Pharmacist Prescribing?

[konkan]

As some of you already know, starting November 2005, UK pharmacists and specialized nurses can INDEPENDENTLY prescribe ANY medication with the except of controlled medications. What do you think about it? When pharmacists will have this right here? For me it makes so much sense, cause pharm. students have pharmacotherapy for 4 semesters, whereas med. students have it only for 1 semester. Shouldn't pharm. lobbyists push it even harder to get this authority for pharmacists?

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[genesis09]

In some states, pharmacists can prescribe a limited number of drugs. The segregation of prescribing and dispensing can be dated to about a hundred years ago. Pharmacists and Doctors agreed that pharmacists would dispense drugs and doctors would prescribe, and that agreement became law. Before that point, doctors and pharmacists could do both.

 

[ethyl]

Would pharmacists end up with more expensive malpractice insurance?

 

[insipid1979]

Shouldn't pharm. lobbyists push it even harder to get this authority for pharmacists?

Just out of curiosity...what would your opinion be if someone tried to let physicians be able to prescribe and dispense drugs themselves at their practice?

 

[UTCPharm]

I think the system should stay the way it is. Although it would be really handy to prescribe a medication every now and then for a sick family member, the system is the way it is for a reason. You have somebody writing the prescription, and a different person looking at it when it is dispensed...that is how and why errors are discovered. Everybody, no matter how good they are, makes mistakes sometimes. By making the process a little longer and less convenient by involving more people, we stand a much better chance of preventing mistakes. Although, I suppose it would eliminate any mistakes that arise from communication problems...

 

[konkan]

Just out of curiosity...what would your opinion be if someone tried to let physicians be able to prescribe and dispense drugs themselves at their practice?

It would be fine with me as long as pharmacists would be allowed to prescribe and dispense

 

[JackFruitLover]

Although pharmacists go through vigorous training, doctors must go through 4 to 5 years of vigorous residency training in order to have full authority for prescribing. Presribing takes a lot of experience because its very complicated to know which prescription fits each disease. I only support it if pharmacist had to do atleast 2 years extra of residency.

 

[calrx]

Just out of curiosity...what would your opinion be if someone tried to let physicians be able to prescribe and dispense drugs themselves at their practice?

good point.

 

[VCU07]

Although pharmacists go through vigorous training, doctors must go through 4 to 5 years of vigorous residency training in order to have full authority for prescribing. Presribing takes a lot of experience because its very complicated to know which prescription fits each disease. I only support it if pharmacist had to do atleast 2 years extra of residency.

I agree...I believe there would be a huge mess if all pharmacists were allowed to prescribe. Pharmacists who have done 2 yrs of residency training are well prepared and know their speciality inside and out. I recommend prescribing power for these clinical pharmacists.

 

[Aznfarmerboi]

As some of you already know, starting November 2005, UK pharmacists and specialized nurses can INDEPENDENTLY prescribe ANY medication with the except of controlled medications. What do you think about it? When pharmacists will have this right here? For me it makes so much sense, cause pharm. students have pharmacotherapy for 4 semesters, whereas med. students have it only for 1 semester. Shouldn't pharm. lobbyists push it even harder to get this authority for pharmacists?

Not to mention for the 1 semester of pharmcotherapy that med students do get, they probably sleep through most of it.

 

[spacecowgirl]

I think making a profit from selling what you're prescribing is a conflict of interest. I do think it would be great if we could switch drugs within a class for insurance purposes (like PPIs) or switch dosage forms without calling the doctor. Other than that, I don't really want the liability of prescribing. Pharmacists are very well trained in pharmacotherapy, but I don't think we are adequately trained in diagnostics, not enough to be prescribing.

 

[kwizard]

I think making a profit from selling what you're prescribing is a conflict of interest. I do think it would be great if we could switch drugs within a class for insurance purposes (like PPIs) or switch dosage forms without calling the doctor. Other than that, I don't really want the liability of prescribing. Pharmacists are very well trained in pharmacotherapy, but I don't think we are adequately trained in diagnostics, not enough to be prescribing.

For better or for worse pharmacists will have to eventually obtain prescribing privileges, especially if clinical pharmacy is going to survive (or fully thrive). Without the "power" to prescribe then it is pretty hard to bill for service. You can do all of the med management and counseling you want, but since a pharmacist isn't going to peform an invasive procedure; autonomy needs to be gained for treated pts. Otherwise you just counsel a pt and make your reccomendations to the clinician w/ prescribing privileges and let them bill for your ideas.

Various templates are out there in the various collaborative practice agreements in many states and the various directives in federal sector granting "clinical pharmacists" the right to define a scope of practice w/ prescribing privileges. I remember providing links to articles/directives when this subject came up earlier? Even on a more basic level, most pharmacist in hospital settings have protocols passed by the hospital P&T committee meeting allowing pharmacist (entire dept or a selected few) to renal adjust antibiotic dosing, prescribe anticoag meds (inpt or outpt), order TPNs or adjust and/or order other meds that can be followed via a drug level (i.e. therapeutic drug monitoring of antisz meds, digoxin, etc.). When dealing w/ antbx dosing the same pharmacist adjusting the dose based on renal function is often the same pharmacist dispensing med.

