Pharmacist buying a Medical office

[Wubbalubba]

With the expansion of pharmacists specialties, what would stop a pharmacist from buying a doctor's office and working there under a collaborative practice agreement? For example a pharmacist is board certified in diabetes and either buys out an office that specializes in diabetes treatment, or even buys in as a partner with the office. With the expansion on pharmacists into particularly ambulatory care, what is to stop us from doing this? (This question obviously excludes the states that don't have laws on collaborative practice agreements, and that have ownership laws requiring a licensed physician to have majority ownership of the practice.)

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[Dred Pirate]

nothing is stopping you, but what MD will sell his practice to a Rph so they can now work for you?

I don't see many MD's wanting to take on a RPh as a partner (an employee, yes) but not a partner. Do you know of any other mid levels who are partners or who own the practice of the physician that they work under?

 

[Seriously Serious]

Nothing. Owning an office/clinic does not give you special privileges. It is up to a physician to allow you to see his/her patients under a collaborative agreement. Owning a practice does not mean owning a physician.

 

[Wubbalubba]

A very good point that there aren't many midlevel practitioners out there who own a Doctor's office. Definitely another angle that I need to research. I would guess that there would be no old timers out there willing to partner with a RPh (or for that matter even enter into a collaborative practice agreement), however what about buying out an old timer who is retiring and hiring a younger Doctor who would be more open to the idea as an employee? I think the basis for partnering though would be (and this is just stuff that I'm looking into for my future) if the Pharmacist has an MBA as well and helps to run the business as well, bringing more to the table than just a collaborative practice agreement and seeing some of the Doc's patients. Partnering would also mean that I take on a lower amount of risk that outright purchasing a practice and being the sole owner.
And my whole intention with exploring this is not to "own a Physician" but rather with the corporate take over of the pharmacy world, owning a medical practice may be a safer bet/investment then buying an independent pharmacy (based on the location that I want to live).

 

[lord999]

Stark II, that's how. The burden is on you to show that you don't have a closed market relationship with providers under your roof. This has been thought of before.

 

[Wubbalubba]

I'm not talking about owning a pharmacy under the same roof as a medical practice (I understand how much Stark laws apply in that situation), I'm talking about owning a medical practice as a pharmacist and setting up a collaborative practice agreement with the physician who either works for you since you're the owner or you have bought in as a partner with and working as an ambulatory care pharmacist within the medical practice that you own. Unless you're referring to a non physician owning a medical practice and forcing the physician to do their orders based upon profit and not the patient's best interest. I've tried searching for examples of this on this forum and elsewhere but haven't found any examples. The only similar situation I've found is a businessman owning a medical practice but it's not exactly the same situation and only part of it applies to what I'm looking into. Care to point me in the right direction?

 

[lord999]

I'm not talking about owning a pharmacy under the same roof as a medical practice (I understand how much Stark laws apply in that situation), I'm talking about owning a medical practice as a pharmacist and setting up a collaborative practice agreement with the physician who either works for you since you're the owner or you have bought in as a partner with and working as an ambulatory care pharmacist within the medical practice that you own. I've tried searching for examples of this on this forum and elsewhere but haven't found any examples. Care to point me in the right direction?

Sigh, which state are you from? A direct ownership which benefits the practice outside of pharmacy is almost always disallowed by either the states' practice acts or by Stark without very extensive documentation against coercive practice and for a FMV arms-length transaction. Arizona's is 32-1930 for the section, and they used to be real strict about enforcing this with compounding pharmacies. So, you can, but you can't benefit from that sort of relationship directly. Feel free to do this, but you'll find that it's a bad opportunity cost use of resources (you're probably better off using them to expand your pharmacy's or consulting practice's reach) unless you can form a conspiracy that you can keep away from the government.

So, in your example, what if you rent to a physician who then turns around and says "hell no" to your offer of a collaborative practice relationship? An offer you can't refuse or covenanted with the rent is absolutely illegal (with a couple of specific exceptions). You can't retaliate against them, and if the next renter from you got in because of it, you're going to find out the hard way that Stark and sometimes the practice acts require a positive burden of proof.

 

[Pharmd = Phake Doctor]

I'm not talking about owning a pharmacy under the same roof as a medical practice (I understand how much Stark laws apply in that situation), I'm talking about owning a medical practice as a pharmacist and setting up a collaborative practice agreement with the physician who either works for you since you're the owner or you have bought in as a partner with and working as an ambulatory care pharmacist within the medical practice that you own. Unless you're referring to a non physician owning a medical practice and forcing the physician to do their orders based upon profit and not the patient's best interest. I've tried searching for examples of this on this forum and elsewhere but haven't found any examples. The only similar situation I've found is a businessman owning a medical practice but it's not exactly the same situation and only part of it applies to what I'm looking into. Care to point me in the right direction?

Talk about being uninformed. Physicians form practice groups in order to increase their bargaining power, maximize their patient base, and, ultimately, increase their financial security.

