medicine? NO!!! It would be disastrous to allow every pharmacist to have prescribing powers simply because SOME are competent to do so.

Originally posted by LSUMED2006
.......Retail pharmacists with PharmD's have much more training than they need to adequately do the job. Don't believe me? Pharmacists with BS's do just fine........

......Physicians usually know (MUCH) more about the drugs THEY prescribe than do pharmacists. (There are exceptions, especially in a clinical setting, where there are some really sharp pharmacists. However, this statement usually holds true for retail and non clinical hospital pharmacists).

LSUMED2006,

I let the first statement go by, but after the second shot at lowly BS/retail pharmacists I thought I should respond. I sense a definite dislike of retail and BS pharmacists . Why so antagonistic? In my area of the country, the sharpest people frequently go into retail, and the people who are unable to handle to pressure look for the hospital/clinical jobs.

The current Pharm D degree differs from the previously standard BS in that the Pharm D students receive 1 additional semester of classwork, and 1 additional semester of clinical experience. In reality, this additional year of pharmacy school does not make a pharmacist more capable than a BS pharmacist - the ability as a pharmacist is defined by the individual persons' ability to recall inane facts and the desire to continually learn for the remainder of his/her career.

I could make equally rediculous statements by implying that physicians who attended three year medical schools (as little as 20 years ago) are not as good as a 4 year graduate, or that any physician that did not complete a residency is not as qualified to practice medicine as one who completed a residency.

I think we can agree that the ability to function as a pharmacist or physican is dependant on the person. I know Pharm D's that are dumb as rocks, as well as graduates of prestigous medical schools and residencies that I would not trust to treat anyone.

Just my 2 cents.

Pilot -
Doctor of Pharmacy
OSUMED 2004

>I let the first statement go by, but after the second shot at >lowly BS/retail pharmacists I thought I should respond. I sense >a definite dislike of retail and BS pharmacists . Why so >antagonistic? In my area of the country, the sharpest people >frequently go into retail, and the people who are unable to >handle to pressure look for the hospital/clinical jobs.

No, no, no. I have absolutely NO dislike of retail pharmacists or those w/ a BS. I think it would be wonderful if the BS was offered b/c I feel that those with the BS are totally competant to function in basically every setting. I think it would be wonderful if this degree was still available, because a pharmD is NOT needed to function proficiently in retail, or most clinical work. I don't know if you misunderstood my first statement or not. However, I DO stand by the fact that I have not met a pharmacist (other than a few clinicians who teach) that approach anywhere near the average amount of expertise that I have seen MANY physicians display about the medications they deal with. I know many pharmacists. I know many physicians. I have been in pharmacy school. I am in med school now. My personal opinion is there is no comparison when dealing with the average practicioners in each field. I certainly agree with you that retail work is stressful. I personally would never want to do it again.

>The current Pharm D degree differs from the previously standard >BS in that the Pharm D students receive 1 additional semester >of classwork, and 1 additional semester of clinical experience.

I agree.

>In reality, this additional year of pharmacy school does not >make a pharmacist more capable than a BS pharmacist - the >ability as a pharmacist is defined by the individual persons' >ability to recall inane facts and the desire to continually learn for >the remainder of his/her career.

I agree completely. I don't think there was any reason to do away with the BS degree. The pharmD is great, but I think the BS should be there. I certainly know some excellent pharmacists with BS degrees. No argument there.

>I could make equally rediculous statements by implying that >physicians who attended three year medical schools (as little as >20 years ago) are not as good as a 4 year graduate,

Once again, I think you misunderstood me. I don't think BS pharmacists are less qualified. I said that pharmD was overkill for retail.

>or that any physician that did not complete a residency is not as >qualified to practice medicine as one who completed a residency.

Uhhhh, you are joking, right? Tell me you are joking. OF COURSE a physician that did not complete a residency is NOT AS QUALIFIED to practice medicine as one who did. In fact, you will be hard pressed to get a liscense at all to practice if you don't finish a residency. I am a bit confused about your point.

>I think we can agree that the ability to function as a pharmacist >or physican is dependant on the person. I know Pharm D's that >are dumb as rocks, as well as graduates of prestigous medical >schools and residencies that I would not trust to treat anyone.

Yes, certainly to an extent. But, and a big but, medical school and the medical training program is MUCH, MUCH more rigorous. Sure there are bad medical graduates, but this is much more of an exception than a rule. It has little to do with innate intelligence and everything to do with the fact that physicians are exposed to and expected to learn much, much more. I can vouch for this first hand.

I have no bad feelings towards pharmacists (I almost became one), as you suggest. I think the entire healthcare community is a team, and as such ALL members are VITAL! There is a definite place for pharmacists: counseling patients, double checking doctors, optimizing dosages and medications, ect., ect. I DO have a big problem with the suggestion that pharmacists should have responsibilities that up until now were reserved for physicians such as prescribing. I do stand by my previous statements. Every retail pharmacist I have met can tell me what basically any drug on the shelf does . However, they usually could not give me dosages, or as detailed mechanism of actions and side effects, etc. as could a physician who used these drugs daily.

Let me stick up for the pharm d's..... The pharm d's are the drug experts, not physicians. I have even had MD's admit this to me - before going to pharmacy school my MD said it was always great having pharm d's on rounds because they always knew drug facts that MD's had no clue about. It is very old school to think that physicians are the ones who prescribe and the pharmacists should only interpret and fill the prescription. Maybe I see it wrong, but I would think that someone who spends 3 straight years learning about meds would know a little more about them than the physician who spends 2 years in classwork and have only a percentage of that time spent learning about meds. Here is something else to think about - I have a friend who chose MD over Pharm D because he didn't want to learn the hard chemistry that pharmacists go through. For him, the MD route was the easier way. And contrary to what was stated, pharmacy school is very rigourous........

>And contrary to what was stated, pharmacy school is very rigorous........

Sigh...I guess you would be referring to me as the one who stated that pharmacy school is not very rigorous. Please, show me where I said that. Sometimes people hear only what they want to. Pharmacy school is quite challenging, no doubt about it. It is a huge transition from undergrad. I've been to both medical school and pharmacy school and can speak firsthand about both.

>Let me stick up for the pharm d's..... The pharm d's are the drug experts, not physicians. I have even had MD's admit this to me -

I've also had pharmDs tell me basically the opposite...the point...it's pointless to argue over such things

> before going to pharmacy school my MD said it was always great having pharm d's on rounds during internships because they always knew drug facts that MD's had no clue about.

There are some wonderful clinical pharmacists as I alluded to previously, no argument there. Don't you think the statement "because the always knew drug facts the MDs had no clue about" is generalizing a wee bit? I can assure you, there are plenty of physicians who could do the same thing...again your argument proves nothing other than there is not point arguing over it. Do you REALLY think most pharmDs know more about the medicines an anesthesiologist uses than the anesthesiologist does? Do you REALLY think most pharmDs know more about the medicines a dermatologist uses than the dermatologist? Do you really think a pharmacist knows more about the medicines a cardiologist uses than the cardiologist?

>It is very old school to think that physicians are the ones who prescribe and the pharmacists should only interpret and fill the prescription.

I do know that if you take such an attitude with many physicians, they will not be receptive to it. Is this good? Probably not. The 2 fields can really work together to greatly optimize patient pharmaceutical care. When I was in pharmacy school, I did not understand why physicians had such an attitude and were unreceptive to suggestions. To me, it would be great if we could work together to improve patient care. I understand more now than ever the professional pride many physicians feel due to their training. I don't think anyone other than physicians knows what they really have to go through to get the MD and then board certification.

This is an honest question to you with the best of intentions, if you feel that the days of the physician writing and the pharmacist filling are "old school," what do you feel the role of the pharmacist should be?


>Maybe I see it wrong, but I would think that someone who spends 3 straight years learning about meds would know a little more about them than the physician who spends 2 years in classwork and have only a percentage of that time spent learning about meds.

