prescribing rights for pharmacists

[wagrxm2000]

With the increasing need for MDs does anyone see a bigger push for pharmacists being able to prescribe? Heck we can't possibly be any worse then nurses right?

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[Dr Wario]

Just another metric you will have to meet with no additional help or pay.

 

[owlegrad]

Just another metric you will have to meet with no additional help or pay.

Have you always been this cynical?

 

[Dr Wario]

Have you always been this cynical?

I work for the same company as you but have been doing it for a lot longer, give it time.

 

[HoboCommander]

Pharmacists will have to master the physical exam and take something akin to the USMLE. This may mean 1-2 extra years of school. Meanwhile, your salary will either stay the same or even decrease with the influx of new pharmacy students. Are you sure you want this?

 

[owlegrad]

I work for the same company as you but have been doing it for a lot longer, give it time.

I have worked with our company for >5 years, so I wouldn't consider myself new to how it works.

Don't get me wrong, I ain't arguing with you. More curious than anything.

 

[pharm B]

With the increasing need for MDs does anyone see a bigger push for pharmacists being able to prescribe? Heck we can't possibly be any worse then nurses right?

How comfortable do you feel getting physical with a patient? And to be accurate, NPs and PAs are more than "nurses," in my opinion. I think we would be a great addition to a doctor's office in the form of chronic disease management, but I don't think we could stand alone as independent practitioners without additional training.

That being said, I currently "prescribe" in one of my clinics (technically it's signed off by another pharmacist since I'm a resident). I can change doses or start/stop medications as needed to help patients manage their disease states. I think similar models in the civilian side of things would be a great expansion of pharmacy practice and a big way for us to contribute to patient health.

How do we make that happen? How do we get insurance companies to pay for that?

 

[Gombrich12]

Why? Leave the diagnosis to those who were trained in it. And if you suggest additional training could solve the issue, I say why not just back to school to become a PA?

 

[BF7]

I did a rotation at a military hospital in San Antonio... If you enjoy clinical pharmacy practice, the us military is a great place to practice. They give pharmacists more opportunity and responsibility than in 99% of other settings ( probably because the hospitals can't be sued)

 

[pharm B]

Why? Leave the diagnosis to those who were trained in it. And if you suggest additional training could solve the issue, I say why not just back to school to become a PA?

Because we make more than PAs?

 

[josh6718]

Just another metric you will have to meet with no additional help or pay.

"You met your target for flu-shots last month, but you'll need to work on prescribing more Flonase and tessalon pearls while also improving your WeCare Metrics, KPM, Prescription Validation, MySchedule Optimization, and complete 10 new training modules due next week..."

 

[gwarm01]

There is no way I would want a job where I had to do the initial diagnosis. Pharmacists are not trained to do that and I would feel way too unsafe.

It would be OK with me to adjust therapy for specific disease states but it would be nice to have a physician around in case they had some physical exam finding that I wanted them to look at.

I agree with this. We just aren't trained to do these examinations. We had four years of pharmacy school geared towards being a pharmacist and learning about medications. That's what we do, and frankly there is no need for us to also play the part of a poor man's physician. No one person can do it all, and we already have a lot on our hands practicing as pharmacists today.

Chronic disease state management is something that we are quite good at and many pharmacists do this today via protocol. I would support any of these "advanced practice pharmacist" propositions if it made it easier for us to do these sorts of jobs, where the examination portion is usually limited to a needle stick, BP check, or maybe a little spirometry.

 

[Modest_anteater]

Have you always been this cynical?

Look at his user name. "Dr. Wario" Do you know that Wario is the pessimistic version of Mario? The inversion of the M to a W is a symbolic "corruption" and represents a flipping of Mario's normal traits of hyper optimism, integrity and professionalism.

 

[gwarm01]

I wouldn't describe Wario as pessimistic.. just ambitious and greedy.

 

[Lnsean]

there is no way a pharmacist is trained to diagnose...it goes way beyond the physical exam. the whole thought process and differential requires vast knowledge in patho, anatomy, and physiology. that's why some of the best doctors i've rotated with are IM / EM doctors because you really got to know your sht.

