Prescription rights

Discussion in 'Pre-Pharmacy' started by pharming, Nov 29, 2002.

  1. pharming

    pharming Junior Member

    Joined:
    Nov 29, 2002
    Messages:
    7
    Likes Received:
    0
    Ok - what is your take on giving prescription rights to pharmacists? I would think that with the doctorate degree pharmacists should have plenty of traing to be able to prescribe. Look at NP's and PA's who can prescribe with only a masters degree. If pharmacy is going to survive, this is the only road to take!:mad:
     
  2. Thread continues after this sponsor message. SDN Members do not see this ad.

  3. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    If you believe pharmacy has to become like NP/PA in order to survive, then why not just go to those schools? I think pharmacy needs to find its niche and fill it. We can not try to take someone elses niche in order to be viable. The question we should be asking is what services can pharmacy offer that are not provided for but are needed and that people are willing to pay for. In PA, they recently passed a bill that will allow pharmacist to give immunizations. To me this, and similiar initiatives, are not the long term solution since there are many other providers who perform this function.
     
  4. emedpa

    emedpa GlobalDoc

    Joined:
    Aug 25, 2001
    Messages:
    6,014
    Likes Received:
    297
    Status:
    Post Doc
    pharmacists have great pharm knowledge(obviously), but very little in the way of clinical exam skills. you need to make a dx before writing an rx. this is the reason md/do/pa/np grads can write scripts and pharm folks can't.
     
  5. sistermike

    sistermike Senior Member

    Joined:
    Apr 5, 2002
    Messages:
    341
    Likes Received:
    0
    Oh my lordy, lets not start on this subject again! lol.. There are like 2 other threads devoted to this argument and it always gets hot and heavy.
     
  6. Dr JPH

    Dr JPH Banned
    Banned

    Joined:
    Feb 4, 2000
    Messages:
    5,910
    Likes Received:
    31
    Status:
    Resident [Any Field]

    90% of my friends are Pharmacists or Pharmacy students. (disclaimer I suppose)

    I agree with emedpa.

    I don't see any need for Pharmacists to have prescription rights. Seems like the have enough to do as it is.

    The PharmD education is truly impressive, no doubt about that. But it is lacking in clinical exam skills. From what I see, much of the education is present in a case format, but with the focus on pharmacological intervention, rather than diagnostic skills and methodology of treatment other than pharmaceutical.

    What do I believe pharmacists need more of a push in? Hospitals and clinics.

    As a future physician, here is what I envision my pharmacy brethren doing.

    Rounding with me on the wards. The pt is diagnosed and the treatment is outlined with the pharmacist RIGHT THERE. This does happen to an extent, but with the growing elderly pt population, the multitude of new drugs, and the higher likelyhood (and necessity) of polypharmacy I want a pharmacist there to (1) help the physicians, respiratory therapists, etc do what is best for the pt and (2) cover my ass because I know I will never know as much about drugs as you do.

    Again, nothing against the pharmacy education. I respect what you folks do and it is certainly a field worthy of higher salaries, but the future of pharmacy is not in writing prescriptions, but becoming more involved in the direct consultation of patients...not just filling the scripts that docs write.

    And, from working in a pharmacy for several years, I KNOW how badly we need you guys out there...I can assure you that many doctors know less about drugs than they would like to think.

    Happy holidays.
     
  7. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    JPH,
    I appreciatte your comments in realizing how much pharmacists do know about drugs. However, pharmacists are learning more clinical skills. Since I am still in my first year I can't really comment on the depth of what we learn but supposedly the history taking will be similiar to what the physicians learn in our school, and we will also be learning lab values and how to interpret them. Unlike many pharmacy schools, we also use cadavers in learning anatomy. So I would say that in some aspects we receive much of the same training as physicians but don't go into details of diagnosing.
    So I have a question - if pharmacists would round with every physcian, would we need pharmacists in sitting in a pharmacy inputting and verifying orders? This would lead to a higher quality of care with the pharmacists being more directly involved in patient care. From my experience of working in the pharmacy the pharmacists just at a computer inputting the written orders. If the pharmacists is already on rounds why not electronically transmit the orders and no one in the pharmacy would have to look at them.....
     
  8. Dr JPH

    Dr JPH Banned
    Banned

    Joined:
    Feb 4, 2000
    Messages:
    5,910
    Likes Received:
    31
    Status:
    Resident [Any Field]
    tlh

    I see that you are at the program in Erie (or I am assuming that based on your location). I went through 4 years of undergraduate education in which I took many courses along with pharmacy students in the same year so I am extremely familiar with the coursework.

    Personally, I feel that a PharmD degree is non-sensical for a person wishing to do retail pharmacy. I feel that a PharmD should use all of that he/she learned during school.

    I am aware of the amount of clinical case studies you do, interepreting lab values, etc. However, from what I have seen (now this many be different at your school or change in the future) it is no replacement for a medical school education.

    Is it better? Of course not. Neither medical school or pharmacy school is better, persay. They are different and should remain that way, as should the two professions.

