Clinical Pharmacist Practioner

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Somatic

Somatic

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I've heard that in New Mexico and North Carolina, pharmacists can practice as mid-level practioners and are essentially in the same position as PAs and NPs. However, I wonder if there are many pharmacists that are actually in these positions? Also, the VA system utilizes pharmacists as physician extenders, giving them prescriptive authorities. I think there should be a more widespread pathway for pharmacists who wish to practice as primary care providers. There should be some sort of program (perhaps post pharmD) to give pharmacists the physical assessment skills they would need to practice as primary care providers. This would expand the role of pharmacists greatly and I'm sure, given their background coupled with physical assessment skills, they would be a much better practioner than PAs or NPs who have very little drug therapy knowledge.
 
That is similar to what they are trying to pass in KY right now. The law is currently that a pharmacist must have a collaborative care agreement with a specific physician and a specific patient in order to prescribe, however they are trying to rewrite the law to that one collaborative care agreement can cover many people. If you search the forums there are several debates on pharmacists and prescriptive authority.
 
I had to do an essay on Pharmacists' prescriptive authority throughout the US for my clinical skills class. I came across this article (i think in AJHP) about a clinic hiring a pharmacist (BCPS, since NM law requires a prescribing pharmacist to be BCPS to prescribe). The pharmacist was able to get his own DEA number. The clinic saved over 20,000 bucks.

I will post a link to my essay soon. Wonder if it will be of anyone to anyone
 
Somatic said:
I've heard that in New Mexico and North Carolina, pharmacists can practice as mid-level practioners and are essentially in the same position as PAs and NPs. However, I wonder if there are many pharmacists that are actually in these positions? Also, the VA system utilizes pharmacists as physician extenders, giving them prescriptive authorities. I think there should be a more widespread pathway for pharmacists who wish to practice as primary care providers. There should be some sort of program (perhaps post pharmD) to give pharmacists the physical assessment skills they would need to practice as primary care providers. This would expand the role of pharmacists greatly and I'm sure, given their background coupled with physical assessment skills, they would be a much better practioner than PAs or NPs who have very little drug therapy knowledge.
Click to expand...

Actually, there is already a well established pathway for pharmacists who wish to practice as primary care providers. I think it's very exciting. The program is called medical school and does wonders to prepare people for these positions.
 
F that, I don't want to touch people. I'll save rectal exams and playing with necrotized skin lesions to the suckers....er....physicians. You people don't understand how awesome our job is. We get to sit in the background and take care of the drugs in the nice, clean, pleasant smelling pharmacy while mister MD/DO/whatever has to give a pap smear to a Rosanne Barr looking woman that hasn't showered in 5 months.

I don't know why the hell anyone would go to pharmacy school to do that type of stuff. Hell, go become a PA or NP. It's less school for crying out loud.

PharmDs shouldn't be PCPs in any situation, anyway. In a perfect world, at best, pharmacotherapy would become its own specialty and patients would come to pharmacists for medication management AFTER using a physician for proper diagnostic workups. That won't happen though. Physicians use medication refills to get the come back like a drug dealer selling crack giving away the first sample hit. They won't let that stuff go easy...
 
WVUPharm2007 said:
In a perfect world, at best, pharmacotherapy would become its own specialty and patients would come to pharmacists for medication management AFTER using a physician for proper diagnostic workups. That won't happen though. Physicians use medication refills to get the come back like a drug dealer selling crack giving away the first sample hit. They won't let that stuff go easy...
Click to expand...

I couldn't agree more...what could be done to change this??
 
collegegirl247 said:
I couldn't agree more...what could be done to change this??
Click to expand...

I'm pretty sure we'll see Jews and Arabs skipping down the streets of Palestine singing Kumbaya before physicians willingly give up the right to control the doling out of refills.

