Oh California...

[Slack3r]

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If people put half the effort they spent trying to expand their ancillary healthcare provider's scope of practice into going to med school in the first place, we probably wouldn't have a "doctor shortage" to begin with...

http://www.npr.org/sections/health-...irth-control?utm_medium=RSS&utm_campaign=news

 

[FFH]

In this particular case, I don't see how it's wrong to let the pharmacists to function at the top of their training by doing something they are perfectly able to do.

 

[charmiedermie]

If people put half the effort they spent trying to expand their ancillary healthcare provider's scope of practice into going to med school in the first place, we probably wouldn't have a "doctor shortage" to begin with...

http://www.npr.org/sections/health-...irth-control?utm_medium=RSS&utm_campaign=news

 

[Dares Dareson]

So torn about this...it's good to have expanded access to birth control, but bad if they aren't going in to get pap smear / STI screening / other reproductive stuff. Plus birth control itself can cause a host of problems, right? I'm going to go with...no. This law is bad.

 

[Psai]

What does it mean to be at the top of your license? Did you mean at the top of a real doctor's license? Are these pharmacists going to be taking a detailed history and physical? Know about the patients smoking history and family history of cancer? Be on the lookout for hepatic adenomas or dvts? Know how to work up and treat the depression or hypertension that could come up? It's not about just writing a drug name and dose on a computer and handing out pills willynilly.

 

[touchpause13]

I'd like to see what the pharmacists have to say about this. @GoldfishPharmD ?

My gut says this is a bad idea, but if the pharmacists think they have enough training for this I could be down

 

[Merely]

Someone knowledgeable and experienced should put together a pros and cons list for this new law so people like myself and other inexperienced people can understand both the good and bad.

 

[baxt1412]

Well, let's see. One of the main arguments in here is that pelvic screening rates will go down.


AFAIK, pelvic screenings are not required for prescription of birth control right now, so if the people against this truly desired high screening rates, wouldn't they be lobbying for required screening rather than anti-Rx from pharmDs?

 

[Doctor Bob]

"Have you or a family member been harmed by blood clots caused by birth control pills? If so, call the law firm of Dewey, Cheatem, and Howe. We'll help you get the money you deserve from Walgreens and the pharmacist who prescribed the medicine."


I have fewer objections to this so long as pharmacists have the same legal liability as a physician does for medication adverse reactions.

Not to say I don't still have some objections...

 

[Amazonian Lily]

Well, let's see. One of the main arguments in here is that pelvic screening rates will go down.


AFAIK, pelvic screenings are not required for prescription of birth control right now, so if the people against this truly desired high screening rates, wouldn't they be lobbying for required screening rather than anti-Rx from pharmDs?

I'm curious about this...my PCP who prescribes my birth control refuses to refill my prescription until I've come in for my annual physical and pap smear. Does this have something to do with insurance requirements or can a doctor decide to just enforce this kind of policy?

 

[Psai]

I'm curious about this...my PCP who prescribes my birth control refuses to refill my prescription until I've come in for my annual physical and pap smear. Does this have something to do with insurance requirements or can a doctor decide to just enforce this kind of policy?

So you want someone to prescribe a potentially dangerous medication for you without even taking a look at you?
are you really a medical student?

 

[Amazonian Lily]

So you want someone to prescribe a potentially dangerous medication for you without even taking a look at you?
are you really a medical student?

Lol can you read the post I quoted? I was curious as to whether there is actually a law that requires this or if insurance requires it before they will pay for the birth control. But thanks for making false assumptions.

 

[Morzh]

Law does not require it, and insurance probably doesn't either. But it's good medicine. I'd be worried about having a doctor who didn't require periodic reassessments before refilling long-term meds. Not to mention the potential litigation.

 

[Psai]

Lol can you read the post I quoted? I was curious as to whether there is actually a law that requires this or if insurance requires it before they will pay for the birth control. But thanks for making false assumptions.

try this new thing called google, it's really great for when you need to look up facts

 

[Baller MD]

.

 

[AlbinoHawk DO]

Can't have it. They may know about how drugs work and interact, but they are not trained to do all the necessary things to ensure each patient is safe.

 

[deleted480308]

This should not happen..."top of their license" is just the same cliche type of line the nurses have been using to get into territory they aren't qualified for

 

[Winged Scapula]

Law does not require it, and insurance probably doesn't either. But it's good medicine. I'd be worried about having a doctor who didn't require periodic reassessments before refilling long-term meds. Not to mention the potential litigation.

Yep.

If you're not seeing a patient, it can be construed as a lack of a physician-patient relationship. No one should be medically managing a patient that they haven't examined recently (this is the sticky wicket physicians get into when prescribing for friends, family and colleagues). OCPs can have some pretty serious side effects, even in young women.