    Again, I feel that the work that pharmacists do in a retail setting is in no way indicative of the amount of training they receive.

    I think that the PharmDs SHOULD be on rounds. There SHOULD be a method of getting the Rx orders out faster. There SHOULD be an in-house system for such a thing so that it makes the entire health care delivery more efficient and patient friendly.

    Again, two different professions which need to grow closer in the future if we both want to continue to help people in the best manner possible.

    I applaud you for making the decision to become a pharmacist. I know while sitting in my intro to pharmacology lectures this past term I sure wish I had taken better notes from undergrad. A pharmacy friend once told me..."I work so hard because I don't want to kill anybody when I'm out there working."

    How true that is. That's why we need the separate occupations, focuses, and "territory of expertise", if you will.
     
  9. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    I agree a pharm d for retail is a bit of an overkill, unless retail becomes more clinical. That will never happen though since these large chains will never want to take on the liability involved if pharmacists would make clinical decisions.

    How different would doctor offices operate if they were located within Walmart, Target or some other retailer? Physicians would lose a lot of control and that will never happen, but that is what happened to pharmacy. Decisions are made by business men and not by those with the technical training. I wonder how much this will hinder the future growth of retail pharmacy.....
     
  10. pharming

    pharming Junior Member

    Joined:
    Nov 29, 2002
    Messages:
    7
    Likes Received:
    0
    No one still answered my q - why can't pharmacists have prescription power? :mad:

    We are more educated than others who, so why not include a little more training so we can prescribe? Can pharmacy survive otherwise? :confused:

    Pharmacists are not idiots!
     
  11. sistermike

    sistermike Senior Member

    Joined:
    Apr 5, 2002
    Messages:
    341
    Likes Received:
    0

    There are like 2 other threads devoted to this question on the Pharm.D. board, I suggest you take a look at those. Of course pharmacy is going to survive! If you want to have prescription power, then I suggest you go become an NP/PA/Doctor because I highly doubt that anytime in the near future will prescription rights be granted to Pharmacists. You may think Pharmacists deserve prescription rights but as you can see they don't have the rights, so apparently the national pharmacy board (or whatever it is) disagrees with you and I don't think they care to listen to your suggestions concerning pharmacists and prescription rights.
     
  12. DrMom

    DrMom Official Mom of SDN
    Physician Moderator Emeritus

    Joined:
    Apr 24, 2002
    Messages:
    43,317
    Likes Received:
    20
    Status:
    Attending Physician
    No one is implying that pharmacists are idiots. In fact, the posts have been quite supportive of pharmacists.

    I believe that your question has been answered. Pharmacists are more knowledgeable about the drugs themselves, but are not equivalently knowledgeable about clinical examination and diagnosis.
     
  13. HanSolo

    HanSolo Member

    Joined:
    Apr 17, 2002
    Messages:
    98
    Likes Received:
    0
    Writing prescription is not a Right that one is entitled to just because one has the abbreviation Dr in front of or after one's name; it's a Privilege to whom the public has entrusted upon, and deemed to have the prequisite qualification and trust and confidence of the public. If one is craving for the prescription privilege, then by all means please get into medical school, pass the USMLE, finish the post-grad residency training, and be board-certified. If you dont put in the time and the work, then please dont expect the same privileges that someone do. It really bothers me when someone is demanding the same privileges that physicians have, yet do not put in the time and the work that physicians do. Now, cheers...;)
     
  14. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    Han,
    What about NP/PA's? They don't put in as much as a MD/DO does into schooling yet they have prescription rights so I am not sure your arguement works. Although I agree that pharmacists have completely different training than physicians.
     
  15. Dr JPH

    Dr JPH Banned
    Banned

    Joined:
    Feb 4, 2000
    Messages:
    5,910
    Likes Received:
    31
    Status:
    Resident [Any Field]
    NPs and PAs have an education that, although not as comprehensive as an MD or DO education, it follows along the same path.

    PAs can only prescribe under the license of a physician. So, if they make a mistake, it is the same as the doc making the mistake (more or less).

    NPs are independant practitioners. They prescribe medications, but many NPs will only deal with the meds that are within their specialty.

    Each state has different laws governing what both of these groups of practitioners can prescribe (regarding CII especially).

    As for pharmacists, once you can show me that a PharmD can diagnose a disease or condition as well as an MD or a DO, then they can write scripts. I see no logical reason for pharmacists to even NEED to write prescriptions. Where would they be "practicing"? Would they set up a private practice like a physician? Would they have a mini-office right next to the CVS counseling area? I don't see the logic.

    Again, pharmacy is a great profession and pharmacists need to know a great deal about meds. Talk to some pharmacists...I have...I don't know many (or any at all, for that matter) who would feel comfortable writing prescriptions for patients...particularly for certain meds.

    If you can't find some satisfactory answer in what has already been posted, then you're not listening.

