Doctors are so scared of our profession

[Kwiz]

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Don't be scared guys, you can always take your expertise training bus to your non-solo jobs

"Death of the Solo Practitioner is Almost Complete"

http://physiciansmoneydigest.com/yo...ris&utm_medium=Email&utm_campaign=PMD+7-13-12

 

[hereticmnk]

Don't be scared guys, you can always take your expertise training bus to your non-solo jobs

"Death of the Solo Practitioner is Almost Complete"

http://physiciansmoneydigest.com/yo...ris&utm_medium=Email&utm_campaign=PMD+7-13-12

Not really that surprising.. We pharmacists have long lost any autonomy, I am just surprised it took the doctors that long to lose theirs 🙁

 

[HoltMD]

If you pharmacists/pharmacy students are so eager to write prescriptions and play doctor then, why didn't you go to med school?

Pretty simple solution folks!

Just because one works as a construction worker does not mean that s/he is now a civil engineer.

 

[hereticmnk]

If you pharmacists/pharmacy students are so eager to write prescriptions and play doctor then, why didn't you go to med school?

Pretty simple solution folks!

Way to boil down a complicated issue into a simple sentence without reading any of the posts. Thank you soooo much for your insight 🙄

 

[notafraid87]

If you pharmacists/pharmacy students are so eager to write prescriptions and play doctor then, why didn't you go to med school?

Pretty simple solution folks!

Just because one works as a construction worker does not mean that s/he is now a civil engineer.

Get out of here, pre-med. Only med students/docs will get a good response. And cross out the MD for now, pre-med. Because...you're just a pre-med

 

[HoltMD]

Get out of here, pre-med. Only med students/docs will get a good response. And cross out the MD for now, pre-med. Because...you're just a pre-med

Spoken like a true pharmacy student. I know many and they are the dumbest group I have encountered thus far.

Nevertheless, they are very well suited for Walgreens and Walmart.

Way to boil down a complicated issue into a simple sentence without reading any of the posts. Thank you soooo much for your insight 🙄

It is not a complicated issue. Why don't you practice what you are trained to do? Sounds simple enough to me.

 

[owlegrad]

Wow, lets not let this spiral out of control. Obvious troll is obvious. Trolls hate to be ignored, so I recommend that we all just do that. 😉

 

[hereticmnk]

It is not a complicated issue. Why don't you practice what you are trained to do? Sounds simple enough to me.

There have been some good points made previously in this thread if you would like to go back and read them.

Current crop of pharmacists are trained to manage diseases, not diagnose them (that will be your job in the future). Any pharmacist with proper training can manage conditions like HTN, DM etc. change doses, formulations etc. Can add or delete therapy based on patient response.

Pharmacists already have the authority to prescribe in almost all states with the collaborative practice agreements and in independently in the VA system, which has been fine so far. Anyway these points are already stated before.

Idk if you are trolling or not because you speak in absolutes where as anyone with actual clinical experience would at least acknowledge the complexity of the situation.

 

[notafraid87]

Wow, lets not let this spiral out of control. Obvious troll is obvious. Trolls hate to be ignored, so I recommend that we all just do that. 😉

Alright, alright...but let me say one more thing...

Spoken like a true pharmacy student. I know many and they are the dumbest group I have encountered thus far.

Nevertheless, they are very well suited for Walgreens and Walmart.



It is not a complicated issue. Why don't you practice what you are trained to do? Sounds simple enough to me.

Spoken like a true pre-med student. I know many more and they are the dumbest group I have encountered thus far 😉

 

[BenJammin]

It is not a complicated issue. Why don't you practice what you are trained to do? Sounds simple enough to me.

If you want us to do what we're trained to do then let us do it. But you won't because the fact that we get so much training in pharmacological treatment of disease and have the expertise to monitor and provide appropriate therapy given a diagnosis is a threat to your job and paycheck.

Yet again, physician arrogance strikes again yet it's of the *****ic student variety. Keep hitting your head with the hammer buddy. I'm sure it will stop hurting eventually.

 

[pinipig523]

If you want us to do what we're trained to do then let us do it. But you won't because the fact that we get so much training in pharmacological treatment of disease and have the expertise to monitor and provide appropriate therapy given a diagnosis is a threat to your job and paycheck.