Checks and balances scenario...I know the big fear is that if all pharmacists have prescribing privileges than who is checking the meds? Well in most cases what we may see in the US is "clinical pharmacists" as the ones actually using these prescribing privileges and a separate group of pharmacists still responsible for checking the medication to ensure it is appropriately written, no ADRs, drug interactions, etc. I only use the term "clinical" pharmacist to describe the individual who has gained the necessary requirements to obtain prescribing privliges as so defined by their practice setting and/or state/federal regulations. Think of it like Nurse Practitioners (NP). A NP is basically a RN w/ additional training (i.e. a BSN and MSN w/ several more yrs of clinical training than a RN) and we are all registered pharamcists (some w/ more clinical training than others). However if a NP wanted to pick up extra hrs, they could always still work as a RN if they wanted to. I know some NPs who moonlight periodically as RNs on the floor and actually make more per hr as a RN then they do per hour as a NP given the shortage for RNs on the unit. Maybe not the best analogy, but I'm just trying to illustrate that you can have more than one tier of professionals within one profession.

So therefore the likelihood of someone prescribing and dispensing all in the same course of action would be rare. However in some cases when your working with limited staff or you need the drug in a quick manner you sometimes do see the same pharmcist who prescribes the med also processing the order and dispensing (I typically only do this in the case of coumadin dosing on wknds or antibiotic dosing w/ stat doses). Otherwise it would probably be most appropriate ethically for another pharmacist to check the order.

Doctors prescribing and dispensing...Well I guess it depends on how many samples they give out. Nonetheless I don't think this will be a worry as inventory for keeping so many meds in the office would be too much of a hassle for the many physicians to even want to bother with.

 

[sdn1977]

For better or for worse pharmacists will have to eventually obtain prescribing privileges, especially if clinical pharmacy is going to survive (or fully thrive). Without the "power" to prescribe then it is pretty hard to bill for service. You can do all of the med management and counseling you want, but since a pharmacist isn't going to peform an invasive procedure; autonomy needs to be gained for treated pts. Otherwise you just counsel a pt and make your reccomendations to the clinician w/ prescribing privileges and let them bill for your ideas.

Various templates are out there in the various collaborative practice agreements in many states and the various directives in federal sector granting "clinical pharmacists" the right to define a scope of practice w/ prescribing privileges. I remember providing links to articles/directives when this subject came up earlier? Even on a more basic level, most pharmacist in hospital settings have protocols passed by the hospital P&T committee meeting allowing pharmacist (entire dept or a selected few) to renal adjust antibiotic dosing, prescribe anticoag meds (inpt or outpt), order TPNs or adjust and/or order other meds that can be followed via a drug level (i.e. therapeutic drug monitoring of antisz meds, digoxin, etc.). When dealing w/ antbx dosing the same pharmacist adjusting the dose based on renal function is often the same pharmacist dispensing med.

Checks and balances scenario...I know the big fear is that if all pharmacists have prescribing privileges than who is checking the meds? Well in most cases what we may see in the US is "clinical pharmacists" as the ones actually using these prescribing privileges and a separate group of pharmacists still responsible for checking the medication to ensure it is appropriately written, no ADRs, drug interactions, etc. I only use the term "clinical" pharmacist to describe the individual who has gained the necessary requirements to obtain prescribing privliges as so defined by their practice setting and/or state/federal regulations. Think of it like Nurse Practitioners (NP). A NP is basically a RN w/ additional training (i.e. a BSN and MSN w/ several more yrs of clinical training than a RN) and we are all registered pharamcists (some w/ more clinical training than others). However if a NP wanted to pick up extra hrs, they could always still work as a RN if they wanted to. I know some NPs who moonlight periodically as RNs on the floor and actually make more per hr as a RN then they do per hour as a NP given the shortage for RNs on the unit. Maybe not the best analogy, but I'm just trying to illustrate that you can have more than one tier of professionals within one profession.

So therefore the likelihood of someone prescribing and dispensing all in the same course of action would be rare. However in some cases when your working with limited staff or you need the drug in a quick manner you sometimes do see the same pharmcist who prescribes the med also processing the order and dispensing (I typically only do this in the case of coumadin dosing on wknds or antibiotic dosing w/ stat doses). Otherwise it would probably be most appropriate ethically for another pharmacist to check the order.

Doctors prescribing and dispensing...Well I guess it depends on how many samples they give out. Nonetheless I don't think this will be a worry as inventory for keeping so many meds in the office would be too much of a hassle for the many physicians to even want to bother with.

I agree with much of what Kwizard has said. However, I do feel prescribing will be within a collaborative practice agreement model or for medications which might be moved to a "by pharmacist access only" level - between OTCs & rx (excluding the pseudoephedrine debacle currently). I don't feel retail pharmacists have access & time for complete physical & laboratory assessments, so the medications which they might have available to "prescribe", for lack of a better word, would be those which have shown themselves to be "safe", but which might be misued - fluconazole 150mg po as one example.

Inpatient drug protocols and adjustments are so commonplace by pharmacists that I believe its a non-issue. They have access to labwork which makes dosing so much easier.

There are a couple of misconceptions, I feel, regarding drug education of physicians. Long, long time ago, when I was a student, I took microbiology, biochemistry & physiology with medical & dental students during my first two years. Drugs were introduced during that time & mechanisms discussed (ie - gm+ cocci susceptible to pcn due cleavage of beta-lactam ring in cell wall, how resistance develops, etc). Obviously, my education went on in my direction, but their exposure to medications also went on in theirs. My daughter as a second year medical student now has had similar exposure. In her first year, she learned about antibiotics during micro, during second year she is learning anticonvulsants, adrenergic agonists, sedative-hypnotics, etc in neuro. Now, she is learning basic pharmacology - no kinetics or dosing yet. When she gets into more diagnosis, rather than just altered & normal physiology, she'll learn why you choose one over the other. The semester of pharmacolgy goes over the classes & reviews the differences within classes (ie lidocaine, flecainide, encainide, etc..), kinetics, toxicology, etc..Yes..much less than the detail we learned didactically, but over the 4 years of medical school, far more depth with regard to using drugs to manage disease states. However, the real depth comes with their residency.

