Should Pharmacists perform physical exams?

[Old Timer]

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Translation: we PharmDs are feeling unloved and dont get the same respect/importance that the physicians get. Therefore we are unilaterally going to try and squeeze into their turf so we can pretend to be doctors too! That way everybody will think of the pharmacist as their primary care doctor and we'll get to make tons more money!

What do you major in, twister? Pretzel making? This is the new reality. Unless you want to be a pill counter, you will have to adapt. So will the docs. The good one's will utilize the pharmacists, CRNP's and P.A.'s to do the grunt work and alert them when there is an issue. The reason is, Doctors do not have time to see patients. How long is the wait at the average MD office? How many offices are there that offer same day appointments? Get a life and look at the real world. I'd rather have a PharmD check my BP than someone who graduated from a two month medical assistant class. This is the wave of the future. You can rail at it, but either you surf it or it will drown you.

As for DR JPH, that was the worst straw man argument I have ever heard. Your argument assumes the pharmacist replaces the doctor as the monitor of the patient's BP. Then you jump to the conclusion the patient's BP increase is due to a PE as opposed to some other less innocuous cause. It is unworthy of a physician. Try sticking with facts instead of building up straw men you can knock down. Nowhere in this thread does it say patients should skip seeing their doctor to get their BP checked. Now we have ruled out skipping the doctor. Do you have your patients come in and get their BP checked every time they get a refill? I don't think so. So what is the harm of the patient having their BP checked once a month by the pharmacist who can immediately alert the physician of a problem and the physician can decide to see the patient in the office or the ER or whatever follow up is necessary? The answer is NONE. Would you rather they get their BP checked by a machine at the mall? Get off your high horse and get used to the fact that the pharmacist is part of the team of professionals that care for the patient. In the long run your life will be easier once you accept that fact.

 

[bananaface]

Translation: we PharmDs are feeling unloved and dont get the same respect/importance that the physicians get. Therefore we are unilaterally going to try and squeeze into their turf so we can pretend to be doctors too! That way everybody will think of the pharmacist as their primary care doctor and we'll get to make tons more money!

MTM is new turf, not physician turf. And, it is correctly done in coordination with PCPs, not in lieu of them.

 

[Caverject]

What do you major in, twister? Pretzel making? This is the new reality. Unless you want to be a pill counter, you will have to adapt. So will the docs. The good one's will utilize the pharmacists, CRNP's and P.A.'s to do the grunt work and alert them when there is an issue. The reason is, Doctors do not have time to see patients. How long is the wait at the average MD office? How many offices are there that offer same day appointments? Get a life and look at the real world. I'd rather have a PharmD check my BP than someone who graduated from a two month medical assistant class. This is the wave of the future. You can rail at it, but either you surf it or it will drown you.

As for DR JPH, that was the worst straw man argument I have ever heard. Your argument assumes the pharmacist replaces the doctor as the monitor of the patient's BP. Then you jump to the conclusion the patient's BP increase is due to a PE as opposed to some other less innocuous cause. It is unworthy of a physician. Try sticking with facts instead of building up straw men you can knock down. Nowhere in this thread does it say patients should skip seeing their doctor to get their BP checked. Now we have ruled out skipping the doctor. Do you have your patients come in and get their BP checked every time they get a refill? I don't think so. So what is the harm of the patient having their BP checked once a month by the pharmacist who can immediately alert the physician of a problem and the physician can decide to see the patient in the office or the ER or whatever follow up is necessary? The answer is NONE. Would you rather they get their BP checked by a machine at the mall? Get off your high horse and get used to the fact that the pharmacist is part of the team of professionals that care for the patient. In the long run your life will be easier once you accept that fact.

well said 👍

 

[Dr JPH]

What do you major in, twister? Pretzel making? This is the new reality. Unless you want to be a pill counter, you will have to adapt. So will the docs. The good one's will utilize the pharmacists, CRNP's and P.A.'s to do the grunt work and alert them when there is an issue. The reason is, Doctors do not have time to see patients. How long is the wait at the average MD office? How many offices are there that offer same day appointments? Get a life and look at the real world. I'd rather have a PharmD check my BP than someone who graduated from a two month medical assistant class. This is the wave of the future. You can rail at it, but either you surf it or it will drown you.

As for DR JPH, that was the worst straw man argument I have ever heard. Your argument assumes the pharmacist replaces the doctor as the monitor of the patient's BP. Then you jump to the conclusion the patient's BP increase is due to a PE as opposed to some other less innocuous cause. It is unworthy of a physician. Try sticking with facts instead of building up straw men you can knock down. Nowhere in this thread does it say patients should skip seeing their doctor to get their BP checked. Now we have ruled out skipping the doctor. Do you have your patients come in and get their BP checked every time they get a refill? I don't think so. So what is the harm of the patient having their BP checked once a month by the pharmacist who can immediately alert the physician of a problem and the physician can decide to see the patient in the office or the ER or whatever follow up is necessary? The answer is NONE. Would you rather they get their BP checked by a machine at the mall? Get off your high horse and get used to the fact that the pharmacist is part of the team of professionals that care for the patient. In the long run your life will be easier once you accept that fact.

I dont think anything I said in my post above came across in a derogatory manner towards pharmacists. Im sorry if you felt that it did.

And for the record, if I were a PCP I would indeed check the BP on my patients every time they came to the office for a med refill...just as I would hope you would review a patients allergy profile every time you filled a prescription.

 

[Moxxie]

I dont think anything I said in my post above came across in a derogatory manner towards pharmacists. Im sorry if you felt that it did.

And for the record, if I were a PCP I would indeed check the BP on my patients every time they came to the office for a med refill...just as I would hope you would review a patients allergy profile every time you filled a prescription.

But how often do patients come into your office for a med refill? Once, maybe twice a year? Most patients on maintenance meds come into the pharmacy at least once a month (often more, due to the fact that refill dates don't always coordinate).

And yes, a lot of what you say comes off as derogatory towards pharmacists and anyone else that doesn't have an MD.

 

[Dr JPH]

But how often do patients come into your office for a med refill? Once, maybe twice a year? Most patients on maintenance meds come into the pharmacy at least once a month (often more, due to the fact that refill dates don't always coordinate).

And yes, a lot of what you say comes off as derogatory towards pharmacists and anyone else that doesn't have an MD.

I will have my wife read it when she gets home and get her opinion.

I didnt think saying "pharmacists should not perform physical exams" was inappropriate.

No more than saying "Physical Therapists should not perform surgery" or "RNs should not write prescriptions".

