Pharmacists getting hosed on Capitol Hill

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
RutgersEMSOP10 said:
guys,

let this guy be. he didn't want to be a pharmacist, and he's not going to be. he, though, does not speak for everyone and has NO clue how we feel about it and can try to pretend he does, but that doesn't make it true.


To the issue at hand - I am very concerned. We have already seen nurses marginalize physician's in the form of NP (and various other letters that I have no clue what they mean, but I know they usually end up being the ones we have to call back because their prescriptions are wrong)...We know they have the power to do it to us as well.

I respect nurses. They do amazing and needed work. I don't respect the fact that they are trying to take over all aspects of health care. Their unions have made them the most powerful, but often least educated, health care professional (not a flame, just true).

It has already been shown time and time again that getting pharmacists involved in all aspects of medication administrationa nd utilization decrease medication related errors, morbidity and mortality. This is the reason why nurses no longer mkae IVs on the floor and have as little stock as possible in nursing stations. The fact that one would argue against this now, even with all the data, is mind boggling.

Even if you don't agree that MTM is our future, we cannot allow ourselves to be pushed to the back over and over. Our voices are important. The fact that we were not even invited is frightening.



And yes, no link, just an email from one of our deans
Click to expand...


Were DOs invited?
 
is it posted anywhere who was invited and who actually sat at the table?
 
slight365 said:
Again, I didn't "go overseas to go to med school".

:laugh:
"Competing with all these FMG's"?

What are you, a racist?

It's also kind of bold to think my primary goal is to come back, considering I actually live here outside of my schooling. It's an option I would like to keep open.

However, being replaced by a robotic arm that counts pills in an Rx mill might not be an option you would have in the near future 😱
Click to expand...

Take it easy, guy.

If you present the argument rationally, you might find that people may not disagree with your point of view as much as they disagree with the way you present it.

I was accepted to Wayne state med-school years ago, so you could say that I have seen both sides of the fences.

First off, let me agree with you that pharmacy is an politically underrepresented faction. I had no idea that pharmacists are so un-unified before I joined pharmacy school. And this annoys me greatly, and will undoubtedly impact the future of our careers. But mean while, it offers a well paid job, with a shorter and affordable education and a good job market. While the lack of political clout would limit the expansion of pharmcists's role in health care, but the basic job is not substitutable for the next 10-20 years.

AMA is a powerful force, and allows a sense of security under its umbrella. But the education cost is out of control, the length is long, residents are underpaid and over worked. The general practitioner is underpaid, malpractice insurance of some specialties are insane. Physicians do have more political clout, but the whole health care system is unsustainable, and being a far greater source of cost, something has to give over there as well.

In life, things are not so simple. Every career has its benefits and trade-offs. Mean while, the best we can do is position ourselves and our professions to better adapt to those changes.
 
RutgersEMSOP10 said:
guys,

let this guy be. he didn't want to be a pharmacist, and he's not going to be. he, though, does not speak for everyone and has NO clue how we feel about it and can try to pretend he does, but that doesn't make it true.


To the issue at hand - I am very concerned. We have already seen nurses marginalize physician's in the form of NP (and various other letters that I have no clue what they mean, but I know they usually end up being the ones we have to call back because their prescriptions are wrong)...We know they have the power to do it to us as well.

I respect nurses. They do amazing and needed work. I don't respect the fact that they are trying to take over all aspects of health care. Their unions have made them the most powerful, but often least educated, health care professional (not a flame, just true).

It has already been shown time and time again that getting pharmacists involved in all aspects of medication administrationa nd utilization decrease medication related errors, morbidity and mortality. This is the reason why nurses no longer mkae IVs on the floor and have as little stock as possible in nursing stations. The fact that one would argue against this now, even with all the data, is mind boggling.

Even if you don't agree that MTM is our future, we cannot allow ourselves to be pushed to the back over and over. Our voices are important. The fact that we were not even invited is frightening.



And yes, no link, just an email from one of our deans
Click to expand...

pharmacy is being squeezed by both nurses and physicians, now even PA's.

IMHO, MTM is flawed as it stands. Without prescribing rights, MTM is impotent. Instead of trying to focus on MTM, which doesn't have a financially solid footing, we should focus on gathering the tools -- limited prescribing rights. That's what nurses fought and got, which is what allowed them to eat into physician's part of the pie.
 
xiphoid2010 said:
pharmacy is being squeezed by both nurses and physicians, now even PA's.