As far as prescribing authority, a physician has full prescribing authority after they receive their MD/DO & have passed two of their licensing exams (STEP I & II for MD's). They do not need to finish their residency for this to happen (after all - some surgeons can take 7 years to finish residency alone!). But...my experience with new physicians is just because they can prescribe doesn't mean they do prescribe. By the time they have started on their residency, they usually have the sense there is so much more they still don't know than they do know. A first year resident doesn't write many orders independent of consultation with their senior resident or attending, so their education on how drugs are utilized within their chosen specialty is continued on for more years.

One final thought which always bothers me is the sense of "turf". Ask yourself a question - do you want prescribing authority because you feel you "deserve" it or is it better for the patient? Good patient care should always be the priority, IMO. If we can improve access for safe & effective medications in which a delay of diagnosis will not adversly affect the pts outcome, then by all means, we should find a way to do it. But...if our lack of diagnostic capability results & giving an incorrect medication, the I'd question if that were really in the patients best interest. I apologize for the long post....I'm way too windy!

 

[FamilyMD]

Just out of curiosity...what would your opinion be if someone tried to let physicians be able to prescribe and dispense drugs themselves at their practice?

Uhhh, I dispense over 30 types of meds from my office. Patients love not having to "waste time" at the pharmacy. I'm quite surprised you did not know most Dr's (at least around here) dispense quite a bit (and it's profitable )

 

[dgroulx]

Uhhh, I dispense over 30 types of meds from my office. Patients love not having to "waste time" at the pharmacy. I'm quite surprised you did not know most Dr's (at least around here) dispense quite a bit (and it's profitable )

I just finished pharmacy law last year and it is illegal for a physician to dispense without going through lots of extra steps. It must be a separate entity (corporation), but can be located in the same building. You must get a state license, you cannot sell samples, there are tons of forms and paper work and it generally is not a profitable venture because of the costs involved. You may become profitable by limiting the meds you supply, but that doesn't have the patient's best interest. If you are supplying the medication that makes you money, but is not the best one for the patient then you will be in legal trouble. BTW, where exactly is "around here"?

In Florida, Publix supermarkets are going to be installing a small clinic next to their pharmacy. People will get prescriptions from a PA or NP, and have it filled right there, then pick it up when they are done shopping. Publix have had flu vaccines at the pharmacy for years, so this is a natural progression.

 

[FamilyMD]

I just finished pharmacy law last year and it is illegal for a physician to dispense without going through lots of extra steps. It must be a separate entity (corporation), but can be located in the same building. You must get a state license, you cannot sell samples, there are tons of forms and paper work and it generally is not a profitable venture because of the costs involved. You may become profitable by limiting the meds you supply, but that doesn't have the patient's best interest. If you are supplying the medication that makes you money, but is not the best one for the patient then you will be in legal trouble. BTW, where exactly is "around here"?

In Florida, Publix supermarkets are going to be installing a small clinic next to their pharmacy. People will get prescriptions from a PA or NP, and have it filled right there, then pick it up when they are done shopping. Publix have had flu vaccines at the pharmacy for years, so this is a natural progression.

Some student telling someone in the real world what is and isn't happening. You are an idiot. Go to allscripts.com or medline.com. Order your meds, a log book, some stickers and voila! No extra license, paperwork, etc. Again, you are an idiot for questioning someone in the real world, guess you better go study harder.

 

[spacecowgirl]

Some student telling someone in the real world what is and isn't happening. You are an idiot. Go to allscripts.com or medline.com. Order your meds, a log book, some stickers and voila! No extra license, paperwork, etc. Again, you are an idiot for questioning someone in the real world, guess you better go study harder.

And you are a dick

 

[FamilyMD]

And you are a dick

why???? cause I shared what's it's like in the real world? I don't have anything against pharms, my cousin is one at a CVS in virginia (wants to blow his brains out) but it annoys me when someone implies I am lying when I'm just telling you the facts. MANY Dr's dispense. In my case, I dispense generic abx, ativan, xanax, steroid creams, codeine syrup, and someother generics. Pts LOVE it!
Obviously I don't sell Benicar, Ketek, etc. as it would cost the pt's more than their copay. Oh well, whatever, believe what you want.

 

[sdn1977]

Some student telling someone in the real world what is and isn't happening. You are an idiot. Go to allscripts.com or medline.com. Order your meds, a log book, some stickers and voila! No extra license, paperwork, etc. Again, you are an idiot for questioning someone in the real world, guess you better go study harder.

Hmmm...its done & ethical & legal to a certain extent. But..you gotta be careful. Most states are scrutinizing internet pharmacies & making them more difficult, altho not impossible to function. I'll try to give you some specific detail, at least for my state - CA, later so you don't run into trouble (like lose your license). But...I gotta go to work (my real world) right now.

 

[twester]

Some student telling someone in the real world what is and isn't happening. You are an idiot. Go to allscripts.com or medline.com. Order your meds, a log book, some stickers and voila! No extra license, paperwork, etc. Again, you are an idiot for questioning someone in the real world, guess you better go study harder.