Anyone can be taught to recognize some normal v abnormal findings, but its what you do with the information that matters. Not only that, sometimes recognizing the abnormal can be difficult and takes years of training...something a pharmacists education does not entail.

If you are going to examine a patient you need to be held accountable for what you find or dont find. If you find something but dont recognize it for what it is OR you miss something, then you need to answer for that.


As a pharmacist are you going to want to be held accountable?

You can say its a long shot or a straw man argument or whatever, but thats the plain and simple truth.

 

[Old Timer]

I dont think anything I said in my post above came across in a derogatory manner towards pharmacists. Im sorry if you felt that it did.

And for the record, if I were a PCP I would indeed check the BP on my patients every time they came to the office for a med refill...just as I would hope you would review a patients allergy profile every time you filled a prescription.

Not only did you not address the straw man argument, you also don't read very carefully. I did not say you don't check your patients when they are in the office, I said you don't see them every time they refill the prescription.

I do not expect pharmacists will be doing full physical exams and ordering blood test or the like. The pharmacist will use the skills they are taught as part of the team approach to patient care to monitor the patient's response to therapy and transmit any findings to the physician, if needed. This is not practicing medicine.

Monitoring the BP regularly can only help those physicians whose minds are open the advantage this can have for your patients. The same goes with listening to the lungs and monitoring edema in patients with CHF. Checking peak flow in asthmatics or blood sugar in diabetics are other areas where the pharmacist can assist the physician and making sure the patient is compliant with the therapy and if the patient is responsive to the therapy.

You seem to assume we are somehow taking authority and therefore need to accept responsibility for the outcome. We cannot change therapy or give medical advice. We gather information and report that information to the physician who makes the calls and accepts the responsibility.

If you cannot see the advantage of having a knowledgeable health professional monitor your patients BP in between (NOT IN PLACE OF) office visits and transmitting any findings to the physician in a timely manner, maybe you should put down your scalpel and choose a different line of work. Stop throwing road blocks in the way and pointing out imaginary problems in order to justify the unjustifiable. For goodness sakes they monitor their BP at the mall. If you can't see the pharmacist as a better choice than a machine at the mall then there is no point in continuing the conversation.

 

[Dr JPH]

If you can't see the pharmacist as a better choice than a machine at the mall then there is no point in continuing the conversation.

Agreed.

 

[PharmDstudent]

C'mon everybody. You're talking to a doctor. His livelihood is at stake here. If a PharmD could practice maintenance medicine independently then he won't have a job.
THAT'S REALITY!

 

[Epic]

 

[Old Timer]

I love a good discussion. I like to be proven wrong. (OK I don't like it, but I can accept it). In good discussion you use something called logic and you also use facts. Not much of either in this thread.

Fact One: Pharmacists are NOT attempting to usurp the authority of Physicians. Not one person in support of pharmacists performing aspects of a physical examination, such as BP monitoring has advocated the pharmacist would do anything other than MONITOR. To suggest otherwise is to erect a false straw man you can knock down in support of of your ridiculous and erroneous conclusions. The pharmacist may make a recommendation to the physician based on his/her findings, but the physician is the one who writes the orders. Pharmacists are not performing full and complete physical exams. They are using certain skills such as measuring BP to monitor the therapy the physician has ordered. I don't think anyone has advocated going to the drug store for your yearly exam.

Fact Two: Please do not impune the motives of people who post here
While I am sure there are some who feel that way, most physicians and I will include Dr. JPH in this do not go to medical school only (or even primarily) for the money. The good doctor is arguing (without logic) on medical/patient care grounds. He is not nor should anyone post he is basing his opinions on loss of income.

Fact Three: Patients are already monitoring their therapy in between physician office visits. They monitor their BP at the mall or the supermarket. Does anyone feel these are superior to having it done by a pharmacist. There is also not one recorded case in the literature that I am aware of where a patient died of a PE because the pharmacist checked his blood pressure.

Fact Four: This is happening whether any of you like it or not. This is the future of pharmacy. Unless there are some studies that show the pharmacist is unable to provide any benefit or causes some harm, this is happening. Dispensing pills is the pharmacy of my lifetime. M.T.M. is the pharmacy practice of the future. Physicians who understand and make use of this information will flourish.

Fact Five: Pharmacists are the drug experts. As medications get more complex and more potent, the chance of injury increases. A study just published at the University of California-San Diego showed 47% of the patients who experienced a known side effect of statins were brushed off by their physician when the patient brought it up. Does that mean doctors don't know about side effects, no it means as the number of medications has increased and physicians work loads have increased, some things slipped through the cracks.

What this means in a nutshell is pharmacists will remain part of the team of health care professionals who care for their patients. The days of shut up and do what the doctor says are over. We will do this by speaking with patients, evaluating physician's orders and consulting when required. It also means monitoring the patient by measuring many factors. Some of this monitoring will require the use of those skills being discussed in this thread. Any physician that feels threatened by this needs to get into the twenty first century and also needs to examine their attitudes towards the roles of their colleagues.

 

[SpirivaSunrise]

I think we may be taking this a little far...

The physical assessment classes provided in pharmacy school are extreeeeeeemly basic. There's just no way that after a few days of going over the basics one could be prepared to perform a thorough physical exam. And I think that's what the OP was asking. They do however provide enough background so that when students go out on rotations, they will be able to look through a patient's chart and not be hung up on what PERRLA, RRR, bruit, DOE, and so on mean.

 

[Hels2007]

I think the problem of this thread is that "physical exam" is not defined. I mean, if you understand physical exam as a complete physical, with looking for weird moles and palpating lymph nodes - definitely not a pharmacist's job. I get far too many patients asking me questions way out of my scope of practice - and I have worked closely enough with good doctors to know how much I don't know (such as, I can think of two or three reasons for that leg pain... they know about 10, and can differentiate them a lot better than I could).

On the other hand, if you take physical exam (more appropriately called assessment) to mean things like blood pressure monitoring, blood glucose monitoring (plenty of pharmacies offer a service where a patient bring there meter, connects it to the pharmacy computer so graphs print out and pharmacists go over that with them) for a small fee, cholesterol monitoring - that's a very different story. And it relates directly to our primary function - managing medication therapy. Don't forget the legal aspects and implications of practicing our profession. 🙂

 

[Epic]

I think we may be taking this a little far...

The physical assessment classes provided in pharmacy school are extreeeeeeemly basic. There's just no way that after a few days of going over the basics one could be prepared to perform a thorough physical exam. And I think that's what the OP was asking. They do however provide enough background so that when students go out on rotations, they will be able to look through a patient's chart and not be hung up on what PERRLA, RRR, bruit, DOE, and so on mean.

