Physicians Opposing Pharmacist Expanded Practice

[Chrish]

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Tele doc is a joke. Anytime I have an issue with the script (incorrect quantity, verification on a dosing), I am told pt will have to make another tele appointment. Really? I am not even sure how it’s legal.

I have a feeling it’s made of physicians who either couldn’t hack it in real world, or folks who are making money on the side and don’t particularly care about the job.

 

[voxveritatisetlucis]

Physicians who advocate telework are in a sense digging their own figurative graves. Would lead to massive price competition, driving down reimbursements and potentially outsourcing.

 

[Radishguy]

Chocolate milk and condoms would be a waaaay better combo. And if someone at the drive through told me they needed chocolate milk and condoms, I would turn around and yell to the technician, “Hey, can you grab this guy some chocolate milk and condoms?! He is in a hurry!”

But yea - again, it goes to my point that 90% of the resistance to pharmacists from physicians is entirely ego-driven. There are a few reasonable arguments about diagnostic training but that is it - anything else is just speculative, territorial, ego driven nonsense. I am fortunate to work with very gracious physicians in my work and this attitude that you see above is entirely non-existent. We are simply doing the work that we are all fully qualified to accomplish.

These goofballs that take time out of their day to make a one-time appearance in our space to do nothing more than, “pull rank” can go fly a kite.

I don’t know if it’s as much ego as self-preservation. There is definitely a lot of concern over what I said in terms of safety. However, the bulk of the pushback is coming because doctors are getting the scope creep from all ends. In NY there is legally no longer any functional difference between a doctor with a year of experience and an NP with a year of experience. Then there are telehealth companies using an army of PAs all working under one doctor who might be in Barbados. Then you have this… you can see how the self preservation reflex kicks in

 

[VA77]

Yeap and physicians have a slower than average (3%) for the next decade so they are protecting their turf which I can understand cause I sure don't want tech-check-tech. The bottom line is you always get what you pay for and if you feel that your car is in good hands with the apprentice mechanic then so be it but maybe it might be more cost and time effective to see the grizzled veteran with some experience.

 

[WVUPharm2007]

It's bad enough when the physicians leak into here, now we got lawyers in here. Are accountants and plumbers going to weigh in next.

 

[WVUPharm2007]

I guess you are all OK with practitioner dispensing.

They already can and do.

 

[WVUPharm2007]

There isn’t, even if they are judgment proof. If the suit doesn’t include the pharmacist then the pharmacy can use that as a sort of defense (really just a delay tactic). Wasn’t us, the pharmacist was acting on their own. So even if it’s some kid out of school with more debt than anything resembling an asset, they still need to be included in order to tie in the pharmacy and the pharmacist together.

I’m done practicing and I never really liked the idea of suing doctors/nurses/pharmacists, but when a medical professional does something so dumb it verges on intentional, they bring it upon themselves. Pharmacists prescribing medications without doing histories, exams, follow-ups, and without having the training to do those things— well that’s pretty darn close to intentional.

Next question.

Let's say I do something that will get me sued. How long do I have to liquidate all of my assets and flee to like Albania or something in order to avoid the long arm of the law ever reaching me?

I feel like this is good information to have.

 

[JustFillIt]

It's bad enough when the physicians leak into here, now we got lawyers in here. Are accountants and plumbers going to weigh in next.

If their feelings are sufficiently hurt about pharmacists stepping up to the plate and demanding respect for the quality/service they provide - I would not be surprised if plumbers show up next.

 

[nowaysanjose]

This is pretty much how I feel about it. The training is the issue. Put in 2,000 clinical hours over a year like a PA and I would think the missing skills could be built to a level that would allow for independent practice. Also some changes to the base pharmacy curriculum to really focus on diagnosis and management without extending the overall length of training.

Let’s be honest this 2000 hours isn’t anywhere near enough time to be doing the things PAs are doing. Even worse for NPs.

 

[WVUPharm2007]

Let’s be honest this 2000 hours isn’t anywhere near enough time to be doing the things PAs are doing. Even worse for NPs.

That actually does seem low. Basically a full time job for a year. I required a few thousand more hours of clinical experience just to count out penis pills for old people.