Do you actually think a physician is gullible enough to join a practice in which:
(a) they are partnered with a "clinician" who cannot bill for their services but have to justify their salary via cost-savings to the group.
(b) they are partnered with a "clinician" who does not have the education to perform an adequate physical exam much less form a proper diagnosis.
(c) they are partnered with a "clinician" who has ZERO bargaining power when it comes to negotiating contracts with insurance companies and practice sites (i.e. hospitals)

I've only seen ambulatory/clinical pharmacists employed in large practices (Kaiser, VA, Cleveland Clinic). They can justify ambulatory care pharmacists because they have large patient bases, from which they can use pharmacists to see and treat the most mundane cases.

It doesn't seem like pharmacy is for you. If you wanted to practice medicine, then go to PA, NP, MD, or DO school. No one forced you to become a pharmacist and you would think a person who graduated pharmacy school wasn't dense enough to actually ask a question this stupid.

(Edit - Fixed typos)

 

[Seriously Serious]

Talk about being uninformed. Physicians form practice groups in order to increase their bargaining power, maximize their patient base, and, ultimately, increase their financial security.

Do you actually think a physician is gullible enough to join a practice in which:
(a) they are partnered with a "clinician" who cannot bill for their services but have to justify their salary via cost-savings to the group.
(b) they are partnered with a "clinician" who does not have the education to perform an adequate physical exam much less form a proper diagnosis.
(c) they are partnered with a "clinician" who has ZERO bargaining power when it comes to negotiating contracts with insurance companies and practice sites (i.e. hospitals)

I've only seen ambulatory/clinical pharmacists employed in large practices (Kaiser, VA, Cleveland Clinic). They can justify ambulatory care pharmacists because they have large patient bases, from which they can use pharmacists to see and treat the most mundane patients.

It doesn't seem like pharmacy is for you? If you wanted to practice medicine, then go to PA, NP, MD, or DO school. No one forced you to become a pharmacist and you would think a person who graduated pharmacy school wasn't dense enough to actually ask a question this stupid.

^ This

If you are doing this for an increase in pay, there are easier ways to make money. If you are doing this to try and reap the benefits of being an MD without being an MD, it will never happen. Pharmacists need to know their place in healthcare; all of this reaching BS is just cringe-worthy...

 

[CetiAlphaFive]

OP would literally be better off just operating as the landlord alone

 

[Wubbalubba]

Wow didn't realize how offensive it was to just ask a question. And who ever said that I'm a pharmacist? All of my responses have been theoretical. If an idea upsets this many people this much there's usually something to it. If it's too stupid of a question, most people would just say to themselves that it's a stupid question and move on with their lives, not be a troll and write up a huge response then go back to check the thread on a regular basis. Why does such an idea upset so many people? My best guess is that it upsets the status quo.

 

[babybull]

Wow didn't realize how offensive it was to just ask a question. And who ever said that I'm a pharmacist? All of my responses have been theoretical. If an idea upsets this many people this much there's usually something to it. If it's too stupid of a question, most people would just say to themselves that it's a stupid question and move on with their lives, not be a troll and write up a huge response then go back to check the thread on a regular basis. Why does such an idea upset so many people? My best guess is that it upsets the status quo.

Why are you surprised? Pharmd=phake doctor is from a Trump-voting, gun-toting, red state. People in that category just tend to be angry people, based on personal experience lol.

 

[Digsbe]

Why are you surprised? Pharmd=phake doctor is from a Trump-voting, gun-toting, red state. People in that category just tend to be angry people, based on personal experience lol.

I think it has little to do with politics and more so to do with disparaging doctors of pharmacy.

 

[CetiAlphaFive]