IMHO, MTM is flawed as it stands. Without prescribing rights, MTM is impotent. Instead of trying to focus on MTM, which doesn't have a financially solid footing, we should focus on gathering the tools -- limited prescribing rights. That's what nurses fought and got, which is what allowed them to eat into physician's part of the pie.
Click to expand...

In essence, that is not happening any time soon. Professionally speaking, pharmacists cant touch, poke (except flu and pneumo vacc, haha), look, feel etc. They are not trained to, and they do NOT want to.

You should hear the eews and awws during a derm lecture in my class. This is totally harmless stuff, like acne or dermatitis... Now, amplify that 20 times during an STD lecture.

Ever been to a nursing class? the abovementioned stuff is has no shock value, its a learning experience. THey are taught how to do physical exams and assess patients. Its no surprise that with another 2 years on top of BSN, you can prescribe C2s, of course with supervision. Midlevels are ambitiously taking over primary care as MDs bogged down by hefty loans seek greener pastures in specialties.

Prescriptive priveledges are far fetched in pharmacy world.
 
bigpharmD said:
i prescribe all the time...huh crazy
Click to expand...

🙂...more power to you, do you think its sustainable for residency trained pharmds?
Assuming you are not a medical resident, how many pharmDs can do this currently?
 
eightball said:
In essence, that is not happening any time soon. Professionally speaking, pharmacists cant touch, poke (except flu and pneumo vacc, haha), look, feel etc. They are not trained to, and they do NOT want to.

You should hear the eews and awws during a derm lecture in my class. This is totally harmless stuff, like acne or dermatitis... Now, amplify that 20 times during an STD lecture.

Ever been to a nursing class? the abovementioned stuff is has no shock value, its a learning experience. THey are taught how to do physical exams and assess patients. Its no surprise that with another 2 years on top of BSN, you can prescribe C2s, of course with supervision. Midlevels are ambitiously taking over primary care as MDs bogged down by hefty loans seek greener pastures in specialties.

Prescriptive priveledges are far fetched in pharmacy world.
Click to expand...

First, I'll agree that it's not something that we could achieve immediately. But I'm not talking about diagnosis or administration. So sticking and poking, isn't what I had in mind. To really do MTM, you need to be able to change and prescribe medication to that patient without seeking the authorization of a physician. This is the only way that MTM can stand on its own legs. So before we shoot for MTM, we need to work on this first.

What I would prefer is limited prescribing rights, limited to medications approved to the treatment of a given diagnosis, to only pharmacist with formal training (either a specific residency or board certification).
 
xiphoid2010 said:
Take it easy, guy.

If you present the argument rationally, you might find that people may not disagree with your point of view as much as they disagree with the way you present it.

I was accepted to Wayne state med-school years ago, so you could say that I have seen both sides of the fences.

First off, let me agree with you that pharmacy is an politically underrepresented faction. I had no idea that pharmacists are so un-unified before I joined pharmacy school. And this annoys me greatly, and will undoubtedly impact the future of our careers. But mean while, it offers a well paid job, with a shorter and affordable education and a good job market. While the lack of political clout would limit the expansion of pharmcists's role in health care, but the basic job is not substitutable for the next 10-20 years.

AMA is a powerful force, and allows a sense of security under its umbrella. But the education cost is out of control, the length is long, residents are underpaid and over worked. The general practitioner is underpaid, malpractice insurance of some specialties are insane. Physicians do have more political clout, but the whole health care system is unsustainable, and being a far greater source of cost, something has to give over there as well.

In life, things are not so simple. Every career has its benefits and trade-offs. Mean while, the best we can do is position ourselves and our professions to better adapt to those changes.
Click to expand...

just look at the bickering that goes on here, no wonder rph cant get together to represent themselves as a whole for the betterment of the field
 
I wonder if any of you have researched how pharmacists save money for the health system.

If so, I'd appreciate it if you would post some studies!

Personally, I think most of us have stories of saving money for a patient or the hospital, but none of us ever keeps track or analyzes the cost-benefit of our profession.
 
eightball said:
🙂...more power to you, do you think its sustainable for residency trained pharmds?
Assuming you are not a medical resident, how many pharmDs can do this currently?
Click to expand...