Yet again, physician arrogance strikes again yet it's of the *****ic student variety. Keep hitting your head with the hammer buddy. I'm sure it will stop hurting eventually.

And you guys have so much training in the diagnosis of disease that you are willing to write scripts for it?

 

[pinipig523]

Physician arrogance blows my mind.

And so does yours.

 

[pinipig523]

My preceptor just got a PGY1 physician doing rounds with us. I do pre rounds in the morning and then my preceptor rounds with me in the afternoon to check my work off.

This physician is only with us for 2 weeks. He already told me to take a break and give him all my patients (when originally I was going to give him half of my patients he wants them ALL.)

Okay, that's fine with me LESS WORK for me!

The WORST part of all this is he would call me every 20 minutes and ask me questions about the patient and ask me to teach him and hold his hand on the pre rounds! 🙄

I told him the required readings that must be done and he will always tell me he "forgot" to do them. He will ask me a million questions about the patients and what to do...YET he still thinks he should get ALL the patients and not let me work on any of them. (however, he wants to call me for "help" 100X a day! )

This ladies and gentlemen is a MD's attitude. 🙄

He is also don't listen...I told him to make a copy of the order after he write it and send it to the pharmacy and he says it's no need!

He also FORGOT to label the orders with the patients names!!!! The pharmacy had to call me and ask for the patient's names on each order! WTF....

So this is a MD for you. First time I ever worked with one and boy its real work.

And these guys are suppose to be the smartest of them all? I am not impressed at all after meeting this one...sorry.

That's ONE MD... save us your blanket conclusions. Some of us actually read. And all you pharmacists are the best in your class? What happened to your bell curve?

 

[pinipig523]

And this topic has been beaten down in a previous thread.

http://forums.studentdoctor.net/showthread.php?t=929136

Why would pharmacists want to pursue the ability to prescribe certain drugs when they are not trained to do so in pharmacy school? Your association cannot even control the number of schools opening, you cannot begin to tell me that you are graduating prime candidates from pharmacy school given that some states have schools in duplicity... yet you want to be given authority to perform an action beyond your standard training?

For what? So that your retail pharmacy giant can gain money from your prescription? You think WAGS will pay you extra for each script you write when you aren't even given a bonus for the numerous vaccinations you give at the counter?

 

[HoltMD]

Careful there! You may be categorized as a troll. I just received a formal warning.

I guess they don't want to engage in a thoughtful discussion, knowing that they are not qualified to diagnose and hence write a prescription. My question is, what if nurses decide that they should be able to dispense? What will pharmacists do?

And this topic has been beaten down in a previous thread.

http://forums.studentdoctor.net/showthread.php?t=929136

Why would pharmacists want to pursue the ability to prescribe certain drugs when they are not trained to do so in pharmacy school? Your association cannot even control the number of schools opening, you cannot begin to tell me that you are graduating prime candidates from pharmacy school given that some states have schools in duplicity... yet you want to be given authority to perform an action beyond your standard training?

For what? So that your retail pharmacy giant can gain money from your prescription? You think WAGS will pay you extra for each script you write when you aren't even given a bonus for the numerous vaccinations you give at the counter?

 

[notafraid87]

And this topic has been beaten down in a previous thread.

http://forums.studentdoctor.net/showthread.php?t=929136

Why would pharmacists want to pursue the ability to prescribe certain drugs when they are not trained to do so in pharmacy school? Your association cannot even control the number of schools opening, you cannot begin to tell me that you are graduating prime candidates from pharmacy school given that some states have schools in duplicity... yet you want to be given authority to perform an action beyond your standard training?

For what? So that your retail pharmacy giant can gain money from your prescription? You think WAGS will pay you extra for each script you write when you aren't even given a bonus for the numerous vaccinations you give at the counter?

Watch it. Questioning a pharm graduate's qualifications solely based on a no-name school is not what I expected from an attending physician.

It's very discouraging to hear someone like you asking questions that we have heard over and over...and we know the answer. IMHO, I do believe that pharmacists lack sufficient training, so giving prescribing rights might not be a bright idea. On the other hand, why not let pharmacist play limited role in prescribing medicine (ie during emergency, prescribe currently used medicine, etc.)