Why are you surprised? Pharmd=phake doctor is from a Trump-voting, gun-toting, red state. People in that category just tend to be angry people, based on personal experience lol.

~~~~Le Politics Meme~~~~~

Wow so virtue
So topical
Much social justice

 

[AlwaysContrary]

Wow didn't realize how offensive it was to just ask a question. And who ever said that I'm a pharmacist? All of my responses have been theoretical. If an idea upsets this many people this much there's usually something to it. If it's too stupid of a question, most people would just say to themselves that it's a stupid question and move on with their lives, not be a troll and write up a huge response then go back to check the thread on a regular basis. Why does such an idea upset so many people? My best guess is that it upsets the status quo.

The number one way to trigger everyone on SDN is to post about a progressive idea. Probably one of the biggest reasons why the profession hasn't grown, lol

 

[Pharmd = Phake Doctor]

Wow didn't realize how offensive it was to just ask a question. And who ever said that I'm a pharmacist? All of my responses have been theoretical. If an idea upsets this many people this much there's usually something to it. If it's too stupid of a question, most people would just say to themselves that it's a stupid question and move on with their lives, not be a troll and write up a huge response then go back to check the thread on a regular basis. Why does such an idea upset so many people? My best guess is that it upsets the status quo.

You asked a question and you got an answer. I'm sorry you got "triggered" by my response. The world doesn't revolve around you or your stupid, poorly thought-out ideas. It's obvious you're a greenhorn when it comes to medical politics.

 

[lord999]

Wow didn't realize how offensive it was to just ask a question. And who ever said that I'm a pharmacist? All of my responses have been theoretical. If an idea upsets this many people this much there's usually something to it. If it's too stupid of a question, most people would just say to themselves that it's a stupid question and move on with their lives, not be a troll and write up a huge response then go back to check the thread on a regular basis. Why does such an idea upset so many people? My best guess is that it upsets the status quo.

Then, it is fair to ask what are you if you are not a pharmacist considering the wording of the question? We are trying to help out other pharmacists and pharmacist hopefuls (students and going to be students) or has some direct relevancy to their current work (some other health practitioner on this board that has run into a pharmacy sort of problem). So why the question if you are not such or have a specific stake (like a physician that a pharmacist approached to do that sort of business arrangement)?

And my answer was not from a position of upset, it was from the idea that if you are a pharmacist, my answer included a "how did you sleep through your business associate and ownership law section (which definitely gets covered because of the fraud implications that our profession routinely deals with in a way that even medicine does not)?" This is sort of covered in the basics of conflict-of-interest matters that the feds or a state would definitely take interest in.

 

[Pharmd = Phake Doctor]

Why are you surprised? Pharmd=phake doctor is from a Trump-voting, gun-toting, red state. People in that category just tend to be angry people, based on personal experience lol.

Yes, because all people in red states are right-wing, bible-thumping, gun-nuts.

The number one way to trigger everyone on SDN is to post about a progressive idea. Probably one of the biggest reasons why the profession hasn't grown, lol

I presented a coherent argument and the best you guys could come up with are ad hominem attacks. Pathetic. How about refuting my argument with a well-presented and well-researched response?

Better yet, you can take your silly ideas and post them to the physician subforums of SDN. Based on what I've seen, they'll be less receptive to your goofy, supposedly progressive ideas.

 

[Seriously Serious]

Wow didn't realize how offensive it was to just ask a question. And who ever said that I'm a pharmacist? All of my responses have been theoretical. If an idea upsets this many people this much there's usually something to it. If it's too stupid of a question, most people would just say to themselves that it's a stupid question and move on with their lives, not be a troll and write up a huge response then go back to check the thread on a regular basis. Why does such an idea upset so many people? My best guess is that it upsets the status quo.

You are asking a hypothetical question about a pharmacist's capabilities on a pharmacy forum..

The number one way to trigger everyone on SDN is to post about a progressive idea. Probably one of the biggest reasons why the profession hasn't grown, lol

It's less about being progressive, and more about having order. A century from now, California will be giving out a NPDDSPharmDMD degree.

 

[AlwaysContrary]

Yes, because all people in red states are right-wing, bible-thumping, gun-nuts.

I presented a coherent argument and the best you guys could come up with are ad hominem attacks. Pathetic. How about refuting my argument with a well-presented and well-researched response?

Better yet, you can take your silly ideas and post them to the physician subforums of SDN. Based on what I've seen, they'll be less receptive to your goofy, supposedly progressive ideas.

I still think my point is correct, lol.

My argument is anecdotal much like yours was, but my hometown had a family practice that was co-owned by a family doc and a pharmacist. The pharmacists owned a pharmacy in the practice but also did a lot of ambulatory "clinical" stuff such like taking med recs, counseling patients directly after receiving a prescription from the doctor, taking care of chronic disease patients that needed medication adjustments, schedule appointments with patients for MTMs, and all that stuff. The pharmacist actually was way more successful then the physician. The physician ended up selling his part of the practice to a hospital and became salaried because he wasn't making enough money to run his portion. The pharmacist left the practice and opened up a stand alone pharmacy and offered the same services he did before and is still killing it.

so yes, it is possible.

 

[Chriskahn]

I always thought it would be cool to run a drug testing office as a side gig but that would most likely get in the way of practicing pharmacy and I'm also lazy so its never going to happen

 

[northeast-southwest]

