Physicians Opposing Pharmacist Expanded Practice

[KidPharmD]

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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 appreciate your honest discussion btw, and I understand the reasons for some being gun-shy. I also absolutely get being a bit of a control freak.
Personally, I am not too keen on this particular test and treat plan because it doesn't really do much to actually provide for the time it will take to do it right and still do all the other things community pharmacists would do.

I would love for there to be federal legislation setting up a easier method for setting up CPA's in a more straight forward way. I feel like if the MD's and PharmD's can agree on the protocol it shouldn't be a problem. Recently we tried to get a CPA approved hear that was supported by every one of our physicians and our legal team thought it was too risky because it gave the pharmacists too much leeway.

As for the feeling of financial issues - this is a story I have heard all my career. I had mentors talk about how difficult just getting to be able to give flu shots was here. One older one even told of how often he was yelled at by MD's for counseling patients after those rules were passed (not sure what the motivation was there). All this arguing over scope seems so ridiculous when I am no longer allowed to see my MD for any kind of "sick" visit even if I am willing to wait a couple of weeks. If I can't wait the months they are scheduled out, I am supposed to go see the NP at the clinic owned urgent care. She is great, but I also really like my doc and wish I could see him more than once a year. I can't imagine what it would be like if I had significant medical issues. If I had to see an MD/DO in my area for everything some said I needed to, I just wouldn't be able to get any care because there aren't enough of them.

 

[VA Hopeful Dr]

I appreciate your honest discussion btw, and I understand the reasons for some being gun-shy. I also absolutely get being a bit of a control freak.
Personally, I am not too keen on this particular test and treat plan because it doesn't really do much to actually provide for the time it will take to do it right and still do all the other things community pharmacists would do.

I would love for there to be federal legislation setting up a easier method for setting up CPA's in a more straight forward way. I feel like if the MD's and PharmD's can agree on the protocol it shouldn't be a problem. Recently we tried to get a CPA approved hear that was supported by every one of our physicians and our legal team thought it was too risky because it gave the pharmacists too much leeway.

As for the feeling of financial issues - this is a story I have heard all my career. I had mentors talk about how difficult just getting to be able to give flu shots was here. One older one even told of how often he was yelled at by MD's for counseling patients after those rules were passed (not sure what the motivation was there). All this arguing over scope seems so ridiculous when I am no longer allowed to see my MD for any kind of "sick" visit even if I am willing to wait a couple of weeks. If I can't wait the months they are scheduled out, I am supposed to go see the NP at the clinic owned urgent care. She is great, but I also really like my doc and wish I could see him more than once a year. I can't imagine what it would be like if I had significant medical issues. If I had to see an MD/DO in my area for everything some said I needed to, I just wouldn't be able to get any care because there aren't enough of them.

Yeah I don't understand doctors whose offices are set up that way. I have 4-6 same day appointments that can't be scheduled until that day. They usually fill up, and if they don't and I have a couple of open spots its not a big deal. Gives me time to catch up on busy work.

 

[zelman]

I hope it will let me finally write a script for diabetic supplies. Most ignorant thing that we cannot write for something as simple as a glucose meter.

Why would you order diabetic supplies? To get glucose readings and then not be able to adjust their med regimen? The problem isn’t that we can’t prescribe. It’s that prescribers suck at it.

 

[VA Hopeful Dr]

Why would you order diabetic supplies? To get glucose readings and then not be able to adjust their med regimen? The problem isn’t that we can’t prescribe. It’s that prescribers suck at it.

I wouldn't put it that way when testifying to various legislatures hoping too expand what you can do

 

[VA77]

Why would you order diabetic supplies? To get glucose readings and then not be able to adjust their med regimen? The problem isn’t that we can’t prescribe. It’s that prescribers suck at it.

Pharmacists cannot bill Medicare or most insurance plans for DME

 

[Rockinacoustic]

Update: FDA authorizes pharmacists to prescribe Paxlovid

Coronavirus (COVID-19) Update: FDA Authorizes Pharmacists to Prescribe Paxlovid with Certain Limitations

The FDA revised the EUA for Paxlovid to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients, with certain limitations.

www.fda.gov

 

[Dred Pirate]

Nice, do epipen next

if anything epi pen should be before a drug like paxlovid- I haven't read the article, but are their limitations - like - if a patient is on an offending drug that needs to be stopped, can we stop the other drug? (likely not)- or can we prescribe but tell the pt "you need to verify with your doc?" or do we just saw "no"?