And what the heck is with the last paragraph? We know a lot about WAGS and their schemes, thank you very much.

 

[naseuy]

That's ONE MD... save us your blanket conclusions. Some of us actually read. And all you pharmacists are the best in your class? What happened to your bell curve?

There are some very bad medical interns/residents, and there are also some dumb as brick pharmacy interns/pharmacists.

And this topic has been beaten down in a previous thread.

http://forums.studentdoctor.net/showthread.php?t=929136

Why would pharmacists want to pursue the ability to prescribe certain drugs when they are not trained to do so in pharmacy school? Your association cannot even control the number of schools opening, you cannot begin to tell me that you are graduating prime candidates from pharmacy school given that some states have schools in duplicity... yet you want to be given authority to perform an action beyond your standard training?

For what? So that your retail pharmacy giant can gain money from your prescription? You think WAGS will pay you extra for each script you write when you aren't even given a bonus for the numerous vaccinations you give at the counter?

I am inclined to agree that pharmacists in the community should not introduce new medications for a patient. In this setting, pharmacists simply do not have the full picture. Yes, the VA model is very efficient, and pharmacist run clinics are effective, however, retail pharmacies do not have access to all the necessary patient information to introduce new agents.

It is not a complicated issue. Why don't you practice what you are trained to do? Sounds simple enough to me.

What do you think pharmacists are trained to do?

Additionally, feel free to participate in "thoughtful discussion", but the language that you are using is clearly inflammatory and adds nothing to the discussion. Try harder.

 

[BenJammin]

And you guys have so much training in the diagnosis of disease that you are willing to write scripts for it?

I never said we can diagnose, I said we can provide appropriate treatment if given a diagnosis. You guys don't even want to hear what we have to say, do you? Leave that to the AMA lol

 

[BenJammin]

Why would pharmacists want to pursue the ability to prescribe certain drugs when they are not trained to do so in pharmacy school?

WE ARE! THAT'S THE DAMN POINT! We are trained to do that if you give us a diagnosis.

 

[All4MyDaughter]

And this topic has been beaten down in a previous thread.

http://forums.studentdoctor.net/showthread.php?t=929136

Why would pharmacists want to pursue the ability to prescribe certain drugs when they are not trained to do so in pharmacy school? Your association cannot even control the number of schools opening, you cannot begin to tell me that you are graduating prime candidates from pharmacy school given that some states have schools in duplicity... yet you want to be given authority to perform an action beyond your standard training?

For what? So that your retail pharmacy giant can gain money from your prescription? You think WAGS will pay you extra for each script you write when you aren't even given a bonus for the numerous vaccinations you give at the counter?

There are more medical schools in the US than pharmacy schools. Does the number of medical schools (and the number currently in development) mean that medical graduates are subpar? And that states that have schools "in duplicity" (I think you mean multiple schools in one state?) have physicians of lower quality? I'll be sure to stay out of California, Ohio, and Texas.

 

[SHC1984]

That's ONE MD... save us your blanket conclusions. Some of us actually read. And all you pharmacists are the best in your class? What happened to your bell curve?

Fair enough it's just one MD. I hope the others ones I work with in the future are much better.

I did not have a problem with him wanting to learn more and therefore want all the patients, BUT if you want to learn more than you should be able to look up the patient's chart, READ IT and find out more about the patient. I should not have to tell you the patient's medical history, disease state, and other very simple stuff that you can easily look up yourself.

I would never ask anyone anything unless it's something that I have NO way of knowing without asking.

Lastly, you are right....I do NOT want prescribing ability...unless my salary is going to increase to 200K a year, I do NOT want extra work for the same pay. LOL

 

[hereticmnk]

I mean tbh there have been people from the pharmacy side using inflammatory language also.

The future is great for pharmacist (as a profession, oversupply ignored) especially with the formation of the Accountable Care Organizations. There is going to be a dearth of PCP's in the coming years and pharmacists need to step up to fill that role. The NP and PA will probably also try and fill that void.

 

[naseuy]

I mean tbh there have been people from the pharmacy side using inflammatory language also.

The future is great for pharmacist (as a profession, oversupply ignored) especially with the formation of the Accountable Care Organizations. There is going to be a dearth of PCP's in the coming years and pharmacists need to step up to fill that role. The NP and PA will probably also try and fill that void.