    If you are upset about your career decision and truly desire the right to write a prescription, then please check out the following websites.

    www.aapa.org
    www.ama-assn.org
    www.aoa-net.org
     
  16. Thread continues after this sponsor message. SDN Members do not see this ad.

  17. emedpa

    emedpa GlobalDoc

    Joined:
    Aug 25, 2001
    Messages:
    6,014
    Likes Received:
    297
    Status:
    Post Doc
    JP-just a point of clarification-pa's write rx's under their own dea #s. the supervising md/do shares some responsibilty for the overall care but we write prescriptions under our own name.recently the state of california tried to change their prescribing guidelines so that pa's could only write under the dea # of the supervising doc but the dea would not allow this and california became a sch-3 pa state. states limit the type of dea license a pa can have. I currently work in washington with a sch-2(unrestricted) dea license and oregon with a sch-3(nothing stronger than vicodin) license.
    cheers-e
     
  18. DDuncan

    DDuncan Senior Member

    Joined:
    May 22, 2000
    Messages:
    91
    Likes Received:
    0
    I am a pharmacist, who has returned to med school. I worked for 4 years in the retail pharmacy setting.

    The pharmacy profession is seeking numerous avenues to increase their scope, and keep the profession growing. Rx rights is NOT one of their priorities. Patient education has been the big push for the past 10 years. Many have tried to embrace this movement, very FEW have success (read: made money).

    There has been the suggestion of a 3rd category of medications, which are certain prescription medications which could be "prescribed" by a pharmacist (or by the physician). I have heard that some topical antivirals were allowed this status in FL. There are a few medications that I feel could be safely implemented in this category (antihistamines, decongestants, cough suppressants, .... maybe anti-nausea like phenergan. Some have suggested albuterol inhalers, some low potency NSAIDS) Many of these are drugs that could be brought to OTC anyway.

    Pharmacists have a rather weak government lobby. Physicians usually win when a turf battle ensues. Pharmaceutical manufacturers are even stronger.

    I raised the concern in the early 1990's when the all PharmD movement was rolling, that the profession was "pricing" itself out of the market for bright high school graduates that have an interest in health care. 6 years for a license to practice pharmacy or to be a PA? Plus to get the really good pharm jobs you will do a residency year. So that is 7 years to be pharmacist, 6 to be a PA. PA's have a lot of autonomy in many settings. Heck you would be almost through with medical school (or done if you went to a BSMD program).

    There will always be many more pharm jobs at retail chains than in clinical (hospital/clinic) settings. Good luck to all of you seeking those few clinical jobs. I would think 5 to 10 years down the road there are still going to be a lot of disgruntled (sp?) PharmD's churning out the pills in bottles at Walgreens, with fleeting dreams those few jobs in clinical settings.
     
  19. The Pill Counter

    The Pill Counter Senior Member

    Joined:
    Dec 6, 2001
    Messages:
    478
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I'm an MS2 with a Bachelors in Pharmacy, so I am not familar with how much further the PharmD takes clinical training. I believe it is mostly concerned with clinical therapeutics and more complex polypharmacy.
    I have worked in hospital settings, retail- both large chains and independent and long-term care, and at no point did I ever consider myself equipped to prescribe. Sure, it's easy to rhyme of dosages and treatments for a well-established condition for a patient, but the pharmacist is not the one with the responsibility to diagnose. As mentioned by others in this thread, why would pharmacists want to prescribe? If I could, I know I would be influenced to write scripts for whatever made me more money. It's a ridiculous and blatant conflict of interest. In hospital? Well, then you're just getting way to many cooks in the kitchen.
     
  20. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    Pill counter made a great point, "to many cooks in the kitchen." I attend a undergrad school with a pharmD program with a very very very large pre-pharm pop. Most of my friends are in the pharm program an I have seen the class they take. I have respect for the profession and agree that a pharm. will always know more about drugs than a Doctor.

    With that said, I'm not sure if they should have the right to prescribe. Where would we draw the line. It seems as if they would just be anouther sub-set of doctors with a private practice.

    If you look at the history of medicine you will see that in the begining there were no pharm, just doctors. Then as medications started to get to numorous, the pharm was born and the professions split. Then when making the drugs got to complicated for the pharm to make and dispence, the manufacture was made.

    If we grant the right to prescribe meds to pharm, we will be going back in time. Now is that bad? I don't know. The only way it could possibly work (in my mind) is this, and I think this is how most want it to be, the MD/DO/PA/NP/OD/DDS/DPM makes the diagnoisis and sends that with the patient. Then the pharm gets the diagnosis and then is allowed to prescibe the best medication. This method limits the problems. The doctors, with limited pharmocology training, don't prescribe, and the pharmD, with limited clinal diagnostic training, does not diagnose. I could really see this happening in the future.

    This would allow pharmD's from wasting away at Walgreen and let them actually use there training.
     
  21. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    So if the physician gives a diagnostic and the pharmacists is to prescribe the medicine, could there be a potential conflict of interest? For example, if the patient comes in needing allergy medicine would prescribe the cheap over the counter med or would you chose one of those nice expensive prescriptions? To me this is an obvious conflict of interest.....
     