Nice social skills, graduate from charm school lately?

On the Internet, everyone is an authority and no one is credible. For all I know, you're the guy I saw licking MgCl off the cars in the parking lot this morning. Having read many of Dgroulx's posts, I would listen to her over you any day - even if I've disagreed with her opinions on occasion.

Now to wrest the thread from your sticky little hands...

If I wanted to diagnose and prescribe, I'd go to medical school. A pharmacist's job is to know drugs inside and out and to apply that knowledge as part of a team comprised of other medical professionals. One-man shows are not in the best interests of the patient. (Maybe I copied that out of a brochure, maybe it's original.)

I do think that pharmacists may be qualified to do some limited prescribing of things that are time-sensitive (like emergency contraception) or routine (like vaccinations). Do I want to be in charge of Mr. Jones' anti-coagulants? Not a chance.

But then again, I'm just a student or maybe I'm a professional alligator wrestler. You decide.

 

[Moxxie]

why???? cause I shared what's it's like in the real world? I don't have anything against pharms, my cousin is one at a CVS in virginia (wants to blow his brains out) but it annoys me when someone implies I am lying when I'm just telling you the facts. MANY Dr's dispense. In my case, I dispense generic abx, ativan, xanax, steroid creams, codeine syrup, and someother generics. Pts LOVE it!
Obviously I don't sell Benicar, Ketek, etc. as it would cost the pt's more than their copay. Oh well, whatever, believe what you want.

Dana wasn't calling you a liar - she was telling you that what you're doing is illegal in Florida (and possibly illegal where you live as well). If you frequent these boards at all, you'll discover that she is NOT an idiot at all - in fact, she's one of the main people on this board that I would trust with issues such as this.

Please don't be bashing. The name-calling wasn't appropriate at all, and spacecowgirl simply called you out on it. The issue raised in this discussion is whether or not pharmacists can prescribe, not whether doctors should dispense. I'm all for clinical pharmacists having prescribing privileges, but someone ELSE should actually fill the script, for the reasons that kwizard brought up - it's good to have someone else check for possible mistakes.

You seem like the type of MD that pharmacists dread - the "I'm a doctor so I know everything" type. You might not respect what we do, but please don't make pharmacists' lives more difficult.

 

[FamilyMD]

Dana wasn't calling you a liar - she was telling you that what you're doing is illegal in Florida (and possibly illegal where you live as well). If you frequent these boards at all, you'll discover that she is NOT an idiot at all - in fact, she's one of the main people on this board that I would trust with issues such as this.

Please don't be bashing. The name-calling wasn't appropriate at all, and spacecowgirl simply called you out on it. The issue raised in this discussion is whether or not pharmacists can prescribe, not whether doctors should dispense. I'm all for clinical pharmacists having prescribing privileges, but someone ELSE should actually fill the script, for the reasons that kwizard brought up - it's good to have someone else check for possible mistakes.

You seem like the type of MD that pharmacists dread - the "I'm a doctor so I know everything" type. You might not respect what we do, but please don't make pharmacists' lives more difficult.

Oh I see, so it's ok to call people a dick though....now I get it....NOT!

 

[Moxxie]

Oh I see, so it's ok to call people a dick though....now I get it....NOT!

Well, you deserved it, Dana did not. I call 'em like I see 'em.

 

[insipid1979]

Uhhh, I dispense over 30 types of meds from my office. Patients love not having to "waste time" at the pharmacy. I'm quite surprised you did not know most Dr's (at least around here) dispense quite a bit (and it's profitable )

Why do you go on other boards and try to belittle people? You pulled the same crap on the Optometrist board. How have you not been banned yet?

...I should probably stop feeding this troll.

Judging from your other posts it seems like you are bitter because your parents forced you into being an MD...so I guess you have to try to make yourself feel better by trying to put other people down.

 

[FamilyMD]

Why do you go on other boards and try to belittle people? You pulled the same crap on the Optometrist board. How have you not been banned yet?

...I should probably stop feeding this troll.

Judging from your other posts it seems like you are bitter because your parents forced you into being an MD...so I guess you have to try to make yourself feel better by trying to put other people down.

You are truly a bizarre person. I was only correcting one person here who tried to sound like an authority on what I can and cannot dispense, even implied I was breaking the law. This person was PLAIN wrong and you guys keep defending her despite the FACTS. Where do you people think people got their meds before apothecaries were invented?
I have ALWAYS wanted to be an MD for as long as I can remember, glad I became one and did not have to setle. No idea why you would think my parents (do you even know them??) forced me to do anything. Please seek help, it's out there......

 

[konkan]

Oh I see, so it's ok to call people a dick though....now I get it....NOT!

You don't seem too much insulted being called a dick..)

 

[insipid1979]

You are truly a bizarre person. I was only correcting one person here who tried to sound like an authority on what I can and cannot dispense, even implied I was breaking the law.

When I said you were trolling...I was referring to the comment you made about your patients wasting time in a pharmacy.

I have ALWAYS wanted to be an MD for as long as I can remember, glad I became one and did not have to setle. No idea why you would think my parents (do you even know them??) forced me to do anything.

You said in a post before that your parents are forcing your sister to become a physician. I just put that and your bitterness together and figured you didn't want to become one. Why else would you try to put down other professions? Are you angry that being a physician isn't what you thought it was all cracked up to be?

 

[twester]

Where do you people think people got their meds before apothecaries were invented?