 

[CetiAlphaFive]

honest to god, as a pharmacist coming out of school, i don't want anything to do with prescribing.
a pharmacist's job is to check medications and make sure they're safe and appropriate for the patient.
that's all. i know in other settings and with other pharmacists, they like all that stuff but adding that into law and making it a requirement where I have to do it, makes me regret being a pharmacist.
if i wanted to prescribe anything at all, then i would have gone to med school.

Give it a year.
You'll realize that the majority of PCPs are garbage. I could literally do a better job of managing their amb care patients.

Then again you might just be a sub par RPh.
I knew P4s that didn't know how ACEinhibitors worked

 

[VA Hopeful Dr]

Give it a year.
You'll realize that the majority of PCPs are garbage. I could literally do a better job of managing their amb care patients.

Then again you might just be a sub par RPh.
I knew P4s that didn't know how ACEinhibitors worked

There's some sad truth in this...

 

[Sparda29]

I dont wanna do jack **** other than verify and watch Youtube and Netflix. Pay me more if you want me to prescribe, MTM, vaccinate, etc.

 

[CetiAlphaFive]

I dont wanna do jack **** other than verify and watch Youtube and Netflix. Pay me more if you want me to prescribe, MTM, vaccinate, etc.

Yeah, they'd end up paying me more than a FM MD before I'd consider doing it

 

[imcallingcorp]

I dont wanna do jack **** other than verify and watch Youtube and Netflix. Pay me more if you want me to prescribe, MTM, vaccinate, etc.

lol sounds like the mentality of the pharmacists from the golden era of i have a pulse and a license so you need me. if i was your boss and wanted you to vaccinate and do mtm you would and i wouldnt pay you a penny more. and id have a stack of applications to replace you should you think otherwise. sorry to interrupt your netflix lol

 

[lord999]

lol sounds like the mentality of the pharmacists from the golden era of i have a pulse and a license so you need me. if i was your boss and wanted you to vaccinate and do mtm you would and i wouldnt pay you a penny more. and id have a stack of applications to replace you should you think otherwise. sorry to interrupt your netflix lol

"If" being the qualifying laconism answered in the firm negative in both sparda's and my case. Aside from that, even if I were doing explicit 100% dispensing, I never cared enough about the clinical aspects to ever want to do them and would always refuse to if ordered. They have a stack of applications for "play doctor", excuse me, "clinical pharmacist" too, doesn't mean I have to be one of them when there is plenty of "pharmacist" work to get done. Oh, and if you were my boss and were confrontational about it, I'd figure out how to sabotage your metrics as hard as possible with crediting the problem to you. That sort of "work to rule" has always been an easy defense against uppity management (and something that I do fear as management now, there's real reasons not to be an overt dick to your staff besides The Golden Rule).

If my employees were efficient enough to get the job done, I don't care what the hell they do with their down time as long as it doesn't get my business sued or customers mad. I do think sparda should be running his own side business or day trading rather than watching Netflix, but to each, their own.

 

[imcallingcorp]

"If" being the qualifying laconism answered in the firm negative in both sparda's and my case. Aside from that, even if I were doing explicit 100% dispensing, I never cared enough about the clinical aspects to ever want to do them and would always refuse to if ordered. They have a stack of applications for "play doctor", excuse me, "clinical pharmacist" too, doesn't mean I have to be one of them when there is plenty of "pharmacist" work to get done. Oh, and if you were my boss and were confrontational about it, I'd figure out how to sabotage your metrics as hard as possible with crediting the problem to you. That sort of "work to rule" has always been an easy defense against uppity management (and something that I do fear as management now, there's real reasons not to be an overt dick to your staff besides The Golden Rule).

If my employees were efficient enough to get the job done, I don't care what the hell they do with their down time as long as it doesn't get my business sued or customers mad. I do think sparda should be running his own side business or day trading rather than watching Netflix, but to each, their own.

vaccinations make good profit and doing your assigned MTM cases has an impact on your Stars rating which will impact your pharmacy. unless you ever cut the paychecks you won’t understand. honestly you just went on a rant sounding ridiculous. sabotage metrics lol calm down 007

 

[CetiAlphaFive]

vaccinations make good profit and doing your assigned MTM cases has an impact on your Stars rating which will impact your pharmacy. unless you ever cut the paychecks you won’t understand. honestly you just went on a rant sounding ridiculous. sabotage metrics lol calm down 007

MTM cases do not have a direct impact on your STAR rating. CMRs are important for one part, but TIPs are not
Also, vaccinations being profitable should be a secondary focus. They're mainly a tool for converting new customers.
Is English a second language for you?