I know a multi-pharmacy (6ish) owner who is opening a new practice with a good MD friend of his. This owner already has CPAs with several doctors, regularly writes scripts under the CPA contract, and has his own prescription pad. DM me if you want more info.

 

[lord999]

I always thought it would be cool to run a drug testing office as a side gig but that would most likely get in the way of practicing pharmacy and I'm also lazy so its never going to happen

That's not a bad idea. Let's just say that there's other pharmacists who actually started a consulting service (and laboratory proxy) for this sort of work (preemployment drug screening before the actual official one), and it's quite a good sidejob. I consider it morally questionable, but there is a good market for that sort of consulting.

 

[Rouelle]

That's not a bad idea. Let's just say that there's other pharmacists who actually started a consulting service (and laboratory proxy) for this sort of work (preemployment drug screening before the actual official one), and it's quite a good sidejob. I consider it morally questionable, but there is a good market for that sort of consulting.

With the ready availability of at-home testing kits, how did they “sell” it? More drugs screened? Better accuracy?

 

[lord999]

With the ready availability of at-home testing kits, how did they “sell” it? More drugs screened? Better accuracy?

What not to do and did the numbers on how to ensure normal elimination from the system. And what you said.

(There's another aspect that I think you can figure out if you had access as well to a prescriber, where you turn a True Positive into a False Positive, but I'm not in that business, and I have said repeatedly to them that if that every comes up, they are certainly toast.)

 

[Rouelle]

What not to do and did the numbers on how to ensure normal elimination from the system. And what you said.

(There's another aspect that I think you can figure out if you had access as well to a prescriber, where you turn a True Positive into a False Positive, but I'm not in that business, and I have said repeatedly to them that if that every comes up, they are certainly toast.)

Well you had me interested in a side business of my own for about 5 minutes. But I don’t think I could do that. I’m no saint, but a clear conscience is too important for me.

 

[lord999]

Well you had me interested in a side business of my own for about 5 minutes. But I don’t think I could do that. I’m no saint, but a clear conscience is too important for me.

Too late , you're working in a system that obviously is corrupt. That said, I do understand and draw the distinction between working in a corrupt system and being personally responsible for corrupting the system.

 

[CetiAlphaFive]

I still think my point is correct, lol.

My argument is anecdotal much like yours was, but my hometown had a family practice that was co-owned by a family doc and a pharmacist. The pharmacists owned a pharmacy in the practice but also did a lot of ambulatory "clinical" stuff such like taking med recs, counseling patients directly after receiving a prescription from the doctor, taking care of chronic disease patients that needed medication adjustments, schedule appointments with patients for MTMs, and all that stuff. The pharmacist actually was way more successful then the physician. The physician ended up selling his part of the practice to a hospital and became salaried because he wasn't making enough money to run his portion. The pharmacist left the practice and opened up a stand alone pharmacy and offered the same services he did before and is still killing it.

so yes, it is possible.

RonBurgundySayingIDontBelieveYou.mov

 

[Pharmd = Phake Doctor]

I still think my point is correct, lol.

My argument is anecdotal much like yours was, but my hometown had a family practice that was co-owned by a family doc and a pharmacist. The pharmacists owned a pharmacy in the practice but also did a lot of ambulatory "clinical" stuff such like taking med recs, counseling patients directly after receiving a prescription from the doctor, taking care of chronic disease patients that needed medication adjustments, schedule appointments with patients for MTMs, and all that stuff. The pharmacist actually was way more successful then the physician. The physician ended up selling his part of the practice to a hospital and became salaried because he wasn't making enough money to run his portion. The pharmacist left the practice and opened up a stand alone pharmacy and offered the same services he did before and is still killing it.

so yes, it is possible.

Actually, you're wrong. And you managed to prove yourself wrong without even knowing it.

You know that out of all the services that the pharmacist in your story provided (med recs, counseling patients directly after receiving a prescription, performing medication adjustments, MTMs), the only thing that he or she can bill to insurance is the MTM? And none of these services are unique to ambulatory care:

• Techs can do med recs, and they do it quite often in the hospital setting.
• Community pharmacists and interns provide free counseling on new prescriptions (which is required by most state laws).
• Hospital pharmacists (under hospital protocol) and some community pharmacists (under a CPA protocol) will often change medications; again nothing spectacular, and this activity isn't reimbursed by insurance.
• And I've seen a few independent pharmacies do MTM services on the side. You don't need to be an ambulatory care pharmacists to do that.

From the way you describe the pharmacist, it sounds like he was running an independent pharmacy. If he was able to make good money, it was because he was good at running a pharmacy and had nothing to do with being skilled as an ambulatory care pharmacist.

So, your story is nothing new or revolutionary. Also, it doesn't apply to this thread because the OP wanted to practice ambulatory care by coercing physicians into illegal CPA contracts.

You made the bold claim that there was a medical practice co-owned by a physician and a pharmacist, in which the pharmacist was able make more money than the physician doing ambulatory care. But obviously this isn't the case.

Maybe you should put more thought into your argument before you make a post here.

 

[AlwaysContrary]

Actually, you're wrong. And you managed to prove yourself wrong without even knowing it.

You know that out of all the services that the pharmacist in your story provided (med recs, counseling patients directly after receiving a prescription, performing medication adjustments, MTMs), the only thing that he or she can bill to insurance is the MTM? And none of these services are unique to ambulatory care:

• Techs can do med recs, and they do it quite often in the hospital setting.
• Community pharmacists and interns provide free counseling on new prescriptions (which is required by most state laws).