Once again, I speak firsthand from experience. True, physicians do spend 2 years in class work, BUT the 2 years of work is unreal. I truly cannot begin to describe the volume of material. The 2 years of medical school work is easily comparable to 4 or more years of undergraduate work (I did not say pharmacy school). Physicians learn probably more than you realize about pharmacology. (Not to mention the 3-7 year long residency/fellowship process). During this time, physicians are required to learn. There's no point arguing this. I've seen both. All I can do is tell you what I have seen, if you don't accept it, that's fine by me. Pharmacists are very important members of the healthcare team, as are nurses, PAs, etc. The 2 fields don't "compete" with each other. Can't we all just get along?

>I have a friend who chose MD over Pharm D because he didn't want to learn the hard chemistry that pharmacists go through. For him, the MD route was the easier way.

I personally found OMC was my most favorite class I have ever taken. I was lucky and had an amazing teacher and was able to understand med chem on a conceptual level. You certainly are correct that many people find it difficult.


Im really interested what you think about my question earlier: if you feel that the days of the physician writing and the pharmacist filling are "old school," what do you feel the role of the pharmacist should be?


Jason

Originally posted by tlh908
Let me stick up for the pharm d's..... The pharm d's are the drug experts, not physicians. I have even had MD's admit this to me - before going to pharmacy school my MD said it was always great having pharm d's on rounds because they always knew drug facts that MD's had no clue about. It is very old school to think that physicians are the ones who prescribe and the pharmacists should only interpret and fill the prescription. Maybe I see it wrong, but I would think that someone who spends 3 straight years learning about meds would know a little more about them than the physician who spends 2 years in classwork and have only a percentage of that time spent learning about meds. Here is something else to think about - I have a friend who chose MD over Pharm D because he didn't want to learn the hard chemistry that pharmacists go through. For him, the MD route was the easier way. And contrary to what was stated, pharmacy school is very rigourous........

To anyone who may have misquoted me, I did not say that pharmacy school was not hard. I just said that physicians should NOT be stripped of the power to prescribe treatment. Nor did I say that MDs/DOs know more about drugs than the pharms.
Physicians prescribe physical therapy, occupational therapy, all kinds of therapy that they themselves do not perform. After all, what did you send a medical student to school for if he or she was going to be stripped of prescribing authority? I guess that everybody has a right to argue her or his point, but as for me, I am getting out of this quickly.

there is a very good reason why Pharm Ds shouldn't be prescribing medication: follow-up care...

I believe Pharm Ds are a wonderful resource for the healthcare industry: they develop new drugs, they provide drug counseling, they are a wonderful encyclopedia of pharma-stuff.... however they are not trained in patho-phys, nor in patient management. The physician who diagnoses should treat or refer to a specialist for treatment, and in turn continue managing the patient throughout that treatment as well as manage the complications of that treatment. Something the PharmD is not trained to do...
here is an example: patient presents with TIA to the ER and is found to be in rapid a-fib, this is diagnosed by the ER physician - he/she calls the Pharm D and asks for them to prescribe something... well, should we cardiovert? should we start on a diltiazem drip? should we anticoagulate? and what are the risks involved with those decisions - now lets say we don't cardiovert as she is relatively hemodynamically stable and we don't know when the a-fib started, so we start her on a diltiazem drip --- do we also start anticoagulating her? (she just happens to have a history of Subdural and subarrachnoid bleeds from falls)... now what? her pressure starts dropping? now what? she starts infarcting because we didn't drop her heart rate fast enough..? now what? i can go on... but there is obviously more to patient management than drug prescription, how ever drug prescription plays an imminent role in patient management and these can never and should never be separated... for obvious reasons.

i can't think of a medical situation where it would be appropriate for a pharmacist to prescribe drugs without having to also carry the burden of liability for the care and management of that patient --- i really hope that Pharm Ds will realize that i am NOT trying to downplay the unbelievable significance of pharmacists in my life as a physician. And there are quite a few times that i am grateful to have a pharmD around to assist in drug decisions.

now as far as ridiculous arguments over which is "harder" or "tougher".... gimme a break... what will that discussion lead to? everybody thinks their job/education was the best/toughest/yada yada - and yet they don't realize that it doesn't mean squat... what does matter is that we can use our collective backgrounds/trainings and improve patient care by working as a team.

Originally posted by Tenesma
there is a very good reason why Pharm Ds shouldn't be prescribing medication: follow-up care...

.... they are not trained in patho-phys, nor in patient management. The physician who diagnoses should treat or refer to a specialist for treatment, and in turn continue managing the patient throughout that treatment as well as manage the complications of that treatment. Something the PharmD is not trained to do...

Wrong. PharmD's do indeed get quite a bit of training in pathophysiology, physical assessment and patient management. In fact, my school's program used to take pathophys with the medical students. Those students carried comparable course loads and held their own quite well in the class. Pharmacists are quite capable of providing follow-up care--it is ONLY because the current health care system is not set up for them to do so, that they do not.

In fact, I would argue that a PharmD's knowledge base and training is AT LEAST equivalent to that of NPs or PAs, both of whom are allowed to prescribe. And provide follow-up care.

i can't think of a medical situation where it would be appropriate for a pharmacist to prescribe drugs without having to also carry the burden of liability for the care and management of that patient

Agreed. And the pharmacists who want to prescribe are perfectly willing to accept responsibility for the care and management of the patient. This is an argument FOR rather than against pharmacist prescribing--physicians can safely delegate more of the burden of care, which they already willingly delegate to NPs and PAs.

now as far as ridiculous arguments over which is "harder" or "tougher".... gimme a break... what will that discussion lead to? everybody thinks their job/education was the best/toughest/yada yada - and yet they don't realize that it doesn't mean squat... what does matter is that we can use our collective backgrounds/trainings and improve patient care by working as a team.

Agreed. The knowledge required to care for patients skillfully is difficult to master--whatever the particular emphasis of your training. Insulting the education or training of other professions serves no purpose, and often only reveals your own ignorance.

Wrong. PharmD's do indeed get quite a bit of training in pathophysiology, physical assessment and patient management. In fact, my school's program used to take pathophys with the medical students. Those students carried comparable course loads and held their own quite well in the class. Pharmacists are quite capable of providing follow-up care--it is ONLY because the current health care system is not set up for them to do so, that they do not.

wrong... a lot of pharmd programs take a lot of different classes with med students: sometimes they share pharm classes, sometimes they share path-phys classes, sometimes they even share ethics classes... but taking a class with med students does not provide the same depth of knowledge, because the med students will continue to gain greater depth during the clinical years... it is like saying the PhD students who took our microbiology class are now qualified to treat infections.

In fact, I would argue that a PharmD's knowledge base and training is AT LEAST equivalent to that of NPs or PAs, both of whom are allowed to prescribe. And provide follow-up care.

wrong... your knowledge base is different from NPs or PAs - it may be actually broader than NPs/PAs, but very different... if you feel that NPs/PAs are equivalent to PharmDs, then why don't we hire NPs/PAs to run pharmacies and give pharmacologic advice in the ICU??? and they do prescribe, but under the supervision of a physician, and they do provide follow-up care, but under the supervision of a physician... do you realize there is far more to patient management then providing medication?


And the pharmacists who want to prescribe are perfectly willing to accept responsibility for the care and management of the patient. This is an argument FOR rather than against pharmacist prescribing--physicians can safely delegate more of the burden of care, which they already willingly delegate to NPs and PAs.

what is delegated to NPs/PAs is simple management of simple patients with relatively straightforward algorithms - and this was mainly done due to growth of the patient population and the decreased amount of time that can be spent with patients... i doubt the extra 30 seconds it takes to write a prescription to treat what was diagnosed would be reasoning to have another health professional involved.

. The knowledge required to care for patients skillfully is difficult to master--whatever the particular emphasis of your training. Insulting the education or training of other professions serves no purpose, and often only reveals your own ignorance

my ignorance? i am surprised that you feel insulted by what i have said so far... the years spent obtaining a PharmD are well-spent, and like i said before PharmD serve their purpose well and are a wonderful resource.... for those PharmDs who want to prescribe medications, treat and manage patients, why not just become a medical doctor and that way you can practice medicine to your hearts content.

Originally posted by Tenesma
but taking a class with med students does not provide the same depth of knowledge, because the med students will continue to gain greater depth during the clinical years... it is like saying the PhD students who took our microbiology class are now qualified to treat infections.