That's true, even the title of this thread is a bit provocative.

 

[pinipig523]

WE ARE! THAT'S THE DAMN POINT! We are trained to do that if you give us a diagnosis.

That's the thing - the diagnosis may be there, it may be existing. But it's still not as simple to prescribe a drug based on the diagnosis. There are many instances in which a secondary issue arises that is not immediately visible that you may need further w/up for and not simply a drug refill.

There's just too much liability and this is fraught with issues that I just don't see how it is completely viable without pharmacists getting liability insurance and extra training.

Fair enough it's just one MD. I hope the others ones I work with in the future are much better.

I did not have a problem with him wanting to learn more and therefore want all the patients, BUT if you want to learn more than you should be able to look up the patient's chart, READ IT and find out more about the patient. I should not have to tell you the patient's medical history, disease state, and other very simple stuff that you can easily look up yourself.

I would never ask anyone anything unless it's something that I have NO way of knowing without asking.

Lastly, you are right....I do NOT want prescribing ability...unless my salary is going to increase to 200K a year, I do NOT want extra work for the same pay. LOL

Yes, if they increased pay - hey... I'm sure my wife and brother would be all for it. So would I.

I mean tbh there have been people from the pharmacy side using inflammatory language also.

The future is great for pharmacist (as a profession, oversupply ignored) especially with the formation of the Accountable Care Organizations. There is going to be a dearth of PCP's in the coming years and pharmacists need to step up to fill that role. The NP and PA will probably also try and fill that void.

Exactly.

Watch it. Questioning a pharm graduate's qualifications solely based on a no-name school is not what I expected from an attending physician.

It's very discouraging to hear someone like you asking questions that we have heard over and over...and we know the answer. IMHO, I do believe that pharmacists lack sufficient training, so giving prescribing rights might not be a bright idea. On the other hand, why not let pharmacist play limited role in prescribing medicine (ie during emergency, prescribe currently used medicine, etc.)

And what the heck is with the last paragraph? We know a lot about WAGS and their schemes, thank you very much.

1. I'm not questioning this particular guy's qualifications - I'm restating the same facts that you guys are spouting out in your forum. That there are tons of new schools opening up, who knows what their credentials are, who knows what kind of pharmacists they graduate (because they are new, obviously). I'm sure becoming a pharmacist is easier now (say, in IL) where there are at least 6 schools whereas 5 years ago there were only 3 and 1 was way south. But that's for another thread.

2. I'm all for helping out the common folk/patients. But to give pharmacists who have no training prescription privileges (even for certain drugs), that's asking for trouble UNLESS you've completed a residency on it. I will concede - you complete a residency in following patients at a PCP office, you can write a script.

3. WAGS and their schemes need to be discussed over and over. They are taking advantage of YOU guys.

 

[All4MyDaughter]

That there are tons of new schools opening up, who knows what their credentials are, who knows what kind of pharmacists they graduate (because they are new, obviously). I'm sure becoming a pharmacist is easier now (say, in IL) where there are at least 6 schools whereas 5 years ago there were only 3 and 1 was way south. But that's for another thread.

As long as you concede that the same issues exist in the medical profession with all the new schools.

 

[owlegrad]

Every forum on SDN has home field advantage. If any user from pharmacy dropped in on the MD forums and said they are the dumbest group of people they ever meet, they would get an infraction. We do not allow people from other professions to drop in and insult the other professions. That has also been SDN's policy. To me it also seems like common sense, but maybe not.

Thoughtful discussion welcome, blanket insults on the entire profession are not. 😉

 

[joetrisman]

NP have what, like 500 clinical hours and have prescribing rights? I'm fairly fresh in my career and naive, but considering the training I've had thus far, I'd say at least the newer pharmacists could be able to handle run of the mill chronic disease states like DM, HTN, asthma, etc. POC testing devices have really made a lot of this more feasible imo. However, with the way most of retail is right now, I'd say thanks but no thanks. For this to really pan out, I think you'd need postgrad trained and/or certified clinical community pharmacist that did only that and other pharmacist dispensing/verifying. I'd like to see the split in community into different paths and the chains supporting the expanded scope financially by hiring more rphs, setting up offices for consultations, vaccines, etc, but I doubt it will pan out anytime soon if at all.

