Can MDs Dispense....And Should They?

[MS05']

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Hello pharmacy people! I'm coming over from the emergency medicine board with the hopes that you guys could solve a question of mine. Got into a discussion in the ED the other day regarding the above topic and no one knew the answer (at least to the "can MDs dispense") question. What do you think and if they can, do you think they should...?

 

[Oneday_9]

Hello pharmacy people! I'm coming over from the emergency medicine board with the hopes that you guys could solve a question of mine. Got into a discussion in the ED the other day regarding the above topic and no one knew the answer (at least to the "can MDs dispense") question. What do you think and if they can, do you think they should...?

This may seem rudimentary, but do MD's want to dispense? What is the extra benefit? As far as I know, the continuning trend is less and less time with patients, dispensing and all the hang ups that go into keeping an inventory, etc. may make it more of a hassle than an innovative addition to physician practice. More so, I believe, pharmacists are doing quite alright working with patients, giving advice, and handling this aspect of healthcare.

I believe, MD's can have a stock of medications (at least here in CA). I'll try to find an answer to this.

 

[TrojanAnteater]

This may seem rudimentary, but do MD's want to dispense? What is the extra benefit? As far as I know, the continuning trend is less and less time with patients, dispensing and all the hang ups that go into keeping an inventory, etc. may make it more of a hassle than an innovative addition to physician practice. More so, I believe, pharmacists are doing quite alright working with patients, giving advice, and handling this aspect of healthcare.

I believe, MD's can have a stock of medications (at least here in CA). I'll try to find an answer to this.

Yeah, I've just started to notice this Oneday, my doc a couple times recently has gone into his little room filled with sample packs of medications and given me stuff from there.

 

[Trancelucent1]

I'm pretty sure in Florida that they are not allowed to. They can only dispense sample packs. And I can tell you from some of the scripts that I've seen lately, I wouldn't want them dispensing. Today alone I had to call 3 doc's b/c they wrote scripts for drugs that didn't come in those strengths.

Nothing beats a few weeks ago when this pt needed a new script b/c she was on another doctor's orders that she could not swallow pills and the nurse calls us and asks us what medications she can get. We start naming some and she's like yeah that sounds good. I was rather bothered by this.

 

[ilovepharmacy]

Nothing beats a few weeks ago when this pt needed a new script b/c she was on another doctor's orders that she could not swallow pills and the nurse calls us and asks us what medications she can get. We start naming some and she's like yeah that sounds good. I was rather bothered by this.

Yeah that just happened to me last weekend - I had to name off alternatives for Flexeril and the nurse recognized Soma I guess so she said "yeah yeah! Soma 350" and when i asked about the quantity she said "i don't know... how much do you think is ok?" 😕 I think if I said #100 the patient would have been very happy

 

[Oneday_9]

Yeah, I've just started to notice this Oneday, my doc a couple times recently has gone into his little room filled with sample packs of medications and given me stuff from there.

Well yea, samples, I know, but I don't think this is what the question was in regards to and it is well known samples are available.

I was speaking to having a stock of their own medications, like controls or the like that they can buy from an actual pharmacy, which is legal in California. My pharmacist here at Safeway does have physicians come and buy their own stock.

 

[NYCillini]

Maybe there's certain guidelines like living in a remote or rural area. In rural Illinois, I have seen it done in MDs offices whereas the strongest painkillers dispensed are tylenol 3. I would describe the some of the stock as BC pills, antibiotics, vitamins, maybe some heart meds, etc.... not very expansive and nothing too complicated. It just saves folks a trip to the next town, however, this method I believe doesn't factor in insurance (as it is meant to serve as a convenience and not place for refilling on a constant basis).

 

[bananaface]

The dispensing laws vary by state. In WA MDs/DOs may dispense, but not for profit. Interestingly, the law says that all prescription items must be labeled with the patient name, directions, and doctor's name - even samples - but no one follows or enforces this rule.

Personally, I like to see patients get all ther meds at one location, whether it be their physician's office or a local pharmacy, so that all potential interactions are screened for. My feeling is that pharmacies are the best place to get meds, since we are easily accessible for follow-up questions, are willing to front the cost of carring a full stock of meds, are open during times that physician's offices are not, offer a double check of the physician's work, etc. I personally have issues with physicians dispensing narcotics out of their offices, because I feel that the potential for misbehavior is unecessarily heightened when dispensing and prescribing is not separated.

 

[MS05']

Thanks for the feedback everyone. I guess I should have been more specific in the question, but I wasn't so much referring to an md dispensing from the office, but rather finding a job (being hired) with a local pharmacy, walgreens, rite-aid, family owned pharmacy, etc.

 

[dgroulx]

Personally, I like to see patients get all ther meds at one location, whether it be their physician's office or a local pharmacy, so that all potential interactions are screened for.

My preceptor for my 1st year practicum class worked at Ameridrug. They were connected to the clinic for that HMO and only served patients from that HMO. The patients had to walk out the front door of the doctor's office and into the front door of the pharmacy, but the two were actually connected. All the staff got along and there was mutual respect for all involved. There were no insurance problems because you had to use the HMO. It looked like a pretty stress-free working environment.