 

[UGAZ]

If your passion is prescribing, then you shouldn't be a pharmacist, to be honest. Go to medical school or PA school or becoming an NP. You will prescribe all day long. I don't understand why our profession is heading to prescribing privileges ...what for? I understand under certain disease state management/collaboration, you should be allowed to prescribe within that area/protocol...However, extending prescribing privileges overall, that's a big liability. B Stupid professors who have never really worked in real life, during pharmacy school, kept preaching about how wonderful clinical pharmacy was. I bet they are also the ones pushing toward prescribing agenda.
Again, if your passion is prescribing, writing orders...you should get out pharmacy STAT and go to medical school.

 

[CetiAlphaFive]

If your passion is prescribing, then you shouldn't be a pharmacist, to be honest. Go to medical school or PA school or becoming an NP. You will prescribe all day long. I don't understand why our profession is heading to prescribing privileges ...what for? I understand under certain disease state management/collaboration, you should allow to prescribe within that area/protocol...However, extending prescribing privileges overall, that's a big liability. B Stupid professors who have never really worked in real life, during pharmacy school, kept preaching about how wonderful clinical pharmacy was. I bet they are also the ones pushing toward prescribing agenda.
Again, if your passion is prescribing, writing orders...you should get out pharmacy STAT and go to medical school.

Our profession needs to head in the opposite direction:

ANTI-PRESCRIBING.


Get a prescription for a holy Trinity? Deactivate the doctor's DEA for the day.

Get a prescription for Carvedilol 25mg "1/2 to 1 qd prn if blood pressure is high" for an obese patient with 160/89 BP?
reject with prejudice and force the doctor to take the USMLE again.


Get a prescription for augmented betamethasone for a 5 month old when the parent has an IQ that matches the number of tattoos they have?
Push a button on the screen to open a trapdoor in the doctor's office and literally drop the pediatrician into the depths of hell.


HAHAHA

 

[UGAZ]

Our profession needs to head in the opposite direction:

ANTI-PRESCRIBING.


Get a prescription for a holy Trinity? Deactivate the doctor's DEA for the day.

Get a prescription for Carvedilol 25mg "1/2 to 1 qd prn if blood pressure is high" for an obese patient with 160/89 BP?
reject with prejudice and force the doctor to take the USMLE again.


Get a prescription for augmented betamethasone for a 5 month old when the parent has an IQ that matches the number of tattoos they have?
Push a button on the screen to open a trapdoor in the doctor's office and literally drop the pediatrician into the depths of hell.


HAHAHA

I like...I like...

 

[lord999]

vaccinations make good profit and doing your assigned MTM cases has an impact on your Stars rating which will impact your pharmacy. unless you ever cut the paychecks you won’t understand. honestly you just went on a rant sounding ridiculous. sabotage metrics lol calm down 007

Numbers are a tool, nothing more or less in terms of overseeing a pharmacy. No, vaccinations by themselves are not that profitable for pharmacy (they aren't a discount island, but they do not sustain a practice). MTM specifically does not offset your salary unless you are making $42/hour and everything else is paid for already. Those are services, and they are offered for driving the customer base rather than true profit centers in their own right.

My response was from the idea that if I did have you as a boss, I would immediately be dismissive of you as a tool of corporate, then payback the idea with a better one that if you want to live by corporate, I'll make you die by corporate. Especially if you threaten me with the idea that you have piles of applications behind me to my face, and I would show you just how hard it is to get rid of someone who is a passive saboteur, and making it a point to screw up your store such that no one in their right mind would take your store. It's real hard to prove negligence on someone who is making it a point to be careful about looking stupid. You cannot purely use a stick, you have to have some carrot involved.

Then again, I'm not the average worker. You can get away with that sort of attitude if you have dumb sheeple on the job. That said, if you do, they can never be really helpful to your cause, they just breathe air and take up space.

