I have two questions in this thread.

[SeekerofTruth]

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1) If MDs and other doctors can prescribe medication, why can't they dispense it as well?

It was just a thought. Doesn't it show incompetence in the part of prescribers that they need pharmacists to look over their work?

2) How difficult is it to become a pharmacist in industry?

3) This is just an agree or disagree statement.
Pharmacists, as well as Ph.Ds, MDs, DDS, ED.D, and all the other doctorate holders go through so much schooling. They all have earned the right to be called "Doctor."

 

[owlegrad]

1) If MDs and other doctors can prescribe medication, why can't they dispense it as well?

It was just a thought. Doesn't it show incompetence in the part of prescribers that they need pharmacists to look over their work?

2) How difficult is it to become a pharmacist in industry?

3) This is just an agree or disagree statement.
Pharmacists, as well as Ph.Ds, MDs, DDS, ED.D, and all the other doctorate holders go through so much schooling. They all have earned the right to be called "Doctor."

1) They can. Seriously. No joke, they can dispense. For real.

2) It's an 8.

3) Agree, you have the right - but I don't plan on using it myself. I don't need my ego stroked.

 

[SeekerofTruth]

ahha yeah I know, I wasn't going to ask the third one and then I just forgot.

I plan on working hard my entire life. I HAVE worked hard till date. I think that when I obtain a PharmD and when everyone else obtains a doctorate, they have earned the right to have the respect they deserve.
To each his/her own I suppose.

That means pharmacists SHOULD do something other than simply dispense in retail. right?

 

[crazybob]

The only time I've seen a physician "dispense" something was when he brought in a box of Nasonex and gave me the spray to use it, and told me how to use it.

 

[SeekerofTruth]

The only time I've seen a physician "dispense" something was when he brought in a box of Nasonex and gave me the spray to use it, and told me how to use it.

My physician has given me sprays for congestion. That's it. I'm just saying, if they can prescribe it, why can't they dispense?

Incompetence if you ask me.

 

[Rockinacoustic]

Free samples at your PCP's office raises an interesting point. Are there any protocols or guidelines that determine which drugs can be given as free samples, essentially without a pharmacist dispensing them?

 

[SHC1984]

1) in order for a physician to dispense a prescription he would have to have a pharmacy inside his practice. I am not sure if it's against the law or not but I guess if a physician wants to open up a pharmacy inside his practice and diagonse a illness and then go to the pharmacy and give the patient their prescription that sounds like a good idea to me! Not sure about the laws of that though...but I don't see why can't a physican open up a pharmacy inside his practice.

2) industry is very competitive. EVERYTHING is very competitive. If you graduate now expect to apply to a job with 20 or more people also wanting the same job as you. That's for every field of pharmacy. Nothing is "easy" to get into anymore.

3) I agree with Owlegrad on this one. If you demand someone to call you a doctor then you are a douche bag. I had a professor one time that demand a student call her doctor. The student accidently called her Ms and she got pissed off! That is beyond stupid...if you have to be call doctor to improve your self esteem then there is something WRONG with you. I personally prefer everyone call me by my first name. Doctor makes me sound like a old man. No thanks! 🙂

 

[PharmD RPh]

1) in order for a physician to dispense a prescription he would have to have a pharmacy inside his practice. I am not sure if it's against the law or not but I guess if a physician wants to open up a pharmacy inside his practice and diagonse a illness and then go to the pharmacy and give the patient their prescription that sounds like a good idea to me! Not sure about the laws of that though...but I don't see why can't a physican open up a pharmacy inside his practice.

2) industry is very competitive. EVERYTHING is very competitive. If you graduate now expect to apply to a job with 20 or more people also wanting the same job as you. That's for every field of pharmacy. Nothing is "easy" to get into anymore.

3) I agree with Owlegrad on this one. If you demand someone to call you a doctor then you are a douche bag. I had a professor one time that demand a student call her doctor. The student accidently called her Ms and she got pissed off! That is beyond stupid...if you have to be call doctor to improve your self esteem then there is something WRONG with you. I personally prefer everyone call me by my first name. Doctor makes me sound like a old man. No thanks! 🙂

Yes a physician can dispense but by doing so would have to meet all the legal requirements of a pharmacy. There is now a trend of pain management physicians dispensing out of their office which is bogus IMO. It's also stupid for a physician to try to dispense out of the officeon a regular basis or for anything besides samples. Pharmacists are an integral part of checks and balances. Take us out of the equation and I think you've got a lot of problems on your hand.