 

[BenJammin]

That's the thing - the diagnosis may be there, it may be existing. But it's still not as simple to prescribe a drug based on the diagnosis. There are many instances in which a secondary issue arises that is not immediately visible that you may need further w/up for and not simply a drug refill.

We're trained for that as well. Keep throwing them and I'll hit them out of the park.

 

[pinipig523]

We're trained for that as well. Keep throwing them and I'll hit them out of the park.

How are you trained for that?

 

[pinipig523]

Every forum on SDN has home field advantage. If any user from pharmacy dropped in on the MD forums and said they are the dumbest group of people they ever meet, they would get an infraction. We do not allow people from other professions to drop in and insult the other professions. That has also been SDN's policy. To me it also seems like common sense, but maybe not.

Thoughtful discussion welcome, blanket insults on the entire profession are not. 😉

I always thought it was most professional to keep the insults to a minimum. I come here and the first several threads are bashing MDs. And then someone echoes a sentiment that most pharmacists are fearing (new schools, etc) and then I get picked out as the bad guy? How does that work? We are all professionals - be professional.

 

[pinipig523]

NP have what, like 500 clinical hours and have prescribing rights? I'm fairly fresh in my career and naive, but considering the training I've had thus far, I'd say at least the newer pharmacists could be able to handle run of the mill chronic disease states like DM, HTN, asthma, etc. POC testing devices have really made a lot of this more feasible imo. However, with the way most of retail is right now, I'd say thanks but no thanks. For this to really pan out, I think you'd need postgrad trained and/or certified clinical community pharmacist that did only that and other pharmacist dispensing/verifying. I'd like to see the split in community into different paths and the chains supporting the expanded scope financially by hiring more rphs, setting up offices for consultations, vaccines, etc, but I doubt it will pan out anytime soon if at all.

I would agree with you, an expanded scope with further training - yes, I'm very comfortable with that.

 

[pinipig523]

As long as you concede that the same issues exist in the medical profession with all the new schools.

I don't think new medical schools opening are as rampant as new pharmacy schools opening. I've been in the Chicago area all my life and the same medical schools that exist there, still exist today. Meanwhile, pharmacy schools tripled in that area.

If you have numbers and data, I would definitely like to see it for my own edification.

 

[All4MyDaughter]

I always thought it was most professional to keep the insults to a minimum. I come here and the first several threads are bashing MDs. And then someone echoes a sentiment that most pharmacists are fearing (new schools, etc) and then I get picked out as the bad guy? How does that work? We are all professionals - be professional.

Owle is correct about the home court advantage policy. It's in the terms of service. You can't come into a forum and insult the home profession. The same protection is afforded to the MDs in your home forums.

 

[All4MyDaughter]

I don't think new medical schools opening are as rampant as new pharmacy schools opening. I've been in the Chicago area all my life and the same medical schools that exist there, still exist today. Meanwhile, pharmacy schools tripled in that area.

If you have numbers and data, I would definitely like to see it for my own edification.

It's easy enough to verify. There are a 160 or so medical schools with about 20 or so in development. In my home state, there are two pharmacy schools and three medical schools. The 3rd medical school and 2nd pharmacy school are recent (last decade or so) arrivals and the 3rd medical school is easily considered to be one of the worst in the country, if you believe posters on SDN. I'm just saying your profession is not immune to the forces that are currently at work in the pharmacy profession.

 

[pinipig523]

Owle is correct about the home court advantage policy. It's in the terms of service. You can't come into a forum and insult the home profession. The same protection is afforded to the MDs in your home forums.

Fair enough - home court it is.

But even if it's not on terms of service - it's still not professional to insult another profession, especially 2 that work together and side-by-side.

In my years at the ER forum, I don't recall any rampant pharmacist bashing and I have never uttered a word of insult to YOU guys. I merely stated a point that was beaten down by many threads on this forum - including the "Diploma Mill" thread.

 

[pinipig523]

It's easy enough to verify. There are a 160 or so medical schools with about 20 or so in development. In my home state, there are two pharmacy schools and three medical schools. The 3rd medical school and 2nd pharmacy school are recent (last decade or so) arrivals and the 3rd medical school is easily considered to be one of the worst in the country, if you believe posters on SDN. I'm just saying your profession is not immune to the forces that are currently at work in the pharmacy profession.