 

[Radishguy]

Next question.

Let's say I do something that will get me sued. How long do I have to liquidate all of my assets and flee to like Albania or something in order to avoid the long arm of the law ever reaching me?

I feel like this is good information to have.

Start building the offshore account now. Or better yet, form an LLC, hire yourself as the sole employee, have your pharmacy pay your LLC and then form a corporation that buys the LLC. Pay yourself entirely in dividends and avoid most taxes while protecting yourself in case you make a prescribing/dispensing mistake. You’re employee, of the LLC, so if you do get sued, it’s the corporation that gets sued and bonuses paid out by the LLC to their employees, you, are generally sheltered. This way, you don’t have to deal with uncertainly of air travel while fleeing the country. Airplanes are dangerous nowadays. You might get punched in the face by a passenger or a flight attendant depending on what color shirt you wear.

 

[VA77]

Let’s be honest this 2000 hours isn’t anywhere near enough time to be doing the things PAs are doing. Even worse for NPs.

I agree with the hours but schools do what is in their best interests($$$). FWIW, my niece just graduated PA program and had 2 jobs even before being licensed and making more than me and her curriculum wasn't nearly as intense.

 

[Mad Jack]

Let’s be honest this 2000 hours isn’t anywhere near enough time to be doing the things PAs are doing. Even worse for NPs.

That ship has sailed though. If anyone else wants on it I want them to adhere to the same minimum standards

 

[mustang sally]

If their feelings are sufficiently hurt about pharmacists stepping up to the plate and demanding respect for the quality/service they provide - I would not be surprised if plumbers show up next.

And my next trick as a pharmacist will be to fix this leaky toilet. At least I will save $300.

 

[JustFillIt]

And my next trick as a pharmacist will be to fix this leaky toilet. At least I will save $300.

Maybe we should start to try and encroach into the plumbing business?

Let’s see how many “rank pullers” we can attract to this forum by leveraging our position as an alternative to a traditional plumber.

Maybe we could dump a bunch of Creon into a toilet instead of using a snake. A plumber does not have access to Creon, so…..

 

[TranslationalRPh]

That ship has sailed though. If anyone else wants on it I want them to adhere to the same minimum standards

At a minimum, you are consistent.

 

[Mad Jack]

They actually does seem low. Basically a full time job for a year. I required a e thousand more hours of clinical experience just to count out penis pills for old people.

NPs have a minimum of 650 clinical hours that you can arrange yourself at whoever will take you. It's... Bad. I like NPs, but I really feel like their training could use substantially better consistency and rotation sites.

 

[VA Hopeful Dr]

Well, would doctor talk over the phone with patients that has stuffy nose, sore throat, head-ache and tell them to get some benadryl, Mucinex DM all day long without getting paid? If so, leave their clinic number up here. Will gladly tell patient to call that number to get a good medicine practice. Or they want patient to come in and then prescribe the same thing with zyrtect, flonase, Mucinex and then charge patients?
I thought Dr nowaday complains about work loads and metrics too like how long they should see a patient etc. If RPh can decrease the work loads for docs by taking care of those minor, acute sickness, that would be wonderful for the healthcare, no?

Recommend OTC stuff all day long, I'm 100% OK with that.

But prescribing antibiotics without either testing or an exam isn't good practice.

 

[Rockinacoustic]

Recommend OTC stuff all day long, I'm 100% OK with that.

But prescribing antibiotics without either testing or an exam isn't good practice.

What about antivirals for COVID?

 

[JustFillIt]

Recommend OTC stuff all day long, I'm 100% OK with that.

But prescribing antibiotics without either testing or an exam isn't good practice.

This is why my focus has always been on chronic conditions where the monitoring, labs, and history is all there and documented. This removes diagnosis from the context and allows for pharmacotherapy to take over from there.

When there is a significant change of condition which warrants further diagnosis, the patient goes back to the drawing board for a revised care plan and diagnosis.

 

[VA Hopeful Dr]

What about antivirals for COVID?

As I said earlier in this thread: if you're comfortable assessing whether or not someone might need admission and have a full medication history for the shocking number of drug interactions with those antivirals then go for it.