  22. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    Of course there is a conflict of interest, just like now. OD's could try and sell the most expesive glasses, DDS could try and sell braces when they are not needed or drill a cavity that isn't there, DPM could sell special shoes that won't help, MD/DO (orthopeadic surgerons) can sell support devieces that serve no purpose. Right now when you get a medication you are always offered the name brand version and the generic if it is avalible. Does the pharm push the name brand, possible. It is always going to be a problem with the system, lets just hope human morals will over power our greed for money.

    About the allergy idea, I'm sure the doctor will tell the patient if they are going to need a Rx or just an over the counter pill to help them. Then the pharm won't be able to sell a drug that is not needed. Besides, most pharms now days are going to chain stores. Because of this they are on salary and it is of no benefit to them to sell the expensive drug, they get paid either way.
     
  23. LSUMED2006

    LSUMED2006 Senior Member

    Joined:
    Sep 7, 2002
    Messages:
    170
    Likes Received:
    0
    > Most of my friends are in the pharm program an I have seen the class they take. I have respect for the profession and agree that a pharm. will always know more about drugs than a Doctor.

    "will always know more ab out drugs than a doctor." I've made this statement before, and I'll make it again, you are very, very wrong if you hold this to be true. Anesthesiologists know much, much, much more about the drugs they use than a pharmacist, and this goes for oncologists, cardiologists, rheumatologists, and on and on. Your statement is a silly generalization that is FAR from being accurate.


    >With that said, I'm not sure if they should have the right to prescribe. Where would we draw the line. It seems as if they would just be anouther sub-set of doctors with a private practice.

    What would pharmacists DO in private practice, other than what they currently do? They are not trained to function as someone who sees patients, prescribes them medication, and follows up on there care. This is why they are NOT allowed to prescribe to begin with.

    >I think this is how most want it to be, the MD/DO/PA/NP/OD/DDS/DPM makes the diagnoisis and sends that with the patient. Then the pharm gets the diagnosis and then is allowed to prescibe the best medication.


    So, you are saying that your friendly pharmacist gets to determine the medications a cardiologist, dermatologist, rheumatologist, famly practitioner, etc. would prescribe? Wow. Let me just say, for you to make that statement you have no concept of what either pharmacists, physicians, or both are taught. The fact, and it is a fact, physicians are aware or and familiar with MANY, MANY more conditions than a pharmacist! How on earth could a pharmacist prescribe something for a condition he has never heard of? Physicians are much, much more competant to be prescribing medications.


    >This method limits the problems.

    THis method opens a pandoras box of unimaginable problems.


    >The doctors, with limited pharmocology training, don't prescribe, and the pharmD, with limited clinal diagnostic training, does not diagnose.

    That statement is a half truth. Give you a hint, physicians have MUCH more pharmacology training than you are aware of.

    >I could really see this happening in the future.

    This will NEVER happen.


    >This would allow pharmD's from wasting away at Walgreen and let them actually use there training.

    They are not trained to do what you have suggested. Furthermore, physicians will never give up the rights you have suggested because patient health would drastically suffer.
     
  24. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    LSUMED2006,
    Thank you for attacking my statments. I really appreciate it when a student attempts to make others sound stupid. It is really a great way to get through life.

    You are correct, I'm just a student with a doctor for a dad and goes to a school with a pharmD program. I have no idea what I'm talking about.

    If you read my post, this is exactly what I said.


    This forum is to discuss new issues in medicine, this is what we are doing. The first time I heard the idea of pharm perscribing meds, I almost laughed. Then I gave it serious thought. It is not a horrible idea. Sure, there are questions to be addressed, but lets not just dismiss the idea.

    There is a point to which you may have been trying to make, but never did successfully...specialist in medicine study a certain field for 3-7 years after they receive their doctorial degree. This gives them plenty of time to learn a lot about what types of meds they may need to prescribe within their field. If I had a serious disease, I would not trust my gen. MD/DO to prescribe my med, I would go and see a specialist in the field. So why would I trust a pharm who is trying to know everything about every type of medication, it is not going to happen. This is why the system is the way it is, no one person can know everything. The role of the pharm is to watch the docs and make sure the drugs make sence.

    The reason we have the problems we do is because people would complain that pharms did not know enough about the drugs that they were handing out. So in responce, the schools added to the programs so pharms would know a lot more about medicine. Now that the pharms know so much more than they did, they want to use their knowledge. This is where the Rx problem occurs. I think we need to draw the line somewhere, perhaps this is where it needs to be drawn.

    I'm open to hear other's ideas, but don't attack what I said.
     
  25. LSUMED2006

    LSUMED2006 Senior Member

    Joined:
    Sep 7, 2002
    Messages:
    170
    Likes Received:
    0
    I was unaware I was attacking you, strongly disagreeing with you, but attacking no. I will respond and pose some questions for you.

    >I'm just a student with a doctor for a dad and goes to a school with a pharmD program. I have no idea what I'm talking about.

    I don't follow that sentence, but I think you are trying to say that your dad is a doctor and you attend a school with a pharmd program. I still stand by my origninal statemet. Simply having a family memeber who is a physician or attending a school with a pharmd program does not mean you have an in depth knowledge of what is taught in either profession.