In the hospital it's sustainable...many pharmds prescribe under certain protocols etc....i read a study recently of a pharmd who does pain medicine in a neurosurgery clinic and has his own DEA number....some states have "clinical pharmacy clinicians"...there are ways to prescribe if thats what you want to do...or i like I me...i work with a group of physicians who trust me to help them manage medications...i have my role on the team and that is to focus on medications...our patients are often on 10-15 different meds and it is important to have someone focusing on that part of the picture
 
powertoold said:
I wonder if any of you have researched how pharmacists save money for the health system.

If so, I'd appreciate it if you would post some studies!

Personally, I think most of us have stories of saving money for a patient or the hospital, but none of us ever keeps track or analyzes the cost-benefit of our profession.
Click to expand...


i have quite a few...will send them out tomorrow..dont have them on this computer...there was a recent one in pharmacotherapy...anytime you have someone focusing on medications you can save a significant amount of money
 
powertoold said:
I wonder if any of you have researched how pharmacists save money for the health system.

If so, I'd appreciate it if you would post some studies!

Personally, I think most of us have stories of saving money for a patient or the hospital, but none of us ever keeps track or analyzes the cost-benefit of our profession.
Click to expand...

There in lies the problem my friend. You will not find any studies or you will find very few. Pharmacy is one of the only heath professions that has failed to prove their worth. It is not an easy thing to do. How do you show or prove results? Any results you can come up with will be theoretical at best.

For MTM to become the standard pharmacists are going to have to show how the cost of MTM services actually lowers total heath care costs. Not easy.

The hospital I worked several years ago used to keep track of pharmacist interventions and the theoretical money they saved. Stuff like changing from IV to PO, using the least expensive drug in a class ect. Other things like drug interactions were documented as well and drug allergy interactions. I saw a pharmacist put down a potential savings 0f 200,000 dollars for catching a PCN allergy. They justified it by using the worst-case scenario. Patient has a full blown anaphylactic reaction, stops breathing has to be resuscitated and spends a week in the ICU. Far fetched but I suppose it could have happened.
 
Last edited:
MountainPharmD said:
There in lies the problem my friend. You will not find any studies or you will find very few. Pharmacy is one of the only heath professions that has failed to prove thier worth. It is not an easy thing to do. How do you show or prove results? Any results you can come up with will be theoretical at best.

For MTM to become the standard pharmacists are going to have to show how the cost of MTM services actually lowers total heath care costs. Not easy.
Click to expand...


Maybe not at CVS...but i can send a thousand studies dealing with pharmacists saving money in the ICU, ID, Oncology, transplantation, cardiology (this was an MTM one), ER, and the list goes on.........
 
bigpharmD said:
Maybe not at CVS...but i can send a thousand studies dealing with pharmacists saving money in the ICU, ID, Oncology, transplantation, cardiology (this was an MTM one), ER, and the list goes on.........
Click to expand...

Since the majority of pharmacists work retail this is where the studies need to be done.
 
retail pharmacy is the problem child...nobody is trying to make any progress in this area, yet it accounts for 70% (estimate) of pharmacy operations.

progressives and academics have their arms elbow deep in clinical pot-pie yet its the lesser fraction. Not to start a flame war but I think residencies are the next big thing, next to a ponzi scheme.

these guys at my hospital walk around recommending regimens. Operative word, recommending.
 
Last edited:
eightball said:
retail pharmacy is the problem child...nobody is trying to make any progress in this area, yet it accounts for 70% (estimate) of pharmacy operations.

progressives and academics have their arms elbow deep in clinical pot-pie yet its the lesser fraction. Not to start a flame war but I think residencies are the next big thing, next to a ponzi scheme.

these guys at my hospital walk around recommending regimens. Operative word, recommending.
Click to expand...

and the problem with that is what?? that is our job...I get called all day for recommendations...some patients I just go write orders...MD anderson one of the best cancer hospitals in the US has 90 specialists with "prescriptive authority" on staff...i dont get your point...ID goes around and "recommends" things all day (that NO one follows)....hepatology goes around and recommends things....our transplant patients are taken care of by critical care directly out of transplant and our surgeons who did the operation can only make recommendations....everyone recommends...by the way not trying to be an a$% just saying thats real life in the hospital

I would rather be progressive than status quo...
 