 

[baxt1412]

Would the pharmacists be taking on extra malpractice insurance for this then? I'm wondering if those types of laws/regulations would even be in place. This is far more complex than "Yes you guys can Rx it now"

 

[samac]

... Does it bother no one else that they will have the right to change dosage on diabetes and hypertension meds?
You go in they take your blood sugar. "Oh it's running a little high today, let's up your dosage" When in reality the patient just ate a doughnut because they were just going to the pharmacy and they're too embarrassed to tell the pharmacist.

 

[Slack3r]

Unsure what point I missed. Or are you talking out of your ass, as usual?

 

[NickNaylor]

Progression of how this will work:

1) People like that they can show up at a pharmacy and get instant OCPs
2) Pharmacy lobby: "look, we increased access to OCPs and got people birth control that other wouldn't!" (cite AMA policy paper)
3) Pharmacy lobby: "now just imagine how much good we can do if we could do things like change HTN meds, diabetes meds, COPD meds, and [insert chronic condition meds]"
4) State legislature: "wow, this is fantastic - look at how much money we can save when we provide pseudo medical care"

Boom, pharmacists begin prescribing meds.

 

[deleted480308]

Progression of how this will work:

1) People like that they can show up at a pharmacy and get instant OCPs
2) Pharmacy lobby: "look, we increased access to OCPs and got people birth control that other wouldn't!" (cite AMA policy paper)
3) Pharmacy lobby: "now just imagine how much good we can do if we could do things like change HTN meds, diabetes meds, COPD meds, and [insert chronic condition meds]"
4) State legislature: "wow, this is fantastic - look at how much money we can save when we provide pseudo medical care"

Boom, pharmacists begin prescribing meds.

you forgot step 5.....pharmacists start demanding equal pay saying they doing the same thing

 

[Doudline]

... Does it bother no one else that they will have the right to change dosage on diabetes and hypertension meds?
You go in they take your blood sugar. "Oh it's running a little high today, let's up your dosage" When in reality the patient just ate a doughnut because they were just going to the pharmacy and they're too embarrassed to tell the pharmacist.

Yes honey, I'm QUITE convinced that pharmacists do not know about blood sugar and what influences it. They must think it is the will of God if your blood sugar goes up. Or caused by the weather, like arthritis, right?

Oh, and I hear people never lie to their physician either. Isn't that wonderful?

 

[NickNaylor]

Yes honey, I'm QUITE convinced that pharmacists do not know about blood sugar and what influences it. They must think it is the will of God if your blood sugar goes up. Or caused by the weather, like arthritis, right?

Oh, and I hear people never lie to their physician either. Isn't that wonderful?

The problem that I see is that you now have two people that have the ability to change medication doses who may or may not communicate with one another. If you're an MD that prescribes X dose of whatever and you find out a month later that the patient was taking Y dose because it was altered by the pharmacist, what then? Who becomes liable? How does that serve the patient if your plans aren't actually being followed? Is the pharmacist going to call you up and get your rationale for dosing every medication the way you are? Who has time for that?

This also says nothing of the fact that I doubt pharmacists will actually be examining patients on a regular basis. That's not really providing any degree of medical care. That's messing with numbers. I'm pretty confident that any M3/M4 could manage diabetes/HTN in a halfway competent way for most people, but we don't allow them to practice medicine. And they likely have substantially more clinical experience than a pharmacist with a complete tool set that includes the physical exam.

In that same vein, I could probably train a high school graduate to look at numbers and alter medication doses if the goal is simply to make sure blood sugars or blood pressures fall within a certain range. I would like to think we provide patients more than that in our encounters.

 

[RxStudentatUB]

you forgot step 5.....pharmacists start demanding equal pay saying they doing the same thing

This is more like pre-step 1/step 0, LOL.

 

[charmiedermie]

Unsure what point I missed. Or are you talking out of your ass, as usual?

Says the guy who said people are gunning for psychiatry so they can go full cash pay.

There are some things a pharmacist can easily do based on their 4 year professional education. Same with optometrists vs. ophthalmologists, as there are some things optometrists learn and do in their 4 year professional school, but aren't allowed to do in the real world, because of the Ophtho lobby. But no, all those pharmacists should just go to med school. 🙄

 

[Baller MD]

Says the guy who said people are gunning for psychiatry so they can go full cash pay.

There are some things a pharmacist can easily do based on their 4 year professional education. Same with optometrists vs. ophthalmologists, as there are some things optometrists learn and do in their 4 year professional school, but aren't allowed to do in the real world, because of the Ophtho lobby. But no, all those pharmacists should just go to med school. 🙄

Why shouldn't they? You can use the same logic for nurse practitioners wanting more privileges.