Pharmacy students also continue to gain greter depth of understanding during their clinical training. PhD students receive no clinical training, therefore they are not an appropriate comparison.



wrong... your knowledge base is different from NPs or PAs - it may be actually broader than NPs/PAs, but very different... if you feel that NPs/PAs are equivalent to PharmDs, then why don't we hire NPs/PAs to run pharmacies and give pharmacologic advice in the ICU??? and they do prescribe, but under the supervision of a physician, and they do provide follow-up care, but under the supervision of a physician... do you realize there is far more to patient management then providing medication?

I've spoken extensively with NP's and PA's on the training they receive. The training a PharmD receives provides patient care skills at least equivalent to theirs.

We don't hire NPs and PAs to run pharmacies because the law doesn't ALLOW it. Pharmacists don't provide follow up care because the law doesn't PAY for it. Different issue completely.

It makes me unbelievably angry to hear you imply that simply because my training is from a pharmacy school, that drugs are all I know about when it comes to managing patients and their diseases. That is simply not true. I know how to do a great deal more than I can be reimbursed for by law, and it is reimbursement that drives the structure of medical care provision.




what is delegated to NPs/PAs is simple management of simple patients with relatively straightforward algorithms - and this was mainly done due to growth of the patient population and the decreased amount of time that can be spent with patients... i doubt the extra 30 seconds it takes to write a prescription to treat what was diagnosed would be reasoning to have another health professional involved.

There's no reason those simple patients with straightforward algorithms can't be cared for just as well by a pharmacist as by an NP or PA. It's not done because Medicare can't be billed for it.



i am surprised that you feel insulted by what i have said so far... the years spent obtaining a PharmD are well-spent, and like i said before PharmD serve their purpose well and are a wonderful resource

Why shouldn't I be insulted? You've demeaned my training and my skills and my value as a health professional. I am not a walking reference book--although I'm willing to provide that service, since my training equips me well to do so. I am there because I want to care for patients, and I could do it quite competently if I were allowed.

.... for those PharmDs who want to prescribe medications, treat and manage patients, why not just become a medical doctor and that way you can practice medicine to your hearts content.

That's just mean. But I'll give you an answer on behalf of my current profession anyway.

You should let PharmD's prescribe and treat because there aren't enough medical schools to train enough doctors to treat all the patients who need care. There aren't even enough to train all the people who want to be doctors. So why not let people who HAVE sufficient training, even if by another route, treat and manage the overflow?

samoa... from what i understand from your other postings on the forum, you will be going to medical school soon too...

so please email me after 4 years of med school, and one year of internship - after you pass USMLE step 3 (combined that is the training required in order to prescribe on your own)... I'd like to know how you will feel then about Pharm Ds prescription rights.

and i am assuming (based on your previous responses to mine) that the reason you are going to med school is to further your knowledge in something else other than patient management, since you will have that under your belt with the Pharm D... in fact you might even want to ask your future med school, if you can skip the 3rd and 4th years altogether - since it would only be redundant to you...

good luck with your endeavors

Originally posted by Samoa
Pharmacy students also continue to gain greter depth of understanding during their clinical training. PhD students receive no clinical training, therefore they are not an appropriate comparison.

I've spoken extensively with NP's and PA's on the training they receive. The training a PharmD receives provides patient care skills at least equivalent to theirs.

We don't hire NPs and PAs to run pharmacies because the law doesn't ALLOW it. Pharmacists don't provide follow up care because the law doesn't PAY for it. Different issue completely.

It makes me unbelievably angry to hear you imply that simply because my training is from a pharmacy school, that drugs are all I know about when it comes to managing patients and their diseases. That is simply not true. I know how to do a great deal more than I can be reimbursed for by law, and it is reimbursement that drives the structure of medical care provision.

There's no reason those simple patients with straightforward algorithms can't be cared for just as well by a pharmacist as by an NP or PA. It's not done because Medicare can't be billed for it.

Why shouldn't I be insulted? You've demeaned my training and my skills and my value as a health professional. I am not a walking reference book--although I'm willing to provide that service, since my training equips me well to do so. I am there because I want to care for patients, and I could do it quite competently if I were allowed.

You should let PharmD's prescribe and treat because there aren't enough medical schools to train enough doctors to treat all the patients who need care. There aren't even enough to train all the people who want to be doctors. So why not let people who HAVE sufficient training, even if by another route, treat and manage the overflow?

Exactly how do these PharmD's get the same patient care contact as NP's and PA's? I have yet to see a PharmD student do a complete history and physical, write an entire set of admission orders and make daily progress notes and patient visits. Exactly where do you get this training? Where do you learn to read x-rays, perform thoracentesis, and perform minor procedures? Where exactly do you do these rotations that are just like NP and PA school?

I have to strongly agree with tenmesa and ponyboy. The training pharmacists recieves concerning patient care skills is not at all comparable to PA/NPs. I speak from personal experience, as I've been to pharmacy school and am in a medical school which has PA/NP programs. To ponyboy, pharmacy schools do 10-12 months of clinical rotations the 4th and final year. Of these, approximately 30% are retail, 30% are hospital pharmacy
based, and the remainder are actual clinical work. Now, there is NO WAY for a pharmacist to learn to care for patients with LESS than 6 months of actual training in a clinical setting! The idea is absurd. NPs/PAs recieve a relatiely much more thorough training to care for patients.

When compared to the clinical training physicians recieve (at least 2 years in medical school + 3-8 years residency), the idea of pharmacists being competant to manage patient health becomes silly. Physicians cannot be board certified and practice independently without a MINIMUM of 5 years of superivised clinical experience. Why on earth should pharmacists be managing patient care with less than 6 months experience????

Tenmesa's most recent post is humorous, and the point is well taken. The 2 years of clinical work medstudents do is vastly more thorough than the 6 months max pharmacists do, and it SHOULD be. Pharmacists are NOT trained to manage patients. For what they ARE trained for, they are certainly the most qualified for.

As far as Tenmesa's statment being "mean," maybe it was offensive to some (although, for the life of me, I don't see how), but it is true. It seems MANY people want to be doctors, CRNAs, NPs, ODs, etc., but they DON'T want to go through what every physician has to do to earn his degree. I must agree with tenmesa. For those who want to prescribe, manage patient care, etc. indepentdently, then why not become a physician, rather than want equal responsibilities with much less training?

Jason

Originally posted by LSUMED2006
[B] The training pharmacists recieves concerning patient care skills is not at all comparable to PA/NPs. I speak from personal experience, as I've been to pharmacy school and am in a medical school which has PA/NP programs. To ponyboy, pharmacy schools do 10-12 months of clinical rotations the 4th and final year. Of these, approximately 30% are retail, 30% are hospital pharmacy
based, and the remainder are actual clinical work.

Your information is outdated. 1/12 of the rotations are in retail pharmacy, 1/12 are in hospital pharmacy, and 10/12 are clinical. That provides equivalent training to that received by NPs and PAs.

When compared to the clinical training physicians recieve (at least 2 years in medical school + 3-8 years residency), the idea of pharmacists being competant to manage patient health becomes silly. Physicians cannot be board certified and practice independently without a MINIMUM of 5 years of superivised clinical experience.

Again, I'm not comparing the training PharmDs receive to that received by physicians. I am comparing them to NPs and PAs.

Pharmacists are NOT trained to manage patients.

Again, your information is outdated. YOU probably were not trained to manage patients, as a holder of a BS degree in pharmacy. But the PharmD curriculum does provide that training, and every student now graduates with a PharmD.

It seems MANY people want to be doctors, CRNAs, NPs, ODs, etc., but they DON'T want to go through what every physician has to do to earn his degree. I must agree with tenmesa. For those who want to prescribe, manage patient care, etc. indepentdently, then why not become a physician, rather than want equal responsibilities with much less training?

You missed my point entirely. Physician training is far more rigorous and lengthy than pharmacist training. It would be stupid to argue with that. What I am saying is that med schools don't have enough spaces to train the people who DO want that responsibility, and they aren't producing enough physicians to meet the future demand for patient care. NP's and PA's are allowed to provide this care, and PharmD's should be also, at the same level. In fact, NP's and PA's receive almost no postgraduate training, while PharmD's often do a 1 or 2 year residency in a hospital after receiving their degree. So you really can't argue that they are less qualified to manage and treat patients than an NP or a PA.