• Hospital pharmacists (under hospital protocol) and some community pharmacists (under a CPA protocol) will often change medications; again nothing spectacular, and this activity isn't reimbursed by insurance.
• And I've seen a few independent pharmacies do MTM services on the side. You don't need to be an ambulatory care pharmacists to do that.

From the way you describe the pharmacist, it sounds like he was running an independent pharmacy. If he was able to make good money, it was because he was good at running a pharmacy and had nothing to do with being skilled as an ambulatory care pharmacist.

So, your story is nothing new or revolutionary. Also, it doesn't apply to this thread because the OP wanted to practice ambulatory care by coercing physicians into illegal CPA contracts.

You made the bold claim that there was a medical practice co-owned by a physician and a pharmacist, in which the pharmacist was able make more money than the physician doing ambulatory care. But obviously this isn't the case.

Maybe you should put more thought into your argument before you make a post here.

lmao, no.

This was OP question, "With the expansion of pharmacists specialties, what would stop a pharmacist from buying a doctor's office and working there under a collaborative practice agreement? For example a pharmacist is board certified in diabetes and either buys out an office that specializes in diabetes treatment, or even buys in as a partner with the office." which is exactly what I answered. He was part owner of a independent practice. Had a Collaborative care agreement, but also ran the pharmacy portion of the business (since, you know, he's a pharmacist). I believe he was board certified in amb care but i'm not entirely sure.

sounds like you need a hug though. I don't know why you're so angry about this.

 

[Wubbalubba]

I presented a coherent argument and the best you guys could come up with are ad hominem attacks. Pathetic.

Actually, you're wrong.

You asked a question and you got an answer. I'm sorry you got "triggered" by my response.

Talk about being uninformed.

I legitimately can't tell if this guy loves Trump so much that he writes his responses the same way that his idol tweets, or if he's trying to pull off a "Colbert Report" type persona of being so far right wing that he is actually making fun of the right wing. Sad.

Either way, it creates more comments on this thread which gives me more material to research and people who are actually trying to help. Thanks!

 

[Pharmd = Phake Doctor]

lmao, no.

This was OP question, "With the expansion of pharmacists specialties, what would stop a pharmacist from buying a doctor's office and working there under a collaborative practice agreement? For example a pharmacist is board certified in diabetes and either buys out an office that specializes in diabetes treatment, or even buys in as a partner with the office." which is exactly what I answered. He was part owner of a independent practice. Had a Collaborative care agreement, but also ran the pharmacy portion of the business (sense, you know, he's a pharmacist). I believe he was board certified in amb care but i'm not entirely sure.

sounds like you need a hug though. I don't know why you're so angry about this.

I'll explain this in a manner that even a complete idiot will understand.

You've changed the pharmacist in your story to an independent pharmacy owner who may or may not do ambulatory work on the side. This is in stark contrast with your previous description of the same pharmacist as someone who:

did a lot of ambulatory "clinical" stuff such like taking med recs, counseling patients directly after receiving a prescription from the doctor, taking care of chronic disease patients that needed medication adjustments, schedule appointments with patients for MTMs, and all that stuff

I pointed out that these activities were not exclusive to ambulatory care. There is nothing "progessive" about this. In fact, these are tasks that regular pharmacists can do in the community setting. So your story wasn't about a pharmacist who worked as a provider, it was about a pharmacist who worked as a dispenser.

You inflated your story to fit the OP's question, but now that I've debunked it, you still want to pretend that it's still relevant. The OP asked if he could work as an ambulatory care pharmacist not as a independent pharmacy owner. Do you know the difference between those two practice settings? Or is that too hard to understand?

It sounds like you don't know much about pharmacy given your posts. Maybe you should get some real-life experience in the pharmacy world before you spout your meaningless platitudes and make up imaginary stories in your head.

 

[Pharmd = Phake Doctor]

Either way, it creates more comments on this thread which gives me more material to research and people who are actually trying to help. Thanks!

Translation: I'm a special snowflake, and the world revolves around me. The people who are criticizing my naive idea are meanies who aren't as special as I am. I'm not listening to them, since I can't cope with being offended.

FTFY

It's sad to live in a world where a generation of kids were raised on participation prizes. I've met too many young people who cannot take the answer "you are wrong" without being triggered.

It doesn't sound like you understand what pharmacy is about. And it doesn't sound like you are interested in being a pharmacist.

If you don't want to practice pharmacy (dispensing medications, verifying prescriptions or orders), then don't go to pharmacy school. There are significantly less opportunities to practice direct patient care as a pharmacist. If you want to practice direct patient care (AKA medicine), then go to NP, PA, MD or DO school.

 

[Wubbalubba]

FTFY

It's sad to live in a world where a generation of kids were raised on participation prizes. I've met too many young people who cannot take the answer "you are wrong" without being triggered.

It doesn't sound like you understand what pharmacy is about. And it doesn't sound like you are interested in being a pharmacist.

If you don't want to practice pharmacy (dispensing medications, verifying prescriptions or orders), then don't go to pharmacy school. There are significantly less opportunities to practice direct patient care as a pharmacist. If you want to practice direct patient care (AKA medicine), then go to NP, PA, MD or DO school.