 

[crazybob]

3) I agree with Owlegrad on this one. If you demand someone to call you a doctor then you are a douche bag. I had a professor one time that demand a student call her doctor. The student accidently called her Ms and she got pissed off! That is beyond stupid...if you have to be call doctor to improve your self esteem then there is something WRONG with you. I personally prefer everyone call me by my first name. Doctor makes me sound like a old man. No thanks! 🙂

It's very common to call them "Dr. ____" if they are a professor and have a PharmD or a PhD.

Some (PhD) professors will tell you that they worked to hard for their doctorate to be called Mr. ___ or Ms. ___.

 

[owlegrad]

It's very common to call them "Dr. ____" if they are a professor and have a PharmD or a PhD.

Some (PhD) professors will tell you that they worked to hard for their doctorate to be called Mr. ___ or Ms. ___.

This brings up an interesting point bob. In the academic setting basically everyone who has a PhD expects to be called by Dr. because they worked too hard not to be. But that's not the case in basically in other setting. The PhD holders I worked with at The Smithsonian didn't use the honorific, and we all know that few PharmD's use it. I don't plan to use it, except with my family😉.

So what do you think? Is it just another example of pretentiousness, or do academics have the right idea demanding that people address them properly?

 

[crazybob]

This brings up an interesting point bob. In the academic setting basically everyone who has a PhD expects to be called by Dr. because they worked too hard not to be. But that's not the case in basically in other setting. The PhD holders I worked with at The Smithsonian didn't use the honorific, and we all know that few PharmD's use it. I don't plan to use it, except with my family😉.

So what do you think? Is it just another example of pretentiousness, or do academics have the right idea demanding that people address them properly?

I think it would depend on the relationships you have with the pharmacists.

I've heard of a P4 student on a rotation with a pharmacist calling the preceptor by his first name while I referred to the pharmacist as "Dr. ____"

 

[VA Hopeful Dr]

1) If MDs and other doctors can prescribe medication, why can't they dispense it as well?

It was just a thought. Doesn't it show incompetence in the part of prescribers that they need pharmacists to look over their work?

Many states have laws preventing physicians from owning pharmacies, for the obvious self-referral issue.

Samples are different because you can't charge for them.

 

[Jabberwocky12]

Many states have laws preventing physicians from owning pharmacies, for the obvious self-referral issue.

Samples are different because you can't charge for them.

Not to mention that most doctors don't readily have the same drug knowledge for interactions as a pharmacist would. Most doctors know a handful/formulary of drugs relating to their specialty and to some related specialties so they can work with a patient but sometimes a therapy is just wildly "out there." A pharmacist is there to double-check a patient is getting the right medicine, and the pharmacy also serves as a hub to make sure the patient isn't getting multiple interactions the doctor might not know about due to other doctors.

Some people could get the same/similar meds from an ER doc, specialist, and general practitioner and none of them know it. Or worse, conflicting drugs. The whole point is a check-and-balance to make sure there aren't any screw ups. A specialist to find out what is wrong with a patient is used, then a specialist to determine valid/optimal treatment is used.

 

[PharmD RPh]

👍

Not to mention that doctors don't have the drug knowledge for interactions. Most doctors know a handful of drugs relating to their specialty. But a pharmacy is there to double-check a patient is getting the right medicine, and the pharmacy also serves as a hub to make sure the patient isn't getting multiple interactions the doctor might not know about due to other doctors.

Some people could get the same/similar meds from an ER doc, specialist, and general practitioner and none of them know it. Or worse, conflicting drugs. The whole point is a check-and-balance to make sure there aren't any screw ups. A specialist to find out what is wrong with a patient is used, then a specialist to determine valid/optimal treatment is used.

👍

 

[VA Hopeful Dr]

Not to mention that doctors don't have the drug knowledge for interactions. Most doctors know a handful of drugs relating to their specialty. But a pharmacy is there to double-check a patient is getting the right medicine, and the pharmacy also serves as a hub to make sure the patient isn't getting multiple interactions the doctor might not know about due to other doctors.