Fine, then we're all screwed.

 

[All4MyDaughter]

Fair enough - home court it is.

But even if it's not on terms of service - it's still not professional to insult another profession, especially 2 that work together and side-by-side.

In my years at the ER forum, I don't recall any rampant pharmacist bashing and I have never uttered a word of insult to YOU guys. I merely stated a point that was beaten down by many threads on this forum - including the "Diploma Mill" thread.

Oh I agree that it's unprofessional, but it's rampant on SDN and it's not just pharmacists blowing off steam about prescribers. It's gas guys venting about surgeons, specialists making fun of PCPs, physicians telling pharmacists to "shut up and count pills," everyone venting about nurses, etc. There's no point in getting upset about it because it happens on SDN and IRL. But, we do enforce the "home court advantage" to give our professions a break from outsiders trolling their forums or people coming in just to start stuff.

 

[pinipig523]

I think this is partially due to greed and partially a safety concern. How is a pharmacist filling several hundred rxs per day going to have time to order/interpret labs, evaluate a patient, monitor patient, etc? Pharmacists barely have time to do all the crap that they already have to do. Imagine having to get a BP on every patient who walks through your door wanting a new rx for HTN meds. This new class of meds will spell nothing but trouble for pharmacists. Authorizing refills ad infinitum is just going to hurt the patients as well since they do need to be seen to make sure the current therapy is effective. I honestly don't see which healthcare professionals would benefit from this since it will just make everyone's life more difficult.

Probably the best post I've seen on this issue in a while.

 

[pinipig523]

Oh I agree that it's unprofessional, but it's rampant on SDN and it's not just pharmacists blowing off steam about prescribers. It's gas guys venting about surgeons, specialists making fun of PCPs, physicians telling pharmacists to "shut up and count pills," everyone venting about nurses, etc. There's no point in getting upset about it because it happens on SDN and IRL. But, we do enforce the "home court advantage" to give our professions a break from outsiders trolling their forums or people coming in just to start stuff.

Just because it's rampant, doesn't mean it's right. I don't sling these negative phrases around. But what do I know, I don't belong here.

 

[pinipig523]

Don't even get me started...

Physician arrogance blows my mind.

Benj -

Why the animosity? Care to explain your position?

 

[All4MyDaughter]

Just because it's rampant, doesn't mean it's right. I don't sling these negative phrases around. But what do I know, I don't belong here.

Oh no, the "I'm going to take my toys and go home" response. I ignore that from my kids and I should ignore it from you.

But really, this thread started going off track when some pre-med kid showed up and started trolling. I don't even see that many posts insulting MDs in this thread. 😕

Unless you are talking about SHC, and you spend enough time in this forum to know that her drivel is hardly representative of the majority of us.

 

[notafraid87]

That's the thing - the diagnosis may be there, it may be existing. But it's still not as simple to prescribe a drug based on the diagnosis. There are many instances in which a secondary issue arises that is not immediately visible that you may need further w/up for and not simply a drug refill.

There's just too much liability and this is fraught with issues that I just don't see how it is completely viable without pharmacists getting liability insurance and extra training.



Yes, if they increased pay - hey... I'm sure my wife and brother would be all for it. So would I.



Exactly.



1. I'm not questioning this particular guy's qualifications - I'm restating the same facts that you guys are spouting out in your forum. That there are tons of new schools opening up, who knows what their credentials are, who knows what kind of pharmacists they graduate (because they are new, obviously). I'm sure becoming a pharmacist is easier now (say, in IL) where there are at least 6 schools whereas 5 years ago there were only 3 and 1 was way south. But that's for another thread.

2. I'm all for helping out the common folk/patients. But to give pharmacists who have no training prescription privileges (even for certain drugs), that's asking for trouble UNLESS you've completed a residency on it. I will concede - you complete a residency in following patients at a PCP office, you can write a script.