 

[Saiyo]

Give it a year.
You'll realize that the majority of PCPs are garbage. I could literally do a better job of managing their amb care patients.

ha, I've seen some hospitalists and NPs that I can only describe as "low effort." Statements like "Uh yeah, I dunno man I just started tygacil for the UTI since I saw it was susceptible, you can change it if you want" isn't very inspiring after the first few times. I think collaborative practice agreements are a pretty neat thing- you get to provide important services docs are too busy or lazy to do under the protection of a protocol. I'm sure someone has already found a way to ruin that concept though.

I don't really see the utility of pharmacists having independent prescribing rights though. What are we supposed to prescribe? I've had one class on patient assessment that I honestly didn't do that well in, and no experience with diagnosing. Unless you want me to prescribe birth control off a protocol or docusate for constipation it really isn't going to be that exciting.

By the way, speaking of low effort, are the NOACs monitored nowadays or are patients just sent out to disappear into the void with a pamphlet on bleeding signs?

 

[imcallingcorp]

Numbers are a tool, nothing more or less in terms of overseeing a pharmacy. No, vaccinations by themselves are not that profitable for pharmacy (they aren't a discount island, but they do not sustain a practice). MTM specifically does not offset your salary unless you are making $42/hour and everything else is paid for already. Those are services, and they are offered for driving the customer base rather than true profit centers in their own right.

My response was from the idea that if I did have you as a boss, I would immediately be dismissive of you as a tool of corporate, then payback the idea with a better one that if you want to live by corporate, I'll make you die by corporate. Especially if you threaten me with the idea that you have piles of applications behind me to my face, and I would show you just how hard it is to get rid of someone who is a passive saboteur, and making it a point to screw up your store such that no one in their right mind would take your store. It's real hard to prove negligence on someone who is making it a point to be careful about looking stupid. You cannot purely use a stick, you have to have some carrot involved.

Then again, I'm not the average worker. You can get away with that sort of attitude if you have dumb sheeple on the job. That said, if you do, they can never be really helpful to your cause, they just breathe air and take up space.

I was actually speaking from the point of view from an indy pharmacy . and guess what mtm is done for the stars ratings like i said which in the next few years will affect things like reinbursement snd vaccines like flu make more more than most scripts you fill. and guess what when patients come in and ask hey do you do flu shots and we dont while every other pharnacy does how does that make us look. based on your tone i think you might need to talk to someone. you sound very angry .

 

[CetiAlphaFive]

I was actually speaking from the point of view from an indy pharmacy . and guess what mtm is done for the stars ratings like i said which in the next few years will affect things like reinbursement snd vaccines like flu make more more than most scripts you fill. and guess what when patients come in and ask hey do you do flu shots and we dont while every other pharnacy does how does that make us look. based on your tone i think you might need to talk to someone. you sound very angry .

What are you smoking, homie?

What part of that sounds angry?

 

[BidingMyTime]

Pharmacists will have to master the physical exam and take something akin to the USMLE. This may mean 1-2 extra years of school. Meanwhile, your salary will either stay the same or even decrease with the influx of new pharmacy students. Are you sure you want this?

Yeah, pretty sure PA's & NP's don't take USMLE or anything close to it (wasn't there one study where NP's were given step 1 and something like only 30% of them could pass it? But I agree with you, pharmacists don't know anything about diagnosis, so the idea of prescribing for anything that isn't already diagnoses (whether self-diagnosed or by protocol), is ludicrous.

That being said, I currently "prescribe" in one of my clinics (technically it's signed off by another pharmacist since I'm a resident). I can change doses or start/stop medications as needed to help patients manage their disease states. I think similar models in the civilian side of things would be a great expansion of pharmacy practice and a big way for us to contribute to patient health.
How do we make that happen? How do we get insurance companies to pay for that?

This makes sense, the diagnosis is already made, the pharmacist is managing the medication treatment. This pharmacists could do. As for how to get ins companies to pay for it? While anything is possible, the reality is, under real world circumstances of today, it isn't going to happen.

That's what we do, and frankly there is no need for us to also play the part of a poor man's physician. No one person can do it all, and we already have a lot on our hands practicing as pharmacists today.

This, there are enough "prescribers" already, the country doesn't need more. Pharmacists need to be doing pharmacist type stuff.