I'm sorry but can you tell where exactly I can find a PharmD student who will perform a full history (not just a medication history, but a full medical history) and physical (not just listening to the heart with their stethescope, a full head to toe physical), order all the investigations, interpret all of the investigations independently, perform any diagnostic and therapeutic procedures (LP's, paracentesis, chest tubes, sutures) and be the patients primary care giver (ie. no one else repeating or reordering other tests/therapies) while in hospital? I've worked with PharmD's and I've never seen these students work in the hospital with the responsibilities of a medical student/PA/NP student. I'd really like to see where this is occurring. I've seen Pharm students on clinical rotations that have acted in the capacity of a clinical pharmacist but never have I seen them act in the capacity of a clinical MD/NP/PA student.

Samoa, I was enrolled in a pharmD program. My information was 100% head on for the schools in state. This proves a valuable point, with SO much variation in training and the focus of training, it would be outlandish to assign patient management responsibilities to pharmacists across the board. I know for a fact that pharmacists coming out of this state would NOT have anywhere near the level of patient management that you speak of. There are vast variations in the focus of many pharmD programs. To state that, across the board, pharmcists should manage patients is dangerous. Additionally, THe focus of pharmD training is NOT THE SAME as NP/PA...PERIOD. They may spend comparable amounts of tiem in the hospital, but the focus is not the same...there is no disputing this point.

If people want to manage patients on their on, MD/DO is the only way; if people want to do it supervised, then they should become NPs/PAs. I'm sorry, but pharmacists are NOT trained to do so.

Are there some pharmacists who are competant to do so? Sure there are. However, the vast majority are NOT. YOu cannot base the argument that pharmacists are able to manage patients on these exceptions to the rule.

Jason

My understanding is that in order to be accredited, PharmD programs must conform to certain requirements. 6 months of rotations would not suffice. From what I know of schools across the nation, the program you attended is certainly the exception rather than the rule.

It's true that the program I attended has a reputation for being one of the most rigorous. I think it has that reputation because it has traditionally attracted the best students, who would make any program shine as graduates. It's also true that for many years the faculty there were considered the trailblazers of the profession. And you do receive a higher quality education when your teachers are the leaders in the field.

I think that right now, you may have a point, that the education of PharmDs is not of a consistent quality across the nation. But I do think that a substantial portion of today's graduates (although maybe not from your program), are very well-equipped to function at the same level as an NP or PA. And they certainly are after having completed a residency, or equivalent clinical experience. Perhaps the solution would be to offer a different licensing credential for those PharmD's who feel competent to practice on that level? That would allow for verification of the skills needed, which I will grant you that pharmacist licensure in no way tests or requires.

>My understanding is that in order to be accredited, PharmD programs must conform to certain requirements. 6 months of rotations would not suffice. From what I know of schools across the nation, the program you attended is certainly the exception rather than the rule.


Where I attended school, there were something like 10 to 11 month long rotations, of these, less than half were actually clinical. The others were retail, community, hospital, etc. based. Accredidation was not a problem, and the school was the best in the state, with something like a > 96-98% pass rate the boards.



>I think that right now, you may have a point, that the education of PharmDs is not of a consistent quality across the nation.

I would certainly agree.

>But I do think that a substantial portion of today's graduates (although maybe not from your program), are very well-equipped to function at the same level as an NP or PA.

I just don't agree. The focus of the single pharmd clinical year is different that that of NP/PA, plain and simple. Are pharmds taught to read films, suture, perform minor proceedures etc. etc.?

When you say function at the same level as NP or PA, you are referring to practicing directly under a physician and prescribing under his authority? Or are you reffering to independent patient care?


>And they certainly are after having completed a residency, or equivalent clinical experience.

Depends just what is the focus of the residency. Optimizing patient medication is not the same, obviously.

>Perhaps the solution would be to offer a different licensing credential for those PharmD's who feel competent to practice on that level?

I feel that the solution, IF (and that is a big if) pharmds were to ever practice similar to a NP/PA UNDER a physicians supervision, would be to have a 2 year residency that undergoes the same accredidation as NP's/PA's. Pharmacists, certainly could undergo a 2 year residency and be competant to treat patients, as an NP/PA does. However, I feel the vast majority are NOT able to directly out of school.

>That would allow for verification of the skills needed, which I will grant you that pharmacist licensure in no way tests or requires.

I would agree that very stringent verification of needed skills would be required. Why not just have a 2 year residency and liscensure exam for those who wish to treat patients under supervision? No one is arguing that pharmacists CANNOT be made competant to treat patients, the aregument is that most simply are not. Why not simply become a NP/PA if treating patients is desired, rather than enter a profession that does not always train for it and a legal system that does not allow it?

Samoa, as someone who has been through pharmacy school, you can appreciate my questions: Why did the role of the pharmacist begin to change with the BS to PharmD? Personally I feel that in no small part it was the rise of automated dispensing technology. I feel that pharmacists, in the "old" model, saw the writing on the wall. A tech can type an RX into the computer, and within a minute have it out to the patient with no errors, provided it was typed in correctly. I feel that some innovative, and correct, pharmacists realized that in order to continue to secure a place in healthcare, pharmacists had to grow and expand. With this growth came the PharmD, drug expert title, and desire to prescribe and treat patients. I feel the profession is going through some growing pains, where the profession's desires (being the true drug experts, prescribing, treating patients, etc.) are being manifested, but the profession is not quite able to achieve them...yet. I may be wrong, but I believe the new paradigm of pharmacy has not been reached...but it likely will. I think it has too, or the profession would take a downturn and not command the salary it does.

Jason

First of all, NP's and PA's are NOT required to train beyond the two years (1 didactic, 1 clinical) leading to graduation. This is the same as what PharmDs do.

My rotations were as follows: 3 in adult internal medicine, hospital based, rounding either with a lone physician or a teaching service, becoming ACLS certified on one of the three, 1 on inpatient psychiatry at a state hospital, where I routinely assessed patients' mental status and made recommendations based on my assessment, 1 at a national referral center for inpatient neuropsychiatric rehabilitation, where I covered a locked and an open unit and did 1/3 of the consults, 1 at a contract research organization, where I wrote informed consents, planned study budgets, and learned how to draw blood, 1 rotation in hospital pharmacy, 1 rotation in retail pharmacy, and 1 rotation as a legislative intern for a state representative.

I'm sure that I could learn to suture fairly readily, if that were within the legal scope of my profession. But it's not, and I assure you that's the only reason I didn't push to learn it.

The PharmD began to be offered in the early 70's, long before it became apparent that technology would make the dispensing role obsolete. It was offered because some pharmacists wanted a higher level of clinical practice, and there was no route for them to pursue within pharmacy. These people were well respected, and often had de facto prescriptive authority, and some even ran clinics where they were a provider of care alongside the physician.

The advent of the universal PharmD is indeed a result of the rise of automation in pharmacy. And the profession is at war with itself over the purpose of the degree--community pharmacists feel it's overkill, while for clinical pharmacy it needs to be supplemented by further training and experience. But that's no different from a medical degree. The result of this division is that the profession has been unable to advocate effectively for its own place alongside other clinicians. It's a sad state of affairs, and it will be at least 10 years before any significant progress is made.

The reason progress is slow is because whoever is leading this fight has decided that the whole profession has to be recognized equally. It's rather like arguing that ALL nurses should be able to function on the level of NPs. There's a clear difference in training and skills, and above all, interest. What pharmacy needs to do is acknowledge that in a manner that does not assume that a BS pharmacist is unskilled, or that a PharmD pharmacist is automatically capable. There are pharmacists out there with only a BS degree who can run circles around me clinically, and there are PharmDs who definitely wasted their money on the extra schooling. I just think the medical profession is foolish not to take advantage of the full range of services that clinically-trained pharmacists can provide.

Anyway, I'll get off my soapbox now.

Originally posted by Samoa

My rotations were as follows: 3 in adult internal medicine, hospital based, rounding either with a lone physician or a teaching service, becoming ACLS certified on one of the three, 1 on inpatient psychiatry at a state hospital, where I routinely assessed patients' mental status and made recommendations based on my assessment, 1 at a national referral center for inpatient neuropsychiatric rehabilitation, where I covered a locked and an open unit and did 1/3 of the consults, 1 at a contract research organization, where I wrote informed consents, planned study budgets, and learned how to draw blood, 1 rotation in hospital pharmacy, 1 rotation in retail pharmacy, and 1 rotation as a legislative intern for a state representative.