 

[PharFromNormal]

How about spacers for inhalers next

 

[RXDOC1986]

I don't understand why 4 pages on this topic has exclusively revolved around Retail Pharmacy Practice. As a hospital, and before that Oncology Clinical pharmacist, I have always been able to confirm diagnosis, interpret lab work, prescribe and dispense a large variety of pharmaceutics. At our hospital, for example, the physician or PA initiates Sepsis Protocol, at which time we take over, order labs and cultures, interpret results, decide on appropriate antimicrobials, figure out kinetics, dose patient with multiple ABX, and follow up. All the ID doc needs to do is read our notes. Every Rx goes in under my name as prescriber. This carries over to anticoagulation, hyperglycemia, pain management, and seizure therapy.
So in some settings, we are there! No fight, no conflict, dealing with patient care.

 

[JustFillIt]

I don't understand why 4 pages on this topic has exclusively revolved around Retail Pharmacy Practice. As a hospital, and before that Oncology Clinical pharmacist, I have always been able to confirm diagnosis, interpret lab work, prescribe and dispense a large variety of pharmaceutics. At our hospital, for example, the physician or PA initiates Sepsis Protocol, at which time we take over, order labs and cultures, interpret results, decide on appropriate antimicrobials, figure out kinetics, dose patient with multiple ABX, and follow up. All the ID doc needs to do is read our notes. Every Rx goes in under my name as prescriber. This carries over to anticoagulation, hyperglycemia, pain management, and seizure therapy.
So in some settings, we are there! No fight, no conflict, dealing with patient care.

Yea well - this bruises some peoples ego, which is a huge part of the pushback.

 

[TranslationalRPh]

I don't understand why 4 pages on this topic has exclusively revolved around Retail Pharmacy Practice. As a hospital, and before that Oncology Clinical pharmacist, I have always been able to confirm diagnosis, interpret lab work, prescribe and dispense a large variety of pharmaceutics. At our hospital, for example, the physician or PA initiates Sepsis Protocol, at which time we take over, order labs and cultures, interpret results, decide on appropriate antimicrobials, figure out kinetics, dose patient with multiple ABX, and follow up. All the ID doc needs to do is read our notes. Every Rx goes in under my name as prescriber. This carries over to anticoagulation, hyperglycemia, pain management, and seizure therapy.
So in some settings, we are there! No fight, no conflict, dealing with patient care.

Great example, thank you for sharing your experience. FYI, I think this has focused on retail pharmacy just because that is where the majority of pharmacists work.

 

[Rockinacoustic]

if anything epi pen should be before a drug like paxlovid- I haven't read the article, but are their limitations - like - if a patient is on an offending drug that needs to be stopped, can we stop the other drug? (likely not)- or can we prescribe but tell the pt "you need to verify with your doc?" or do we just saw "no"?

See bolded:

Under the limitations outlined in the authorization, the state-licensed pharmacist should refer patients for clinical evaluation with a physician, advanced practice registered nurse, or physician assistant licensed or authorized under state law to prescribe drugs, if any of the following apply:

• Sufficient information is not available to assess renal and hepatic function.
• Sufficient information is not available to assess for a potential drug interaction.
• Modification of other medications is needed due to a potential drug interaction.
• Paxlovid is not an appropriate therapeutic option based on the current Fact Sheet for Healthcare Providers or due to potential drug interactions for which recommended monitoring would not be feasible.

The bigger question becomes: how does this language make said pharmacist proceed where therapy does not need to be modified empirically, but has the potential to cause as ADE (i.e. someone on amlodipine who becomes hypotensive, on clonazepam and becomes overly sedated).

 

[Chrish]

If we are allowed to prescribe Paxlovid, it will be a disaster.. Already thinking about additional 100 calls a day..

 

[farmadiazepine]

AMA is all about job security.

 

[RxPreceptor]

If we are allowed to prescribe Paxlovid, it will be a disaster.. Already thinking about additional 100 calls a day..

Hmmm not quite yet…remember, most people forget Covid exists in the summer. **** will surely hit the fan come back to school season as usual

 

[VA Hopeful Dr]

I'm fine with this. I hate dealing with the almost infinite drug interactions with Paxlovid and y'all are likely better at it anyway.

 

[Sleepingdoc]

pharmacist doing vaccines and maybe able to write for the right type of needle and diabetic supplies, incontinence supplies are ok but anything more than that may not be worth a liability.