Some people could get the same/similar meds from an ER doc, specialist, and general practitioner and none of them know it. Or worse, conflicting drugs. The whole point is a check-and-balance to make sure there aren't any screw ups. A specialist to find out what is wrong with a patient is used, then a specialist to determine valid/optimal treatment is used.

I don't think you meant it the way that first sentence reads, but I find that fairly offensive. Unless my patients are on weird drugs from their specialists (rheumatology is the worst offender), then I am expected to know interactions. I'm not saying I'm better at it than you folks are (after all, I'm not a pharmacist), but for the majority of the drugs I use and the most common ones that specialists use I am usually pretty aware of any potential interactions. Though I certainly don't always know about every drug my patients are getting from every doctor, and I do appreciate the heads-up from the pharmacy if something new pops up.

Besides, if I am making mistakes about prescribing and not knowing interactions, why aren't I getting calls from the pharmacy to change meds?

 

[PharmD RPh]

I don't think you meant it the way that first sentence reads, but I find that fairly offensive. Unless my patients are on weird drugs from their specialists (rheumatology is the worst offender), then I am expected to know interactions. I'm not saying I'm better at it than you folks are (after all, I'm not a pharmacist), but for the majority of the drugs I use and the most common ones that specialists use I am usually pretty aware of any potential interactions. Though I certainly don't always know about every drug my patients are getting from every doctor, and I do appreciate the heads-up from the pharmacy if something new pops up.

Besides, if I am making mistakes about prescribing and not knowing interactions, why aren't I getting calls from the pharmacy to change meds?

I agree that there is a shared liability in this case. For example, patient brings me rx from pcp for biaxin and is on methadone from pain management. Patient has risk factors for qt prolongation already (Cardiac disease, low electrolytes etc.). I dispense thinking its not a big deal to call md on it and patient ends up in er with life threatening arrhythmia. Assuming both pharmacist and doctor has knowledge of patients current meds we'd both legally share liability in a mal-practice lawsuit.

Physicians are usually familiar with what they prescribe on a regular basis, but the poster is right as most interactions I call back on are from multiple docs in which both docs aren't familiar with the meds each are prescribing. I also still find it interesting that most med students get only 1 semester of pharmacology in medical school.

 

[Quiksilver]

I don't think you meant it the way that first sentence reads, but I find that fairly offensive. Unless my patients are on weird drugs from their specialists (rheumatology is the worst offender), then I am expected to know interactions. I'm not saying I'm better at it than you folks are (after all, I'm not a pharmacist), but for the majority of the drugs I use and the most common ones that specialists use I am usually pretty aware of any potential interactions. Though I certainly don't always know about every drug my patients are getting from every doctor, and I do appreciate the heads-up from the pharmacy if something new pops up.

Besides, if I am making mistakes about prescribing and not knowing interactions, why aren't I getting calls from the pharmacy to change meds?

Well said

 

[PharmD RPh]

Many states have laws preventing physicians from owning pharmacies, for the obvious self-referral issue.

Samples are different because you can't charge for them.

I'd like to know how pain management clinics prescribe and fill controls for their patients without pharmacist over sight. I know of 1 such clinic. They won't give copies and patients tell me the refuse to write a script because part of your treatment agreement is filling RXs at the in-office dispensery. I can see 2 sides of this....

1. It allows the treating physician to more closely monitor narcotics usage, but
2. The physician also financially gains from dispensing controls to the patient which IMO seems unethical and
3. No checks and balances with pharmacist oversight. Potentially more errors reach the patient this way.

 

[owlegrad]

I'd like to know how pain management clinics prescribe and fill controls for their patients without pharmacist over sight. I know of 1 such clinic. They won't give copies and patients tell me the refuse to write a script because part of your treatment agreement is filling RXs at the in-office dispensery. I can see 2 sides of this....

1. It allows the treating physician to more closely monitor narcotics usage, but
2. The physician also financially gains from dispensing controls to the patient which IMO seems unethical and
3. No checks and balances with pharmacist oversight. Potentially more errors reach the patient this way.