3. WAGS and their schemes need to be discussed over and over. They are taking advantage of YOU guys.

1. Can't speak for all pharmacists, but I'm sure most agree that we're worried about number of new pharmacy schools (ie RFU, TJU, FDU, etc). But here's where you're wrong: we certainly don't question their training. You really think a new pharmacy school would receive accreditation automatically? Schools that are approved are legit, plain and simple.
What about the new medical schools, such as Hofstra-LIJ, Central Michigan, or another in CA? Do you question their credentials and training given to their students? And what about DO students? Becoming a doctor is getting a tad easier, I guess.

2. I wholeheartedly agree with you on this comment (surprise). I certainly would want a well-trained pharmacist to receive prescription privileges, compared to someone working in retail for their entire career (no offense, guys).

3. If you come visit our forum more often, you'll see that we ALWAYS keep a close eye on Wags/CVS/DR/and other retails. Problem is, we're helpless. Don't think we could convince the retail leaders to listen and reach out.

 

[joetrisman]

Problem is, we're helpless. Don't think we could convince the retail leaders to listen and reach out.

Eh, I think the ideal thing would be to move to ND where pharmacies are legally required to be owned by pharmacists and not bean counters. I just need to get the wife on board

 

[group_theory]

Hypothetical - you have a patient on a statin (initiated by a pharmacist after a patient brings a copy of his labwork showing he has high cholesterol). Let's say the doctor has told the patient he has high cholesterol but declined to start a new med (I know, rare!!!). The patient thinks he needs meds for his dyslipidemia ("ask your doctor/pharmacist if *this statin* is right for you" is very effective public campaign). That pharmacist also ordered routine labwork which initially shows normal LFTs but later on, shows elevated LFTs. You tell the patient to stop the statins. LFTs still remain elevated. How will you proceed with the workup?

(if you refer to GI - their waitlist can be months, and the patient's abnormal lab will still be your responsibility even if the patient is lost to follow-up. if you refer to PCP, he/she will punt it back to "the ordering provider" to do the workup)

Let's say the down the road, the patient never sees GI (since the referral was 6-8 months ago, and he is feeling fine). Will he continue to have periodic follow-up of his LFTs? Let's say years from now, he has end-stage liver disease - thanks to the current medical-legal environment, the lawyer will argue that the pharmacist missed the opportunity to diagnose early liver disease and intervene. It's one of the leading causes of medical malpractice lawsuits (missed early diagnosis). Yes, the patient should have follow-up as you recommended (contributory negligence) but you're still on the hook (did you continue to check labs? did you send certified mail asking him to return for labs? did you send certified mail asking him to follow up with GI because he missed his appointment? did you follow-up with any imaging results? did you order any liver biopsy? did you order any autoimmune workup? did you order any hepatitis panel? Do you have a system in place to do the above (especially at a retail level)? My guess is that is one reason why pinipig523 rarely starts someone on a statin in the ED, probably because his group doesn't want the additional liability and inability to conduct long term follow-up,


The VA system works great for the above because they are a closed system (same computer network), pharmacists operate with a collaborative agreement (so PCP can't punt it back to the pharmacists if something warrants further workup), the VA will hound vet if there is a miss appointment, and any lawsuit is not against any individual but against the federal government (and the US Department of Justice will defend the VA and you)


*state laws and court cases will vary amongst states. Contributary negligence is also handled differently in each states - some may reduce the jury by the porportioned amount, others will still make you fully liable unless the contributary negligence is greater than 50%. Contributary negligence is determined by a jury. And they are good at determining how much of your money and assets should go to the plantiff.


If the right system is set up (appropriate follow-ups, agreement between doctors to follow-up on abnormal labs) and the pharmacists are appropriately train (frankly, I think some sort of ambulatory or clinical residency for pharmacist is neccessary for this to occur - the graduating pharmacy student just doesn't have enough clinical experience yet - based on my experience working with lots of pharmacy students on rotations - now the residency educated pharmacists - smart bunch they are 🙂), I can support such a system. A PCP's office is busy enough (which is why they will punt it back to you, they don't want the extra work, extra headache, and extra liability) that they may be willing to work with a local pharmacist for this type of agreement. In an office settings, they sometimes spend an extra (uncompensated) hour or two just filling out prescription fax request (or patient phone-in request) or pharmacy request.