Nobody except for a few physicians listen to my recommendations. It's honestly rather embarrassing the stuff they let go...then continue to let go even after I tell their dumb asses it needs attention.

I don't think they are too out of line...like "recommending" that a patient with acute renal failure on PhosLo...I dunno...gets a phos level...or a patient with a home regimen of warfarin...I dunno...gets a pt/ptt drawn...or a patient with a (legit) vanc trough of 3...I dunno...gets a dose adjustment...or a patient with a K+ of 6.1...I dunno...maybe cut the KDur for now...you know...stuff any idiot can see.

Sometimes I think they ignore the recos out of spite because they don't want their perceived god-like omnipotence usurped.

Then there is the money thing. I could save that hospital thousands if they actually LET ME put some of those *****s in their place. Sure....there is an auto sub of albuterol in place of Xopenex...but all the wankers have to due is write "brand required" and their expensive fancy f'ing nebulizer treatment that offers zero benefit over the vastly cheaper option is still used. My director is too much of a pansy to tell them to screw off and JUST NOT stock the stuff. I'm in a damn wage freeze and these ****ers are wasting money because they get paid no matter what the hell they use. grrr/angry face


I mean, sure, all of this **** is well and good in academia, but in the real world, you just get ignored the majority of the time...even though you are probably right...
 
WVUPharm2007 said:
Nobody except for a few physicians listen to my recommendations. It's honestly rather embarrassing the stuff they let go...then continue to let go even after I tell their dumb asses it needs attention.

I don't think they are too out of line...like "recommending" that a patient with acute renal failure on PhosLo...I dunno...gets a phos level...or a patient with a home regimen of warfarin...I dunno...gets a pt/ptt drawn...or a patient with a (legit) vanc trough of 3...I dunno...gets a dose adjustment...or a patient with a K+ of 6.1...I dunno...maybe cut the KDur for now...you know...stuff any idiot can see.

Sometimes I think they ignore the recos out of spite because they don't want their perceived god-like omnipotence usurped.

Then there is the money thing. I could save that hospital thousands if they actually LET ME put some of those *****s in their place. Sure....there is an auto sub of albuterol in place of Xopenex...but all the wankers have to due is write "brand required" and their expensive fancy f'ing nebulizer treatment that offers zero benefit over the vastly cheaper option is still used. My director is too much of a pansy to tell them to screw off and JUST NOT stock the stuff. I'm in a damn wage freeze and these ****ers are wasting money because they get paid no matter what the hell they use. grrr/angry face


I mean, sure, all of this **** is well and good in academia, but in the real world, you just get ignored the majority of the time...even though you are probably right...
Click to expand...
What if you phrased your recommendations like: "He needs a phos level... he needs more K+... he needs his Vanco cut back..." Sometimes I think if you say something in a way that doesn't leave any room to argue, then you're more likely to get your way.

(However, people have called me "demanding" in the past... 😛 But I couldn't care less, because I don't take any BS. Things are what they are, you know?)
 
PharmDstudent said:
What if you phrased your recommendations like: "He needs a phos level... he needs more K+... he needs his Vanco cut back..." Sometimes I think if you say something in a way that doesn't leave any room to argue, then you're more likely to get your way.

(However, people have called me "demanding" in the past... 😛 But I couldn't care less, because I don't take any BS. Things are what they are, you know?)
Click to expand...

Not allowed to. We have to word it like:

"Pts k is 6.1. Please consider cutting KCL 40mEq. Thank You"

No, I'm not joking. We are afraid we will hurt their feelings or something, hell if I know.
 
WVUPharm2007 said:
Not allowed to. We have to word it like:

"Pts k is 6.1. Please consider cutting KCL 40mEq. Thank You"

No, I'm not joking.
Click to expand...
What about "Pts k is 6.1. Cutting KCl 40mEq should be considered. Thank You."?
 
Last edited:
WVUPharm2007 said:
We are afraid we will hurt their feelings or something, hell if I know.
Click to expand...
... I work with 80 yo men who tell me that "[they] just want to get out of here".

There are no "feelings" in retail... :meanie:
 
PharmDstudent said:
What about "Pts k is 6.1. Cutting KCl 40mEq should be considered. Thank You."?
Click to expand...

I would go to the chart, grab an order, write: "Discontinue potassium chloride" and sign/stamp my name. They would thank me later.
 