I see what you did there. Very clever.

 

[Quiksilver]

I'd like to know how pain management clinics prescribe and fill controls for their patients without pharmacist over sight. I know of 1 such clinic. They won't give copies and patients tell me the refuse to write a script because part of your treatment agreement is filling RXs at the in-office dispensery. I can see 2 sides of this....

1. It allows the treating physician to more closely monitor narcotics usage, but
2. The physician also financially gains from dispensing controls to the patient which IMO seems unethical and
3. No checks and balances with pharmacist oversight. Potentially more errors reach the patient this way.

In new york state that is downright illegal unless you are a doctors office basically in the middle of nowhere and there isn't a pharmacy for miles and miles.

It sounds like there needs to be reform. I mean its a pain clinic with a pharmacy, I wonder what the ethics are like there.

 

[VA Hopeful Dr]

In new york state that is downright illegal unless you are a doctors office basically in the middle of nowhere and there isn't a pharmacy for miles and miles.

It sounds like there needs to be reform. I mean its a pain clinic with a pharmacy, I wonder what the ethics are like there.

Yeah, that's quite illegal in my state as well. Maybe Kentucky is different.

 

[Jabberwocky12]

I don't think you meant it the way that first sentence reads, but I find that fairly offensive. Unless my patients are on weird drugs from their specialists (rheumatology is the worst offender), then I am expected to know interactions. I'm not saying I'm better at it than you folks are (after all, I'm not a pharmacist), but for the majority of the drugs I use and the most common ones that specialists use I am usually pretty aware of any potential interactions. Though I certainly don't always know about every drug my patients are getting from every doctor, and I do appreciate the heads-up from the pharmacy if something new pops up.

Besides, if I am making mistakes about prescribing and not knowing interactions, why aren't I getting calls from the pharmacy to change meds?

I would certainly agree that doctors aren't fools when it comes to medicines and they also have the ability to research and determine relevant information about drugs when it becomes necessary, such as having a hunch for interactions. This becomes especially true when they are giving out samples so there isn't a paper trail of what a patient is taking at one time. The intent was not to offend doctors; the sentence would probably have been better saying they don't have as much handy information about drugs as pharmacists do. I'll do a brief edit out of respect. But at the same point, a pharmacist does go through 3 years + rotations about drugs so there would be some logic to say that they would have a leg up when it comes to interactions. And going with that, I have had doctors who swear that lortab and norco are two drugs with completely different ingredients and usages. While pharmacists can be just as guilty (one didn't truly know that women benefit from extra iron during menstrual cycles) it would call to show that having an expert on diagnosing a patient and an expert on treatment show better therapies. I wouldn't go to a pharmacist and tell them some symptoms and ask for a diagnosis of anything either because they don't have the knowledge a doctor does for diagnosing. Both professions can try to do each other's job but the best therapy comes in when both work together.

But yeah, no harm or disrespect intended. I think you guys do a great job at what you do and the majority of scripts that come in are correct and suitable for a patient. Half the time pharmacists are there mainly for the weirdo drugs or therapies just like you said. Just keep neat handwriting and select the right script directions on your computer for the patient and we'll be all happy. ^^

Now in response to another post, from what I understand (not in pharm school so a lot of this is what my pharmacists tell me) is that if a patient gets an obvious medicine interaction that the blame goes primarily to a pharmacist. A doctor won't be safe from lawsuit, obviously, but a pharmacist let the medicine go out the door so therefore they had the last seal of approval for the patient. So if a doctor does write something and it looks even slightly fishy then a call is in order. One of the pharmacist buddies I have in RA said that a doctor wrote for a high dosage of ADD pills and the pharmacist called the doctor on it; the doctor said he was trying some type of therapy experiment on the patient he had literature about and the pharmacist wouldn't let it go through until he had some kind of documentation showing the doctor wasn't off his rocker. I don't know how that played out though. I don't necessarily think though a study would safe harbor a pharmacist though since they have the overall say on a drug getting to a patient.

 

[Prx]

1) If MDs and other doctors can prescribe medication, why can't they dispense it as well?

It was just a thought. Doesn't it show incompetence in the part of prescribers that they need pharmacists to look over their work?

2) How difficult is it to become a pharmacist in industry?

