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20 Questions: Cindy Stowe, PharmD
- Thread starter CaffeinatedSquirrel
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The larger issue facing this profession is the super saturation and lack of jobs. New schools open to meet a need for demand, but where is the demand? Where do all these graduates go? High student loan debt with diminishing job prospects. IMO
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Can someone please explain to me what the general expectations of pharmacists wanting to go into "direct patient care". I'm an incoming medical student and asked a friend (in pharmacy school) what this meant to her and what she described was essentially the work of a primary care physician. This can't be the long term goal of pharmacists, right?
That is interesting that there are several paths to primary care based on where you are at the moment.
Path 1) Shorter path from undergrad to PA-C
Path 2) Longer path from undergrad to MD/DO
Path 3) From mercantile based PharmD (no residency) to clinical PharmD (add residency)
Maybe the PharmD decided to be clinical after a few years of pharmacy school but doesn't want to do PA-C or MD/DO?
Path 4) From regular RN to Advanced Practice Nurse or even Doctor Nurse Practitioner (or not primary care: Nurse Anesthetist)
So those alternate paths to primary care are ways to change your course to a more clinical role after getting too deep into a degree you don't really feel all that enthusiastic about . . . career change with less drastic transition?
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Are pharmacists even trained to deal with patients? IE differential diagnosis, treatment plans, etc? I guess I just don't understand it. If you want to be a dentist, go to dental school. Ditto for medical school.
I hope their residencies give them more in depth training to deal with patients above and beyond the across-the-pharmacy-counter training.
Tying what Mehd School is saying into what VCU07 is saying, the super-saturation plus having a more clinical role is meant to benefit the big pharmacy chains. Having more people to choose from allows them to have more ability to have more authority over their pharmacists as employees, without worrying about filling in gaps if a pharmacist resigns/disagrees. Also, the push for more clinical pharmacist abilities gives benefit to big pharmacy chains because they can make money for more services rather than just from drugs.
The higher student loan debt means that the more gifted pharmacists will have to think twice about going to medical school. The more clinically inclined pharmacists will get paid (40k $ per year?) for their residency versus losing money at PA-C school or MD/DO training.
This is very good if you have a big business to keep talent in fields that can make you money and have a greater chance of building a network of experienced employees that have less motivation to leave/disagree and more motivation to stay/agree.
But I digress.
I think in a lot of routine cases a pharmacist could easily provide the same advice and solutions that a PCP could (eg colds, allergies, headaches, etc) in the same way that for a lot of routine issues a physical therapist could easily provide the same advice and treatment as an orthopedist could (eg back pain, sprained ankles, etc). In a large number of PCP visits, the doc simply writes a prescription, essentially referring the patient straight to a pharmacist, and in a lot of visits to orthopedists the doc simply refers the patient straight to PT and maybe orders an x-ray. If patients with colds and allergies went straight to pharmacists (who could write prescriptions) and patients with sprained ankles went straight to PT's (who could order x-rays), a lot of expense associated with unneeded physician visits could be avoided. But relying on pharmacists to replace PCP's or PT's to replaced orthopedists would obviously be unreliable and present clinicians with too many patients they are not specifically trained for. Docs don't want "allied" health professions encroaching on their dominion, and allied health professionals want to better utilize the extensive training they receive these days (which docs often seem unaware of or at least unwilling to acknowledge). Nevertheless, MD's/DO's do receive much more extensive training than any other health professional and both the docs and all the other providers need to have their skill sets maximally and appropriately utilized for the healthcare system to become less wasteful and more efficient.
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I could think of an argument to grant a medical doctor drug dispensing authority for similar reasons. In general, a medical doctor would not have sufficient pharmacy knowledge/training or a pharmacist without enough medical knowledge/training to properly diagnose because their respective schooling/training are not geared for practicing as both a medical doctor and a pharmacist. It is intentionally so to ensure and maintain a check and balance in healthcare system. If a doctor is granted drug dispensing authority or a pharmacist is granted prescribing authority, the insufficient knowledge/training would led to serious compromises in patients' safety. I agree that allied health professionals received more training than the past, but imho still not enough to allow them to practice independently.
More importantly, humans are normally prone to making mistakes and errors. A doctor or a pharmacist with BOTH prescribing and dispensing authorities will compromise the check and balance in healthcare system to ensure patient's safety.
There are certainly some costs for a proper check and balance and/or having the right persons for the right jobs, but the alternative is the safety and lives of the patients at stake. Many things you would think as very simple matters like the cases you listed above, but those could turn out to something else, which might be very different from what you expected and might be too late when you find out that is the case now.
If a pharmacist would like to prescribe, he/she should be doing that under the supervision of a medical doctor, just like a PA or nurse practitioner. On the other hand, if a medical doctor wants to dispense medications, he/she should be doing that under the supervision of a pharmacist.
anyway the article above provides me no new ideas or insights at all. A lot of answering-but-not-actually-answering-anything answers or double-talks. A true must-have politician's skill 🙂
The basis for the argument here is incorrect. Pharmacists will never take over primary care, esp in not a capacity as NPs or PAs. The role of pharmacy in this setting is medication mgt. I see a VA type model where pharmacists are managing chronic disease med tx in clinics or under the same roof as physicians. There are already numerous examples of this occurring, esp under contracts where state law allows. This needs to expand and billing for services will need to be obtained (prescriber status).
You definitely make some excellent points. If doctors had dispensing authority or pharmacists had prescribing authority, it would probably have to be to limited to be very helpful. And I thought the same thing about the Q&A in the article. Not to surprised to see this is someone who has moved through the ranks from professor to associated dean to dean.
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This article really doesn't seem to add anything incredibly new. It sounds a lot like the things my professors have told us, even though there is a saturation going on in the field. I do think pharmacy has become a different and perhaps more relatively exciting field than it used to be, but unfortunately with so many students graduating at the same time, there is an increasing amount of students wanting to do residency and clinical pharmacy and not enough residencies/jobs for that kind of role.