I don't know, probably the same place they got their leeches and emetics. You don't really advocate a return to 15th century medicine do you?

How about those pharmacists prescribing medications? It's been clearly established that you have no ethical qualms about dispensing medications, so how about pharmacists diagnosing and prescribing? According to Wikipedia, the repertory of all things modern and colloquial , a troll is:

"someone who comes into an established community such as an online discussion forum, and posts inflammatory, rude or offensive messages designed to annoy and antagonize the existing members or disrupt the flow of discussion (see Anonymous Internet posting)."

So, Mr. FamilyMD, whatdya think of pharmacists prescribing medications?

 

[FamilyMD]

When I said you were trolling...I was referring to the comment you made about your patients wasting time in a pharmacy.

Good Lord man! Notice the quotes?? That's what pts tell me! Just quotiing them. I know in your world, pharmacies are a fun place, but here's breaking new for ya, most people don't would rather be elsewhere.

 

[insipid1979]

I know in your world, pharmacies are a fun place, but here's breaking new for ya, most people don't would rather be elsewhere.

Kind of like a Doctor's office? I'm sure most people would rather go to a pharmacy if they have a flu and just have the pharmacist prescribe them a drug instead of going to a doctor to pay them 70 dollars for the Doctor to tell them something they already know...just a thought.

 

[Requiem]

Good Lord man! Notice the quotes?? That's what pts tell me! Just quotiing them. I know in your world, pharmacies are a fun place, but here's breaking new for ya, most people don't would rather be elsewhere.

In turn, a doctor's office isn't a fun place, neither is a dentists, and im sure everyone would "rather be elsewhere", however you know people are going to take those kinds of comments the wrong way; I certainly don't spam the med boards with "patients tell me they hate going to see their doctor when theyre just waiting and waiting and then only get 5 minutes of contact before theyre hurried out"

We both can generalize and produce negative quotes of each others profession, and i'm sure patients would love the convienece of being able to go straight to a pharmacy, get an antibiotic prescribed, get their meds and get out. The idea is with a physician-pharmacist system we put our expertise together for the patients benefit, not their convienence.

 

[konkan]

You are truly a bizarre person. I was only correcting one person here who tried to sound like an authority on what I can and cannot dispense, even implied I was breaking the law. This person was PLAIN wrong and you guys keep defending her despite the FACTS. Where do you people think people got their meds before apothecaries were invented?
I have ALWAYS wanted to be an MD for as long as I can remember, glad I became one and did not have to setle. No idea why you would think my parents (do you even know them??) forced me to do anything. Please seek help, it's out there......

hey dude why on earth you keep showing up here?
Nobody invited you here, nobody is interested in your biography, or what your parents ( especially your dad) forced you to do during your childhood...
Go to med. forum, open up your own thread...and stay there

 

[FamilyMD]

I don't know, probably the same place they got their leeches and emetics. You don't really advocate a return to 15th century medicine do you?

How about those pharmacists prescribing medications? It's been clearly established that you have no ethical qualms about dispensing medications, so how about pharmacists diagnosing and prescribing? According to Wikipedia, the repertory of all things modern and colloquial , a troll is:

"someone who comes into an established community such as an online discussion forum, and posts inflammatory, rude or offensive messages designed to annoy and antagonize the existing members or disrupt the flow of discussion (see Anonymous Internet posting)."

So, Mr. FamilyMD, whatdya think of pharmacists prescribing medications?

You know what this is so stupid. I have NEVER posted on this pharm board before but you people are so defensive. Honestly, pharmacists will NEVER prescribe to any significant amount. You guys are great at what you do, cross checking interactions, giving OTC advice to customers, etc., but you can not honestly tell me you have the CLINICAL training to dx. As I said, I am NOT anti-pharm and even have a cousin doing it. Someone said I was bitter???!!! Puh-leez. I have the best job in the world. Wanna talk bitter, everytime I talk to my cousin he says there is not a day he doesn't think of quitting as he stands at the drive thru (a la McDonald's) and has to go fetch the "patient" her charmins. Very demoralizing.
As suggested, I will leave now and post no more, I only posted to correct a blatant error.

 

[insipid1979]

You guys are great at what you do, cross checking interactions

It is great that you bypass this by dispensing drugs at your practice...I would love to be one of your patients

You know how a lot of people talk ill about the personality and attitude of Doctors? Yeah everything they talk about you sum up pretty well

Honestly, pharmacists will NEVER prescribe to any significant amount.

Kind of like Nurses with Nurse Practitioners, right? People are realizing a lot of what Doctors do is redundant and over costly to people. Hence the shift the healthcare industry has been taking recently and how new jobs are coming up that are crossing over into what once was only things a physician would do. Personally I wouldn't care if I was allowed to prescribe or not...you can keep the malpractice insurance

As I said, I am NOT anti-pharm and even have a cousin doing it.

I am not quite sure how having a cousin who is a pharmacist makes you "NOT anti-pharm"...but whatever.

As suggested, I will leave now and post no more, I only posted to correct a blatant error.

Classic internet copout. Good riddance.

 

[karariki]

i think keeping the old system is fine. pharmacists dispense while doctors prescribe. doctors are trained to diagnose correctly while pharmacists are trained to look at possible drugs complication. Each spend years to gain expertise in their field.
With this current systerm, doctors and pharmacists are cross-checking each other to prevent mistakes.
If pharmacists want to prescribe, they should become doctors, and if doctors want to dispense, they should become pharmacists. a career change may take time, but if that's ur calling, go ahead & switch.