 

[charmiedermie]

... Does it bother no one else that they will have the right to change dosage on diabetes and hypertension meds?
You go in they take your blood sugar. "Oh it's running a little high today, let's up your dosage" When in reality the patient just ate a doughnut because they were just going to the pharmacy and they're too embarrassed to tell the pharmacist.

Do u think pharmacists do not learn physiology and pharmacology like you do? And yeah, I'm sure when that patient goes to the physician they'll automatically admit they ate a doughnut, because they are a physician after all.

 

[charmiedermie]

Why shouldn't they? You can use the same logic for nurse practitioners wanting more privileges.

Do nurse practitioners have the exact same tasks and responsibilities as physicians? If that is the case, then maybe medical schools should change the way they are educating students for effectively the same license at double the tuition. Nope, let's instead just stomp our feet and complain why the public just doesn't see it our way.

 

[calvnandhobbs68]

Yes honey, I'm QUITE convinced that pharmacists do not know about blood sugar and what influences it. They must think it is the will of God if your blood sugar goes up. Or caused by the weather, like arthritis, right?

Oh, and I hear people never lie to their physician either. Isn't that wonderful?

When was the last time you saw a pharmacist spend more than 30 seconds talking to someone about their medication? Most encounters with the Walgreens/CVS pharmacists I've seen go along the lines of "Got any questions? Nope? See ya." You really think the big pharmacy chains (who are the ones who are obviously going to push hard for laws like this) are going to decrease their pharmacist's productivity by allowing them 15 minutes to counsel someone on why they're adjusting the medication dosage?

I'm not saying it's the pharmacist's fault but there's just no way they'll be allowed to have the same kind of face time when they have 20 more orders behind them they need to fill. They don't have appointment times built into the day the way a physician does.

 

[Baller MD]

Do nurse practitioners have the exact same tasks and responsibilities as physicians? If that is the case, then maybe medical schools should change the way they are educating students for effectively the same license at double the tuition. Nope, let's instead just stomp our feet and complain why the public just doesn't see it our way.

They want the same tasks but without the responsibility...

And licensing doesn't mean much. Politics is more important: see opt out states for anesthesia.

 

[charmiedermie]

They want the same tasks but without the responsibility...

And licensing doesn't mean much. Politics is more important: see opt out states for anesthesia.

So the answer to my question is no, right? And licensing does mean everything. Almost every profession, besides fast food worker, requires some type of occupational license, and that is controlled by the public. It doesn't matter what your formal education is up to that point since you need a license to work.

 

[deleted480308]

So the answer to my question is no, right? And licensing does mean everything. Almost every profession, besides fast food worker, requires some type of occupational license. It doesn't matter what your formal education is up to that point since you need a license to work.

he's saying the licensing can give people powers that their training does not justify.....the government can license my pizza guy to a fly a plane but it doesn't mean it's a good idea

 

[samac]

Yes honey, I'm QUITE convinced that pharmacists do not know about blood sugar and what influences it. They must think it is the will of God if your blood sugar goes up. Or caused by the weather, like arthritis, right?

Oh, and I hear people never lie to their physician either. Isn't that wonderful?

I'm not belittling them saying that they don't know anything, but I'm saying without a full knowledge of the patient they might not make the best choices over a physician who has been seeing Mr. Doughnut for the past 6 years.

 

[deleted480308]

I'm not belittling them saying that they don't know anything, but I'm saying without a full knowledge of the patient they might not make the best choices over a physician who has been seeing Mr. Doughnut for the past 6 years.

I am saying that they don't have the training to diagnose and prescribe

 

[charmiedermie]

he's saying the licensing can give people powers that their training does not justify.....the government can license my pizza guy to a fly a plane but it doesn't mean it's a good idea

I know. I didn't say they are infallible. It is the same protection where an MD graduate can't just walk into a high school classroom and start teaching. You need a teaching license.

You are treating the public, therefore the public decides the rules, not just in medicine, but in any profession. This is really true in medicine though because the taxpaying public subsidizes medical schools and subsidizes residencies, without which you would have no residency to go to.

 

[deleted480308]

I know. I didn't say they are infallible. It is the same protection where an MD graduate can't just walk into a high school classroom and start teaching. You need a teaching license.

You are treating the public, therefore the public decides the rules, not just in medicine, but in any profession. This is really true in medicine though because the taxpaying public subsidizes medical schools and subsidizes residencies, without which you would have no residency to go to.

it isn't the public asking for this, it's pharmacists

and if the public agrees, they are wrong

 

[charmiedermie]

it isn't the public asking for this, it's pharmacists

and if the public agrees, they are wrong

Occupational licensing is under the control of the public, usually at the state level. It has never been under control by universities.

