Woah...
Hmm...I agree with some stuff that tupac_don said, but others I have a different opinion on. By the way Basilisk, I earned my doctorate in pharmacy (PharmD) in May and will be enrolled as a medical student this fall. I have utter most respect for pharmacy and I always will. I entered into the pharmacy profession knowingly that I would gain an accumen of knowledge that is unique from that of a physician. The pharmacy profession isn't only desirable from that of financial perks and hour maintenance, but the ability to make a difference in patient's care that is often overlooked by other health care providers. I've definitly had the experience of seeing physicians (notice I say physicians or MDs versus doctors---PharmDs are Doctors Too (Pharmacy Doctors) Clinicians educated in the science of Pharmacotherapy. A clinical professor gave the best analogy I've heard in explaining to people what PharmDs are (just as you have MDs speciailized in Neurology or Cardiology, we're essentially the doctors trained in drug therapy) Physicians have a semester if even that of pharmacology training. Often, many revert to this recipee book approach to prescribing meds to their patients--what does the manual say or what drug rep gave me this pen. PharmDs on the other hand with considerably larger amount of training in Pharmacology, Medicinal Chemistry, Pharmaceutics, and Pharmacotherapy look at or SHOULD look at their work as an art. Certainly it's easy to fall into the same mode as the pharmacist 5 years ago who looked to MDs as the end all and be all of care. I certainly do NOT subscribe to this notion. Physicians help coordinate care, but they should not take it upon themselves to be the "all mighty doctor" who knows more than everyon else. Check your ego at the door, because last time I checked we practice team based approach care to ensure the patient gets the best care possible. GOOD physicians consult with other health care providers--pharmacists, nurses, therapists, technicians and working in coordination with the team in ensuring that care is OPTIMIZED. BAD physicians override or ignore others' recommendations for the simple fact that he feels they are "lower than Him/Her". Give me a break! By the way, if a physician chooses to ignore a valid recommendation of a health care provider who has docummented their input in the chart or in their own notes, that MD is in deep ****. Because then our friendly local lawyer/district attorney will have their a** for lunch when they deliberate in a court of law. Health care providers should never consider themselves "better" than someone else, regardless of the initials at the end of their names. Be open minded regarding what others offer, because yes there were times when a group of specialists were deliberating on a difficult case and they just couldn't understand why they weren't seeing results--until a techician popped into view and made mention of something they were overlooking the whole time.
Next, the amount of knowledge that a pharmacist has is NOT below that of a physician. It is different --like comparing apples and oranges. I guarantee you, just as a PharmD would find it difficult to place a Swan Ganz catheter inside a patient, an MD would find it difficult to compound medications, counsel EFFECTIVELY (we've all seen how our friendly MDs leave patients with sufficient knowledge that ensures accurate drug delivery)--I've seen everything from patients leaving the clinics without any clue about using their first meter dose inhaler or how to inject their Lovenox subcutaneously. That is where pharmacists come in to counsel. Hence, I am truly disappointed in some Pharmacists (PharmDs and RPhs, alike) in their attitude regarding Patient Counseling. Stop hiding behind the counter! This patient doesn't just need to have the 5 Rights implemented for proper drug delivery--the 6th right is that the patient/caregiver knows how to properly administer/take their medication. PharmDs and MDs receive different training, just as RNs or PTs or OTs. We all have some basal understanding of what the other person does, but you would not be able to do their job. While there are patients out there who unfortunately don't recognize what their pharmacist can offer, there are also many patients that trust their PharmD/RPh more so than their MD. Both in the hospital and in the community. We are the first person they often see when they are sick and try to see if there are ways to treat without seeing an MD/ waiting a loooooong time in the waiting room and in the exam room, and paying a nice chunk of copay (if they even have insurance) after a nice 7 minute work up. Now, if you're the pharmacist who is IGNORANT and decides that everything should require the MDs "Midas touch" then I'm sorry, I don't have any respect for you. This isn't directed to any pharmacist in particular, just those that are ignorant about their knowledge. I'm not saying that pharmacists should overstep their boundaries, but they certainly need to function within their knowledge base (and if you use lack of it as your excuse, go back to school and learn or pick up some CEs, attend seminars). PharmDs are equipped with the skills to recommend an over the counter treatment or refer the patient to their physician for further evaluation due to the severity of the symptoms/requirement for Rx drugs/or the extended duration that the symptoms persist.
I would like to echo and reaffirm some things that my colleague had mentioned regarding limited salaries regardless of the level of knowledge. Certainly, it will go up, but not to extent of let's say double their salary. Yet, many would concur that the satisfaction of providing a higher level of care is enough compensation. The reason for this is that Pharmacists start of with a high pay (I'm sorry, 6 figures is alot in anybody's book! Sure, MDs also make an obscene amount of money, but they have this thing called malpractice insurance, costs related to opening up their own practice, and other hidden costs not to mention the 4-5 years of post graduate training when they were paid peanuts--$30-40,000/year. while PharmDs who've graduated already bought their first "Benz" and are putting away a nice investment towards retirement.) But yeah, I think sometimes we lose track of how financially rewarding our professions are because we see 6 figures, while many families, happy families, are able to comfortably live on much less annual income.
Pharmacists don't walk around as a walking PDR. Sure, we have the capacity to look up the high end of a dose in a book, but guess what, MDs can do the same thing. No, we provide drug expertise throguh literature evaluation, prospective and retrospective drug utilization evaluation, and a thorough assessment of patient symptomatology, laboratory and diagnostic results, and targeted endpoints of therapy. My experiences with interactions between MDs and PharmDs in the hospital is that they interact regularly through clinical rounds and PharmDs are often consulted when the therapy implemented is not yielded expected results. In return, MDs help PharmDs under the finer points in particular diagnostic exams and the significance of their results. Together, these CLINICIANS can collaborate and find solutions to their problems and ensure once again a higher level of care is provided to our patients. In the community, I've seen GOOD pharmacists take that step in calling prescribers regarding drug therapy that is questionable or even dangerous to the patient. As humans, we are all prone to some error, but fortunately and unfortunately, in medicine and pharmacy, the only error that is acceptable is 0%. So a preoccupied physician prescribes Amoxil for a patient who had an anaphylactic reaction to Veetids 3 years ago and inadvertently failed to review the allergic history. A pharmacist who is trained specifically to evaluate drug therapy and its implications catches the error and contacts the MD. The MD is certainly relieved and together they choose an alternative with a similar spectrum of activity. Once again patient care is optimized when collaboration and teamork takes presidence over authoritative prescribing and egotistical clinicians.
PS: Within my little diatribe, I've mentioned scenarios that may seem to say that ALL physicians or pharmacists practice as such. That, obviously is not the case, there are GOOD and BAD MDs and PharmDs. (and let me take that back) they themselves may not be bad but some of their decisions or their philosophy of practice would be considered by some as below standard. Second, RPhs (BSPharms) that have garnered experience and training are not excluded from the skills we expect from PharmDs today. They are certainly valuable colleagues to myself and the medical and pharmacy community as a whole. My intentions were not to attack anyone's beliefs, but to provide some insight into what many clinicians today are adhering, if not progressing towards in regard to standards of professional care.
Thanks.