You really didn't understand what I was saying do you? Even though all you're doing is arguing on the thread, it still pushes the thread to the top of the forum since there are new comments and other people chime in on the idea. All I have to do is "poke the bear" every couple days and you're sure to come back to the thread and have to argue over something especially since you can't stand to not have the last word haha. Which again only brings the thread back to the top of the forum giving it more exposure and more ideas and thoughts and angles to it. Since your first comment, that's literally all I've done and look how many more people chimed in. Again it gives me more angles to look at the problem and more things to research. So again: Thanks!

 

[RHannosh]

You really didn't understand what I was saying do you? Even though all you're doing is arguing on the thread, it still pushes the thread to the top of the forum since there are new comments and other people chime in on the idea. All I have to do is "poke the bear" every couple days and you're sure to come back to the thread and have to argue over something especially since you can't stand to not have the last word haha. Which again only brings the thread back to the top of the forum giving it more exposure and more ideas and thoughts and angles to it. Since your first comment, that's literally all I've done and look how many more people chimed in. Again it gives me more angles to look at the problem and more things to research. So again: Thanks!

PharmD=PhakeDoctor = CHECK MODEEEEEE.

And Wubbalubba, actually, I have had a similar idea. I've looked into it to. although I have absolutely no interest in amb care, I think the problem is simply reimbursements. AmbCare pharmacists have to see a patient like every 15 minutes to be profitable - at least that is what I was told once by a professor of mine.

 

[babybull]

Talk about being uninformed. Physicians form practice groups in order to increase their bargaining power, maximize their patient base, and, ultimately, increase their financial security.

Actually, you're wrong. And you managed to prove yourself wrong without even knowing it.

Maybe you should put more thought into your argument before you make a post here.

FTFY

It's sad to live in a world where a generation of kids were raised on participation prizes. I've met too many young people who cannot take the answer "you are wrong" without being triggered.

It doesn't sound like you understand what pharmacy is about. And it doesn't sound like you are interested in being a pharmacist.

I LOVE the WAY you use colored text to get your point across. Looks beautiful.

 

[BidingMyTime]

A healthcare system might be willing to pay a pharmacist to be work as an ambulatory care pharmacist, but no sole practitioner doctor is going to do that....there is just no financial reason why they would want to, as has been explained in previous responses. Why would the doctor want to pay a pharmacists salary to a Pharm D to educate on diabetes, instead of paying the lesser salary to hire a nurse CDE to do the same?

Even if the doctor did, the legality would have to be carefully examined due to Stark.

Maybe, there is some unique, geographical anomaly, or other special case why a PharmD/MD arrangment as you described would make financial sense, but these cases are few and far between.

 

[AlwaysContrary]

A healthcare system might be willing to pay a pharmacist to be work as an ambulatory care pharmacist, but no sole practitioner doctor is going to do that....there is just no financial reason why they would want to, as has been explained in previous responses. Why would the doctor want to pay a pharmacists salary to a Pharm D to educate on diabetes, instead of paying the lesser salary to hire a nurse CDE to do the same?

Even if the doctor did, the legality would have to be carefully examined due to Stark.

Maybe, there is some unique, geographical anomaly, or other special case why a PharmD/MD arrangment as you described would make financial sense, but these cases are few and far between.

I've read somewhere (I wish I could remember where it was or else I would post a link) that having a pharmD on site allows a physician to accept more complex patients. I've posted on here that pharmacists are more geared to treat complex patients then simple. Really only a pharmacist and physician can take care of a patient with multiple comorbidities and a million medications. More complex patients = more money the physician can make = worth it to have a pharmD around

I'm not sure about the practicality of it though.

 

[Pharmd = Phake Doctor]

I've read somewhere (I wish I could remember where it was or else I would post a link) that having a pharmD on site allows a physician to accept more complex patients.

It doesn't. Having specialized training through residencies and fellowships allows physicians to see more complex patients (as specialists, in contrast to generalists or General Practitioners). A physician worth their title wouldn't depend on a pharmacist to help crack a complex patient on their own; they would refer the patient to the proper specialist physician.

I've posted on here that pharmacists are more geared to treat complex patients then simple. Really only a pharmacist and physician can take care of a patient with multiple comorbidities and a million medications. More complex patients = more money the physician can make = worth it to have a pharmD around

I'm not sure about the practicality of it though.

No one gives a damn about the imaginary practice structure you cooked up in your mind. It's cute that you think pharmacists are geared to 'treat more complex patients then [sic] simple' and that some physician-pharmacist duo or team are treating the most complex patients out there, but none of that is true. It's sad that you swallow every bull-s@#$ idea that your pharmacy professors spout, because their ideas don't matter in the real world.

Physicians are trained to diagnose and treat (which includes prescribing medications); while pharmacists are trained to know prescribing guidelines and important contraindications (at least when it comes to dealing with prescriptions). Physicians are tasked with clinical decision making; pharmacists are tasked with ensuring that the drugs are used in a safe and proper manner. These are different areas of practice! And they have been practiced in different settings (private practice office for physicians, and community pharmacies for pharmacists). This is nothing new.

Contrary to what you hear from your professors and from the pharmacy organizations, the greater public and the laws in this country do no put a lot of trust in the prescribing capabilities of a pharmacist. Hence, pharmacists are relegated to telling patients that they need to discuss their treatment options with a provider when the patient asks for something not OTC. That's a far cry from your statement that 'pharmacists are more geared to treat complex patients then [sic] simple'