That's because you went to school in the swampland..

 

[SpirivaSunrise]

That's because you went to school in the swampland..

haha...and i'm sure you're extremely qualified to perform a physical exam 🙄😉

 

[PharmDstudent]

I love a good discussion. I like to be proven wrong. (OK I don't like it, but I can accept it). In good discussion you use something called logic and you also use facts. Not much of either in this thread.

Fact One: Pharmacists are NOT attempting to usurp the authority of Physicians. Not one person in support of pharmacists performing aspects of a physical examination, such as BP monitoring has advocated the pharmacist would do anything other than MONITOR. To suggest otherwise is to erect a false straw man you can knock down in support of of your ridiculous and erroneous conclusions. The pharmacist may make a recommendation to the physician based on his/her findings, but the physician is the one who writes the orders. Pharmacists are not performing full and complete physical exams. They are using certain skills such as measuring BP to monitor the therapy the physician has ordered. I don't think anyone has advocated going to the drug store for your yearly exam.

Fact Two: Please do not impune the motives of people who post here
While I am sure there are some who feel that way, most physicians and I will include Dr. JPH in this do not go to medical school only (or even primarily) for the money. The good doctor is arguing (without logic) on medical/patient care grounds. He is not nor should anyone post he is basing his opinions on loss of income.

Fact Three: Patients are already monitoring their therapy in between physician office visits. They monitor their BP at the mall or the supermarket. Does anyone feel these are superior to having it done by a pharmacist. There is also not one recorded case in the literature that I am aware of where a patient died of a PE because the pharmacist checked his blood pressure.

Fact Four: This is happening whether any of you like it or not. This is the future of pharmacy. Unless there are some studies that show the pharmacist is unable to provide any benefit or causes some harm, this is happening. Dispensing pills is the pharmacy of my lifetime. M.T.M. is the pharmacy practice of the future. Physicians who understand and make use of this information will flourish.

Fact Five: Pharmacists are the drug experts. As medications get more complex and more potent, the chance of injury increases. A study just published at the University of California-San Diego showed 47% of the patients who experienced a known side effect of statins were brushed off by their physician when the patient brought it up. Does that mean doctors don't know about side effects, no it means as the number of medications has increased and physicians work loads have increased, some things slipped through the cracks.

What this means in a nutshell is pharmacists will remain part of the team of health care professionals who care for their patients. The days of shut up and do what the doctor says are over. We will do this by speaking with patients, evaluating physician's orders and consulting when required. It also means monitoring the patient by measuring many factors. Some of this monitoring will require the use of those skills being discussed in this thread. Any physician that feels threatened by this needs to get into the twenty first century and also needs to examine their attitudes towards the roles of their colleagues.

Fact one: I am entitled to my own opinion.
Fact two: I am entitled to express my opinion so long as I keep the opinion civil.
Fact three: Opinions are NOT facts.

 

[Caverject]

Fact one: I am entitled to my own opinion.
Fact two: I am entitled to express my opinion so long as I keep the opinion civil.
Fact three: Opinions are NOT facts.

okay and this adds to the discussion how? or is this just a post pad for you?

 

[PharmDstudent]

okay and this adds to the discussion how? or is this just a post pad for you?

I'm tired of Old Timer's belittling tone. He acts like everything that he says is fact and the complete, utter truth.
I usually refrain from being direct, because I regret the way it comes off.

 

[cycloketocaine]

I'm tired of Old Timer's belittling tone. He acts like everything that he says is fact and the complete, utter truth.
I usually refrain from being direct, because I regret the way it comes off.

This is getting fun!!!!

 

[All4MyDaughter]

Please discuss the topic of the thread and NOT the personalities of the members posting in it. 🙂

 

[Doctor M]

Theres nothing wrong with taking a BP, or blood sugar and making a recommendation. I dont see Dr. JPH's remarks as deragotory. We are not trained to do physicals, but we can help monitor patients with repect to BP, diabetes etc. Just go out and practice pharmacy. Thats all im gonna say.

 

[stagesic]

These "patient assessment" classes shouldn't be part of the core cirriculum in Pharmacy Schools.

There is a potential upside with respect to patient outcomes if pharmacists posses these skill-sets, but a more intensive course elective(s) would better suit University goals:

You get the students who really want to pursue such avenues, and you give them better than rudimentary training.

So I guess my answer is yes, but not necessarily every graduating PharmD.

 

[JerryPharmD]

I don't think we should. Become a MD/DO/PA/NP if you want to do that. Too much patient contact.

 

[MacGyver]

Fact One: Pharmacists are NOT attempting to usurp the authority of Physicians. Not one person in support of pharmacists performing aspects of a physical examination, such as BP monitoring has advocated the pharmacist would do anything other than MONITOR. To suggest otherwise is to erect a false straw man you can knock down in support of of your ridiculous and erroneous conclusions. The pharmacist may make a recommendation to the physician based on his/her findings, but the physician is the one who writes the orders. Pharmacists are not performing full and complete physical exams. They are using certain skills such as measuring BP to monitor the therapy the physician has ordered. I don't think anyone has advocated going to the drug store for your yearly exam.

Thats BS man and you know it. Dont piss on my back and tell me its raining. You and I both know that this is but a first step. The camel is trying to stick its dirty nose under our tent to get a sniff around first before trying to squeeze the whole hump in.

I've read all the propaganda that your pharmacist organizations are putting out. They are already hinting that pharmacists will be future "primary care providers" or "physician extenders." You guys are trying to expand your billing authority under Medicare and other insurance providers to include far more than medication collaboration and move it into the realm of primary care management and diagnosis.

Everybody on this board is literally GUSHING over the role that PharmDs have in the VA system. Its obvious to anyone here that the people on this board, pharmDs in general, and pharmD leadership organizations in particular are trying to get this model expanded nationwide.

I also know about your little dirty schemes in Canada. Yeah we heard about your attempt to remove any physician collaboration for MTM in Canada to move directly to a "pharmacist independent prescription" program.

The gig is up. Everybody knows what you are planning and what your motives are. Again, dont piss on my back and tell me its raining.

 

[sdn1977]

Thats BS man and you know it. Dont piss on my back and tell me its raining. You and I both know that this is but a first step. The camel is trying to stick its dirty nose under our tent to get a sniff around first before trying to squeeze the whole hump in.

I've read all the propaganda that your pharmacist organizations are putting out. They are already hinting that pharmacists will be future "primary care providers" or "physician extenders." You guys are trying to expand your billing authority under Medicare and other insurance providers to include far more than medication collaboration and move it into the realm of primary care management and diagnosis.