 

[twester]

You know what this is so stupid.

Amen to that.

I have NEVER posted on this pharm board before but you people are so defensive. Honestly, pharmacists will NEVER prescribe to any significant amount. You guys are great at what you do, cross checking interactions, giving OTC advice to customers, etc., but you can not honestly tell me you have the CLINICAL training to dx.

Yes, we defended the fellow forum member who you patronizingly called "idiot" and then continued with the rants and insults.

Thanks for your input. I don't disagree. The current state of pharmacist training is not conducive to giving them the duty to diagnose. Some pharmacy schools are moving in that direction, though, in one form or another. If a pharmacist has at least an understanding of diagnostic techniques he or she can better collaborate on care.

As I said, I am NOT anti-pharm and even have a cousin doing it. Someone said I was bitter???!!! Puh-leez. I have the best job in the world. Wanna talk bitter, everytime I talk to my cousin he says there is not a day he doesn't think of quitting as he stands at the drive thru (a la McDonald's) and has to go fetch the "patient" her charmins.

Sorry about your cousin. Sounds like maybe he made a bad career choice. I have two friends who are pharmacists. Both say they "have the best job in the world".

The underlying message of that paragraph, however, is how ****-on pharmacists are and how intent you are to aid in the process. It's unproductive and anti-social. I do believe you have serious issues that I'm not qualified to "dx" (somebody watches too much ER).

As suggested, I will leave now and post no more, I only posted to correct a blatant error.

No you posted to insult and demean. But believe what you will. Bye.

 

[VCU07]

maybe we should report him to the board of medicine...

 

[dgroulx]

From AMA website:

1) Physicians should prescribe drugs, devices, and other treatments based solely upon medical considerations and patient need and reasonable expectations of the effectiveness of the drug, device or other treatment for the particular patient. (2) Physicians may not accept any kind of payment or compensation from a drug company or device manufacturer for prescribing its products. Furthermore, physicians should not be influenced in the prescribing of drugs, devices, or appliances by a direct or indirect financial interest in a firm or other supplier, regardless of whether the firm is a manufacturer, distributor, wholesaler, or repackager of the products involved. (3) Physicians may own or operate a pharmacy, but generally may not refer their patients to the pharmacy.

 

[sdn1977]

Whew! In spite of how busy I was at work, I was probably better off than watching this thread develop. But...I said I'd be back to give the CA experience, so here it is...There are actually a number of sub-issues involved in the argument...

First is pharmacy ownership. To have a brick & mortar pharmacy in CA, you must have a license issued by the state board. It doesn't matter if the pharmacy is free standing, in a grocery store, hospital, or md's office. A license will NOT be issued to the following:
1. persons authorized to prescribe (exception is pharmacist collaborative practice agreements)
2. persons who share a financial interest with someone authorized to prescribe
3. a corporation in which 10% or more of the stock is owned by persons who cannot otherwise obtain a pharmacy license (ie - a corporation of prescribers)

Second, if you are able to obtain a license, assuming you are a non-pharmacist (& not a prescriber) you must have a pharmcist-in-charge...so now you must employ a pharmacist since only a pharmacist is authorized to fill a prescription (H&S 11207)

Third - what about physician dispensing (which I think is what FamilyMD was referring to..)? CA law delineates 8 conditions which must be met with the salient ones being (this is the noncontrolled substances) (B&P4170)

1. the prescriber does not keep a pharmacy, advertised or otherwise, for the retailing the drugs or devices (in other words - you cannot charge for what you dispense)
2. the prescriber offers to give a written rx to the pt
3. the prescribeer must provide a written disclosure that the pt has a choice between obtaining the rx from the prescriber or obtaining from a pharmacy of the pts choice
None of these conditions prevents prescribers from providing samples (which are labeled by the manufacturer as samples) or drugs administered directly to patients in the office (ie 2 Gm of amox administered to a pt in a dental office before a procedure).

Fourth - the dispensing of controlled drugs has its own, separate set of laws (H&S 11158). A prescriber may dispense directly to the patient a controlled substance (CII-V) in an amount not to exceed a 72 hr supply & only if the patient is not expected to require an additional amount of controlled substance beyond 72 hours.

Fifth - federal law will require by 2007 reporting of ALL dispensing activities of controlled drugs electronically in real time, which will negate all log sheets & require computer software to communicate with the Department of Justice. Currently 32 states require this now. Wholesale purchases are currently monitored online, so the DOJ sees how much each "purchaser" (pharmacy or md) is buying & follows records of dispensing. Discrepancies cause reason for investigation. I usually get 1 suponea every year from the the CA state board of medicine requesting dispensing records linked to one prrescribers DEA #.

Finally is the issue of the non-brick & mortar pharmacies - the internet pharmacy. To dispense to any pt in the US, an internet pharmacy must be licensed in the state in which the pt resides. The same stipulations exist as to ownership of a brick & mortar pharmacy as well as an internet pharmacy in CA. If an internet pharmacy in Georgia, for example, wants to fill an rx for a CA patient - they must be licensed as a CA "out-of-state" pharmacy & provide documentation of ownership. Every legitimate mail order or online pharmacy is registered in every state.

We won't even get into the pending legislation of documentation of drug pedigree which will take effect in 2007 & goes from manufacturer of raw materials all the the to the ultimate dispenser to patient.