I'm sure that I could learn to suture fairly readily, if that were within the legal scope of my profession. But it's not, and I assure you that's the only reason I didn't push to learn it.


These rotations are no where near the level of patient care as the rotations of a med student or a PA student. If these are the typical rotations of a Pharm student, then I fail to see how PharmD's are equally qualified as PA's to treat patients.

>First of all, NP's and PA's are NOT required to train beyond the two years (1 didactic, 1 clinical) leading to graduation. This is the same as what PharmDs do. I'm sure that I could learn to suture fairly readily, if that were within the legal scope of my profession. But it's not, and I assure you that's the only reason I didn't push to learn it.

Exactly, the focus of the training between NPs/PAs and pharmds is quite different, that is the entire point. Pharmacists are not trained to do what NPs/PAs do (ie suture, read films, perform proceedures, etc.) because the focus of the training is not the same. IN the same token, pharmds are vastly more competant to do what they do than NPs/PAs...

>The advent of the universal PharmD is indeed a result of the rise of automation in pharmacy. And the profession is at war with itself over the purpose of the degree--community pharmacists feel it's overkill, while for clinical pharmacy it needs to be supplemented by further training and experience.

I wish that the BS was still offered for those desiring the degree, as those with one are more than competant to perform most functions. Additionally, I also wish the pharmd, as it is a terminal degree that carries the title of doctor, would require more training than simply 1 semester of classroom work and 1 semester of clinical work. Maybe this choice of degrees would make everyone happy.

>But that's no different from a medical degree.

I don't understand this point. The MD is just a starting point in the medical training experience. I couldn't imagine ANY new MD graduate feeling competant to independently practice medicine. The need for postgraduate resident training is without question.

>reason progress is slow is because whoever is leading this fight has decided that the whole profession has to be recognized equally. It's rather like arguing that ALL nurses should be able to function on the level of NPs.

Great point.

>There's a clear difference in training and skills, and above all, interest. What pharmacy needs to do is acknowledge that in a manner that does not assume that a BS pharmacist is unskilled, or that a PharmD pharmacist is automatically capable.

I agree completely. I still do not feel that basically any new pharmd graduates are trained with the same focus as NPs/PAs. As said before, pharmacists are not trained to read films, suture, perform minor surgical proceedures, assist in surgery, etc. I do feel that they certainly could be made to be equal to them, with respect to training, provided the pharmd curriculum was either lengthened, vastly revamped, or an accredited post graduate residency process with this goal exclusively in mind.

What a dichotomy we have in the pharmacy profession: one of the toughest to attain and longest to earn Bachelor's degree, but the shortest to earn Doctorate. It is reminiscent of affirmative action.

Lawyers went through the same evolution. Not content with earning another bachelor's degree (LLB), they changed the law degree to a Juris Doctorate (JD). However they retained the title of Mr. or Mrs. (Note: I realize that 97% of PharmD?s outside of academia, don?t use the Dr moniker)

The old PharmD progression of BS Pharm graduates continuing on for two years to attain PharmD gave legitimacy to the PharmD as a professional doctorate. Now it is ? as my wife with a PharmD refers to it ? a ?Ph scribble D? The current PharmD is master?s elite, but short of doctorate.

What is my point? No point in general ? just hope to provoke discussion. By the way, I?m not a pharmacist.

Originally posted by TPJ
Lawyers went through the same evolution. Not content with earning another bachelor's degree (LLB), they changed the law degree to a Juris Doctorate (JD). However they retained the title of Mr. or Mrs.

Part of the reason lawyers still go by Mr./Ms. is because they grandfathered everyone with the LLB degree who requested an upgrade to the JD, rather than making them take additional courses to EARN the doctorate. So nobody took them seriously. Pharmacy did not grandfather, partly for that reason, and partly because there IS additional coursework, and there's supposed to be a difference in skill and knowledge as a result.

The correct title for a PharmD is "Dr." according to pharmacy's main professional organization. The length of study is the same as dentistry--6 years minimum. Dentistry does it as 3 years of undergrad and 3 years to get the DDS. Pharmacy does it as 2 years of undergrad and 4 years to get the PharmD. And we call dentists "Dr."

So I ask to be called Dr. on all my formal correspondence. I darn well earned that degree with as much hard work as anyone else with a doctorate that people DO recognize. And if someone is uncomfortable using the title in reference to me in a formal setting--which I think is completely buttheaded and snobby, by the way--I simply ask them to use my first name. It offends me to be called "Ms." by people who know I have a PharmD. I never make a stink about it, because I have more productive things to do with my time and energy. But nonetheless, I am offended.

not trying to fan the flames here but as a working pa I feel I may be able to offer another perspective. my clinical year was comprised of the following rotations :
internal medicine/inpatient infectious disease
trauma surgery to include extensive o.r. time and ATLS class
emergency med in busy trauma ctr with ACLS class
obgyn at busy inner city hospital/clinic/L+D/O.R. with NALS class
pediatric emergency med at childrens hospital with PALS class
acute care inpatient psych with multiple new onset psych d/o's
family medicine
community hospital er(elective)

how many pelvic exams does a pharmd student do in school?
fracture reductions?
chest tubes? central lines? DPL's? cut downs? crichs?
1st assist c-sections or hysterectomies?
complex peds lac repair under conscious sedation?
obgyn deliveries? fb removals from"insert name of orifice here"
DKA admits to ICU?
intubations?


I think I have made my point. people go to pa/np programs to become pa's/np's and people go to pharm school to become pharmacists. they are not and should not be the same.
in my inpatient training we had pharmd students present. they were very helpful when it came to rx selection but did not know the first thing about physical dx or procedural skills., no offense intended.the 2nd year of pa school is equivalent in every way to the 3rd year of med school.based on the description of pharmd rotations above, it looks like < 50% of the clinical time spent in a typical pa program and entirely free of procedural skills.

I am a little confused on the proper title for pharm d's. I know it is a doctorate degree, yet the title Dr does not seem to be prevalent. When I worked in a hospital pharmacy, the pharm d's were never referred to as Dr but simply by the first name. In college we call our pharm d's Dr. I have never heard a pharm d in retail called Dr. So when is the title doctor appropriate? What about casual settings such as when with friends? Or when you book an airplane ticket do you use the title Dr or Mr?
I know I don't want to be like chiropractors where they have signs that say "Dr. Clark" and try to lead people into calling them Dr. I think John Clark, Pharm D. is much less tacky and people should know to use the title Dr. I am not trying to start a war, but just asking so I know.....

Arrgghh, the tricky problem of proper title and address :) The easy and obvious way out is to get a PhD or MD, then there would be no confusion :-p
Seriously, why would get so fuss up about the "doctor" title...unless you are in your chosen profession for the "big name" :cool: "Doctor" means teacher, so unless one is willing to teach, the word is meaningless.

doctor: means teacher... very true, but nowadays anybody who obtains a doctorate (regardless of whether it is in medicine, dentistry, pharmacy, psychology, botany, chiropractic, podiatry, theology, jurisprudence, etc...) is entitled to the title of "doctor"... they can put it on their formal correspondence if they so desire....

however (unfortunately) the lay public is not aware of this, and therefore misrepresentations are common... for example, a respiratory therapist who happens to have a PhD should not introduce themselves as a doctor to their patients as this will cause confusion - especially since they will not be providing "doctoring" - the term loosely describing the practice of medicine....

casual settings: who makes their friends address them as dr.??? that sounds kinda pompous
dinner/airplane reservations: that sounds kinda pompous too... and it invites all kinds of legal conundrums (think of the diner/airplane passenger collapsed on the floor - will a podiatrist/pharmacist/dermatologist know what to do?)

now i know that everybody who just recently graduated wants to throw around their title for bragging rights --- it is only human --- but get it out of your system quickly, because on the airplane it doesn't mean anything (you won't get better seats), your friends will never call you dr..., and the people in the hospital only care if it can help them...

by the way, i am on a first name basis with my pharmacists, but if i don't know them i will address them as dr... (because i, unlike my patients, understand the title)

To Samoa:

I have a few queries, why were you drawing blood in hospital? Secondly, were you ever formally taught full clinical history and examination skills? How would you propose to enter the hospital system and work specifically in the capacity of an intern or NP/PA?