3) This is just an agree or disagree statement.
Pharmacists, as well as Ph.Ds, MDs, DDS, ED.D, and all the other doctorate holders go through so much schooling. They all have earned the right to be called "Doctor."

I noticed that you applied to Albany College of Pharmacy... I just wanted to let you know that (from what i heard recently) they are on probation from the national boards. But I do know for a fact that student that do attend attend there pray for a 2.3 gpa in order to meet the bear minimum.

 

[SeekerofTruth]

I noticed that you applied to Albany College of Pharmacy... I just wanted to let you know that (from what i heard recently) they are on probation from the national boards. But I do know for a fact that student that do attend attend there pray for a 2.3 gpa in order to meet the bear minimum.

Okay, thank you for the intel. Albany is my second to last choice for pharmacy anyways.

1) Rutgers pharmacy
2) USciences pharmacy
3) ACPHS pharmacy
4) St. John pharmacy
5) Rutgers NB chemistry

 

[SeekerofTruth]

Some of you misunderstood me.

I was asking why the LAW says physicians can't dispense. Pharmacists can discern potential dangerous drug interactions but that's it isn't it? That's in retail though.

How difficult is it getting into industry meaning do I need a residency or fellowship?

 

[SHC1984]

Some of you misunderstood me.

I was asking why the LAW says physicians can't dispense. Pharmacists can discern potential dangerous drug interactions but that's it isn't it? That's in retail though.

How difficult is it getting into industry meaning do I need a residency or fellowship?

Don't know much about the laws for physicians since I never was interested in becoming one.

You need a fellowship to get into industry and it is very competitive.

 

[owlegrad]

Some of you misunderstood me.

I was asking why the LAW says physicians can't dispense. Pharmacists can discern potential dangerous drug interactions but that's it isn't it? That's in retail though.

How difficult is it getting into industry meaning do I need a residency or fellowship?

I not aware of any such law. In fact I think you are way off base here. Just run a google search for "dispensing physicians". I already brought this up before. Physicians CAN dispense.

You are also way off base when you say it's in retail that pharmacists discern potential drug interactions. I assure you we do that in the hospital as well.

 

[SeekerofTruth]

Don't know much about the laws for physicians since I never was interested in becoming one.

You need a fellowship to get into industry and it is very competitive.

this sucks...looks like I need to think about the other pharmacy fields I can see myself doing.

 

[SeekerofTruth]

I not aware of any such law. In fact I think you are way off base here. Just run a google search for "dispensing physicians". I already brought this up before. Physicians CAN dispense.

You are also way off base when you say it's in retail that pharmacists discern potential drug interactions. I assure you we do that in the hospital as well.

then what is the need for retail pharmacists? ppl can go to their doctor and get the medication there.

 

[owlegrad]

then what is the need for retail pharmacists? ppl can go to their doctor and get the medication there.

You're right, I am going to need to think of a new job. 😱

Joking aside, I am not going to be baited into a discussion of why pharmacy exists. If you think we contribute so little you either need to gain experience or look for another field.

 

[PharmD RPh]

You're right, I am going to need to think of a new job. 😱

Joking aside, I am not going to be baited into a discussion of why pharmacy exists. If you think we contribute so little you either need to gain experience or look for another field.

Correct me if I'm wrong, but I think if a physician decides to dispense they have to meet all the regulations as a pharmacy as far as record keeping, laws etc. I think a lot choose not to for a few reasons....

1. Their time is better spent making money being a physician.
2. Their liability increases
3. It's expensive to stock a pharmacy with drugs as it would a dr office.
4. Ins billing is a nightmare.
And the list goes on.

Average Gross profit per rx is about 14-15 dollars. Not worth it if I'm a md.

 

[owlegrad]

Correct me if I'm wrong, but I think if a physician decides to dispense they have to meet all the regulations as a pharmacy as far as record keeping, laws etc. I think a lot choose not to for a few reasons....

1. Their time is better spent making money being a physician.
2. Their liability increases
3. It's expensive to stock a pharmacy with drugs as it would a dr office.
4. Ins billing is a nightmare.
And the list goes on.

Average Gross profit per rx is about 14-15 dollars. Not worth it if I'm a md.