    >There is a point to which you may have been trying to make, but never did successfully...specialist in medicine study a certain field for 3-7 years after they receive their doctorial degree.

    Yes, this is a fact.

    >This gives them plenty of time to learn a lot about what types of meds they may need to prescribe within their field.

    True, among many other things.

    >If I had a serious disease, I would not trust my gen. MD/DO to prescribe my med, I would go and see a specialist in the field.

    Ok. This is why we have specialists. Your GP probably would not prescribe you anticancer,HIV, etc. medications. He/She would refer you to a specialist.

    >So why would I trust a pharm who is trying to know everything about every type of medication, it is not going to happen.

    Ok. Not too much argument here.

    >This is why the system is the way it is, no one person can know everything.

    Right, this is why we have many differnent carreer paths for the MD. Your GP probably wouldn't prescribe medication for a disease outside his/her area of expertise. He/She knows there is a specialist with the knowledge to treat you.

    >The role of the pharm is to watch the docs and make sure the drugs make sence.

    They sure do function in this capacity and can be sued if they miss a physicians mistake. I agree again with you.

    I'm returning back to your statement" There is a point to which you may have been trying to make, but never did successfully..." What exactly is this point? I don't understand what point you are alluding to


    >The reason we have the problems we do is because people would complain that pharms did not know enough about the drugs that they were handing out.

    Easy now, you are about to really offend some pharmacists. So before the pharmd, according to you, bs pharms "did not know enough about the drugs that they were handing out?" The BS pharmacists are VERY, VERY competant to practice pharmacy. You and I, will have to STRONGLY disagree on your point. Also, what evidence do you have to support the notion that "people complained pharms did not know enough about the drugs that they were handing out?"


    > So in responce, the schools added to the programs so pharms would know a lot more about medicine.Now that the pharms know so much more than they did, they want to use their knowledge.

    The schools only added a semester of class work and an semester of clinical work. The statement "the pharms know so much mroe than they did" is likely quite insulting to BS pharmacists.


    Now some questions for you:
    1. How would a pharmacist reach the level of expertise that he/she would be better able to prescribe medications than a specialist? Including knowledge of the diseases the specialist treats. Do you feel that pharmacists currently recieve this training? If not, where would they recieve it?
    2. How would a pharmacist prescribe mediacation for a disease/ condition he/she has never heard of?
    3. Are you enrolled in pharmacy or med school?
    4. What was the point that I was trying to make but so horribly failed?
     
  26. Scientist

    Scientist Member

    Joined:
    Dec 4, 2002
    Messages:
    32
    Likes Received:
    0
    1. What are the roles of pharmacists who specialize in hospital?

    2. What is the PharmD for anyway?

    3. What career possiblities are there for pharmacy majors?

    4. Other than healthcare fields, why do some pharmacists change careers?

    5. Are most pharmacists satisfied in their career?
     
  27. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    The only way for a pharm to get this is by going to medical school and going through a residence program. If not this a new type of residence for pharms to specialize. But if we did this what would seperate them from doctors. This what I attempted to imply in my previous post.

    This is a question that has a simple answer, the same way doctors do, look it up. Lets not assume doctors know of, or have heard of, ever disease they encounter. Regardless, they treat it.

    I am not in a pharm progam, nor do I want that. I am applying to MD/DO and OD schools currently, and have an interview in January.

    This is where I thought you may have been speaking about specialist have a knowledge which others would not. Thus, how can we let them prescribe for all illness.

    Exactly the point I was making.

    I never was trying to say they are not competent to practice pharm. What I was trying to say is this, as we expand the knowledge/education of your professionals we are opening the door for these problems. In a nutshell, "knowledge is power." The more we teach, them more we imply to the student that they are capable to utilize that knowledge. By teaching students a ton about any topic and then not letting them use that knowledge to the full extent, is like putting a steak infront a starving wolf and expecting it not to eat it.

    I don't know the answer to all these questions, but I'm open minded to all the possiblilites. The pharm program is a very good program. Because they leave these programs with such an extensive knowledge base, it is hard for me to justify limiting there job to handing out pills at Walgreens. I know there are other jobs out there, but lets face it, this is what they are allowed to do most of the time. There needs to be something else for them to do, what that is, I don't know.
     
  28. LSUMED2006

    LSUMED2006 Senior Member

    Joined:
    Sep 7, 2002
    Messages:
    170
    Likes Received:
    0
    >The only way for a pharm to get this is by going to medical school and going through a residence program. If not this a new type of residence for pharms to specialize. But if we did this what would seperate them from doctors. This what I attempted to imply in my previous post.

    Exactly, the only way for pharmacists to reach the level of expertise of physicians would be to go through the training physicians do! NO pharmacists (with the exception of those who are now MD/DO) do this! Now, why would we want someone who is LESS qualified than physicians taking away the rights of physicians and performing them themselves?

    >This is a question that has a simple answer, the same way doctors do, look it up. Lets not assume doctors know of, or have heard of, ever disease they encounter. Regardless, they treat it.