Everybody on this board is literally GUSHING over the role that PharmDs have in the VA system. Its obvious to anyone here that the people on this board, pharmDs in general, and pharmD leadership organizations in particular are trying to get this model expanded nationwide.

I also know about your little dirty schemes in Canada. Yeah we heard about your attempt to remove any physician collaboration for MTM in Canada to move directly to a "pharmacist independent prescription" program.

The gig is up. Everybody knows what you are planning and what your motives are. Again, dont piss on my back and tell me its raining.

Oh MacGyver....don't you ever learn? I will express my opinion on your post, which, frankly, I cannot understand why the mods continue to allow!

You disagree with a bunch of stuff that anyone other than MDs (sorry - I don't care enough about what you think to know or care about what you think about DO's) & everyone on the whole board knows it.

But - none of us care (well - perhaps a few pharmacists care...who knows) what you think.

You're just this side of using derogatary language to describe a whole profession & their activities (ie - dirty noses, camels, pissing, etc..) - but, that seems to be what some feel better using when they disagree & you continue to fall into this pattern of behavior. This language style is not restricted to physicians, but if any of us come on physician fourms, we are knocked down faster than one can blink (I know from first-hand personal experience.)

None of these folks are trying to convince you or JPH - again - we don't care what you think. The discussion is on the pharmacy forum & there is obvious disagreement even within our own profession.

Why can't you let that discussion take place in its own civil fashion without bringing in your defamatory language? There is no reason to have us get involved with you AGAIN in practice areas which you've clearly disagreed in the past.

I've asked you before - please feel free & welcome to join in with your opinion if you can keep it civil & professional. Personally, you offend me & your offensive & unprofessional behavior makes me dismiss any possiblity you ever have of me taking your thoughts seriously. You don't seem to be able to find the limit of professional respect & etiquette.

Personally, I think this horse is long dead.........time to stop beating it.

 

[Dr JPH]

C'mon everybody. You're talking to a doctor. His livelihood is at stake here. If a PharmD could practice maintenance medicine independently then he won't have a job.
THAT'S REALITY!

My livelihood isnt at stake at all. I cant see Pharmacists making their way into the OR to perform esophagectomies or Whipples. 😉

 

[Dr JPH]

I love a good discussion. I like to be proven wrong. (OK I don't like it, but I can accept it). In good discussion you use something called logic and you also use facts. Not much of either in this thread.

Fact One: Pharmacists are NOT attempting to usurp the authority of Physicians. Not one person in support of pharmacists performing aspects of a physical examination, such as BP monitoring has advocated the pharmacist would do anything other than MONITOR. To suggest otherwise is to erect a false straw man you can knock down in support of of your ridiculous and erroneous conclusions. The pharmacist may make a recommendation to the physician based on his/her findings, but the physician is the one who writes the orders. Pharmacists are not performing full and complete physical exams. They are using certain skills such as measuring BP to monitor the therapy the physician has ordered. I don't think anyone has advocated going to the drug store for your yearly exam.

Fact Two: Please do not impune the motives of people who post here
While I am sure there are some who feel that way, most physicians and I will include Dr. JPH in this do not go to medical school only (or even primarily) for the money. The good doctor is arguing (without logic) on medical/patient care grounds. He is not nor should anyone post he is basing his opinions on loss of income.

Fact Three: Patients are already monitoring their therapy in between physician office visits. They monitor their BP at the mall or the supermarket. Does anyone feel these are superior to having it done by a pharmacist. There is also not one recorded case in the literature that I am aware of where a patient died of a PE because the pharmacist checked his blood pressure.

Fact Four: This is happening whether any of you like it or not. This is the future of pharmacy. Unless there are some studies that show the pharmacist is unable to provide any benefit or causes some harm, this is happening. Dispensing pills is the pharmacy of my lifetime. M.T.M. is the pharmacy practice of the future. Physicians who understand and make use of this information will flourish.

Fact Five: Pharmacists are the drug experts. As medications get more complex and more potent, the chance of injury increases. A study just published at the University of California-San Diego showed 47% of the patients who experienced a known side effect of statins were brushed off by their physician when the patient brought it up. Does that mean doctors don't know about side effects, no it means as the number of medications has increased and physicians work loads have increased, some things slipped through the cracks.

What this means in a nutshell is pharmacists will remain part of the team of health care professionals who care for their patients. The days of shut up and do what the doctor says are over. We will do this by speaking with patients, evaluating physician's orders and consulting when required. It also means monitoring the patient by measuring many factors. Some of this monitoring will require the use of those skills being discussed in this thread. Any physician that feels threatened by this needs to get into the twenty first century and also needs to examine their attitudes towards the roles of their colleagues.

I think I have a better understanding of where you are coming from.

Do I feel that a pharmacists monitoring a patients BP is better than a machine at the mall? Absolutely I do.

Let me just clarify a few things:

1. I dont feel threatened one bit that this is going to "take business" away from doctors. Patients are always going want their doctor. We see this all the time, especially in clinics with PAs and NPs. Despite how well a patient knows the midlevel practitioner, there are always times when they ask for "the doctor." Besides...you name one primary care doc who is hurting for business and I will show you 1,000 that are overloaded with TOO MANY patients.

2. This affects me the least! Im in Surgery. I dont write for BP meds, insulin or anything like that. Antibiotics and pain meds only. So to say that I am worried about a pharmacists "stepping on my territory" is absurd. I dont care how liberal the system gets, a pharmacist will never scrub in to the OR! 😀 My job is safe.

Now to restate my concern again...which I would like an opinion on.

Patients (and their lawyers) have an expectation that if someone performs even the most BASIC physical assessment on a patient then they are taking at least partial responsibility for that patients care.

So someone who checks a blood pressure, like a pharmacist, must then be held accountable for: 1. The accuracy of their physical assessment, 2. The ability to correctly perform the assessment and 3. The proper intervention based on the physical finding.

So...IF a pharmacist checks a blood pressure on a patient, will it be documented? If so, where?

What if the pharmacist finds a pressure of 200/110. What now? Call the PCP? Call 9-1-1? Instruct the patient to go to the ER?

Let's say you call the PCP and leave a message with the people at the office or you even get to talk to the doc. Now what? Now youre taking this issue and placing it in the hands of the physician...who may or may not be available...or even AWARE of the patient. As you know some patients like to skip visits for YEARS at a time. Unfortunate but true.

So now the doc has the information about the pressure. So now the liability is on the PCP to act.