Pharmacists can recommend treatments, but physicians are the ones who ultimately decide what they're going to prescribe. A private practice doctor gains no benefit from employing a pharmacist to treat complex patients because physicians already fulfill that role. Furthermore, they don't gain any benefits from using pharmacists as cross-checks because community pharmacists already fulfill that role. And if a physician wants to use midlevels to screen patients, they wouldn't use a pharmacist since pharmacists aren't trained to do a physical exam and form a diagnosis.

If your practice model resulted in better reimbursements, then you would see a greater number of PharmDs utilized as providers in private practice settings. In fact, the opposite is true. NPs and PAs, who are less specialized than pharmacists in drug knowledge and pharmacotherapy, but better adept at performing simple physical exams and less complicated diagnoses, are utilized increasingly in private practice because it allows physicians to see more complex patients that cannot be adequately treated by the midlevels.

CODA: As a pharmacy student with several family members who are in medical school, I can tell you that the "physician-pharmacist team that deals with complex patients" meme is spouted endlessly in the pharmacy schools but is never mentioned in the medical schools. You need to realize that pharmacy schools exist in a "bubble" and you need to sift out the academic BS from reality.

 

[Wubbalubba]

And Wubbalubba, actually, I have had a similar idea. I've looked into it to. although I have absolutely no interest in amb care, I think the problem is simply reimbursements. AmbCare pharmacists have to see a patient like every 15 minutes to be profitable - at least that is what I was told once by a professor of mine.[/QUOTE]

Very true, however I was talking to a PA once who said that's about how much time he gets with each patient and he said the same went for the doctor that he worked with. Once an office will accept Medicare/Medicaid (particularly Medicaid) they barely get reimbursed for anything so they have to see that many patients an hour to be profitable. So in all honesty it seems that that's the case at most medical practices. Curious though, what field did you look into? Is there another field of pharmacy that this situation is better suited to? I'm not an amb care pharmacist, I just used that as an example because it is the easiest one to use.

Someone made a joke about it earlier, but I got to thinking about it and it honestly wouldn't surprise me if the pharmacy profession follows the nursing profession and in the next few decades comes out with a "Pharmacist Practitioner" program for post PharmD graduates. (another progressive idea?? Who do I think I am???) Essentially putting them on the same level as NP's with prescriptive authority and the ability to be a solo practitioner. It makes sense to me, and if they were to come out with some program like this, I feel like I would trust being seen by a "Pharmacist Practitioner" over a PA or NP.

CODA: As a pharmacy student with several family members who are in medical school, I can tell you that the "physician-pharmacist team that deals with complex patients" meme is spouted endlessly in the pharmacy schools but is never mentioned in the medical schools. You need to realize that pharmacy schools exist in a "bubble" and you need to sift out the academic BS from reality.[/QUOTE]

Still can't figure you out my man. You're only a pharmacy student? Why haven't you just cut your losses and dropped out of school? It's pretty obvious that you hate the field of pharmacy and take every chance you can to try to steer people away from the field because I assume you're the nicest/wisest person in the world and are trying to help others from making the same mistake you've made (unless of coarse, like 90% of SDRN, you're just doing it to stop others from going to pharmacy school so you have less competition when you get out).

 

[Rouelle]

Well I guess if we’re going to graduate PharmD/NPs now, then why not?

 

[percyeye]

Well I guess if we’re going to graduate PharmD/NPs now, then why not?

Do we call you Doctor, or Nurse, or Pharmacist when I call into the pharmacy?

 

[Wubbalubba]

Do we call you Doctor, or Nurse, or Pharmacist when I call into the pharmacy?

I mean there is at least one program out there that is an 8 year program that you will graduate with both a PharmD and a MD degree at the end of it all.

 

[Pharmd = Phake Doctor]

Still can't figure you out my man. You're only a pharmacy student? Why haven't you just cut your losses and dropped out of school? It's pretty obvious that you hate the field of pharmacy and take every chance you can to try to steer people away from the field because I assume you're the nicest/wisest person in the world and are trying to help others from making the same mistake you've made (unless of coarse, like 90% of SDRN, you're just doing it to stop others from going to pharmacy school so you have less competition when you get out).

And you are "who"?

Given that I come from a family of pharmacists, I couldn't care what a nobody like you thinks of me. Several of my family members are still active in the pharmacy profession. I'm the son of a hospital staff pharmacist. I have an uncle who is a DOP and another uncle who is a (successful) independent pharmacy owner. My aunt was head of pharmacy services for an entire health system until she retired.

So, I'm sorry I hurt your fragile feelings, but when I point out that you're full of s@#$, I mean it. It sounds like you want pharmacy to be something its not.

Someone made a joke about it earlier, but I got to thinking about it and it honestly wouldn't surprise me if the pharmacy profession follows the nursing profession and in the next few decades comes out with a "Pharmacist Practitioner" program for post PharmD graduates. (another progressive idea?? Who do I think I am???) Essentially putting them on the same level as NP's with prescriptive authority and the ability to be a solo practitioner. It makes sense to me, and if they were to come out with some program like this, I feel like I would trust being seen by a "Pharmacist Practitioner" over a PA or NP.

Pharmacy was never about diagnosing diseases. Is that so hard to understand? If you want to be a doctor or a midlevel practitioner, then go to MD, DO, PA or NP school. What's the point of going to pharmacy school if what you want is something that doesn't even exist?

 

[Pharmd = Phake Doctor]

I mean there is at least one program out there that is an 8 year program that you will graduate with both a PharmD and a MD degree at the end of it all.

Are you too stupid to realize that everyone on this board is laughing at the idea of a combined PharmD/NP program? No one in their right mind would waste their time getting two degrees when they're only going to use one of them in the long run.