Though if it's done right, it would actually increase their business. As they come in for basic refills the pharmacist could chart any complaints or reports of symptoms and forward them to the physician...if severe enough, refer them back to the PCP. They could also still get the power script control by authorizing medication management for a patient for a set period of time or whatever.

I mean, use your imagination. Any one of many setups is superior to how the system runs now. We know, they know, everyone in the healthcare field knows that pharmacists know more about drugs in general and pharmacotherapy than anyone. That we don't have a bigger role in the selection of products is stupid. Academia has caught on. Pharmacists are on internal medicine teams in every major academic hospital in the country. Why? Because there is empirical evidence that pharmacists can increase drug efficacy and decrease patient morbidity when they have expanded roles in therapy. Anyone who has ever done a rotation where they were on a medicine team with a pharmacist knows what I'm talking about. Every day they make dozens and dozens of changes and suggestions that improve drug regimens.
 
WVUPharm2007 said:
Any one of many setups is superior to how the system runs now.

Anyone who has ever done a rotation where they were on a medicine team with a pharmacist knows what I'm talking about. Every day they make dozens and dozens of changes and suggestions that improve drug regimens.
Click to expand...
I saw the other thread...guess you really are leaning towards the clinical stuff. lol
 
What are you guys complaining about now? You can already script with a collaborative agreement, do coumadin scripts, manage HTN meds, etc.

I might even agree to "collaborate" with you if I get paid while you see all of my annoying patients who take up an hour of your time to ask BS questions about tiny pharmacological differences between teh different beta blockers. But you're not getting independent practice. If you wanted to play doctor you shoulda gone to med school.

Show me the money.
 
Why oh why does the pharmacy forum get only the nasty med students?
 
If a Pharmacist is the only health-care professional in a remote area (i.e. my cousin several years ago in the Appalachian Mountains) s/he should be given basic diagnosing authority. I agree WVU, i don't wanna touch all the gross stuff either, but IMO PharmD's are better educated than (no offense) PA's CRNA's etc, and I don't think there is anything wrong with refilling someones test strips (to clear insurance) and not having to fax the doctor...
 
Majic said:
If a Pharmacist is the only health-care professional in a remote area (i.e. my cousin several years ago in the Appalachian Mountains) s/he should be given basic diagnosing authority. I agree WVU, i don't wanna touch all the gross stuff either, but IMO PharmD's are better educated than (no offense) PA's CRNA's etc, and I don't think there is anything wrong with refilling someones test strips (to clear insurance) and not having to fax the doctor...
Click to expand...

You're being incredibly disingenuous. You and I both know that pharmacists have no interest in working in rural areas. The PAs/CRNAs/NPs/psychologists said the same thing. They got theri foot in the door and then used their newly usurped authority to run to the big cities just like everybody else.
 
You gotta love MacGyver. This is what he posted in the Allopathic forum:

http://forums.studentdoctor.net/showthread.php?p=6814039#post6814039

MacGyver said:
You guys dont get it. This isnt about knowledge, its about money. If pharmacists want to counsel patients, thats fine by me as long as it doesnt contradict my stuff.

What I do have a problem with is the pharmacy lobby trying to get Medicare/insurance reimbursement for these tasks.

Medicare is a zero sum game. When pharmacists bill medicare for their counseling services, it means doctors get paid less.
Click to expand...

At least he's honest with his intention but do take what he says with a huge grain of salt. He has his own political agenda. He knows what pharmacists can do and he knows it is a threat to his wallet.
 
How do you know? With that logic, no 3rd world countries would have any medical care 🙄. I guess doctors, being the generous people they are, would jump at the chance to forgo a lucrative practice to help those less fortunate...👍 BTW BMBiology, I LOVED your video "Confessions of a Former Drug Rep". Most definitely the white elephant in the room...
 
BMBiology said:
At least he's honest with his intention but do take what he says with a huge grain of salt. He has his own political agenda. He knows what pharmacists can do and he knows it is a threat to his wallet.
Click to expand...