Priapism321 said:
I would go to the chart, grab an order, write: "Discontinue potassium chloride" and sign/stamp my name. They would thank me later.
Click to expand...

You'd be sent to the gulag at my joint. It's like medicine in the 1980s though...keep that in mind...physicians are still seen as gods...it's rather annoying.

Like last week they had a patient start on an acute heparin drip infusion. At the same time, they filled out the routine admit orders...which include lovenox 40 daily for the obligatory dvt prophylaxis...the physician obviously checked the box out of habit and didnt think about it...I had to spend like 20 minutes arguing with a nurse why I wasn't going to send them the lovenox...analogies about drops in oceans and all...and her response.."The doctor ORDERED IT. I need it now!" I just ignored her and obviously didn't send it...but STILL...
 
Last edited:
physicians have large egos that are quite fragile. Put the recommendation in the form of a question might be better. Like "his CD4 count is 129. Maybe we should prophylax for PCP? What do you think?"
 
WVUPharm2007 said:
Nobody except for a few physicians listen to my recommendations. It's honestly rather embarrassing the stuff they let go...then continue to let go even after I tell their dumb asses it needs attention.

I don't think they are too out of line...like "recommending" that a patient with acute renal failure on PhosLo...I dunno...gets a phos level...or a patient with a home regimen of warfarin...I dunno...gets a pt/ptt drawn...or a patient with a (legit) vanc trough of 3...I dunno...gets a dose adjustment...or a patient with a K+ of 6.1...I dunno...maybe cut the KDur for now...you know...stuff any idiot can see.

Sometimes I think they ignore the recos out of spite because they don't want their perceived god-like omnipotence usurped.

Then there is the money thing. I could save that hospital thousands if they actually LET ME put some of those *****s in their place. Sure....there is an auto sub of albuterol in place of Xopenex...but all the wankers have to due is write "brand required" and their expensive fancy f'ing nebulizer treatment that offers zero benefit over the vastly cheaper option is still used. My director is too much of a pansy to tell them to screw off and JUST NOT stock the stuff. I'm in a damn wage freeze and these ****ers are wasting money because they get paid no matter what the hell they use. grrr/angry face


I mean, sure, all of this **** is well and good in academia, but in the real world, you just get ignored the majority of the time...even though you are probably right...
Click to expand...

Thats some of your problem right there. DO you have a clinical director who helps set up protocols etc so you can get stuff changed

I round and work with all private physicians. I have absolutely nothing to do with academia

Rounding is not the only responsibility of my job..everyone gets all hyped up on rounding
 
bigpharmD said:
Thats some of your problem right there. DO you have a clinical director who helps set up protocols etc so you can get stuff changed
Click to expand...

Ok...you don't seem to understand...imagine this is 1987. Ask that question again. The very IDEA that a pharmacist is capable of anything more that mixing IVs and sending down drugs is still unfathomable to some of these people. It's the atmosphere. These physicians are babied to their greatest desire because it is IMPOSSIBLE to attract them to the town I work in. It's an old, depressed rust belt town 1.5 hours from Pittsburgh. We get the bottom of the barrel and the hospital admin will do anything to keep them. It is what it is.
 
xiphoid2010 said:
pharmacy is being squeezed by both nurses and physicians, now even PA's.

IMHO, MTM is flawed as it stands. Without prescribing rights, MTM is impotent. Instead of trying to focus on MTM, which doesn't have a financially solid footing, we should focus on gathering the tools -- limited prescribing rights. That's what nurses fought and got, which is what allowed them to eat into physician's part of the pie.
Click to expand...
That's what CPAs are for, people.
 
WVUPharm2007 said:
Ok...you don't seem to understand...imagine this is 1987. Ask that question again. The very IDEA that a pharmacist is capable of anything more that mixing IVs and sending down drugs is still unfathomable to some of these people. It's the atmosphere. These physicians are babied to their greatest desire because it is IMPOSSIBLE to attract them to the town I work in. It's an old, depressed rust belt town 1.5 hours from Pittsburgh. We get the bottom of the barrel and the hospital admin will do anything to keep them. It is what it is.
Click to expand...