PharmD or BSc, pharmacy school is not medical school. If it was then the last year and the next three of my life would be a complete duplicate and waste of time. However, I am not duplicating myself, and am learning so much new material. Sure, pharmacology is a joke for me, but it's only a small facet.

[QUOTE]Originally posted by Samoa
[B]Part of the reason lawyers still go by Mr./Ms. is because they grandfathered everyone with the LLB degree who requested an upgrade to the JD, rather than making them take additional courses to EARN the doctorate. So nobody took them seriously. Pharmacy did not grandfather, partly for that reason, and partly because there IS additional coursework, and there's supposed to be a difference in skill and knowledge as a result.

The JD replaced the LLB, it did not become a "higher" degree with additional coursework. True it evolved from a true BS to a post BS , but that had occurred prior to the "switch." Yes, some LLBs were grandfathered that did not attain the additional coursework, while others did attain the additional coursework but earned an LLB and later granted the JD. I don?t dispute the sentiment you expressed ?nobody took them seriously? as it sounds plausible.

[QUOTE]Originally posted by Samoa
The correct title for a PharmD is "Dr." according to pharmacy's main professional organization. The length of study is the same as dentistry--6 years minimum. Dentistry does it as 3 years of undergrad and 3 years to get the DDS. Pharmacy does it as 2 years of undergrad and 4 years to get the PharmD. And we call dentists "Dr."

I'll call it a doctorate, but "Dr." is not a functional title for an RPH. Not picking on RPh's, I'd also argue that a DPT, a DOT, or even the PhD psychologist should not roam the halls with "Dr." emblazoned on their lab coat.

Was not aware that DDS is a three year program. Good point. But then I go back to lawyers with 4 years of undergrad and three years to get JD - 7 years minimum

In case you are interested, a majority of dental students have at least a bachelors degree. As with medical school it is possible to gain admittance without a four-year degree, but such a practice is becoming less common. Dental school is typically a four-year endeavor, however there is one U.S. dental school that grants a dental degree in three years (I believe this is a ?year round? program for the entire three years). There are a few 6-7 year combined B.S./D.D.S. programs around the country and it is my understanding that these programs are year round as well.

Originally posted by heelpain
FYI: It takes a long time to become a psychologist. You must really have an ego problem. [/B]

No ego problem, please note the context of the halls of a hospital. I'm not disputing that a PharmD's title is not Dr, just noting that they should separate themselves from MDs in "the halls of the hospital."

I think a MD or DO on the coat would be more useful than the "Dr." --especially in an academic hospital where the title "Dr" can cause confusion. If you have a doctorate and wish to be called Doctor, that's one prerogative.

To make things more confusing, one of the fellow(MD) told me that he actually addresses PharmDs as Doctors(I actually had the guts to ask him about this issue)!

:)

I've never heard of a pharmD NOT being addressed as Dr "so-and-so." I don't really see what all the fuss is about.:confused:

I know what the fuss is all about, the doctorizing of all health professionals is confusing to patients as to who their physician is. A friend of mine in New York couldn't believe how many patients came to him thinking their PA was their doctor. MD/DO are physicians and are naturally identified with the doctor title. It's my opinion that even dentists are a stretch, but since they're prescribers, that the titling of Dr. should end at them within the healthcare setting. That's it.

PILL COUNTER- while their pa is not a doctor, they may be their primary care provider, especially in an hmo setting.

They may be their primary care provider, but the point I was trying to make was that many patients wrongly identified thier PA as their doctor, and even referred to them as such.

gotcha-my point was that they may not have a doctor at all. it is amazing how many patients will call me doctor even though I introduce myself as a pa and have pa written all over my scrubs, lab coat, prescriptions, and after visit instructions. some people just assume that anyone doing an exam is" the doctor" even if they are a pa, np, medical student, podiatrist, etc. the term has unfortunately become confused with clinician or provider.
I have even heard people say " my doctor is john smith, the pa".

Well......it is the thought that matters..........they may even call you a Dr just out of respect,too.

Originally posted by The Pill Counter
I know what the fuss is all about, the doctorizing of all health professionals is confusing to patients as to who their physician is. A friend of mine in New York couldn't believe how many patients came to him thinking their PA was their doctor. MD/DO are physicians and are naturally identified with the doctor title. It's my opinion that even dentists are a stretch, but since they're prescribers, that the titling of Dr. should end at them within the healthcare setting. That's it.

So are you saying that practioners that prescribe should be called doctor? That would include NP and PA.

If the original meaning of doctor was teacher, then pharm d should qualify since we do patient education concerning drugs.

HEELPAIN- I meant no disrespect to podiatrists. what I was trying to say(poorly apparently) was that patients assume that anyone who examines them can care for any complaint, be it pneumonia, a sprained ankle, lupus, etc
I know that in a formal sense podiatrists deserve the title of doctor, I was using the term more in the sense of primary care physician. sorry-e

Do Pharmacists have "Dr." written on their labcoats? What's this commotion about... Pharmacists definately deserve it. They go through a ton of training only to do jobs that don't measure up to the skills they learned.

Is the title Dr. supposed to be a consolation for unsatisfactory careers?

Originally posted by PACtoDOC
If you want to practice medicine, you have to go to medical school. You can only practice medicine as a DO/ MD, and that's that. Before I started med school I was a practicing PA who thought that I was by many rights as fit to practice medicine as my physician colleagues. I was wrong. So do you know what I did, I went to medical school.

Pharmacists have a skill that can and only allows for them to dispense medications after they have been ordered by a physician, PA, NP, OD, DPM. The common thread that all these providers have is literally years of normal anatomy, abnormal physiology and pathophysiology, embryology, psychology, pharmacology, biochemistry, histology.

I say pass out the USMLE step one at the grocery store and any person who can pass it under proctured settings should be able to practice medicine. Without the cumulative total of these classes above, it would be impossible to pass this exam, and thus it would be a mute point.

When a pharmacist is required to spend the same amount of time in the basic clinical sciences of medicine, then they will no longer be pharmacists. What pharmacist would still want to be a pharmacist once they had taken the first two years of medical school only to continue on to become a pharmacist?

Pharmacists and Psychologists have their place, but neither should be making individual decisions on the what is best for any patient in terms of medications.

Are you kidding me?

OK...some of what you said makes sense.

But to say that Pharmacists are only trained in pill counting? Give me a break. You have obviously spent little or no time with a pharmacist in an academic setting.

Maybe you are bitter because a pharmacist showed you up at some point in your life.

Hell...I saw early on that pharmacy was not for me. NOT because of lack of interest. NOT because of a worry of lack of respect. NOT because I felt that I would be beneath anyone.

I wanted to become a doctor because THAT was the role I wanted to fill in the medical field.

Hell...I know that when I am practicing in the hospital some day I sure as **** want a pharmacist somewhere around whom I can consult about medication problems. Who the hell but a pharmacist can really keep all those parenteral penicillins and cephalosporins straight, anyway?

Two final points that seem to be a recurring theme:

1. No, pharmacists are not diagnosticians and should not be looked at as such. This is what physicians are for. However, do pharmacists know more about the medications physicians sometimes (often times, for some docs) write blindly to patients? You bet your ass they do.

2. As far as the "doctor" issue. Doctor is a title of respect. It is not a medical role. MD/DO are PHYSICIANS with the PROFESSIONAL title "doctor". Do I think that PharmDs deserve the professional title and respect? Sure. Does it make it more difficult and confusing in a professional setting? Yes it does. I have seen it and seen how and why problems can arise.

Originally posted by PACtoDOC

Pharmacists have a skill that can and only allows for them to dispense medications after they have been ordered by a physician, PA, NP, OD, DPM. The common thread that all these providers have is literally years of normal anatomy, abnormal physiology and pathophysiology, embryology, psychology, pharmacology, biochemistry, histology.



Hasn't this been discussed already? Pharmacists are trained in anatomy (yes, we even have gross anatomy), pathophysiology, pharmacology (more in depth than med students), biochem, and do touch histology and embryology. No we can't diagnois, but to say we can only dispense shows ignorance of the profession.