We deal with this all the time in the hospital. A nurse will write in the chart "patient complained of abdominal pain, physician made aware, physician did not respond to examine the patient." Busted. It doesnt matter if you showed up 2 minutes after that...its in the medical record now. Lawyers can eat you alive.

Another scenario...a patient has a stroke and comes to the ER. "Mr Johnson, when was the last time you saw you doctor about your blood pressure?"

"Well, I dont see my doctor too often but my pharmacist checks my pressure and always tells me its ok."

Now if Im in the ER first thing I am thinking is...OK, pharmacist was monitoring this patient...lets call the pharmacist. Pharmacist had NO record of this patients blood pressures. Now what? I have a patient who is telling me that they have had regular BPs per their pharmacist but I have no paper trail, no proof. Now it falls back to the patient and the PCP who failed to schedule follow ups with this patient.

Pay for performance. Doctors are getting SCREWED when patients dont followup with appointments or tests as ordered. I have seen it first hand and TRUST ME, there are patients and lawyers out there playing these games.

Those are some of my concerns.

Am I worried that a pharmacist cant take an accurate BP? Not at all, I know they could if properly trained.

But what happens with the information gathered?

Is it verbally conveyed to the patient and the responsibility for followup placed on them?

Is the PCP brought into the picture and now obligated to act...perhaps on a patient barely known to them?

Is the patient given advice on altering med dosages? "Take 2 tonight and we will check it again tomorrow...if its still high we will call your doctor." I dont know if I would be comfortable with that.

So again, Im not worried about who collects the data...just what happens with the data after its gathered.


Whew...I dont think I can explain it any better! Hope that spurs a conversation and NOT an argument.

Old Timer & SDN1977...thanks for the comments you have made, as said above I think I have a better understanding of where you are coming from.

Now I need to get back to reading about pancreatic pseudocysts.

 

[Mags]

My thought would be this. Unless you are adequately trained in the full physiology behind the process and have the ability to accurately distinguish one disease process from another, then performing a physical exam to look for pathophysiologic signs is useless.

Lets say a patient comes to you for a refill of their Lisinopril and you check their BP (example given by another poster above). How is their blood pressure going to affect what you do?

Lets say theyre on a beta blocker and an ACE. They come to you for refills, you check their BP. Theyre tachycardic and hypertensive. You tell them they need to be on different meds or perhaps higher dosages. They walk outside and drop dead of a PE.

Well, if you had done a thorough physical exam perhaps you would have caught that. They would have had a low pulse ox, decreased breath sounds in one or more fields, perhaps reproducible pleuritic chest pain.

So if you are simply looking at snippets of clinical information you cant really do anything with the information.

Now...are you going to be held responsible for that? The patient dies. "Well your honor, the victim got his pressure checked by the pharmacist and although it was elevated the pharmacist never told the victim that he was in imminent danger and needed to seek immediate medical attention."

Same can be said for checking blood sugar, pulse ox or even listening to heart & lungs.

I dont get a CT Scan on patients who I KNOW are going to the OR. The information isnt going to change my management of this patient.

If you want to perform physical exams, make diagnoses and manage patients medically then you need to pursue other training.

Just my $0.02

Ok well. I may be the only pharmacist here who agrees with this with one exception:

I spent most of my rotations in one system, and they were all "clinical". (as opposed to other students who did very easy retail/community pharmacy rotations). Ive had enough lectures, and been in cards, onc, and anticoag enough, to know the signs of a PE.

I, (me myself) would not just have sent the patient walking out but would have probably asked more and called either the doctors office ASAP, or, 911. And I think if you have a residency, or were blessed enough to do mostly clinical rotations during 4th year, those people would know a PE too. So, thats mute. By my last two rotations I was out-diagnosing med students in my head just b/c i had seen so much already.

Now thats not to say every pharmacist should (disclaimer of wanting to go to PA school, already stated above)

but i think the legal issue here is what is the concern.... one person gets hurt who wants to blame, and pharmacists liability insurance goes up thru the roof...

for example, im a francophile, including love of their pharmacy system... pharmacist/population.. can dispense a ton w/o a prescription, but everything is behind the counter... you ask them for something, they ask questions (disease states, drugs, allergies) if they think they can handle it, they give you something, if not, they send you to a doctor...

now this maybe some pharmacists/students dream.. but it could never exist in American society b/c we don't ever like to take responsibility for our own actions and health, and someone would sue, and that would be the end of it...

 

[Old Timer]

I think I have a better understanding of where you are coming from.

Do I feel that a pharmacists monitoring a patients BP is better than a machine at the mall? Absolutely I do.

Let me just clarify a few things:

1. I dont feel threatened one bit that this is going to "take business" away from doctors. Patients are always going want their doctor. We see this all the time, especially in clinics with PAs and NPs. Despite how well a patient knows the midlevel practitioner, there are always times when they ask for "the doctor." Besides...you name one primary care doc who is hurting for business and I will show you 1,000 that are overloaded with TOO MANY patients.

2. This affects me the least! Im in Surgery. I dont write for BP meds, insulin or anything like that. Antibiotics and pain meds only. So to say that I am worried about a pharmacists "stepping on my territory" is absurd. I dont care how liberal the system gets, a pharmacist will never scrub in to the OR! 😀 My job is safe.

Now to restate my concern again...which I would like an opinion on.

Patients (and their lawyers) have an expectation that if someone performs even the most BASIC physical assessment on a patient then they are taking at least partial responsibility for that patients care.

So someone who checks a blood pressure, like a pharmacist, must then be held accountable for: 1. The accuracy of their physical assessment, 2. The ability to correctly perform the assessment and 3. The proper intervention based on the physical finding.

So...IF a pharmacist checks a blood pressure on a patient, will it be documented? If so, where?

What if the pharmacist finds a pressure of 200/110. What now? Call the PCP? Call 9-1-1? Instruct the patient to go to the ER?

Let's say you call the PCP and leave a message with the people at the office or you even get to talk to the doc. Now what? Now youre taking this issue and placing it in the hands of the physician...who may or may not be available...or even AWARE of the patient. As you know some patients like to skip visits for YEARS at a time. Unfortunate but true.

So now the doc has the information about the pressure. So now the liability is on the PCP to act.

We deal with this all the time in the hospital. A nurse will write in the chart "patient complained of abdominal pain, physician made aware, physician did not respond to examine the patient." Busted. It doesnt matter if you showed up 2 minutes after that...its in the medical record now. Lawyers can eat you alive.

Another scenario...a patient has a stroke and comes to the ER. "Mr Johnson, when was the last time you saw you doctor about your blood pressure?"