 

[deleted480308]

Occupational licensing is under the control of the public, usually at the state level. It has never been under control by universities.

who said universities?

 

[charmiedermie]

who said universities?

The argument being made (not necessarily you) is that solely due to our educational attainment, we should be given a license which no other license can overlap with ever. That is not at all how occupational licenses work. Licenses are meant to serve the public which is why they were created.

 

[deleted480308]

The argument being made (not necessarily you) is that solely due to our educational attainment, we should be given a license which no other license can overlap with ever. That is not at all how occupational licenses work. Licenses are meant to serve the public which is why they were created.

It does not serve the public to unleash upon them an entire profession of people doing things they don't know how to do

 

[charmiedermie]

It does not serve the public to unleash upon them an entire profession of people doing things they don't know how to do

As determined by who? You? Do you know all the things that are inherent to PharmD school education, if you don't, who are you, with a different occupational license to tell them what they can or can't do? Just because you went to med school?

The public is going to think you're just hiding behind the go-to excuse of patient safety ("No, one will ever be able to treat you as well as I can!), when the real underlying reason is your pocketbook.

 

[deleted480308]

As determined by who? You? Do you know all the things that are inherent to PharmD school education, if you don't, who are you, with a different occupational license to tell them what they can or can't do? Just because you went to med school?

The public is going to think you're just hiding behind the go-to excuse of patient safety ("No, one will ever be able to treat you as well as I can!), when the real underlying reason is your pocketbook.

both professions have money on the line, you can't claim the moral high ground there

what you can try doing is defending why you think pharmacists have the training to conduct physical exams, take histories, order tests, interpret all of those and them prescribe medications to treat the findings.....go ahead, I'll wait

 

[charmiedermie]

both professions have money on the line, you can't claim the moral high ground there

what you can try doing is defending why you think pharmacists have the training to conduct physical exams, take histories, order tests, interpret all of those and them prescribe medications to treat the findings.....go ahead, I'll wait

Except one group is using the moral high ground to stop another group from doing something which more accurately might chip away at their income. It's no different than new American doctors not going into primary care, and then telling everyone else, but no one else is allowed to do it either. No one is fooled and the motive is transparent.

Read the original article again. Pharmacists are not asking for the power you think they are asking for. Go ahead, I'll wait.

 

[deleted480308]

Except one group is using the moral high ground to stop another group from doing something which more accurately might chip away at their income. It's no different than new American doctors not going into primary care, and then telling everyone else, but no one else is allowed to do it either. No one is fooled and the motive is transparent.

Read the original article again. Pharmacists are not asking for the power you think they are asking for. Go ahead, I'll wait.

From the link, "But the law goes beyond birth control pills. It also authorizes pharmacists to prescribe medications for smoking cessation and travel abroad. Pharmacists can administer routine vaccinations to children ages 3 and older. They can even order lab tests and adjust drug regimens for patients with diabetes, hypertension, or other conditions. Kroon says the idea is to make it easier on patients."..................You are wrong if you think any of those powers should come without all of the knowledge/training I mentioned before.

 

[gyngyn]

I'm curious about this...my PCP who prescribes my birth control refuses to refill my prescription until I've come in for my annual physical and pap smear. Does this have something to do with insurance requirements or can a doctor decide to just enforce this kind of policy?

Evidence supports fewer restrictions on access to contraception. This would make your PCP's practice outside of guidelines. ACOG explicitly states that pap smears and pelvic exams are not necessary for safe prescription of contraception. Even OTC access is preferable.
http://www.acog.org/Resources-And-P...ver-the-Counter-Access-to-Oral-Contraceptives

 

[Jabbed]

 

[owlegrad]

FL has had laws on the books for years that allow pharmacists to prescribe certain medications. No one ever did it, just not practical. Now many of the meds on the list have become OTC anyway. I wonder if the same thing will happen with this CA law?

 

[charmiedermie]

From the link, "But the law goes beyond birth control pills. It also authorizes pharmacists to prescribe medications for smoking cessation and travel abroad. Pharmacists can administer routine vaccinations to children ages 3 and older. They can even order lab tests and adjust drug regimens for patients with diabetes, hypertension, or other conditions. Kroon says the idea is to make it easier on patients."..................You are wrong if you think any of those powers should come without all of the knowledge/training I mentioned before.

Yes, because only physicians have the knowledge to give medications like Chantix or nicotine patches and counsel on smoking cessation, only physicians can give scopolamine, only physicians can administer vaccines, etc. Pharmacists are just dumb, amirite?