 

[dgroulx]

Thanks for the feedback everyone. I guess I should have been more specific in the question, but I wasn't so much referring to an md dispensing from the office, but rather finding a job (being hired) with a local pharmacy, walgreens, rite-aid, family owned pharmacy, etc.

I've never heard of that. I don't think a physician is schooled to be a pharmacist. It's like me wanting to be hired as a physician just because I have 4 years of professional school. There is some overlap in the courses taken, but not enough to switch careers.

 

[baggywrinkle]

Thanks for the feedback everyone. I guess I should have been more specific in the question, but I wasn't so much referring to an md dispensing from the office, but rather finding a job (being hired) with a local pharmacy, walgreens, rite-aid, family owned pharmacy, etc.

Nope, not possible, because the board of pharmacy does not know he exists.

Medical credentials not withstanding, by law the practitioner must

a) be a graduate of an approved school of pharmacy and

b) pass the pharmacy board exam. (could ya do it? 😛 )

Now, in states such as Colorado and Florida the physician could work as a TECH! But in licensure states such as Texas and Washington he couldn't even do that. Even though he CAN do it he MAY not.

 

[bananaface]

Nope, not possible, because the board of pharmacy does not know he exists.

Medical credentials not withstanding, by law the practitioner must

a) be a graduate of an approved school of pharmacy and

b) pass the pharmacy board exam. (could ya do it? 😛 )

Now, in states such as Colorado and Florida the physician could work as a TECH! But in licensure states such as Texas and Washington he couldn't even do that. Even though he CAN do it he MAY not.

I know you can't hold dual licensure in WA as a pharmacy tech/pharmacist/intern etc, but you can do a PharmD/PA-C, so there has to be some allowable overlap of licensure. If an MD were functioning as B tech, which requires no formal training outside of an HIV/AIDS awareness course, could he or she counsel? This question is getting pretty strange.

Interestingly MDs in WA are not allowed to own a pharmacy in their location of practice. I wonder if that's a law in other states too.

 

[baggywrinkle]

I know you can't hold dual licensure in WA as a pharmacy tech/pharmacist/intern etc, but you can do a PharmD/PA-C, so there has to be some allowable overlap of licensure. If an MD were functioning as B tech, which requires no formal training outside of an HIV/AIDS awareness course, could he or she counsel? This question is getting pretty strange.

Interestingly MDs in WA are not allowed to own a pharmacy in their location of practice. I wonder if that's a law in other states too.

Seems like I remember in North Dakota pharmacies must be owned by pharmacists. In the states I have lived in anybody with a large checkbook may own a pharmacy.

The question as I perceive it is a licensed physician wanders in and wants a job as a pharmacist - moonlighting? Satisfying masochistic desires? Not gonna happen any more than I am going to wander down to Portland and moonlight for Wallyworld of Oregon. Now it is an interesting question if the board would allow a licensed physician to sit for the pharmacy board exam. I don't think it would b legal for the reasons stated above. It would boil down to an interpretation of the law by board members who are PHARMACISTS and lay persons. The garden variety inspector would be obligated to pop the physician (and pharmacy) for practicing without a license. Just because I can do surgery may I?

This is different from your dual licensure program because accredited schools and competency exams are involved in the process. At the very least I would expect the physician to be required to do the state required internship hours and sit for the board exam to prove competency just as any other practitioner is required to do.

In most states physician dispensing from their office is allowed with varied limitations. No pharmacy within X number of miles, record keeping requirements over and above normal charting, ect, ect. That is why many docs stick to free samples. In a true rural dispensing operation the office would need to register as a pharmacy. When is a pharmacy, a pharmacy? When does administering become dispensing in the eyes of the law? As I recall in Texas it was the difference between popping it into the victim's mouth vs placing it in their hand. When you place it in their hand all the labeling and recording laws come into play. Pharmacy is all about labels. If you have ever seen some of the ER outpatient dispensing units floating around out there you know why casual physician dispensing is a poor idea. It is hard enough to get it right with all the toys employed properly.

This raises a question; may a rural physician dispensing operation properly registered as a pharmacy with the state keep samples legally?

 

[ultracet]

i thought mds could dispense but if they do more than samples they have to register with the board as a pharmacy and follow all pharmacy rules.

hmmm... perhaps its just the states i'm in

 

[museabuse]

In arizona a physician can own a pharmacy as long as they do not fill their own scripts or scripts from their practice or give up prescribing authority.

I don't think a physician would want to get into pharmacy and practice medicine at the same time because now you are opening yourself up to even more lawsuits and liability, not sure if you could get pharmacist malpractice insurance or you would have to add that into your own malpractice which would raise it even more.
Also there are some legal issues. For example you get a great wholsesale price on X drug then you might tend to write prescriptions for X instead of Y which may be better indicated for disease Z. I am sure that could be proven in court and you would be in some deep dog dodo.