Originally posted by LSUMED2006
It seems MANY people want to be doctors, CRNAs, NPs, ODs, etc., but they DON'T want to go through what every physician has to do to earn his degree. I must agree with tenmesa. For those who want to prescribe, manage patient care, etc. indepentdently, then why not become a physician, rather than want equal responsibilities with much less training?

Jason

I was browsing and I found your comment interesting. I am planning to attend OD school. For a long time, I compared the pros and cons of MD/DO vs. OD. After a lot of self analysis, the OD is the better route for me for a variety of reasons. I am only interested in the eye and optics. After speaking to OMD's and ODO's, I realized that there is no guarantee that I would match into ophthalmology residency. Also, I am not interested in eye surgery (or any other type of surgery), another aspect of the ophthalmology training. I did the volunteer work and found out what it is like to have someone die on you; this is not what I want to do for a living. I am not interested in delivering babies, working in the emergency room, etc. Optometry school is 4 years and 1 year of residency (I plan to specialize). So I am going there with a guarantee to do what I am comfortable with. I do not want "equal responsibilities with much less training." That is why I am chosing to go straight into my speciality, rather than going the generalist route then specializing; OD's are specialists and are not generalists and do not purport to be. I am not interested in being a generalist; I want to do what I will be trained to do--treat ocular problems that DO NOT require surgery. But then again, you have insurance company administrators making the final decisions for physicians and other non-physician health care providers, so why bother with med school anyway? :)

Originally posted by rose13
But then again, you have insurance company administrators making the final decisions for physicians and other non-physician health care providers, so why bother with med school anyway? :)

NOW you tell me.

:)

PACtoDOC

I respectfully disagree with your earlier post (your more recent post says it a bit better), but nevertheless I will admit that you are in more of a position to comment on this particular topic...at least from the side of clinical medicine.


Best of luck to you in school.

I'm currently working in a tiny dispensary in a medical building, and as you guys might be able to tell, I have a lot of time on my hands. JP, I don't know whether you graduated from pharmacy or not, but in practice, PACtoDOC is right, in certain regards. I don't know more about insulin dosing than an endocrinologist, or even an internist, nor more about card drugs than a cardiologist. True, I'm a bachelors, not a PharmD, but I still highly doubt that a PharmD or myself should be allowed to make therapeutic decisions. How would I evaluate their efficacy? Are patients going to make follow-up appointments in the pharmacy? I think a pharmacy education makes you well-versed in describing drug therapy, monitoring its effect on a patient and reporting their findings to physicians. Hospital pharmacists do this function very well.

Community pharmacy on the other hand, is difficult to describe to those who haven't worked in that environment. For example, one shift in a long term setting two weeks ago, I spent eight straight hours looking at pills in blisters, and signing my name. Sit back for a second and imagine that. Five years of university and I counted pills and checked them off all day. Where did my training come into play there? After a bitter and pride-swallowing two years did I realise that I had become nothing more than what my name suggests. At present I'm locuming at a clinic where I give patients a 30 second run-down of how to take the medication and then ring the prescription through the till.

Again, hospital pharmacy is a whole different ballgame. I haven't spoken to a medical resident yet that hasn't appreciated pharmacy presence and intervention. Hospital pharmacists utilise their education everyday, participate in Pharmacy and Therapeutics Committee meetings, are influential in setting deparmental drug budgets and are at the forefront of new knowledge and innovation. There were drawbacks to hospital work as well. Lower pay than community counterparts being the chief complaint.

Which begs the question, after spending 6+ years getting a PharmD, are you prepared to do what I do? Because there will only be so many hospital jobs in relation to the need in community. I have never meant to disparage pharmacy as a profession, but truly understand what the career will entail. Hell, I'm getting paid a lot of money to sit and post on this thread, while I fill the occasional prescription. All I can say is thank god second year of med school is about to begin, and I've only got a few shifts left.

Pharm D's are going to write prescriptions. The HMO's don't want to pay for an office visit for a doctor to write a prescription for an antibiotic that the patient didn't need to begin with. Go to another country and you'll find that pharmacists already write prescriptions. It won't be long before that is what happens here. Saving money is more important for the insurance industry.

I'm going into pharmacy because I love chemistry, not because I want to write prescriptions. That will inevitably become part of the job, but it makes no difference to me.

Originally posted by dgroulx
I'm going into pharmacy because I love chemistry, not because I want to write prescriptions. That will inevitably become part of the job, but it makes no difference to me. That's how I feel too. If I wanted to write scrips and see patients, I'd go to medical school. But I don't want to do those things. I'm more interested in pharmacology and drug development, and that's why I'm planning for a Pharm.D.

Originally posted by PACtoDOC
Everyone knows that the biggest push to use generic drugs comes from the pharmacists who often get kick-backs from the generic distributors and the insurance companies.

I don't know about kick-backs from these companies directly, but retail pharmacists do get a boat load of bonuses and incentives to increase the generic % of their store.

Some retail chains give cash bonuses or stock to managers and staff pharmacists who work for a store which has the highest % of generic distribution in a particular region or district.

Usually, a percentage goal is set for a particular store and stores that do not regularly meet their pre-set goal often get visits from members of corporate who want to find out first-hand why that is. It can be ugly business.

And PACtoDOC...I would say the number of times that I have seen Proventil HFA to generic Albuterol dispensed is about 1:10.

FYI: I am NOT a pharmacist...I left that game before I finished school...but I spent enough time behind the counter to get a handle on what's going on.

As far as for pharmacists changing drugs such as Proventil HFA to albuterol I have never seen anyone do this. Most customers fill their prescriptions at a retail pharmacy and there is no personal incentive for us to change a script. We don't get bonuses or kickbacks to change an rx. We offer generics for the CUSTOMERS! Why make a customer pay up to 5-6 times as much for a Proventil HFA when they've had albuterol in the past? It sounds like PAC to DOC is the one who has bought into the drug reps line of b.s.. I personally have never heard of anyone getting a kick back for generics I work for one of the largest retail chains. That would be unethical & there are unethical pac and rphs. But when asked I certainly would advise to take generic. Did you know that Astra Zenaca makes both tamoxifen and Nolvadex? Or that the same factory that packages proventil makes the generic albuterol? What do you think the difference is in the products? If your too stupid to know that it's just the packaging then mark DAW & make your patients pay the difference.

As far as for Rphs bothering a PA to change drugs due to an allergy, my last genuis PA gave their patient Septra with a sulfa allergy and dosed Tussionex: 2 tsp q 4 hours. I'm sorry that you feel inconvienced by the phone call, and I'm sure that the patient would feel inconvienced by going to the emergency room. If your too blind to see that pharmacist and doctors and pacs all should work together then you are missing the big picture and should consider a new profession. I guarantee that you will make a mistake one day (because we all do)& some rph will save your ass, if you take their call and listen.

Please excuse my ignorance of the matter, but why is it to the advantage of pharmacists/pharmacies to promote generic medication?

Your question isn't ignorant; your question hits the nail on the head. There is no personal reason for pharmacists to promote
generics other than to save people money. Most people think
that generics are somehow inferior to brand name medications for different reasons. However, when I explain that the difference is only in cost and demonstrate the savings to them, 99% will take the generic. I see no reason in the world for somebody to pay extra for a brand name when a generic is available. Of course there is that always that one person who insists on getting a brand name. I just shrug my shoulders and fill the rx.
Fill a rx, don't fill an rx, brand or generic, no matter what I do I get paid the same.

Originally posted by Brill
Please excuse my ignorance of the matter, but why is it to the advantage of pharmacists/pharmacies to promote generic medication?

Retail chains make more money on generics. There is a higher mark-up. Buy cheaper, sell cheaper...but get a bigger cut.

Some in the profession may deny this, but look at the books.

Yes, most of the time generics have a larger markup. However,
since most people use insurance for rx and since most insurances work off of Average Wholesale Price (AWP) to figure reimbursement there aren't huge profits. The insurance knows what the drug costs and pays us that cost plus either a dispensing fee and/or a percentage over that cost. So, the patient gets a generic medication that works at the cheapest co-pay that their plan offers. Our average profit is about 20-22%, not unreasonable compared to any other business.