    Of course physicians do look certain things up. However, they are not slaves to a book to perform their jobs. Here again, if physicians are MORE competant than pharmacists to diagnose and treat diseae, which they are, why would we want the LESS competant practicioner looking up the answer in a book in order to determine the treatment regimin? It makes no sense. We would replace experts with someone who would ATTEMPT to look up an answer in the book. The medical profession is much more than facts in books. It is largely about hands on experience, a VITAL requirement. YOu can read about anesthesia, EM, surgery, etc. all day, but that does NOT and never will make you qualified to do any of these fields.

    While we are at it, let's replace pharmacists with pharmacy techs who can look an answer up in a book.

    >I am not in a pharm progam, nor do I want that. I am applying to MD/DO and OD schools currently, and have an interview in January.

    Your views make more sense now. If you decide to go the MD/DO route, your views likely will be very, very different...

    >This is where I thought you may have been speaking about specialist have a knowledge which others would not. Thus, how can we let them prescribe for all illness.


    I don't understand this point. Of course specialists have knowledge others don't. This is why they are specialists. I can't even believe this point is in question. Specialists, or any practicioner for that matter, do not prescribe for every illness.


    I think we can agree that many pharmacists have more education than they need to practice, say retail pharmacy. This does not, however, infer that they should just be handed responsibilities from more competant practitioners.
     
  29. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    We are arguing for the same thing here.
     
  30. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    I think the arguement here is the fundamental arguement that pharmacy is going through right now. I personally think pharmacy will be hindered in its evolution by chains since they do not want to take on added liability. If physicians had to operate from a corner in Wal-Mart there practices would be hindered. Same with pharmacy.......

    One topic I have not seen discussed here is pharmacies role in ambulatory clinics. Maybe this is where pharmacy can make the biggest change and pharmacist make full use of their education. Here is a wild idea - what if in the Dr's office, after the physician has diagnosed and prescribed, the pharmacists comes in and counsels/gives the first months dose. The patient would not need to go a pharmacy since they already have the meds. The pharmacists and physician could split the reimbursement (Of course the physician gets the majority). Refills could be done through mail/internet pharmacies and there would be no need for the chains. Just a brainstorm as to what pharmacy could look like in the future......
     
  31. LSUMED2006

    LSUMED2006 Senior Member

    Joined:
    Sep 7, 2002
    Messages:
    170
    Likes Received:
    0
    >One topic I have not seen discussed here is pharmacies role in ambulatory clinics. Maybe this is where pharmacy can make the biggest change and pharmacist make full use of their education. Here is a wild idea - what if in the Dr's office, after the physician has diagnosed and prescribed, the pharmacists comes in and counsels/gives the first months dose. The patient would not need to go a pharmacy since they already have the meds. The pharmacists and physician could split the reimbursement (Of course the physician gets the majority).

    TLH, we may start agreeing on that one. Scary, huh...j/k :) I was actually talking very recently to my g/f about a very similar idea. I think moving a pharmacy into a primary care practioner's office would be a great idea. Patients could visit the doctor and immediately go to the pharmacy for extensive counseling. In this way, in theory, nearly every script written by the MD would be filled in the in house pharmacy, resulting in more money for the MD (assuming he owns or is co-owner of the in house pharmacy). Additionally, there is a better chance for the pharmacist to be compensated for counseling, as it now is very closely and immediately related to the patients physicians visit. Furthermore, any questions concerning the medication could immediatly be cleared up, resulting in better patient care. Pharmacists could much more easily optomize patient medications for cost efficiency. Also, people generally develop strong ties with their pahrmacists. Once patients begin using the in house pharmacy, they will likely get every script filled there. This will better able the MD to keep track of a patient's medication.

    Another benefit from this scheme would be the patients who walk into the pharmacy with a minor health complaint (cold, cough, allergies). In my time working in a pharmacy, many patients did this; I saw this as an untapped market for the healthcare practioners involved. With the scheme I spoke of above, these patients could have near immediate access to an MD or PA/NP and then have the script filled in house. This results in more money for everyone involved, MD (for the visit and pharmacy usage) and pharmacist (counseling and pharmacy business (assuming he/she is owner/co-owner or recieve production bonuses).

    I do feel that this scheme (ie in house pharmacy/pharmacist) would result in better patient compliance, better counseling, fewer questions, more money, and generally better healthcare. TLH, we certainly have not agreed on everything, but I do see ideas like this to be the future. Pharmaceutical care services are indeed valuable and should be more extensively used. I feel a merger, such as teh one above would be ideal.

    rpames, you quoted yourself and said we are arguing for the same thing. I most certainly DO NOT agree that physicinas should lose their right to prescribe to pharmacists.
     
  32. pharming

    pharming Junior Member

    Joined:
    Nov 29, 2002
    Messages:
    7
    Likes Received:
    0
    I have to agree with TLH and LSU, the idea of pharmacist working with the doctors seems to be something innovative that could actually work. The only problem is getting insurance to go along with the idea.:confused:
     
  33. Tenesma

    Tenesma Senior Member

    Joined:
    Jun 11, 2002
    Messages:
    5,332
    Likes Received:
    126
    Status:
    Attending Physician
    this idea of joining a pharmacy with a practitioners office is an old one... unfortunately due to monopoly laws it is no longer allowed, as it doesn't allow the patient free choice of pharmacy... the same reason applies to xray machines, etc in your office....
     