 

[Rockinacoustic]

As I said earlier in this thread: if you're comfortable assessing whether or not someone might need admission and have a full medication history for the shocking number of drug interactions with those antivirals then go for it.

What exactly do you think we studied for 4 years? Pharmacists are second to urgent cares for "high blood pressure" ED referrals 😉

Again, I fail to understand how for the run-of-the-mill COVID+ patient I can offer ibuprofen, but not offer antiviral treatment after a targeted medical and medication history.

 

[JustFillIt]

As I said earlier in this thread: if you're comfortable assessing whether or not someone might need admission and have a full medication history for the shocking number of drug interactions with those antivirals then go for it.

I have done so many paxlovid drug interaction reviews, at this point, that I can usually do most of the drug adjustments (and holds) by memory.

 

[VA Hopeful Dr]

What exactly do you think we studied for 4 years? Pharmacists are second to urgent cares for "high blood pressure" ED referrals 😉

Again, I fail to understand how for the run-of-the-mill COVID+ patient I can offer ibuprofen, but not offer antiviral treatment after a targeted medical and medication history.

You studied how to do physical exams and learned to tell sick (meaning needs hospitalization) versus not sick (meaning will be safe to go home)?

 

[VA Hopeful Dr]

I have done so many paxlovid drug interaction reviews, at this point, that I can usually do most of the drug adjustments (and holds) by memory.

To paraphrase an internist I know: it's easier to remember all the medicines that paxlovid doesn't interact with since there's only about 6 of them.

 

[Rockinacoustic]

You studied how to do physical exams and learned to tell sick (meaning needs hospitalization) versus not sick (meaning will be safe to go home)?

Does every COVID+ person need a comprehensive workup?

 

[alpha12]

But prescribing antibiotics without either testing or an exam isn't good practice.

Doctors do that a lot.

 

[VA Hopeful Dr]

Doctors do that a lot.

Doctors do a lot of things we shouldn't, doesn't make it right or a good idea.

 

[VA Hopeful Dr]

Does every COVID+ person need a comprehensive workup?

Depends what you mean by comprehensive.

A targeted physical exam to decide if someone is safe to go home with Paxlovid? Yes, that's exactly what's needed. If y'all are trained to do that, great have at it. If you're not, then do what I suggested earlier in the thread and set up a training program where you get that training and have at it.

A head to toe exam with lots of labwork and a CT scan? Probably not.

 

[Rockinacoustic]

Depends what you mean by comprehensive.

A targeted physical exam to decide if someone is safe to go home with Paxlovid? Yes, that's exactly what's needed. If y'all are trained to do that, great have at it. If you're not, then do what I suggested earlier in the thread and set up a training program where you get that training and have at it.

A head to toe exam with lots of labwork and a CT scan? Probably not.

Absolutely fair- and I would hope that if this passes APhA and state boards require some minimum competency for Pharmacists who want to test-and-treat. I do not expect every chain pharmacist to do this, and I personally wouldn't feel comfortable offering treatment for anything beyond a mild COVID case with a known PMH.

I'm not downplaying how crucial medical training is to comprehensively treat a patient. If anything, this policy would hopefully allow ya'll to see the ones who really need true MDM as opposed to the worried well, or ones who progressed to more severe disease because of lack of access to care.

TL;DR - the status-quo sucks, and we are no better prepared for managing the next wave

 

[VA Hopeful Dr]

Absolutely fair- and I would hope that if this passes APhA and state boards require some minimum competency for Pharmacists who want to test-and-treat. I do not expect every chain pharmacist to do this, and I personally wouldn't feel comfortable offering treatment for anything beyond a mild COVID case with a known PMH.

I'm not downplaying how crucial medical training is to comprehensively treat a patient. If anything, this policy would hopefully allow ya'll to see the ones who really need true MDM as opposed to the worried well, or ones who progressed to more severe disease because of lack of access to care.

TL;DR - the status-quo sucks, and we are no better prepared for managing the next wave

I would absolutely love for y'all to see all the COVID patients. I caught COVID from a patient back in January and would prefer to not have that happen again.

 

[KidPharmD]

Does every COVID+ person need a comprehensive workup?