"Well, I dont see my doctor too often but my pharmacist checks my pressure and always tells me its ok."

Now if Im in the ER first thing I am thinking is...OK, pharmacist was monitoring this patient...lets call the pharmacist. Pharmacist had NO record of this patients blood pressures. Now what? I have a patient who is telling me that they have had regular BPs per their pharmacist but I have no paper trail, no proof. Now it falls back to the patient and the PCP who failed to schedule follow ups with this patient.

Pay for performance. Doctors are getting SCREWED when patients dont followup with appointments or tests as ordered. I have seen it first hand and TRUST ME, there are patients and lawyers out there playing these games.

Those are some of my concerns.

Am I worried that a pharmacist cant take an accurate BP? Not at all, I know they could if properly trained.

But what happens with the information gathered?

Is it verbally conveyed to the patient and the responsibility for followup placed on them?

Is the PCP brought into the picture and now obligated to act...perhaps on a patient barely known to them?

Is the patient given advice on altering med dosages? "Take 2 tonight and we will check it again tomorrow...if its still high we will call your doctor." I dont know if I would be comfortable with that.

So again, Im not worried about who collects the data...just what happens with the data after its gathered.


Whew...I dont think I can explain it any better! Hope that spurs a conversation and NOT an argument.

Old Timer & SDN1977...thanks for the comments you have made, as said above I think I have a better understanding of where you are coming from.

Now I need to get back to reading about pancreatic pseudocysts.

Just what I wanted, A mostly well thought out response. The Pharmacist who performs MTM, will need to keep records. No question about it.

If you observe an abnormal BP, you are not placing it in the hands of the physician, it's already there. You are managing the therapy ordered by the physician. Pt comes in to PCP and is diagnosed with HTN. MD prescribes drug X and asks the pt to come back in 4 weeks. Pt comes back & BP is OK. MD reorders drug X and gives the patient 5 refills. Now the MD will not see the patient for six months. In the mean time the patient will see the pharmacist every month. The pharmacist can monitor the BP and reinforce compliance with the medication and diet. If an abnormal finding is made, the patient is returned to the physician for evaluation.

You like to throw out these obscure situations that are not what we are speaking about. If they don't see the doctor, they can't come in and get refills. So we are not speaking about that patient.

Like I said, you just have to get used to having a pharmacist as part of the team. Stop looking for the liabilities and look at the benefits. Your patient will be monitored monthly by a trained professional who will report these findings to you. Your patient will receive better care and you will have access to more information.

 

[sdn1977]

I think I have a better understanding of where you are coming from.

Do I feel that a pharmacists monitoring a patients BP is better than a machine at the mall? Absolutely I do.

Let me just clarify a few things:

1. I dont feel threatened one bit that this is going to "take business" away from doctors. Patients are always going want their doctor. We see this all the time, especially in clinics with PAs and NPs. Despite how well a patient knows the midlevel practitioner, there are always times when they ask for "the doctor." Besides...you name one primary care doc who is hurting for business and I will show you 1,000 that are overloaded with TOO MANY patients.

2. This affects me the least! Im in Surgery. I dont write for BP meds, insulin or anything like that. Antibiotics and pain meds only. So to say that I am worried about a pharmacists "stepping on my territory" is absurd. I dont care how liberal the system gets, a pharmacist will never scrub in to the OR! 😀 My job is safe.

Now to restate my concern again...which I would like an opinion on.

Patients (and their lawyers) have an expectation that if someone performs even the most BASIC physical assessment on a patient then they are taking at least partial responsibility for that patients care.

So someone who checks a blood pressure, like a pharmacist, must then be held accountable for: 1. The accuracy of their physical assessment, 2. The ability to correctly perform the assessment and 3. The proper intervention based on the physical finding.

So...IF a pharmacist checks a blood pressure on a patient, will it be documented? If so, where?

What if the pharmacist finds a pressure of 200/110. What now? Call the PCP? Call 9-1-1? Instruct the patient to go to the ER?

Let's say you call the PCP and leave a message with the people at the office or you even get to talk to the doc. Now what? Now youre taking this issue and placing it in the hands of the physician...who may or may not be available...or even AWARE of the patient. As you know some patients like to skip visits for YEARS at a time. Unfortunate but true.

So now the doc has the information about the pressure. So now the liability is on the PCP to act.

We deal with this all the time in the hospital. A nurse will write in the chart "patient complained of abdominal pain, physician made aware, physician did not respond to examine the patient." Busted. It doesnt matter if you showed up 2 minutes after that...its in the medical record now. Lawyers can eat you alive.

Another scenario...a patient has a stroke and comes to the ER. "Mr Johnson, when was the last time you saw you doctor about your blood pressure?"

"Well, I dont see my doctor too often but my pharmacist checks my pressure and always tells me its ok."

Now if Im in the ER first thing I am thinking is...OK, pharmacist was monitoring this patient...lets call the pharmacist. Pharmacist had NO record of this patients blood pressures. Now what? I have a patient who is telling me that they have had regular BPs per their pharmacist but I have no paper trail, no proof. Now it falls back to the patient and the PCP who failed to schedule follow ups with this patient.

Pay for performance. Doctors are getting SCREWED when patients dont followup with appointments or tests as ordered. I have seen it first hand and TRUST ME, there are patients and lawyers out there playing these games.

Those are some of my concerns.

Am I worried that a pharmacist cant take an accurate BP? Not at all, I know they could if properly trained.

But what happens with the information gathered?

Is it verbally conveyed to the patient and the responsibility for followup placed on them?

Is the PCP brought into the picture and now obligated to act...perhaps on a patient barely known to them?

Is the patient given advice on altering med dosages? "Take 2 tonight and we will check it again tomorrow...if its still high we will call your doctor." I dont know if I would be comfortable with that.

So again, Im not worried about who collects the data...just what happens with the data after its gathered.


Whew...I dont think I can explain it any better! Hope that spurs a conversation and NOT an argument.

Old Timer & SDN1977...thanks for the comments you have made, as said above I think I have a better understanding of where you are coming from.

Now I need to get back to reading about pancreatic pseudocysts.

JPH - you want a sincere opinion & I will give you one as someone who has been in the situation countless times. For the most part, I convey the information to the pt & he/she makes the decision - I don't bring in the physician unless I have an official MTM agreement with that one physician.

In my hospital location - its easy - there are many others who are more skilled than I & I have the ER which is steps away. I've called a code 3 times in my 30 years - some pts just collapse in any given hallway. After I start rescustitation, there are skilled folks who come within a minute & I step away to track the drugs administered.