I hear you. We have some docs like this and any recommendation is shot down with a condescending remark, regardless of how valid it may be. I think they are good doctors, but I also think they have an inflated sense of self that sometimes comes before what is best for the patient. The rest of the med staff is awesome though so I try to ignore those who are arses. Document what you can and keep going.
 
xiphoid2010 said:
pharmacy is being squeezed by both nurses and physicians, now even PA's.

IMHO, MTM is flawed as it stands. Without prescribing rights, MTM is impotent. Instead of trying to focus on MTM, which doesn't have a financially solid footing, we should focus on gathering the tools -- limited prescribing rights. That's what nurses fought and got, which is what allowed them to eat into physician's part of the pie.
Click to expand...

Uh. Personal opinion, but no thank you. The whole idea of checks and balances is to delegate different responsibilities to different entities to ensure safe and effective productivity. What more do you want other than physician-protocols that allow dosage changes, lab ordering and within-class substitution?

And the VA is its own monster if that is an example one would cite... not too applicable to real world unless the methodology is implemented in a closed system, ala' Kaiser.

These are the three tenets I always encourage:

1. Start where you are
2. Use what you have
3. Do what you can

People are so focused on where they want to be, what they don't have, and what they could do, that they forget that there are opportunities sitting in front of their noses.

/soap-box. 😴
 
WVUPharm2007 said:
Not allowed to. We have to word it like:

"Pts k is 6.1. Please consider cutting KCL 40mEq. Thank You"

No, I'm not joking. We are afraid we will hurt their feelings or something, hell if I know.
Click to expand...

East coast ('ish) has notoriously been like this. Partly b/c of AMA strength and influence there.

I always get a kick out of the "Thank you for this interesting consult" whenever a service is consulted on a patient. B/c you know they're think "wtf, seriously?"
 
nikkai said:
Uh. Personal opinion, but no thank you. The whole idea of checks and balances is to delegate different responsibilities to different entities to ensure safe and effective productivity. What more do you want other than physician-protocols that allow dosage changes, lab ordering and within-class substitution?

And the VA is its own monster if that is an example one would cite... not too applicable to real world unless the methodology is implemented in a closed system, ala' Kaiser.

These are the three tenets I always encourage:

1. Start where you are
2. Use what you have
3. Do what you can

People are so focused on where they want to be, what they don't have, and what they could do, that they forget that there are opportunities sitting in front of their noses.

/soap-box. 😴
Click to expand...

I respect differences in opinions on this matter. I know not all pharmacist will want it, hence I specifically said to limit it those who undergo a specialized residency or a board certification. So only those RPhs who are interested may apply.

But I firmly believe that without the independent rights to prescribe and change drugs, trying to implement MTM will largely be futile. I'm not a big fan of MTM partly because it's not really practical in a large scale.
 
WVUPharm2007 said:
Nobody except for a few physicians listen to my recommendations. It's honestly rather embarrassing the stuff they let go...then continue to let go even after I tell their dumb asses it needs attention.

I don't think they are too out of line...like "recommending" that a patient with acute renal failure on PhosLo...I dunno...gets a phos level...or a patient with a home regimen of warfarin...I dunno...gets a pt/ptt drawn...or a patient with a (legit) vanc trough of 3...I dunno...gets a dose adjustment...or a patient with a K+ of 6.1...I dunno...maybe cut the KDur for now...you know...stuff any idiot can see.

Sometimes I think they ignore the recos out of spite because they don't want their perceived god-like omnipotence usurped.

Then there is the money thing. I could save that hospital thousands if they actually LET ME put some of those *****s in their place. Sure....there is an auto sub of albuterol in place of Xopenex...but all the wankers have to due is write "brand required" and their expensive fancy f'ing nebulizer treatment that offers zero benefit over the vastly cheaper option is still used. My director is too much of a pansy to tell them to screw off and JUST NOT stock the stuff. I'm in a damn wage freeze and these ****ers are wasting money because they get paid no matter what the hell they use. grrr/angry face


I mean, sure, all of this **** is well and good in academia, but in the real world, you just get ignored the majority of the time...even though you are probably right...
Click to expand...

you SHOULD put them in their place. tell them "you are wrong", "and here is why"...As a a hopfull future physician I would want to be told if I was presribing something wrong/not safe etc...My ego is far far less important than potential patient harm. And if current physicians will have their feelings hurt because you showed them the error of their ways, so be it.
 