I know I didn't get one, or at least I got no more of an exam that I would be comfortable doing.

As I said earlier in this thread: if you're comfortable assessing whether or not someone might need admission and have a full medication history for the shocking number of drug interactions with those antivirals then go for it.

We don't have to decide if someone needs admission. We do have to be able to tell if someone needs a more extensive exam than we can provide. We already do this in pharmacies across the country every day. The year I worked retail, I probably sent someone to either an Urgent Care or ER a couple of times a week. About every other month, I called an ambulance for someone (I worked in a very doctor averse area).

As for a full medication history, the pharmacy is more likely to have one that the doctor's office is. I believe (granted with no proof) that patient's are much more likely to use one pharmacy than they are to use single physician (or a group that shares an EMR).

I don't really have a dog in this fight, and I certainly know colleagues that would rather not be given another thing to do they don't have time for. However, I do take issue that pharmacists are not trained on when to refer to medical care or how to assess for complex drug interactions.

 

[JustFillIt]

I know I didn't get one, or at least I got no more of an exam that I would be comfortable doing.



We don't have to decide if someone needs admission. We do have to be able to tell if someone needs a more extensive exam than we can provide. We already do this in pharmacies across the country every day. The year I worked retail, I probably sent someone to either an Urgent Care or ER a couple of times a week. About every other month, I called an ambulance for someone (I worked in a very doctor averse area).

As for a full medication history, the pharmacy is more likely to have one that the doctor's office is. I believe (granted with no proof) that patient's are much more likely to use one pharmacy than they are to use single physician (or a group that shares an EMR).

I don't really have a dog in this fight, and I certainly know colleagues that would rather not be given another thing to do they don't have time for. However, I do take issue that pharmacists are not trained on when to refer to medical care or how to assess for complex drug interactions.

In the end - all that any of these rank-pulling gate keepers are doing is presenting speculative roadblock type situations intended to make you go hmmmm in order to rationalize their disdain for a pharmacist. It helps them feel more confident and sure of themselves. It usually involves presenting some sort of complexity which may/may not ever actually present itself in real life and it will typically always highlight the weakness which is perceived by the opposing party in order to delegitimize the one being criticized. It’s just a tactic in communication. In the end, we just need to rise above it and become confident that we have the skills necessary to participate in patient care as a mid-level - period.

It reminds me of that song, “things that make you go hmmmm”

Gawd I miss the 90s…

 

[RxPreceptor]

In short, I must say I can understand the pushback from physicians. Too many variables to consider, mostly environment/work setting location, workload, and resources/means of production. I sure AF would not want this available for RPh in a “community“ chain setting. RPh are fully capable of using standard, straightforward resources to aid in diagnosing but agreed with the sentiment of others on the lack of quality performance with such limited time and resources (spread too thin already in many settings)

 

[aim-agm]

Physicians and Pharmacists both have terminal degrees in specialized but overlapping fields/areas of expertise. Generally speaking, someone who is one would have been capable of being the other, so either would be able to fulfill the other's role or parts thereof with a sufficient amount of training. The essential question comes down to: what is "a sufficient amount of additional training"? It's somewhere between "nothing" and "7-8 years of medical school and residency"/"4-5 years of pharmacy school and residency."

A good way to look at it is how bad an idea do you think it would be, and what would you worry would happen, if physicians were given all or part of the practice authority/scope as pharmacists?

 

[VA Hopeful Dr]

Physicians and Pharmacists both have terminal degrees in specialized but overlapping fields/areas of expertise. Generally speaking, someone who is one would have been capable of being the other, so either would be able to fulfill the other's role or parts thereof with a sufficient amount of training. The essential question comes down to: what is "a sufficient amount of additional training"? It's somewhere between "nothing" and "7-8 years of medical school and residency"/"4-5 years of pharmacy school and residency."

A good way to look at it is how bad an idea do you think it would be, and what would you worry would happen, if physicians were given all or part of the practice authority/scope as pharmacists?

In many states we pretty much have that already. When I had my DPC practice, I operated a dispensary out of it. As long as I followed the law regarding what had to be on the pill bottle label, I could do whatever I wanted.