  34. LSUMED2006

    LSUMED2006 Senior Member

    Joined:
    Sep 7, 2002
    Messages:
    170
    Likes Received:
    0
    Tenesma, how to orthos get away with having xrays, mris, etc. in their office if this is considered a monopoly?
     
  35. Tenesma

    Tenesma Senior Member

    Joined:
    Jun 11, 2002
    Messages:
    5,332
    Likes Received:
    126
    Status:
    Attending Physician
    orthos don't get away with it per se.... there are 2 ways for them to have diagnostic imaging on their premises: 1) they are a JCHAO approved "hospital" facility 2) they include the cost of imaging in their office-visit charges and have to read them on their own.... something which often doesn't get reimbursed by insurance companies as they aren't radiologists.

    the issue at hand is that it would be considered unethical to take away the patients choice of where they get imaging done or where they get meds... the irony of it all, is that it isn't considered unethical to provide all of those services without any choices within the hospital setting.

    i agree... stupid rules... but that is what happens when the government wants to avoid "rich doctors" from getting any richer.
     
  36. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    LSUMED2006
    I know I quoted myself, I'm not an idiot. I'm just saying that we have been saying the same thing about the topic that I quoted.

    I never said they sould. I just stated that in future it could be a possibility. I don't agree with, I'm just say that it may happen.

    You kept refering to the idea that by adding a pharm in the doctors office it would lead to money for all involved. This money thing popped up about 6 times. Maybe money should not play such a huge role in the evolution of medicine.

    I'm not sure if your idea would create more money any. How many patients does a GP see on a good, 25-35. Then, how many actually get an Rx. I don't see how a pharm. could survive on such a low customer base. I would think prices for the patients would skyrocket. You could sell greeting cards to, but how many doctors are going to put a drug store in thier practice. The idea is good on paper: better doc-pharm interaction and consultation, pateint complience... I just doen't see it as happening. People are still going to go to the grocery store and places like Target to get over the counter item like cold pills. With out those sales, the doctor's pharm would starve.
     
  37. LSUMED2006

    LSUMED2006 Senior Member

    Joined:
    Sep 7, 2002
    Messages:
    170
    Likes Received:
    0
    Tenesma, thanks for the explanation...gotta keep those "rich doctors" from making money.

    rpames, with all respect, you have a very limited insight on some issues you speak about. This is not a bad thing per se, and in a year or two you may have much more actual experience. Arguing with you is getting old, but I will address what you said.

    >You kept refering to the idea that by adding a pharm in the doctors office it would lead to money for all involved. This money thing popped up about 6 times. Maybe money should not play such a huge role in the evolution of medicine.

    Don't start to make assumptions about my motives, and please count the times I made a reference to improving patient care. If I could improve patient care while making more money for all, of course I would do it, and I'm sure most everyone else would too. Of course I mentioned money, don't you think that basically all businesses seek ways to make more money while improving service? For better or for worse, money is a MAJOR factor in the evolution of medicine.

    >I'm not sure if your idea would create more money any. How many patients does a GP see on a good, 25-35. Then, how many actually get an Rx. I don't see how a pharm. could survive on such a low customer base. I would think prices for the patients would skyrocket. You could sell greeting cards to, but how many doctors are going to put a drug store in thier practice. The idea is good on paper: better doc-pharm interaction and consultation, pateint complience... I just doen't see it as happening. People are still going to go to the grocery store and places like Target to get over the counter item like cold pills. With out those sales, the doctor's pharm would starve.

    The pharmacy would stay open the same way any other independant pharmacy does. Imagine a building, two entrances, one to the physicians side, one to the pharmacy with the pharmacy and the physicians office connected by a hallway or such. Think about it, the pharmacy functions just like a regular ind. pharmacy as well as what I listed above. I think the pharmacy would do quite well.

    >I never said they sould. I just stated that in future it could be a possibility. I don't agree with, I'm just say that it may happen.

    It will NEVER happen. Doctors will not lose the right to prescribe to pharmacists, not a chance.

    Jason
     
  38. tlh908

    tlh908 Senior Member

    Joined:
    Jan 13, 2002
    Messages:
    174
    Likes Received:
    17
    Status:
    Pharmacist
    So if having a pharmacists in a doctors office is wrong, what about nurses? Why shouldn't the patient be free to go out and find the nurse they want, independent of the doctor? If the patient knows ahead of time that pharmacy is included then that is there choice and I am not sure how this is a monopoly. A monopoly would be if the pharmacists owned every pharmacy in town and you had no choice for treatment.

    Does McDonalds have a monopoly on their french fries since everyone who buys a big mac meal gets an order of their fries? I don't think so......

    Tenesma, what is your source in calling this a monopoly?
     
