Thanks. Let me just throw this out there since i could not find the answers in the faq's.
how do pharmacists keep up to date on laws and regs, and reimbursement changes?
how easy is it to change practice settings? are there competencies that need to be completed to move from say inpatient to out or the reverse?
What are the levels of clinicians? entry level to advanced clinician, clinical specialist etc.
This one i think i have, but there are pharm techs who work in direct supervision of the pharmacist, and the pharmacist. What are the safeguards with respect to the tech, ie. how is the law protected/security in place and supervision? Then there are interns that are doing their clinical rotations, then fellows or residents for advanced practice? Have I got that all right?
as far as prescriptive rights, i have read that Canada has started to open limited prescriptive rights to pharmacists, is the general consensus positive, negative or uncertain? Physical therapy uses that model in the VA setting, but i feel strongly that it is not within our scope of practice, nor do I want that responsibility, my job is hard enough. Do you think with new prescriptive rights, that malpractice insurance will or has gone up?
Thanks a bunch. I hope this is not too much of a pain. hopefully useful discussion material???
How do we keep up with laws? I can only speak for CA, since I'm not licensed anywhere else. 50 states = 50 governing bodies over pharmacies. In my state - we get a newsletter - sometimes 4 times a year, sometimes more often which covers all new laws & other regulatory issues related to the profession. Additionally, my state associations publish pending legislation & their stand on it.
Reimbursement changes - usually on an annual basis. We are in the middle, so our contractual arrangements with suppliers is normally for one year. Likewise, our contractual arrangements with insurers is also for one year (ie for hospitals, this is normally a bundled arrangment & included in a drg - not freestanding). For ambulatory care - it is an arrangement with the patient (ie the reimbursement is set by how much the pt or his/her employer chooses to pay). For services only - an annual reimbursement contract.
How easy is it to change settings & are there competencies - in some cases difficult & yes, there are - others not so much. For nuclear pharmacy, you must be specialized & licensed in that field. For other specialized areas like oncology, peds/NICU/PICU - you must have qualified experience. At this point, no particular competency required, but most recommend a residency unless you have experience sufficient to substitute. For just a switch from inpt acute medicine to ambulatory or closed door pharmacy or vice versa - easy if the economics are in place to make a move, altho there is a learning curve if you've not been in that practice setting and some employers will want a residency or experience - there is no "one" way. Over the years, I've known this to be hard only because the # of pharmacists outnumbers the positions - but we are not in that current situation right now.
The entry level pharmacist is one who has passed their qualifing examinations - usually the NABPLEX & the state law exam, altho some have a compounding portion as well. The entry level degree is the PharmD. You might still see BS pharmacists for awhile since it was last awarded in 1999 in some states. You must have a degree to sit for the state board, but you can have a degree & not be licensed, thus not be in active practice.
Graduates can go on to residencies or fellowships if they choose. It is not required & reflects that individuals area of interest.
Yes - techs are under direct supervision of a pharmacist. The safeguards in place are those laws which determine the techs scope & what is actually required before a prescription or drug order has been completed. Yes, there are interns - these are students in pharmacy school. Residents & fellows normally must be licensed pharmacists.
Prescriptive rights have been covered pretty completely in the thread by WVU - I think he titled it "Prescriptive rights in Alberta" - its not too far down since we just discussed it last week. That covers both the Canadian & US thoughts pretty well - you might look for that.
Yes - I think malpractice insurance will go up with any extension of scop of practice.
Hope I covered it all for you - let me know if not. These things have all been discussed here before, but who knows.....