 

[VA Hopeful Dr]

In the end - all that any of these rank-pulling gate keepers are doing is presenting speculative roadblock type situations intended to make you go hmmmm in order to rationalize their disdain for a pharmacist. It helps them feel more confident and sure of themselves. It usually involves presenting some sort of complexity which may/may not ever actually present itself in real life and it will typically always highlight the weakness which is perceived by the opposing party in order to delegitimize the one being criticized. It’s just a tactic in communication. In the end, we just need to rise above it and become confident that we have the skills necessary to participate in patient care as a mid-level - period.

It reminds me of that song, “things that make you go hmmmm”

Gawd I miss the 90s…

I don't have any disdain for pharmacists generally (have a few locally that I do have disdain for but they have more than earned it, and plenty of local doctors are in that category as well - I'm an equal opportunity curmudgeon).

What I think some might not understand is the general idea behind much of our training. A large portion of my job could be done by midlevels/pharmacists. Much of it is pretty straightforward. Except when its not, and recognizing that part is what makes the difference between physicians and other professions who want to do what has traditionally been our domain. Yes, the majority of COVID patients could be managed by a pharmacist without much difficulty. But then there are the ones who can't be. Sometimes its obvious: the guy who comes in breathing like he just climbed Everest. Many times it isn't. And its the subtle stuff that gets missed: by midlevels and even physicians, though anecdotally less often by the latter in my experience.

 

[VA Hopeful Dr]

I know I didn't get one, or at least I got no more of an exam that I would be comfortable doing.



We don't have to decide if someone needs admission. We do have to be able to tell if someone needs a more extensive exam than we can provide. We already do this in pharmacies across the country every day. The year I worked retail, I probably sent someone to either an Urgent Care or ER a couple of times a week. About every other month, I called an ambulance for someone (I worked in a very doctor averse area).

As for a full medication history, the pharmacy is more likely to have one that the doctor's office is. I believe (granted with no proof) that patient's are much more likely to use one pharmacy than they are to use single physician (or a group that shares an EMR).

I don't really have a dog in this fight, and I certainly know colleagues that would rather not be given another thing to do they don't have time for. However, I do take issue that pharmacists are not trained on when to refer to medical care or how to assess for complex drug interactions.

Awhile back Epic added a function that tracks all prescriptions that patients receive from regular pharmacies (methadone clinics don't register, for instance) that is very helpful. Its not fool-proof but its made a big difference in my practice at least.

Right, the admission part was a bit hyperbolic but the idea of "needs urgent/emergent evaluation" still holds.

 

[KidPharmD]

Awhile back Epic added a function that tracks all prescriptions that patients receive from regular pharmacies (methadone clinics don't register, for instance) that is very helpful. Its not fool-proof but its made a big difference in my practice at least.

Right, the admission part was a bit hyperbolic but the idea of "needs urgent/emergent evaluation" still holds.

Access to the SureScripts database in nice when it works. I use it on almost a daily basis now. The problem is that it relies on database that is either very accurate or very incomplete depending on a patient's specific circumstances. I (and I'm sure you don't either) would never rely on that database in place of an accurate medication history.

And I still maintain that pharmacists are trained to evaluate who needs urgent/emergent evaluation in many situations and it's something community pharmacists do regularly. If anything we might be more likely to send someone who doesn't actually need it than we would be to miss someone who needs it since we have so little at our disposal in the community.

On another comment you made: The practice prescriber dispensing is irresponsible and should be considered practicing pharmacy without a license. The only reason it exists is the greater influence physicians carry over pharmacists.

 

[VA Hopeful Dr]

Access to the SureScripts database in nice when it works. I use it on almost a daily basis now. The problem is that it relies on database that is either very accurate or very incomplete depending on a patient's specific circumstances. I (and I'm sure you don't either) would never rely on that database in place of an accurate medication history.

And I still maintain that pharmacists are trained to evaluate who needs urgent/emergent evaluation in many situations and it's something community pharmacists do regularly. If anything we might be more likely to send someone who doesn't actually need it than we would be to miss someone who needs it since we have so little at our disposal in the community.