Dana alluded to many of these stipulation in FL so they may be similar.
I'd advise FamilyMD to be careful of what he/she dispenses (especially the controlled drugs), how much & the circumstances (are you charging the patient or billing their insurance in which case you are engaging in retail dispensing) - check the laws in your state. It may not be the same as CA. The penalties are huge here- from $5000 to $25,000 per OCCURRENCE (the highest for internet citations). Since 2002 annually, we have citations with fines for some of these occurrences exceeding $1,000,000 not including the license suspensions & revocations (including prescribers who wanted to supplement their billing) - thats a lot of prescriptions you have to fill to cover the expense - is it really worth that?

I apologize again for the very long post, but this is not an easy issue to explain legally and I didn't want to belabor the history of why the laws have developed as they have. As with every pharmacy rule, there will be exceptions, so the laws in your state may not mirror the laws in mine. My earlier comment still stands - what is in the best interest for the patient medically?

 

[Caverject]

Whew! In spite of how busy I was at work, I was probably better off than watching this thread develop. But...I said I'd be back to give the CA experience, so here it is...There are actually a number of sub-issues involved in the argument...

First is pharmacy ownership. To have a brick & mortar pharmacy in CA, you must have a license issued by the state board. It doesn't matter if the pharmacy is free standing, in a grocery store, hospital, or md's office. A license will NOT be issued to the following:
1. persons authorized to prescribe (exception is pharmacist collaborative practice agreements)
2. persons who share a financial interest with someone authorized to prescribe
3. a corporation in which 10% or more of the stock is owned by persons who cannot otherwise obtain a pharmacy license (ie - a corporation of prescribers)

Second, if you are able to obtain a license, assuming you are a non-pharmacist (& not a prescriber) you must have a pharmcist-in-charge...so now you must employ a pharmacist since only a pharmacist is authorized to fill a prescription (H&S 11207)

Third - what about physician dispensing (which I think is what FamilyMD was referring to..)? CA law delineates 8 conditions which must be met with the salient ones being (this is the noncontrolled substances) (B&P4170)

1. the prescriber does not keep a pharmacy, advertised or otherwise, for the retailing the drugs or devices (in other words - you cannot charge for what you dispense)
2. the prescriber offers to give a written rx to the pt
3. the prescribeer must provide a written disclosure that the pt has a choice between obtaining the rx from the prescriber or obtaining from a pharmacy of the pts choice
None of these conditions prevents prescribers from providing samples (which are labeled by the manufacturer as samples) or drugs administered directly to patients in the office (ie 2 Gm of amox administered to a pt in a dental office before a procedure).

Fourth - the dispensing of controlled drugs has its own, separate set of laws (H&S 11158). A prescriber may dispense directly to the patient a controlled substance (CII-V) in an amount not to exceed a 72 hr supply & only if the patient is not expected to require an additional amount of controlled substance beyond 72 hours.

Fifth - federal law will require by 2007 reporting of ALL dispensing activities of controlled drugs electronically in real time, which will negate all log sheets & require computer software to communicate with the Department of Justice. Currently 32 states require this now. Wholesale purchases are currently monitored online, so the DOJ sees how much each "purchaser" (pharmacy or md) is buying & follows records of dispensing. Discrepancies cause reason for investigation. I usually get 1 suponea every year from the the CA state board of medicine requesting dispensing records linked to one prrescribers DEA #.

Finally is the issue of the non-brick & mortar pharmacies - the internet pharmacy. To dispense to any pt in the US, an internet pharmacy must be licensed in the state in which the pt resides. The same stipulations exist as to ownership of a brick & mortar pharmacy as well as an internet pharmacy in CA. If an internet pharmacy in Georgia, for example, wants to fill an rx for a CA patient - they must be licensed as a CA "out-of-state" pharmacy & provide documentation of ownership. Every legitimate mail order or online pharmacy is registered in every state.

We won't even get into the pending legislation of documentation of drug pedigree which will take effect in 2007 & goes from manufacturer of raw materials all the the to the ultimate dispenser to patient.

Dana alluded to many of these stipulation in FL so they may be similar.
I'd advise FamilyMD to be careful of what he/she dispenses (especially the controlled drugs), how much & the circumstances (are you charging the patient or billing their insurance in which case you are engaging in retail dispensing) - check the laws in your state. It may not be the same as CA. The penalties are huge here- from $5000 to $25,000 per OCCURRENCE (the highest for internet citations). Since 2002 annually, we have citations with fines for some of these occurrences exceeding $1,000,000 not including the license suspensions & revocations (including prescribers who wanted to supplement their billing) - thats a lot of prescriptions you have to fill to cover the expense - is it really worth that?

I apologize again for the very long post, but this is not an easy issue to explain legally and I didn't want to belabor the history of why the laws have developed as they have. As with every pharmacy rule, there will be exceptions, so the laws in your state may not mirror the laws in mine. My earlier comment still stands - what is in the best interest for the patient medically?

Can I get a synopsis of this please? Thanks...

 

[sdn1977]

Can I get a synopsis of this please? Thanks...

hmmmm. ok:
1. Interesting posts during the day about prescriber dispensing

2. Prescribers can dispense in CA if ethical & legal about it

3. Sorry about length of post

You're welcome

 

[Sosumi]

I remember watching a few weeks ago when the issue of pharmacists prescribing Plan B in Maryland was being covered on the local news. They interviewed a woman who was against it because pharmacists didn't know their history or when to prescribe it or what to look for. I was like huh??

The law did get passed allowing pharmacists to prescribe Plan B as long as they get training and certification for it. My pharmacist is going to do it since we are one block down from Planned Parenthood.