Oh right, and meanwhile you are totally in favor of pharm techs getting increased autonomy and running their own pharmacies.

Excuse me while I vomit, you hypocrite.

Dont piss on my back and tell me its raining. At least I'm calling it like it is, this is about MONEY and nothing more. I laugh every time I hear one of you pharmacists come up with the crocodile tears and BS people with "we just want to help patients, we dont care about the money."
 
MacGyver said:
Oh right, and meanwhile you are totally in favor of pharm techs getting increased autonomy and running their own pharmacies.

Excuse me while I vomit, you hypocrite.
Click to expand...

I hate to quote myself....I posted this a while ago in another thread:

http://forums.studentdoctor.net/newreply.php?do=newreply&p=6536281

BMBiology said:
If nurses or physicians want to go into the dispensing business, then go ahead.

I also dont have a problem with a pharmacy tech who just graduated from high school and want to dispense. If patients feel it is cheaper to get their medications from a pharmacy tech or over the internet, then they may. I have no problem with that.
Click to expand...
 
WVUPharm2007 said:
F that, I don't want to touch people. I'll save rectal exams and playing with necrotized skin lesions to the suckers....er....physicians. You people don't understand how awesome our job is. We get to sit in the background and take care of the drugs in the nice, clean, pleasant smelling pharmacy while mister MD/DO/whatever has to give a pap smear to a Rosanne Barr looking woman that hasn't showered in 5 months....
Click to expand...

:laugh::laugh::laugh: OMG, that's awesome!
 
slimcutt said:
Actually, there is already a well established pathway for pharmacists who wish to practice as primary care providers. I think it's very exciting. The program is called medical school and does wonders to prepare people for these positions.
Click to expand...

:laugh:
 
WVUPharm2007 said:
F that, I don't want to touch people. I'll save rectal exams and playing with necrotized skin lesions to the suckers....er....physicians. You people don't understand how awesome our job is. We get to sit in the background and take care of the drugs in the nice, clean, pleasant smelling pharmacy while mister MD/DO/whatever has to give a pap smear to a Rosanne Barr looking woman that hasn't showered in 5 months.

I don't know why the hell anyone would go to pharmacy school to do that type of stuff. Hell, go become a PA or NP. It's less school for crying out loud.

PharmDs shouldn't be PCPs in any situation, anyway. In a perfect world, at best, pharmacotherapy would become its own specialty and patients would come to pharmacists for medication management AFTER using a physician for proper diagnostic workups. That won't happen though. Physicians use medication refills to get the come back like a drug dealer selling crack giving away the first sample hit. They won't let that stuff go easy...
Click to expand...

perfect! just gotta love this dude
 
I agree that a PharmD who has complete a residency or equivalent post graduate training should have prescribing powers under certain conditions (collaboration with a physician or managing chronic disease states like diabetes, dyslipidemia, HIV, etc). On my current rotation I had the chance to accompany medical residents in an outpatient clinic. There is without a doubt a need for pharmacists in this environment. I saw so many poor prescribing choices.

I DON'T agree that pharmacists should be primary care practioners in general. While the nasty medical student could have been a bit more diplomatic about it he was right. A pharmacist that wants to diagnose and treat should have gone to medical school. Based on my schooling thus far, I see pharmacists as being the best health care provider to manage and adjust a patients medications once a diagnosis has been made by a physician.
 
Are there actually pharmacists anywhere that WANT to diagnose? I don't know of any. Do any of you? Honestly, we may as well speculate about Front Desk Triage Clerk Practitioners as PCPs .....
 
WVUPharm2007 said:
PharmDs shouldn't be PCPs in any situation, anyway. In a perfect world, at best, pharmacotherapy would become its own specialty and patients would come to pharmacists for medication management AFTER using a physician for proper diagnostic workups. That won't happen though. Physicians use medication refills to get the come back like a drug dealer selling crack giving away the first sample hit. They won't let that stuff go easy...
Click to expand...