On another comment you made: The practice prescriber dispensing is irresponsible and should be considered practicing pharmacy without a license. The only reason it exists is the greater influence physicians carry over pharmacists.

So you can do my job but I can't do yours?

 

[KidPharmD]

So you can do my job but I can't do yours?

Nope. I cannot do your job. I cannot properly come up with and weed through a differential diagnosis. I cannot perform even the simplest of medical procedures. I cannot plan for the preventative care of at risk patients. I cannot decide who is appropriate for primary or specialist care or who can be treated outpatient or who needs admission.

I do think that I can (with a very low threshold for referral) determine who is too sick/complex/etc to be seeking treatment at a pharmacy instead of from an urgent care/ER/PCP. BTW, I do think that a pharmacist could test and treat many COVID patients with the provision it was under a well designed protocol created with the help of specialist physicians. Theoretically that would already be legal under a CPA.

However, I think it is unfair to say that you went through so many 1000's of hours of training to do your job and thus not even the smallest part of it should be done by someone else but you (who definitely did not have anywhere near the drug training I did) can definitely do my job without any near the oversight that we have to (since Boards of Pharmacy don't have authority over MD dispensing and I have never seen a Board of Medicine spend any time thinking about it).

The practice of pharmacy is separate from the practice of medicine for a reason. I just get so tired of the overall profession of medicine being so protective of their scope when they are perfectly happy to invade ours when it is profitable.

 

[vinapharm]

Recommend OTC stuff all day long, I'm 100% OK with that.

But prescribing antibiotics without either testing or an exam isn't good practice.

That is why I mentioned Teledoc dr. They don't need to test or order a lab drawn on me. They just listened to my complaints and prescribed abx, zyrtec, flonase. Since it is allowed like that, I don't see why a pharmacy with a well trained pharmacist can do it also. Just my thought

 

[JustFillIt]

So you can do my job but I can't do yours?

This is a great point - honestly, I don’t mind sharing dispensing with physicians at all.

But seriously - you wouldn’t want to do that. I have 100% confidence that if we (as a society, not me personally as I am not a gatekeeper and will respect my colleagues who are qualified) gave physicians the ability to dispense medications, they would just not do it. Why would you want to bring the nightmare upon yourself? At this point I would drive school bus before I would ever dispense medications again. It’s that bad…. The only ones left doing it are the ones who are fortunate enough to have technicians that did not quit over the past few years or they are killing themselves to do it for the money.

It would be like walking into a burning building with a smile on your face.

 

[KidPharmD]

This is a great point - honestly, I don’t mind sharing dispensing with physicians at all.

But seriously - you wouldn’t want to do that. I have 100% confidence that if we (as a society, not me personally as I am not a gatekeeper and will respect my colleagues who are qualified) gave physicians the ability to dispense medications, they would just not do it. Why would you want to bring the nightmare upon yourself? At this point I would drive school bus before I would ever dispense medications again. It’s that bad…. The only ones left doing it are the ones who are fortunate enough to have technicians that did not quit over the past few years or they are killing themselves to do it for the money.

It would be like walking into a burning building with a smile on your face.

There are plenty of MD's around here that dispense. A couple of them even employ CPhT's that work with essentially no oversight.

 

[JustFillIt]

There are plenty of MD's around here that dispense. A couple of them even employ CPhT's that work with essentially no oversight.

I’m sure it happens and but I have never seen it. If they welcome us there is no reason why we shouldn’t welcome them. We should all follow the same rules.

But in my opinion, the grass is way greener on their side.

 

[KidPharmD]

I’m sure it happens and but I have never seen it. If they welcome us there is no reason why we shouldn’t welcome them. We should all follow the same rules.

But in my opinion, the grass is way greener on their side.

I would be happy if the physician dispensers were regulated in the same way pharmacies are. Except they aren't. They aren't required to follow almost any of the same rules we are, only what the BOM determines necessary. This amounts to what goes on a label. No required counseling, no review of technician (or CNA/CMA) work, very little record keeping rules. It is borderline that physicians can just do what they want, and all that won't ever change until one of them screws up big enough to make the news.