Here's the reason why there's only one PharmD/MD program:

Length of PharmD program = 4 years
Length of MD program = 4 years
Combined length of PharmD + MD schools = 8 years
Length of residency and fellowships after medical school = 3-10 years

Given that you have 7+ years of education and training needed to become a full-fledged MD, most people would just go to MD school and cut out the 4 years of pharmacy education.

Rumor has it that Rutgers established the PharmD/MD program because too many of their pharmacy graduates were applying to medical school after graduation. The job market is awful in the NE.

 

[BidingMyTime]

Whoops! Wrong thread, reposted in the correct thread.

 

[Wubbalubba]

Given that I come from a family of pharmacists, I couldn't care what a nobody like you thinks of me. Several of my family members are still active in the pharmacy profession. I'm the son of a hospital staff pharmacist. I have an uncle who is a DOP and another uncle who is a (successful) independent pharmacy owner. My aunt was head of pharmacy services for an entire health system until she retired.

Wow! You must come from the pharmacy version of the Rothschild family. That's awesome! Coming from such a prestigious family as yours, do you think you could hook me up with a loan? I got this great business idea, that I just know you're going to love.

I couldn't care what a nobody like you thinks of me

Well, you obviously do. Otherwise you wouldn't keep coming back to this thread to argue with me. Although I don't mind it (obviously or I wouldn't continue to antagonize you), it's actually a little too easy to do.

 

[Jbrl]

FTFY

It's sad to live in a world where a generation of kids were raised on participation prizes. I've met too many young people who cannot take the answer "you are wrong" without being triggered.

It doesn't sound like you understand what pharmacy is about. And it doesn't sound like you are interested in being a pharmacist.

If you don't want to practice pharmacy (dispensing medications, verifying prescriptions or orders), then don't go to pharmacy school. There are significantly less opportunities to practice direct patient care as a pharmacist. If you want to practice direct patient care (AKA medicine), then go to NP, PA, MD or DO school.

Agreed, but you seem to be the one triggered here.

Wow! You must come from the pharmacy version of the Rothschild family. That's awesome! Coming from such a prestigious family as yours, do you think you could hook me up with a loan? I got this great business idea, that I just know you're going to love.

What's your value prop to the physician, though? That's the rub.

There's also some legal issues, e.g. the CPM doctrine, which might prevent you from owning a medical practice and employing a physician (e.g. in CA).

 

[Wubbalubba]

What's your value prop to the physician, though? That's the rub.

Definitely would have to convince the physician that is either being partnered with or employed of how this would be beneficial for them. From my point of view, the pharmacist in this situation would also run a lot of the business side of the office and also play the role of the office manager, thus saving money and taking stress off of the physician. And the pharmacist would most likely have time in this situation since they can't see as many patients as the Doc can under a collaborative practice agreement. This really all goes back to wanting to run a medical business as a pharmacist that is not a pharmacy. Due to the area that I live in, independent pharmacies can't compete with the chains and I've never seen one survive more than 5 years before shutting down. So I'm just exploring other opportunities out there to meet this situation.

There's also some legal issues, e.g. the CPM doctrine, which might prevent you from owning a medical practice and employing a physician (e.g. in CA).

So obviously California is out of the question in this scenario haha. I have always questioned how corporations get around laws like this, but they obviously do. But I do know that there are opportunities out there for non-physicians to own medical practices. Just google urgent care franchise. I think as you've brought up though, it's all state dependent.

 

[Jbrl]

Definitely would have to convince the physician that is either being partnered with or employed of how this would be beneficial for them. From my point of view, the pharmacist in this situation would also run a lot of the business side of the office and also play the role of the office manager, thus saving money and taking stress off of the physician. And the pharmacist would most likely have time in this situation since they can't see as many patients as the Doc can under a collaborative practice agreement. This really all goes back to wanting to run a medical business as a pharmacist that is not a pharmacy. Due to the area that I live in, independent pharmacies can't compete with the chains and I've never seen one survive more than 5 years before shutting down. So I'm just exploring other opportunities out there to meet this situation.

So obviously California is out of the question in this scenario haha. I have always questioned how corporations get around laws like this, but they obviously do. But I do know that there are opportunities out there for non-physicians to own medical practices. Just google urgent care franchise. I think as you've brought up though, it's all state dependent.

Some counterpoints: 1) If it's family medicine, you won't be paying the practitioner enough to make it worth his while since you'd be functioning halfway as expensive overhead when he could be hiring a $20/hr assistant to manage the office while pocketing the difference. 2) If it's specialty medicine e.g. endocrinology, you won't have the SME to practice and would then be 100% expensive overhead. 3) Your ability to take low-level cases may or may not be relevant depending on physician capacity to take on patient demand 4) Physicians have egos too. Working underneath a pharmacist wouldn't fly for a plurality of them

If I were a physician: you would have a CPA under me. I have all the leverage, and would propose the inverse ownership structure where I have majority or totality stakes and pay you salary commensurate with your responsibilities. Not to say the arrangement you outlined is impossible, just highly improbable.

And yep, it's state dependent. There are exceptions made to the CPM rule for hospitals and other facilities, which physicians cannot own due to Stark

Not sure what else you could do. PillPack's a good example of something different done in recent years to address a need not filled by chains. Service and personalized medicine are two areas chains don't execute particularly well.