oh yea docs are hard to work with, they are all in it together

i remember the one hospital i rotated with, the orthapod was giving every1 vanco (which is wrong unless pt has pcn allergy or if u have high mrsa rates in ur area [this wasnt true in our case])...over and over again, we told him why ancef was better choice, and he never changed...he even got the ID specialist to say it was ok, and ever since that day, he consults that ID person on like every wound infection case now...so the ID is happy cuz seeing more cases = more $$, and the orthapod is happy cuz he can do watever he wants knowing ID has his back

crap like this goes on everywhere, especially in the depressed area hospitals of the rust belt
 
ThinkTooMuch said:
you SHOULD put them in their place. tell them "you are wrong", "and here is why"...As a a hopfull future physician I would want to be told if I was presribing something wrong/not safe etc...My ego is far far less important than potential patient harm. And if current physicians will have their feelings hurt because you showed them the error of their ways, so be it.
Click to expand...


things are changing...but wvu has a point
 
xiphoid2010 said:
I respect differences in opinions on this matter. I know not all pharmacist will want it, hence I specifically said to limit it those who undergo a specialized residency or a board certification. So only those RPhs who are interested may apply.

But I firmly believe that without the independent rights to prescribe and change drugs, trying to implement MTM will largely be futile. I'm not a big fan of MTM partly because it's not really practical in a large scale.
Click to expand...

In the spirit of friendly debate:

Are you thinking MTM/prescribing only in a clinic setting? Or also within a hospital?

Are you also willing to take on the cost of liability, if you are not under a physician-directed-protocol?

How do you expect to be compensated? B/c, at present, the CPT codes allotted to pharmacists pay jack squat. And for you to bill according to ICD-9, it would be a whole other debate withthe AMA, CMS etc.

Would you want your services to be included in specific DRGs? Which ones and to what extent? How would you offset the amount of capital needed to implement something like this within a hospital setting - there are underlying IT/IS costs, which are no small matter.

Just food for thought.
 
prevacid said:
oh yea docs are hard to work with, they are all in it together

i remember the one hospital i rotated with, the orthapod was giving every1 vanco (which is wrong unless pt has pcn allergy or if u have high mrsa rates in ur area [this wasnt true in our case])...over and over again, we told him why ancef was better choice, and he never changed...he even got the ID specialist to say it was ok, and ever since that day, he consults that ID person on like every wound infection case now...so the ID is happy cuz seeing more cases = more $$, and the orthapod is happy cuz he can do watever he wants knowing ID has his back

crap like this goes on everywhere, especially in the depressed area hospitals of the rust belt
Click to expand...

Our ID docs are flat out incompetent. They sent a woman home on a 3-week vanc home infusion regimen with cellulitis and a trough of about 4. They were just giving her a gram daily...renal function wasn't too bad. WTF? That is so unbelievable.


The word "consult" makes me want to vomit. Where I work, the consulting docs just go around making mass changes to orders without even talking to the attending. Over the weekend I had a hell of a time with a stupid Solu-medrol order. Saturday its 125mg q8...the attending comes in at 6AM (he's weird) and changes it to 40mg q12h...then at 8AM, the consulted pulmonary doc comes in and writes an order that reads "decrease solumedrol to 80mg q8h" because he didn't read the f'ing order the attending wrote...and THEN at like 11AM, a renal doc comes in and, based off of the pulmonary guy's order, writes and order to decrease the dose to 40mg q8h starting Monday. So what the hell do I do? The attending won't respond to my pages...out playing golf *cough*typical*cough*...I just used my judgment and went with the attending's order and left it at that.

But this is what makes their world go round. They consult each other when it isn't really needed...the system is charged a bazillion dollars...and my time gets wasted because the ******s never communicate with each other and something as run-of-the-mill as an iv steroid takes up 30 minutes of my day.
 
WVUPharm2007 said:
Our ID docs are flat out incompetent. They sent a woman home on a 3-week vanc home infusion regimen with cellulitis and a trough of about 4. They were just giving her a gram daily...renal function wasn't too bad. WTF? That is so unbelievable.