Again - I would never, ever stop one of my many physician friends as they pass by, unless the pt was actually coding because, as you say - there are substantial liability issues.

Now - when I work retail - yep, things get cloudy. What do we do?

Well - for a bp that the "machine" says is high - when I ask I tell the pt they need to go get an appt with their doctor. I don't say PCP - pts don't get that.

If they tell me its high & has been for 3 days running, I might ask them to sit down for a bit, have some water & relax, then take it again (again - we could discuss actual numbers, but I don't think thats what you are looking for) - if its still high after "cooling off" from walking across the parking lot, or if there is a substantial difference between the readings (again - no - the numbers are not important - it is the urgency) - I'll still say you need to see your doctor. How to I document? If its a pt of record, I go into my computer & there is a place in "notes" which does not appear on the rx record, but I can record interactions - mostly pts who continually say we shorted Percocets, but it works well for these circumstances.

For runners, atheletes who get dehydrated, sometimes just fluid helps - this is what we can help with because by the time they get to their md...they've cooled down, replaced their fluid & there is nothing to "see" unless its a repeat, which we get when we talk to pts. Most often, these are not pts of record - they are folks who come in & I never get their name and likely won't see them again. Its an "occassional" interaction. Somewhat like you being asked for directions, which lead the person to a dead end where they're then shot by a stray bullet. A bit far fetched - however, it is the "but for" legal standing - "but for" the misdirection, the individual wouldn't be in that place to be subjected to a danger. I've never known that any pharmacist has been put at risk legally for advice - bacitracin vs neosporin, ibuprofen or apap, fluid or physician....but - certainly, it can happen. We give advice all the time on the "occassional" basis.

Now...if I get a pt who has a really high bp - even after sitting down & cooling off, complains of a headache, nausea, not feeling well - I'll tell them they need to see someone TODAY. I don't make the choice - I give them their choices - they can call their doctor (then the doctor's office staff is following his/her orders), they can go to urgent care or they can go to an ER. I stress the urgency of TODAY. This either has been a pt of record or occassional. In these circumstances, while I'm talking with them, I get their name, where they're from, family, etc...& I make computer or handwritten notes & I have a place to keep them filed daily.

There have been a few times - about 6 since I've worked retail, when I KNOW (& later had documented to me) the pt was actually suffering an MI or a stroke, while I was speaking with them. In those very few cases, I tell them I think they are having a "serious issue" (I never, ever say what I think it might be - again, I cannot diagnose!!!) - but, I do impart how serious I think their medical situation is & that they could be significantly helped or harmed by either rapid treatment or a delay in treatment, depending. Again - it is always their choice. I document again, but this time by an incident report. It gives the actual circmstances of my encounter & goes directly to my dm & the corporate lawyers. For the most part, these get filed for the requisite 10 years.

I cannot call 911 unless I actually see someone "down" - which means I've started rescustation efforts. That is just a company policy. The pt can choose to have me call 911, however, I must make sure (& I have to make very certain they are aware they are incurring 911 fees - I must repeat it 3 times in various ways).

Just last week, I had a pt who seriously thought that when I switched her Norvasc to amlodipine generic it was causing hpb. Unfortunately, she had a MacGyver type physician who said to go tell the pharmacist to give her the "right" drug (implying that we gave her the "wrong" drug). So...I encouraged her to come back. I took her generic drug & had my techs prepare the rx with the brand name. While this was happening, I sat her down & asked her about her sx...she told me about her heart racing @ that time, how high her bp was, how bad she felt....& I took her bp with my own cuff - not the store machine x 3. He bp never varied & was wnl. But - the issue here was not her bp - it was her anxiety, which was relieved by using the brand name product - at my loss. But - the pt felt better, which is the real issue here. I documented this on the hard copy of the rx & in the computer file.

Finally, is the MTM pt. These are contracted pts. We have an agreed obligation to perform specific monitoring activities with the physician. In my circumstance, I am hired by a third party to perform this. I file my findings with the third party, which does the billing to whomever is paying. However, my interactions are directly with the physician. It depends on the physician. Sometimes, communication is faster by fax than by phone because of office staff issues. But, the information is sent/communicated the day its obtained.

There is no one purpose for the way we use our physical examination skills. What will I do with them? It varies & depends on the circumstance. I don't go beyond my abilities yet I let each pt know what I think - sometimes it could be don't worry about it - the rash will go away on its own (heat rash), other times its - you need to call your dr, sometimes its I'll let your dr know (an MTM pt), then.....on some occasions its - you need to seek medical help TODAY. I don't document each & every encounter - otherwise, I'd be documenting everytime I recommend the 3 day clotrimazole vaginal cream over the 7 day one. But, I can honestly tell you, I've never done a vag exam to recommend the antifungal tx....but - I have recommended the pt has had more than the normal expected number of infections & there might be something else which needs to be checked, so a visit with the dr might be better than just treating again.

Does that help?

Not everyone sees the issue as you do & certainly this is being discussed within my own state. There are signficant issues of pharmacists who are not competent to make recommendations & can actually increase the number of office visits or make detrimental recommendations.

The issue is certainly far from settled. Thanks for your input - its all valid!

 

[Corona]

As a future pharmacist I will be glad to give my input about patient care however If I wanted to "report" information to the M.D. I would be trying to get into nursing school. If physicians are swamped then they need to hire more N.P./P.A.s, also one of the most common complaints of pharmacist is the lack of a breaks or even a lunch, I think we have plenty to do already (the last thing I need is to have my finger in someone's rectum)(just exaggerating🙂) b.t.w. I will be compensated enough right out of school, so I don't need any sort of billing authority or anything along those lines.

 

[Dr JPH]

Finally, is the MTM pt. These are contracted pts. We have an agreed obligation to perform specific monitoring activities with the physician. In my circumstance, I am hired by a third party to perform this. I file my findings with the third party, which does the billing to whomever is paying. However, my interactions are directly with the physician.

Any online resources where I can read more about this?

👍

 

[Old Timer]

As a future pharmacist I will be glad to give my input about patient care however If I wanted to "report" information to the M.D. I would be trying to get into nursing school. If physicians are swamped then they need to hire more N.P./P.A.s, also one of the most common complaints of pharmacist is the lack of a breaks or even a lunch, I think we have plenty to do already (the last thing I need is to have my finger in someone’s rectum)(just exaggerating🙂) b.t.w. I will be compensated enough right out of school, so I don’t need any sort of billing authority or anything along those lines.