Of course they do, otherwise people would never come back to get whatever problem they have checked. If I were to give a guy 3 years of an ACE inhibitor, I certainly wouldn't see him for 3 years and there's no telling how often or if he'd ever check his own blood pressure. Same thing with OCPs and pelvic exams, diabetics (non-compliant diabetics would never, ever come back in), and of course the psychiatric patients. Those bipolar patients tend to dislike taking their medicine.

I wish it didn't have to be this way, honest truth I do feel kinda dirty about it sometimes. However, most of the physicians I've rotated with try to space out the visits as much as they can without getting nervous about what might happen to the patient.
 
VA Hopeful Dr said:
Of course they do, otherwise people would never come back to get whatever problem they have checked. If I were to give a guy 3 years of an ACE inhibitor, I certainly wouldn't see him for 3 years and there's no telling how often or if he'd ever check his own blood pressure. Same thing with OCPs and pelvic exams, diabetics (non-compliant diabetics would never, ever come back in), and of course the psychiatric patients. Those bipolar patients tend to dislike taking their medicine.

I wish it didn't have to be this way, honest truth I do feel kinda dirty about it sometimes. However, most of the physicians I've rotated with try to space out the visits as much as they can without getting nervous about what might happen to the patient.
Click to expand...

I never said it wasn't needed, I said that they would never allow PharmD directed pharmacotherapy because they need said power of the pill just like the crack dealer getting the come back by giving away the first hit. If pharmacists did that, they'd have nothing to kepp business.
 
Are New Mexico and North Carolina still the only states where Clinical Pharmacist Practitioners exist?
 
Pharmacists don't have enough training to diagnose and we have no business diagnosing. However, pharmacists do have a role in primary care. I rotated at the VA and those PharmDs are great disease state managers. I had the opportunity to sit down with patients and interview them. They were either Coumadin, diabetes, hypertension, or lipid patients. These PharmDs were used to optimize pharmacotherapy. I had the opportunity to adjust doses, etc., under the supervision of the clinical pharmacists. They also had prescribing power. It was one of the most rewarding rotations I did. I would love to see the role of pharmacists as disease state managers expand similar to what the VA system has. These pharmacists are valuable and well-respected members of the TEAM. The VA system really has the whole teamwork thing down, if only everyone could get on board with something like this. Each team consisted of 2 physicians, 2 clinical pharmacists, a nurse practitioner, and some RNs. Anyway, pharmacists are very qualified to manage these disease states as a form of primary care. But diagnosing is beyond our scope of practice. Coming across something and making a physician aware is one thing, but we don't have enough training to independently make a diagnosis. Like I said though, pharmacists still have a valuable role in primary care. Those that disagree either don't have a clue, or they feel threatened by pharmacists in this role.
 
GamecockPharmD said:
Pharmacists don't have enough training to diagnose and we have no business diagnosing. However, pharmacists do have a role in primary care. I rotated at the VA and those PharmDs are great disease state managers. I had the opportunity to sit down with patients and interview them. They were either Coumadin, diabetes, hypertension, or lipid patients. These PharmDs were used to optimize pharmacotherapy. I had the opportunity to adjust doses, etc., under the supervision of the clinical pharmacists. They also had prescribing power. It was one of the most rewarding rotations I did. I would love to see the role of pharmacists as disease state managers expand similar to what the VA system has. These pharmacists are valuable and well-respected members of the TEAM. The VA system really has the whole teamwork thing down, if only everyone could get on board with something like this. Each team consisted of 2 physicians, 2 clinical pharmacists, a nurse practitioner, and some RNs. Anyway, pharmacists are very qualified to manage these disease states as a form of primary care. But diagnosing is beyond our scope of practice. Coming across something and making a physician aware is one thing, but we don't have enough training to independently make a diagnosis. Like I said though, pharmacists still have a valuable role in primary care. Those that disagree either don't have a clue, or they feel threatened by pharmacists in this role.
Click to expand...