The word "consult" makes me want to vomit. Where I work, the consulting docs just go around making mass changes to orders without even talking to the attending. Over the weekend I had a hell of a time with a stupid Solu-medrol order. Saturday its 125mg q8...the attending comes in at 6AM (he's weird) and changes it to 40mg q12h...then at 8AM, the consulted pulmonary doc comes in and writes an order that reads "decrease solumedrol to 80mg q8h" because he didn't read the f'ing order the attending wrote...and THEN at like 11AM, a renal doc comes in and, based off of the pulmonary guy's order, writes and order to decrease the dose to 40mg q8h starting Monday. So what the hell do I do? The attending won't respond to my pages...out playing golf *cough*typical*cough*...I just used my judgment and went with the attending's order and left it at that.

But this is what makes their world go round. They consult each other when it isn't really needed...the system is charged a bazillion dollars...and my time gets wasted because the ******s never communicate with each other and something as run-of-the-mill as an iv steroid takes up 30 minutes of my day.
Click to expand...

This exactly right...thats why we do not consult people unless absolutely necessary...they just order a bunch of needless BS...and we wonder why we need healthcare reform

I just happened to look at a patients mar next to another patient that we were seeing today....the patient was on the vent with MRSA pneumonia....the MAR has zyvox 600 mg IV q24 and has been there for 7 days...and I say to myself WTF?
 
bigpharmD said:
This exactly right...thats why we do not consult people unless absolutely necessary...they just order a bunch of needless BS...and we wonder why we need healthcare reform

I just happened to look at a patients mar next to another patient that we were seeing today....the patient was on the vent with MRSA pneumonia....the MAR has zyvox 600 mg IV q24 and has been there for 7 days...and I say to myself WTF?
Click to expand...

Haha. You guys are making the new super bug. At least our ID docs are just messing up Vanc...which is already on the way to uselessness in the next decade or so...
 
WVUPharm2007 said:
Haha. You guys are making the new super bug. At least our ID docs are just messing up Vanc...which is already on the way to uselessness in the next decade or so...
Click to expand...


thats why i love it when people ask "cant we just automate your job"
 
bigpharmD said:
thats why i love it when people ask "cant we just automate your job"
Click to expand...

I usually respond, "Not until Pauly Shore delivers my Bio-Dome order to protect me from the freak-bugs you'll make. Buuuuuuuuddy."
 
WVUPharm2007 said:
Our ID docs are flat out incompetent. They sent a woman home on a 3-week vanc home infusion regimen with cellulitis and a trough of about 4. They were just giving her a gram daily...renal function wasn't too bad. WTF? That is so unbelievable.


The word "consult" makes me want to vomit. Where I work, the consulting docs just go around making mass changes to orders without even talking to the attending. Over the weekend I had a hell of a time with a stupid Solu-medrol order. Saturday its 125mg q8...the attending comes in at 6AM (he's weird) and changes it to 40mg q12h...then at 8AM, the consulted pulmonary doc comes in and writes an order that reads "decrease solumedrol to 80mg q8h" because he didn't read the f'ing order the attending wrote...and THEN at like 11AM, a renal doc comes in and, based off of the pulmonary guy's order, writes and order to decrease the dose to 40mg q8h starting Monday. So what the hell do I do? The attending won't respond to my pages...out playing golf *cough*typical*cough*...I just used my judgment and went with the attending's order and left it at that.

But this is what makes their world go round. They consult each other when it isn't really needed...the system is charged a bazillion dollars...and my time gets wasted because the ******s never communicate with each other and something as run-of-the-mill as an iv steroid takes up 30 minutes of my day.
Click to expand...

haha yea i can relate to tat story

my personal favorite thou is cipro, and how seemingly every doc i talk to they seem surprised when i tell them it shouldnt be used for resp. infections as 1st or even 2nd line....whenever i call for a levaquin copay too $$ switch to something else, they go for cipro and then i have to tell them why its a bad choice for resp infxn and then get it switched to something else
 
You must log in or register to reply here.

Similar threads

M
Are pharmacists leaving $ on the table?
Replies
2
Views
2K
BenJammin
BenJammin
L
Side Hustles for Pharmacists
Replies
6
Views
3K
projektreverb
P
P
Medication administration by inpatient pharmacists: Innovative interdisciplinary care teams
Replies
1
Views
1K
clarkbar
C
P
  • Question Question
Michigan Pharmacist License by Endorsement for Canadian Pharmacist
Replies
0
Views
727
pharmacist_query
P
P
Walgreens seeks provider status for pharmacists: CEO
Replies
8
Views
3K
CetiAlphaFive
CetiAlphaFive
Top