**now if it is something like changing capsules to tablets, small size tube of cream to large size tube of cream, or cream to ointment change, or changing from nexium to omeprazole, or nasonex to fluticasone nasal - I'm all for it (relatively benign changes that creates hassle on both ends, doesn't need major follow-ups, and generally harmless to the patient). Sometimes it may be patient reference (oh, I want nexium, that omeprazole never works for me, etc). Don't need to be residency educated to do those things too 😛


In terms of expansion of medical school .... I agree (especially with DO schools, but also new LCME MD schools, and expanded class sizes in existing schools). But there is a difference. The rate limiting step in producing new physicians will be residency training (and the numbers are relatively fixed since it cost lots of money to operate and run residencies) ... residency training (or at least one year of residency training) is required in order to get a state license. For pharmacy right now, residency is optional, and all the graduates from all the pharmacy schools (old,established vs news) can get licensed without residency if they fulfill all other requirements (although it seems intern hours are becoming harder to obtain and may be the roadblock in the future)


As for SHC1984, July interns are interesting bunch. I still can't figure out what rotation that intern is on that will have him work directly with pharmacy and have him take pharmacy patients (since he took patients from you). Also, it's July - he is new to the hospital, new to the computer system, and new to whatever policies the hospital have. He should have a senior resident (who should be watching him like a hawk) and an attending physician who is supervising him. He shouldn't be having to run to you for questions (and why is pharmacy calling a pharmacy student for clarification instead of your preceptor if the errors on the orders was made by the PGY1? it's not like you can correct it). But there are some interns who just plain SUCK. But I've seen a lot who fumble early on, and really pick up their game to become strong residents and very good physicians. Residency is a big (and rapid) learning curve. Also, depending on his background, this may be his first exposure to US healthcare (although I've seen some US MDs also suck as July interns)

long rant, some of it on a soap box, thanks for letting me rant

 

[eagles22]

As long as you concede that the same issues exist in the medical profession with all the new schools.

I don't think this analogy is quite accurate.

The difference between med school and pharm with regard to the number of schools is that med students are required to complete a residency to be a full independent practitioner that doesn't have his/her work supervised. This takes years. Pharmacy schools can pump out grads that practice months after graduation with no supervision. You worry about all these new pharmacy schools because you do not have this second stage of quality control with grads.

 

[Pharmacy Kid]

And you guys have so much training in the diagnosis of disease that you are willing to write scripts for it?

The majority of the pharmacists at my place have prescriptive authority . . . just saying.

 

[Pharmacy Kid]

I would agree with you, an expanded scope with further training - yes, I'm very comfortable with that.

Ok, I think I'm starting to see your view. You don't want every single community pharmacist to be able to authorize refills with physician consent. You want pharmacists with additional training like pgy-1 or certificate to have that "perk". I guess that makes sense.

 

[southpharmindy]

I think if there was a change in pharmacy curriculum with more of an emphasis on diagnostics. Then you have a mandatory 2 year residency to go along with 2 years of practical training on rotations. You could also have this pharmacist be under the direct supervision of a Physician for at least a year.

I think this would make an extremely good midlevel practitioner.

 

[Rx MPLS]

I think if there was a change in pharmacy curriculum with more of an emphasis on diagnostics. Then you have a mandatory 2 year residency to go along with 2 years of practical training on rotations. You could also have this pharmacist be under the direct supervision of a Physician for at least a year.

I think this would make an extremely good midlevel practitioner.

Probably, but I have no interest whatsoever in diagnosing, and I don't think I'm unique in feeling this way (at least among pharmacy students). If I did want to diagnose, I would have gone to med school! I like that I don't have to physically touch people except for doing blood pressures/quick screens (like cholesterol), etc. I don't want to palpate. I'll leave that to the MDs and ODs. 🙂

One other person mentioned that the title of this thread is inflammatory. I'd agree -- not so professional. We all have our roles; let's not just jump to attack others without understanding where they are coming from first. Besides, saying doctors are so scared of our profession sounds really middle school.

 

[eagles22]

I think if there was a change in pharmacy curriculum with more of an emphasis on diagnostics. Then you have a mandatory 2 year residency to go along with 2 years of practical training on rotations. You could also have this pharmacist be under the direct supervision of a Physician for at least a year.

I think this would make an extremely good midlevel practitioner.

You just described medical school.