If the patient doesn't have insurance and gets a generic he/she
still saves money. The markup is higher but the savings to the person is still substantial.

I would still like to know how recommending generics to patients to save money is making me rich.

Patented medications sell on the basis of how well the drug company details physicians. Pharmacies have to buy these medications and in most cases, pharmacies are allowed only a tiny markup on these.
In the case of generics, a built-in market for that drug already exists. Generic companies are fighting each other to make sure they are the ones on your shelf. Thus, the success of a generic company resides in their ability to outdo the competition. In this bid, generics offer pharmacies (independent, chain, department store, essentially all of them) discounts, gifts, cashback, 2for1 deals, you name it.
It's deceptive to say that pharmacies do not benefit from having a large percentage of medications dispensed as generic. Patients saving money is a great motivator too, and I've always recommended generic meds as a pharmacist. When I'll be a physician I'll write my scripts generically, and always ask that the lowest priced alternative always be dispensed.

By the way, besides being a pharmacist and in med school, I was a generic drug company rep, so I know a little bit about the behind-the-scenes dealmaking!

I too left pharmacy school before finishing, but I have spent more than enough time behind the counter. Generic medications do make much more money for the pharmacy. I can't count the number of memos, talks, visits from distric managers, etc. that strongly encouraged the use of generics due to the amount of money the store made off of them.

I can also attest to the rampant changing of a brand name drug for generic. In many cases this is best for all involved, but the manner in which it was done did not always follow the law to the letter. Here in LA, as I was getting out of pharmacy, the state legislature passed some law that actually required "DAW" plus a code (I think i remember this correctly) on a script to make it brand name only. Once the law was passed, even if "dispense as written" was checked on the script, pharmacists could sub generic for brand, much to the dismay of some patients and physicians. (we all know phenterimine is only active when called adipex and has blue speckles in the pill).

To MY dismay, patients sometimes requested brand, but the pharmacist found any number of reasons NOT to give it to them. Rather, invariably, generic was substituted due to the fact it made important people money.

Jason

So does this mean that the current push towards generics (re: shortening the length of and/or ignoring pharmaceutical companies' patents over certain medications) is actually beneficial to the retail pharmacy chains? I've been told by some people (who admittedly are not extremely knowledgeable is this area) that increasing the use of generics will result in "less money in the system" and would ultimately result in less jobs and lower salaries for pharmacists. Again, please excuse my ignorance in this area.

I guess my experiences as a pharmacy manager for the largest grocery chain in America are different than other peoples. I don't get any pressure to promote generics, I don't get bonuses based on generic sales, and I don't dispense generic rx for any other reason than to save people money. Sure, my superiors look at
my profits, my scripts per hour, and the cost of my pharmacy inventory. I don't see many drug reps and when I do I politely listen so I get pens for the pharmacy (we always run out).

Yes, generics offer a higher percentage margin. There is no doubt about it. However, like I said, when I bill an insurance company, I don't get this huge profit. They know what it cost me and reimburse my pharmacy a percentage over cost. I get nowhere near retail price. To explain what I mean, here is a good example: today I filled a Prozac rx. The retail price for the brand is about $100 for a month, the generic is about $50. After billing the insurance, the patient payed a $5.00 copay and the insurance gave us an additional $6.15. So, the insurance didn't reimburse us $45 (plus the customers $5.00), the pharmacy got $11.15. We made a profit, but as you can see it isn't astronomical. I can't stress this enough; insurance dictates what they will pay for, how much they will pay and what the copayment is. I was just happy that the patient only had to pay $5.00. Everybody was happy, we made a profit, the insurance got off cheap, and the customer only had to pay $5.00.

Generics are a win-win-win product. The pharmacy makes a little money, the insurance doesn't have to pay for brand, and the customer gets a good copay. Even if the customer doesn't have insurance, they are much happier getting generics at a fraction of the cost. Which would you rather pay, $50 or $100? So what if the percentage is higher, the customer still pays less. Also, remember that higher profit margins are not the same as total profit. If I sell a ten day supply of generic Keflex ( no insurance)
the profit is about $10.00 if I sell brand the profit is about $35.00.
Alot of generics are like that. Sure, the markup is huge but the total profit is moderate. In any situation the patient pays less, isn't that the important thing?

>lot of generics are like that. Sure, the markup is huge but the total profit is moderate. In any situation the patient pays less, isn't that the important thing?

It sure is very important that the customer pay less. A customer that pays less on drugs is likely to be a repeat customer. However, making a (large) profit is also in my mind nearly as important. Profit is not a dirty word, and the bottom line is that pharmacies are buisinesses. This business mentality is what I have seen many, many times cause the very strong push for generic medications, both in retail as well as independent community pharmacies.


>So does this mean that the current push towards generics (re: shortening the length of and/or ignoring pharmaceutical companies' patents over certain medications) is actually beneficial to the retail pharmacy chains? I've been told by some people (who admittedly are not extremely knowledgeable is this area) that increasing the use of generics will result in "less money in the system" and would ultimately result in less jobs and lower salaries for pharmacists. Again, please excuse my ignorance in this area.

I have forgotten exact statistics, but drug companies must spend several hundred million dollars to bring any new drug to market. Now, consider that around only 3-4/10 drugs brought to market turn a profit, you can see a huge problem for drug companies. We live in a capitalistic society, and drug companies make drugs because it makes them rich, period. Because finding a very marketable, successful medicine is a goldmine for these companies, there is a constant drive towards new and better things in order to make money. I'm rambling here, but back to the point. Drugs must be so expensive initially in order for the drug company to recoup the hundreds of millions of dollars it put in to that drugs creation as well as the other 6-7/10 that did not make any money.

Your friends are right in a sense that if generics were allowed to be used say a year after a drug came to market, then, yes, the system would be in grave danger. THis is why the drug companies have a long patent (7 or more years) in which only they may sell the medication.

However, assuming the drugs patent has expired, using generics makes more money for the patients and drug store. It is also worth noting that many manufacturors make the brand as well as generic medicine.


Jason

I just have to add one facet to this conversation. Someone had stated that PAs and NPs are more qualified than PharmDs on the basis of their procedural knowledge and time spent in clinical rotations. I can tell you that this is categorially untrue. PharmDs are certainly quite competent in differential dx, the pathophysiological basis of medicine, and therapeutic management of disease states. In order to fully understand and reccomend a course of treatment, the PharmD has to be well-versed in the pathophysiological/pathological basis of disease in order to reccomend correct and therapeutic treatment. There are many PAs and NPs who are more than capable of preforming clinical procedures but are entirely reliant on a PDA to prescribe appropriate medicinal therapy. I venture to say that this as well goes for MDs judging by the amount of prescribing errors that are made in clinical settings. The other and more important point here is that there was some talk of "years of education" being a factor in terms of competency. What do you say to the PharmD who has done both a PGY1 and PGY2 residency in an area such as hematology/oncology or psychopharmacology or pharmacotherapy and then continues on to become board certified in their disciplines? Would you still say that they are not the equal of an MD, not to mention a PA, in terms of clinical experience, disease state mangement. therapeutic care plan management and competency? I can guarantee you they are.
I think that the greater point here is that healthcare professionals should work together to combine their strengths to the benefit of the patient rather than engage in a pissing contest over status or prestige.
Just my thoughts.

Your first post, and you dig up a 6 year old thread and write that?

:(

We as professionals should be treating each other with respect because we all need each other in order to better the life of the patients we care for. Having worked in a hospital, I see the negativity and the hostility that can come about between various professions... and even between departments. The fact of the matter is, we are all part of a team that has to work together so that the living person who is entrusting us with his or her life will remain living and be better for it.

I've done a complete history and physical examination as part of my PharmD training. I am also a former member of the Infectious Disease Molecular Diagnostics Committee and have successfully designed several diagnostic assays. How many have you designed?

.Exactly how do these PharmD's get the same patient care contact as NP's and PA's? I have yet to see a PharmD student do a complete history and physical, write an entire set of admission orders and make daily progress notes and patient visits. Exactly where do you get this training? Where do you learn to read x-rays, perform thoracentesis, and perform minor procedures? Where exactly do you do these rotations that are just like NP and PA school?