Yes, I think those are all valid points.

 

[SeekerofTruth]

You're right, I am going to need to think of a new job. 😱

Joking aside, I am not going to be baited into a discussion of why pharmacy exists. If you think we contribute so little you either need to gain experience or look for another field.

1) I am not interested in the retail aspect of pharmacy, but industry.
2) I agree pharmacists are important and what is wrong with getting the opinions of pharmacists, people with experience?

 

[iFarm]

PharmD RPh stole my answer. Look 2 posts up

(but I learned how to edit, so not a complete waste of time)

 

[psychoandy]

I was asking why the LAW says physicians can't dispense. Pharmacists can discern potential dangerous drug interactions but that's it isn't it?

If my pharmacy history/law is correct, back in the old days, the lines between MD and druggist/apothecary/pharmacist were a bit more blurred; anyone could make a medication. Whether it worked or not was another story, but that certainly didn't stop people. The point of such laws had little to do with drug interactions, and more to do with money, and a separation between the prescriber and dispensing. If a PCP could make his own poultice of herbs or liniments or magical elixirs, and then prescribe them to his patients, and then dispensed/sold products to them, there'd be a huge conflict of interest.

That, or in the days of yore they wanted to create more healthcare positions and usurp the power of the AMA...

 

[acphs1881]

Hi. I work at Albany College of Pharmacy and Health Sciences. I want to make clear to SDN users that the school is NOT on probation. Any such implication is completely false.

 

[MountainPharmD]

Besides, if I am making mistakes about prescribing and not knowing interactions, why aren't I getting calls from the pharmacy to change meds?

Because it is pointless to try and call a Doctors office for any reason. You are getting calls from the pharmacy. The problem is they are not making it past the layer of idiots you have staffing your office. Likely the receptionist who barley graduated high school is answering the questions.

Example. A prescription hand written with two drugs on it. On the top is Norco 10 1-2 q4-6h prn pain. A clear and distict line has been drawn through the middle of the prescription. Under the line is Ibuprofen 800mg 1 q8h. At the bottom of the script is the standard line for the physicians signature and refills with 1, 2 ,3, 4 ,5 with the 1 circled.

I take this as two separate and distint prescriptions because of the clear and unambiguous line spearating the two drugs. Therefore the 1 circled at the bottom means one refill on the Ibuprofen and not the Norco. Patient comes in to get a refill on the Norco and we tell him there was only refills on the Ibuprofen. He calls the Doctors office and I have the patient and some idiot at the Doctos office yelling at me for not putting a refill on the Norco as well.

Fast forward a few months. My tech shows me a very similar prescrition. She asks me if there are refills on both or only one. Remembering the pain in the ass the last incident was I tell her to get the Doctor on the phone and to clarify it. It took one phone call, two faxes and 36 hours to get a clarification on something as simple as the intended refills on the prescription. A freaking joke! It should have taken one phone call and 15 seconds to clarify the prescription.

So sorry VA doctor hopefull. Pharmacists are calling you and many have probably just given up. I do not have time to play games and wait days and weeks to get a simple question answered. No, I do not find it amusing when I call your office and tell Candy the receptionist there is a drug inteaction and without even a moments hesitation she tells me its okay and I should go ahead and dispense the medication.

 

[VA Hopeful Dr]

Because it is pointless to try and call a Doctors office for any reason. You are getting calls from the pharmacy. The problem is they are not making it past the layer of idiots you have staffing your office. Likely the receptionist who barley graduated high school is answering the questions.

Example. A prescription hand written with two drugs on it. On the top is Norco 10 1-2 q4-6h prn pain. A clear and distict line has been drawn through the middle of the prescription. Under the line is Ibuprofen 800mg 1 q8h. At the bottom of the script is the standard line for the physicians signature and refills with 1, 2 ,3, 4 ,5 with the 1 circled.

I take this as two separate and distint prescriptions because of the clear and unambiguous line spearating the two drugs. Therefore the 1 circled at the bottom means one refill on the Ibuprofen and not the Norco. Patient comes in to get a refill on the Norco and we tell him there was only refills on the Ibuprofen. He calls the Doctors office and I have the patient and some idiot at the Doctos office yelling at me for not putting a refill on the Norco as well.