Fantastic post.
 
CYP3A4 said:
I agree that a PharmD who has complete a residency or equivalent post graduate training should have prescribing powers under certain conditions (collaboration with a physician or managing chronic disease states like diabetes, dyslipidemia, HIV, etc). On my current rotation I had the chance to accompany medical residents in an outpatient clinic. There is without a doubt a need for pharmacists in this environment. I saw so many poor prescribing choices.

I DON'T agree that pharmacists should be primary care practioners in general. While the nasty medical student could have been a bit more diplomatic about it he was right. A pharmacist that wants to diagnose and treat should have gone to medical school. Based on my schooling thus far, I see pharmacists as being the best health care provider to manage and adjust a patients medications once a diagnosis has been made by a physician.
Click to expand...

couldn't agree with you more.
 
GamecockPharmD said:
Pharmacists don't have enough training to diagnose and we have no business diagnosing. However, pharmacists do have a role in primary care. I rotated at the VA and those PharmDs are great disease state managers. I had the opportunity to sit down with patients and interview them. They were either Coumadin, diabetes, hypertension, or lipid patients. These PharmDs were used to optimize pharmacotherapy. I had the opportunity to adjust doses, etc., under the supervision of the clinical pharmacists. They also had prescribing power. It was one of the most rewarding rotations I did. I would love to see the role of pharmacists as disease state managers expand similar to what the VA system has. These pharmacists are valuable and well-respected members of the TEAM. The VA system really has the whole teamwork thing down, if only everyone could get on board with something like this. Each team consisted of 2 physicians, 2 clinical pharmacists, a nurse practitioner, and some RNs. Anyway, pharmacists are very qualified to manage these disease states as a form of primary care. But diagnosing is beyond our scope of practice. Coming across something and making a physician aware is one thing, but we don't have enough training to independently make a diagnosis. Like I said though, pharmacists still have a valuable role in primary care. Those that disagree either don't have a clue, or they feel threatened by pharmacists in this role.
Click to expand...

I bet you I could figure out how to diagnose hypertension, diabetes, and hyperlipidemia (without any of that magical training that you mention above). Not that I am stating I am interested in being a diagnostician (I am fine leaving that to physicians and nurses with a supplemental year of training), just wanting to make clear that this is actually quite simple both on an intellectual and technical level.

On a good day, I might even be able to diagnose a blood stream infection or SIADH!!
 
Priapism321 said:
I bet you I could figure out how to diagnose hypertension, diabetes, and hyperlipidemia (without any of that magical training that you mention above). Not that I am stating I am interested in being a diagnostician (I am fine leaving that to physicians and nurses with a supplemental year of training), just wanting to make clear that this is actually quite simple both on an intellectual and technical level.

On a good day, I might even be able to diagnose a blood stream infection or SIADH!!
Click to expand...

I won't argue that a lot of it is simple. Anyone can take blood pressure, use a glucometer, or look at a lipid panel. But what if we miss something. What if it is diabetes secondary to somatostatinoma, or even something like polycystic ovary syndrome that is causing insulin resistance? One could argue that the patient could be referred to a physician. One could argue that it might take a while for a physician to catch something like that. But I would hope that a physician would be better at figuring out something like that than a pharmacist would. Why should we take on the extra liability? We aren't going to get paid more for it. I'm content with knowing all the problems first and working off of that to improve patients' medication regimens. Your point is well taken, but not everything will be as simple as it seems. And I know the examples I used are probably ridiculous Gregory House ones but I'm just trying to get my point across.
 
Several of my colleagues are CPP's. They have to work under supervision of a physician and within a given protocol (e.g. anticoag) and they do diagnose and prescribe. They really do enjoy what they do.
 