 

[spacecowgirl]

Ha ha, I knew this would get good.

You, FamilyMD, are a rude person who made unjustified insults. I was just calling you on it, it had nothing to do with you "sharing your real world experience" and everything to do with the way you spewed that condescending doctor nonsense. We've all heard it before and frankly, it's tiring. Dana was not calling you a liar, she was saying that what you are doing is at worst illegal and at best, unethical. I can come up with as many or more reasons for docs not to dispense as I can for pharms not to prescribe.

That said, I stand by my original post...the one before this crap started.

 

[spacecowgirl]

One final thought which always bothers me is the sense of "turf". Ask yourself a question - do you want prescribing authority because you feel you "deserve" it or is it better for the patient? Good patient care should always be the priority, IMO. If we can improve access for safe & effective medications in which a delay of diagnosis will not adversly affect the pts outcome, then by all means, we should find a way to do it. But...if our lack of diagnostic capability results & giving an incorrect medication, the I'd question if that were really in the patients best interest. I apologize for the long post....I'm way too windy!

I wanted to add that I heartily agree with this. And that I always appreciate your posts sdn1977, windy or not

 

[Caverject]

hmmmm. ok:
1. Interesting posts during the day about prescriber dispensing

2. Prescribers can dispense in CA if ethical & legal about it

3. Sorry about length of post

You're welcome

ah...thank you!

 

[patmcd]

i think keeping the old system is fine. pharmacists dispense while doctors prescribe. doctors are trained to diagnose correctly while pharmacists are trained to look at possible drugs complication. Each spend years to gain expertise in their field.

If we are going by who has more training in their field, then pharmacists should have significant input on drug treatment plans based on diagnosis by a physician. There is certainly no question in my mind that diagnosis should be left in the hands of a physician. But especially in the specialized clinical fields I think the patient would be just as well served or better by having a pharmacist contribute to the treatment plan. With the rapid expansion of knowledge and number of drugs on the market in a field like oncology it would be hard to keep up with every new development in diagnosis and treatment. Wouldn't the patient be better served by having a physician who concentrates their efforts on correctly diagnosing a cancer type, and then having a qualified pharmacist who is more knowledge about pharmaceutical treatment options choose the most appropriate drug choice?

 

[Peter8989]

If we are going by who has more training in their field, then pharmacists should have significant input on drug treatment plans based on diagnosis by a physician. There is certainly no question in my mind that diagnosis should be left in the hands of a physician. But especially in the specialized clinical fields I think the patient would be just as well served or better by having a pharmacist contribute to the treatment plan. With the rapid expansion of knowledge and number of drugs on the market in a field like oncology it would be hard to keep up with every new development in diagnosis and treatment. Wouldn't the patient be better served by having a physician who concentrates their efforts on correctly diagnosing a cancer type, and then having a qualified pharmacist who is more knowledge about pharmaceutical treatment options choose the most appropriate drug choice?

No offense, but do you really think a pharmacist knows more about cancer drug options than an oncology doctor. They do four years of med school and six years of residency. This is how it is for every specialized doctor. They are trained in a small area of expertise, but they are experts about everything in that area. One of the things they do is keep up with drugs in their field because their livelihood depends on it.

 

[sdn1977]

No offense, but do you really think a pharmacist knows more about cancer drug options than an oncology doctor. They do four years of med school and six years of residency. This is how it is for every specialized doctor. They are trained in a small area of expertise, but they are experts about everything in that area. One of the things they do is keep up with drugs in their field because their livelihood depends on it.

Agree wholeheartedly with this!!! There is absolutely no way I could ever keep up with all the clinical trials, treatment options, diagnostic markers, etc to come close to being responsible for managing treatment of a leukemic child or a 42yo with brain cancer. I feel that way about most medical specialties - it is not just diagnosing a pt then giving a drug & you're done...it is about managing the medical condition, which sometimes requires further testing, interpretation & medication changes - most of which I don't have the time or ability to do. When it comes to dosage changes - like anticoagulants - thats different. But...I absolutely do not want to have to order a 24hr Holter monitor & have to interpret an EKG to assess if the diltiazem is keeping the arrhythmia under control or if the pt would be better served by switching to verapamil or perhaps an ablation is the way to go. Thats why I DIDN'T choose medicine!

 

[Sosumi]

No offense, but do you really think a pharmacist knows more about cancer drug options than an oncology doctor. They do four years of med school and six years of residency. This is how it is for every specialized doctor. They are trained in a small area of expertise, but they are experts about everything in that area. One of the things they do is keep up with drugs in their field because their livelihood depends on it.

I think patmcd is referring to clinical pharmacists who specialize in oncology. These pharmacists do exist already in institutions such as University of Maryland and Johns Hopkins hospital. The job of these pharmacists includes keeping up with every new chemotherapy trial as well as evaluating new chemotherapy and supportive therapy. They go through 4 years of pharmacy school and 2 years of residency specializing in this field. They give input to oncologists during rounds, verify the chemotherapy orders, give seminars on different aspects of oncology to the staff, help develop institution specific protocols and formularies, and provide patient education.

 

[insipid1979]

They go through 4 years of pharmacy school and 2 years of residency specializing in this field. They give input to oncologists during rounds, verify the chemotherapy orders, give seminars on different aspects of oncology to the staff, help develop institution specific protocols and formularies, and provide patient education.

How much do they usually make? I hope they have a pretty high salary...