 

[Chrish]

That is why I mentioned Teledoc dr. They don't need to test or order a lab drawn on me. They just listened to my complaints and prescribed abx, zyrtec, flonase. Since it is allowed like that, I don't see why a pharmacy with a well trained pharmacist can do it also. Just my thought

just because something gets routinely done doesn’t mean it’s okay and that’s what I believe OP is getting at.

Tele doc is a garbage medicine and shouldn’t be used as an example of how something can be done.

 

[VA Hopeful Dr]

This is a great point - honestly, I don’t mind sharing dispensing with physicians at all.

But seriously - you wouldn’t want to do that. I have 100% confidence that if we (as a society, not me personally as I am not a gatekeeper and will respect my colleagues who are qualified) gave physicians the ability to dispense medications, they would just not do it. Why would you want to bring the nightmare upon yourself? At this point I would drive school bus before I would ever dispense medications again. It’s that bad…. The only ones left doing it are the ones who are fortunate enough to have technicians that did not quit over the past few years or they are killing themselves to do it for the money.

It would be like walking into a burning building with a smile on your face.

Lots of DPC doctors do it, usually a fairly small formulary and with minimal mark up (mine was 10%). I carried maybe 20 meds, all very basic: lisinopril, metformin, crestor, toprol, meloxicam, amlodipine, doxycycline, you get the idea. But other than that its pretty rare for all the reasons y'all complain about when working at retail pharmacies.

 

[VA Hopeful Dr]

Nope. I cannot do your job. I cannot properly come up with and weed through a differential diagnosis. I cannot perform even the simplest of medical procedures. I cannot plan for the preventative care of at risk patients. I cannot decide who is appropriate for primary or specialist care or who can be treated outpatient or who needs admission.

I do think that I can (with a very low threshold for referral) determine who is too sick/complex/etc to be seeking treatment at a pharmacy instead of from an urgent care/ER/PCP. BTW, I do think that a pharmacist could test and treat many COVID patients with the provision it was under a well designed protocol created with the help of specialist physicians. Theoretically that would already be legal under a CPA.

However, I think it is unfair to say that you went through so many 1000's of hours of training to do your job and thus not even the smallest part of it should be done by someone else but you (who definitely did not have anywhere near the drug training I did) can definitely do my job without any near the oversight that we have to (since Boards of Pharmacy don't have authority over MD dispensing and I have never seen a Board of Medicine spend any time thinking about it).

The practice of pharmacy is separate from the practice of medicine for a reason. I just get so tired of the overall profession of medicine being so protective of their scope when they are perfectly happy to invade ours when it is profitable.

Yeah lots of doctors are money grubbing jerks, no argument there. Speaking just for myself, I made basically zero money when I dispensed medications. It was purely a service to my patients.

I'm sure there are plenty of physicians that are protective for purely financial reasons. I am not one of them. I'm booked out for new patients 2-3 months. Pharmacists doing more acute care wouldn't do anything to my earnings. But all of us have seen midlevels, non-physician doctors, and so on who really screw stuff up that can actively harm patients so we're all a little gun shy about anyone new wanting to expand what they do. Plus if I'm being honest, I'm a bit of a control freak. I refuse to use scribes and my nurses do way less work than many of my partners. So the idea of anyone else managing my patients always makes me leery.

 

[TranslationalRPh]

Yeah lots of doctors are money grubbing jerks, no argument there. Speaking just for myself, I made basically zero money when I dispensed medications. It was purely a service to my patients.

I'm sure there are plenty of physicians that are protective for purely financial reasons. I am not one of them. I'm booked out for new patients 2-3 months. Pharmacists doing more acute care wouldn't do anything to my earnings. But all of us have seen midlevels, non-physician doctors, and so on who really screw stuff up that can actively harm patients so we're all a little gun shy about anyone new wanting to expand what they do. Plus if I'm being honest, I'm a bit of a control freak. I refuse to use scribes and my nurses do way less work than many of my partners. So the idea of anyone else managing my patients always makes me leery.

I love your candid responses! Thanks for enduring the virtual gauntlet.

To be fair, the more hoops one must jump through to broaden scope, the less people usually willing and/or able to do so. Pragmatically, your turf is probably safe, at least from pharmacists, for now.