I knew P4s that didn't know how ACEinhibitors worked

This is sad, very very sad, given that how they work is in the actual name

 

[Rouelle]

The classic model of separation of prescribing from dispensing serves a real purpose. If the dispensers start prescribing, we lose that additional “check and balance” step.

 

[imcallingcorp]

What are you smoking, homie?

What part of that sounds angry?

Look my own personal troll is back

 

[zelman]

This is sad, very very sad, given that how they work is in the actual name

Yup. That’s why I don’t take mine when I visit Las Vegas. They ruin my blackjack game.

 

[RxPert1911]

With the increasing need for MDs does anyone see a bigger push for pharmacists being able to prescribe? Heck we can't possibly be any worse then nurses right?

I see no need for pharmacist to prescribe

 

[wagrxm2000]

I see no need for pharmacist to prescribe

I've been waiting 3 years to get a response, thank you.

 

[Hello2000]

I'm a pharmacist in the UK, and I am an independent prescriber. I went back to school for a year and spent a lot of time with my physician mentor and he deems me competent to prescribe. I work in an addictions clinic and after an Initial diagnosis opiate dependence by the medic, the patient is passed to me. I prescribe methadone and suboxone within guidelines. I also screen for Hep C and HIV, analyse urine etc. I get paid £100k which was about $150k USD until Brexit and is about $130 now. As I am an independent prescriber I can prescribe Botox and Fillers and run a very successful aesthetics business in the evenings and weekends. I turn over over $200k in my botox and fillers clinic on top of my clinic salary. So to all the neigh sayers out there, pharmacist independent prescribing has been around for about 20 years and the physicians love us as it takes a lot of their workload away and it is very lucrative. Pharmacist prescribers run all sorts of clinics and prescribe in them from addictions to warfarin, diabetes to respiratory you name it we do the lot here in the UK, in some rural areas a pharmacist prescriber acts as the GP for the villages with telehealth connections to the mainland. Best move I ever made, no running around like a madman in dispensary all day, no metrics. Relaxing lunch breaks.

 

[Hello2000]

We also do polypharmacy reviews which is anti-prescribing. Yes sometimes mistakes are made but that is what professional indemnity insurance is for. You need to be well trained, confident and be able to justify any prescribing decisions. If you can do that you won't have any trouble.

 

[CetiAlphaFive]

I'm a pharmacist in the UK, and I am an independent prescriber. I went back to school for a year and spent a lot of time with my physician mentor and he deems me competent to prescribe. I work in an addictions clinic and after an Initial diagnosis opiate dependence by the medic, the patient is passed to me. I prescribe methadone and suboxone within guidelines. I also screen for Hep C and HIV, analyse urine etc. I get paid £100k which was about $150k USD until Brexit and is about $130 now. As I am an independent prescriber I can prescribe Botox and Fillers and run a very successful aesthetics business in the evenings and weekends. I turn over over $200k in my botox and fillers clinic on top of my clinic salary. So to all the neigh sayers out there, pharmacist independent prescribing has been around for about 20 years and the physicians love us as it takes a lot of their workload away and it is very lucrative. Pharmacist prescribers run all sorts of clinics and prescribe in them from addictions to warfarin, diabetes to respiratory you name it we do the lot here in the UK, in some rural areas a pharmacist prescriber acts as the GP for the villages with telehealth connections to the mainland. Best move I ever made, no running around like a madman in dispensary all day, no metrics. Relaxing lunch breaks.

How do i translate the word "Generalizability" to British so i can communicate with you?

 

[lord999]

How do i translate the word "Generalizability" to British so i can communicate with you?

Like you do with connexion. Greek suffix rules. It's nice if you have the NHS and the now defunded NICE behind you when practicing. Our equivalent CMS and pharmacy have been historic enemies for too long to ever have them concede on that point now (and that was definitely pharmacy's fault). But even with those rates, UK and Commonwealth pharmacists make at most 2/3's of the average US pharmacist. Full-time theoretical rate payouts for professional services does not equate to dispensing.

 

[CynicalIntern]

So to all the neigh sayers out there, pharmacist independent prescribing has been around for about 20 years and the physicians love us as it

I'm really not sure why you're arguing with a bunch of horses, but you do you homie.