WVUPharm2007 said:
F that, I don't want to touch people. I'll save rectal exams and playing with necrotized skin lesions to the suckers....er....physicians. You people don't understand how awesome our job is. We get to sit in the background and take care of the drugs in the nice, clean, pleasant smelling pharmacy while mister MD/DO/whatever has to give a pap smear to a Rosanne Barr looking woman that hasn't showered in 5 months.

I don't know why the hell anyone would go to pharmacy school to do that type of stuff. Hell, go become a PA or NP. It's less school for crying out loud.

PharmDs shouldn't be PCPs in any situation, anyway. In a perfect world, at best, pharmacotherapy would become its own specialty and patients would come to pharmacists for medication management AFTER using a physician for proper diagnostic workups. That won't happen though. Physicians use medication refills to get the come back like a drug dealer selling crack giving away the first sample hit. They won't let that stuff go easy...
Click to expand...

In an ideal future:
Physician diagnoses and finds out that patient has high cholesterol/BP/etc. and suggests pharmacotherapy --> Patient gets referred to pharmacotherapist --> Pharmacotherapist looks at patient's genome and finds out that drugs X,Y,Z in doses A,B,C taken at times P,Q,R should lead to optimal outcomes --> Patient undergoes pharmacotherapy for 4 months (gets the meds from InstyMeds) ---> Goes back to doctor and pharmacotherapist and sees that therapy is working well --> and they live happily ever after...

Now if we could only do something to make sure that those pharmacotherapists are actual pharmacotherapists and not just mofos with sub 2.0 GPAs who graduated from an online pharmacy school that you only needed a pulse and a computer to get into.
Make the NAPLEX harder, bomb these diploma mills, raise standards, etc.
 
GamecockPharmD said:
I won't argue that a lot of it is simple. Anyone can take blood pressure, use a glucometer, or look at a lipid panel. But what if we miss something. What if it is diabetes secondary to somatostatinoma, or even something like polycystic ovary syndrome that is causing insulin resistance? One could argue that the patient could be referred to a physician. One could argue that it might take a while for a physician to catch something like that. But I would hope that a physician would be better at figuring out something like that than a pharmacist would. Why should we take on the extra liability? We aren't going to get paid more for it. I'm content with knowing all the problems first and working off of that to improve patients' medication regimens. Your point is well taken, but not everything will be as simple as it seems. And I know the examples I used are probably ridiculous Gregory House ones but I'm just trying to get my point across.
Click to expand...

I completely agree with you. I don't think pharmacists should be in charge of diagnosis.
BUT, I do think that pharmacists should be in charge of all the drug therapy needs of a patient.
Ideally: Accurate Diagnosis (MD) ---> Pharmacotherapy (PharmD)

MDs are trained to accurately diagnose and PharmDs (at least the good ones) are trained to know what the best drug therapy is.
 
illegallysmooth said:
Fantastic post.
Click to expand...

It is a fantastic post but since graduating last year I have been working as a hospital pharmacist in a level 2 trauma center (500 beds) and have the pleasure of getting several calls a day from extremely confused mid-level practitioners (PA, ARNP, NP) that messed up an order or simply have no clue what they are prescribing. I am not picking on the PAs (i do believe they serve an important function) but it's a little insulting that they have prescribing power with just one year of post-grad courses and one year of rotations. I don't see why there shouldn't be a PharmD mid-level practioner in every state as well.

Anyhoo, I guess if I continue to record these frustrating phone calls as "interventions" I will have job security for a long time to come!
 
whitewasheddesi said:
I had to do an essay on Pharmacists' prescriptive authority throughout the US for my clinical skills class. I came across this article (i think in AJHP) about a clinic hiring a pharmacist (BCPS, since NM law requires a prescribing pharmacist to be BCPS to prescribe). The pharmacist was able to get his own DEA number. The clinic saved over 20,000 bucks.

I will post a link to my essay soon. Wonder if it will be of anyone to anyone
Click to expand...

Interesting. Can you please cite that reg? Thanks.
 
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