  39. rpames

    rpames Optometrist

    Joined:
    Apr 30, 2000
    Messages:
    1,179
    Likes Received:
    2
    Status:
    Optometrist
    You are correct, arguing with you got old about 4 post ago. Basically all I have been saying is this, pharms have a very extensive eduaction and it is a shame they can utilize that education. I spoke to a pharmD student (freind) tonight and we breifly disscussed this topic. I think we came to the idea that there are many meds that really don't need a docs Rx, but rather could be restriced instead. These drugs would be avalible through the consent/prescription by a pharmisist. He used the example of "the morning after pill." This class of drugs would not just be over the counter, a consultation with a pharm would be needed.
     
  40. Tenesma

    Tenesma Senior Member

    Joined:
    Jun 11, 2002
    Messages:
    5,332
    Likes Received:
    126
    Status:
    Attending Physician
    there is nothing wrong with a pharmacist in the office, just as there is nothing wrong with a nurse in the office... they both serve to supplement care provided to patients....

    however there are specific monopoly laws that pharmacies have used in the past to stop physicians from running pharmacies within their own office as they provided unfair competition.. can i quote the law here? no... i am a physician and not a lawyer, but i am fully aware of federal jurisprudence. in the 70s and early 80s it was actually quite popular for physicians to have in=house pharmacies, thus not only receiving patient care reimbursement as well as dispensing reimbursement...
    the only times these "monopoly laws" don't apply are in the rural settings where a given pharmacy is a certain distance (in miles) from the practitioner, then the physician can set up a pharmacy.

    the analogy of a pharmacy owning every branch in town and therefore setting the price is considered trust formation/price fixing...

    for those who want to read up about it:

    Federal Trade Commission: 15 U.S.C. ?? 1 and 2. under the Sherman Act - you can skip the Clayton Act as that doesn't apply

    Virginia Board of Pharmacy v. Virginia Citizens Consumer Council, 425 U.S. 748 (1976)

    Capital Imaging Assoc., P.C. v. Mohawk Valley Medical Assoc., Inc., 996 F.2d 537 (2d Cir. 1993) (regarding diagnostic imaging in the office)

    Levine v. Central Florida Medical Affiliates, 72 F.3d 1538 (11th Cir. 1996)
     
  41. Jabberwocky12

    Jabberwocky12 Pharmaceutical Wizard

    Joined:
    Oct 18, 2010
    Messages:
    610
    Likes Received:
    0
    Status:
    Pre-Pharmacy
    Pretty interesting to see that people still have the same debates almost 10 years later...
     
  42. delano2000

    delano2000 D-Mod likes to parTAY
    Pharmacist Moderator Emeritus

    Joined:
    Jul 26, 2009
    Messages:
    7,846
    Likes Received:
    7
    Status:
    Pharmacist

    :mad:
     
  43. Jabberwocky12

    Jabberwocky12 Pharmaceutical Wizard

    Joined:
    Oct 18, 2010
    Messages:
    610
    Likes Received:
    0
    Status:
    Pre-Pharmacy
    I just did the 2. This one I legitimately thought was amusing, the other was because I'm a jerk. Am I on the border of trollin? Prolly, but I won't tip over

    :p

    No worries, I'm done resurrecting. I find it either annoying or amusing when someone else does it.
     
  44. delano2000

    delano2000 D-Mod likes to parTAY
    Pharmacist Moderator Emeritus

    Joined:
    Jul 26, 2009
    Messages:
    7,846
    Likes Received:
    7
    Status:
    Pharmacist

    As long as we are on the same page.:smuggrin:
     
  45. Cloud 9

    Joined:
    Jul 28, 2010
    Messages:
    284
    Likes Received:
    0
    [​IMG]
     
  46. Jabberwocky12

    Jabberwocky12 Pharmaceutical Wizard

    Joined:
    Oct 18, 2010
    Messages:
    610
    Likes Received:
    0
    Status:
    Pre-Pharmacy
    [​IMG]
     
  47. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist

    Joined:
    Mar 19, 2009
    Messages:
    20,448
    Likes Received:
    4,498
    Status:
    Pharmacist
  48. delano2000

    delano2000 D-Mod likes to parTAY
    Pharmacist Moderator Emeritus

    Joined:
    Jul 26, 2009
    Messages:
    7,846
    Likes Received:
    7
    Status:
    Pharmacist

    [​IMG]
     
  49. Jabberwocky12

    Jabberwocky12 Pharmaceutical Wizard

    Joined:
    Oct 18, 2010
    Messages:
    610
    Likes Received:
    0
    Status:
    Pre-Pharmacy
  50. Cloud 9

    Joined:
    Jul 28, 2010
    Messages:
    284
    Likes Received:
    0
    [​IMG]
     
  51. 30Percent

    30Percent Big boy shoes

    Joined:
    Feb 5, 2011
    Messages:
    405
    Likes Received:
    7
  52. meteor2

    Joined:
    Mar 29, 2009
    Messages:
    65
    Likes Received:
    0
    Pharmacist can write prescriptions based on protocols created by physicians. They have been doing that for years in California. End of debate.
     

Share This Page