Fast forward a few months. My tech shows me a very similar prescrition. She asks me if there are refills on both or only one. Remembering the pain in the ass the last incident was I tell her to get the Doctor on the phone and to clarify it. It took one phone call, two faxes and 36 hours to get a clarification on something as simple as the intended refills on the prescription. A freaking joke! It should have taken one phone call and 15 seconds to clarify the prescription.

So sorry VA doctor hopefull. Pharmacists are calling you and many have probably just given up. I do not have time to play games and wait days and weeks to get a simple question answered. No, I do not find it amusing when I call your office and tell Candy the receptionist there is a drug inteaction and without even a moments hesitation she tells me its okay and I should go ahead and dispense the medication.

That does sound frustrating, I don't envy you having to play that role in the middle between opioid patient and doctor.

Any time the pharmacy (or anyone for that matter) calls the office, the staff who answers the phone is required to put the pharmacy's call into the chart and let me know about it. I have yet to not call the pharmacy personally to figure out what's going on (I'm a resident after all, I'll take teaching from whoever wants to offer it). Granted, I think this is mostly due to our EMR that makes all of this much much easier and I'll admit I don't usually call back within the first 30 minutes, but I do try.

So I'll ask this, what are you doing if you don't call the office with interactions? Are you filling it anyway or changing it to something else?

 

[MountainPharmD]

That does sound frustrating, I don't envy you having to play that role in the middle between opioid patient and doctor.

The fact the prescription was for a controlled substance is irrelevent here. I was just illustrating how impossible it is to get even a simple thing like a refill verified.

Any time the pharmacy (or anyone for that matter) calls the office, the staff who answers the phone is required to put the pharmacy's call into the chart and let me know about it. I have yet to not call the pharmacy personally to figure out what's going on (I'm a resident after all, I'll take teaching from whoever wants to offer it). Granted, I think this is mostly due to our EMR that makes all of this much much easier and I'll admit I don't usually call back within the first 30 minutes, but I do try.

So I'll ask this, what are you doing if you don't call the office with interactions? Are you filling it anyway or changing it to something else?

Fist question. How many drug interactions are clinically significant? Not many. How many interactions does my computer flag? About 2 for every prescription.

If I feel the drug interaction is significant (which is rare) I explain it to the patient and tell them to call their Doctor to discuss it. This usually happens with Warfarin and a patient who went to a Doc in the box and got an antibiotic prescription for their viral infection and failed to tell the Doctor they are on Warfarin. I advise them to contact the Warfarin prescriber to get instructions on what to do. I document this on the prescription and move on to the next problem.

 

[group_theory]

Correct me if I'm wrong, but I think if a physician decides to dispense they have to meet all the regulations as a pharmacy as far as record keeping, laws etc. I think a lot choose not to for a few reasons....

1. Their time is better spent making money being a physician.
2. Their liability increases
3. It's expensive to stock a pharmacy with drugs as it would a dr office.
4. Ins billing is a nightmare.
And the list goes on.

Average Gross profit per rx is about 14-15 dollars. Not worth it if I'm a md.

Bingo!!!

In some states, physician can dispense. In Florida, for an addition $100, the physician can obtain a dispensing practitioner license

From the Florida Dept of Health Website
http://www.doh.state.fl.us/mqa/osteopath/os_lic_req.html
"Dispensing - is defined as selling medicinal drugs to patients in the office. A practitioner who writes prescriptions or provides complimentary professional samples is not a "dispensing practitioner," and therefore does not need to register with the department."

But once you start selling meds from the office, the same rules that applies to pharmacies apply to the office. Imagine the logistics of trying to be compliant with all the rules (not just pharmacy, but also medical office setting, etc), as well as the potential overhead cost. Any revenue that can be generated by the in-office pharmacy will likely be minimal (unless you;re dealing with cash only and narcotics)



Physician dispensing is legal in 44 of the 50 states. The states of Texas, New York, and New Jersey have placed restrictions on physician dispensing. Only three states have prohibited physician dispensing: Massachusetts, Montana, and Utah. Of course, each states have their own rules, regulations, and restrictions (I think one of the states need approval from the State Board of Pharmacy)