You will have a sorry career as a pharmacist my friend. Dispensing is the way of the past and MTM is the way of the future. How long off the future is, is unknown at the present. But one thing I can warn you is, pharmacists better expand the scope of what they offer to the public or they will be the air line pilots of the 21st century. Air line pilots saw 30-40% pay cuts and lay offs in the 90's. Just because there is a shortage now, does not mean it will stay that way forever. For you young guys, protect your future. Use the education you have, are presently receiving or about to receive to offer unique services that others will value paying you for.

 

[sdn1977]

Any online resources where I can read more about this?

👍

Yep - there sure are. I'll be happy to pm them to you. Give me a bit of time, ok??? I'm working this weekend & I'm a bit overwhelmed right now.

But...I'll get them asap.

 

[Dr JPH]

Yep - there sure are. I'll be happy to pm them to you. Give me a bit of time, ok??? I'm working this weekend & I'm a bit overwhelmed right now.

But...I'll get them asap.

Got your PM. Thank you very much.

OldTimer: I definitely have a better understanding of what this entails. 👍

 

[Epic]

You will have a sorry career as a pharmacist my friend. Dispensing is the way of the past and MTM is the way of the future. How long off the future is, is unknown at the present. But one thing I can warn you is, pharmacists better expand the scope of what they offer to the public or they will be the air line pilots of the 21st century. Air line pilots saw 30-40% pay cuts and lay offs in the 90's. Just because there is a shortage now, does not mean it will stay that way forever. For you young guys, protect your future. Use the education you have, are presently receiving or about to receive to offer unique services that others will value paying you for.

Comparison of airline pilots to pharmacist is extreme. There is an abundance of pilots who can fly a jet. But it's the US military trained pilot who I would trust to fly me across country instead of a young man who went through your local flight school to get a pilot license just to get in flight attendent's pants. Hence the salary range of airline pilot can stretch from $35,000 to $200,000+ per year. Also, the demand for airtravel is affected by many different factors including geopolitical affairs whereas we see a steady increase in demand for healthcare until the boomers die off.

I agree that the shortage of pharmacist will not last forever nor will it last as long as we think. I do believe the shortage is coming to an end where I really didn't have trouble hiring pharmacists for the past 3 years. And I also see more and more retail pharmacists who float instead of having a store. Even though I still see a shortage in extremely remote areas of the country, I do think the shortage of pharmacist in major cities in the US over. And the wave of new grads from new schools are spilling out faster than we can contain.

As a pharmacist in position to hire specialized clinical pharmacists in hospitals, it's easy for me to shuffle through a stack of resumes to weed out unqualified candidates. Everything being equal, residency trained pharmacist with a pharmacoeconomics sense will always be on the top of my list. And they won't have to worry about oversupply of pharmacist nor a paycut.

 

[hyperioncu]

Comparison of airline pilots to pharmacist is extreme. There is an abundance of pilots who can fly a jet. But it's the US military trained pilot who I would trust to fly me across country instead of a young man who went through your local flight school to get a pilot license just to get in flight attendent's pants. Hence the salary range of airline pilot can stretch from $35,000 to $200,000+ per year. Also, the demand for airtravel is affected by many different factors including geopolitical affairs whereas we see a steady increase in demand for healthcare until the boomers die off.

I agree that the shortage of pharmacist will not last forever nor will it last as long as we think. I do believe the shortage is coming to an end where I really didn't have trouble hiring pharmacists for the past 3 years. And I also see more and more retail pharmacists who float instead of having a store. Even though I still see a shortage in extremely remote areas of the country, I do think the shortage of pharmacist in major cities in the US over. And the wave of new grads from new schools are spilling out faster than we can contain.

As a pharmacist in position to hire specialized clinical pharmacists in hospitals, it's easy for me to shuffle through a stack of resumes to weed out unqualified candidates. Everything being equal, residency trained pharmacist with a pharmacoeconomics sense will always be on the top of my list. And they won't have to worry about oversupply of pharmacist nor a paycut.

there are by far more jobs in retail than in hospital settings, 55% of pharmacist work in retail, and about 20 % in hospitals.the way of the future at least for clinical pharmacist is board certified specialization. Unfortunately not many people follow it since it brings a proffesional rather than a renumerative satisfaction, besides that a residency for 1-2 more year translates into taking a paycut of more than 50% which isnt very appealing to many new graduates.
the comparison may not be ideal but illustrates a very important point, the more you know in healthcare (as long as there is a steady demand) the better opportunities youll have. however given the nature of the pharmacist job, there is always a setting for a pharmacist, pilots well they need an airplane and not everyone is risking to put a several millions airplane in the hands of a unexperienced pilot.

 

[Epic]

there are by far more jobs in retail than in hospital settings, 55% of pharmacist work in retail, and about 20 % in hospitals.the way of the future at least for clinical pharmacist is board certified specialization. Unfortunately not many people follow it since it brings a proffesional rather than a renumerative satisfaction, besides that a residency for 1-2 more year translates into taking a paycut of more than 50% which isnt very appealing to many new graduates.
the comparison may not be ideal but illustrates a very important point, the more you know in healthcare (as long as there is a steady demand) the better opportunities youll have. however given the nature of the pharmacist job, there is always a setting for a pharmacist, pilots well they need an airplane and not everyone is risking to put a several millions airplane in the hands of a unexperienced pilot.

Yearning for professional satisfaction and sacrificing time and money for professional growth will in the end result in a better outcome in the future.

I doubt the cost of airplane is the primary concern for airline industry when hiring a pilot. Lives are.

 

[Corona]

I don’t have a problem with learning new skill’s, what I do have a problem with is de-evolution. We should use our knowledge to better our profession, not turn it into a joke.

 

[Dr JPH]

Even though I still see a shortage in extremely remote areas of the country, I do think the shortage of pharmacist in major cities in the US over.

😱

Come to Philadelphia.

My wife gets denied vacation on a regular basis (so much so that she needs to beg and plead people to cover her shifts) because her company cant find people to cover for her. Yet they continue to open more and more stores.

She prints out the emails she gets with open shifts...ridiculous. 24 hour stores closing overnight, some stores not able to have pharmacy hours on Sunday.

If the shortage is over, then where are all the pharmacists going? Friends tell me their companies are the same way.

 

[Epic]

😱

Come to Philadelphia.

My wife gets denied vacation on a regular basis (so much so that she needs to beg and plead people to cover her shifts) because her company cant find people to cover for her. Yet they continue to open more and more stores.

She prints out the emails she gets with open shifts...ridiculous. 24 hour stores closing overnight, some stores not able to have pharmacy hours on Sunday.

If the shortage is over, then where are all the pharmacists going? Friends tell me their companies are the same way.

No..I'm not going to Philly. Been there...don't like it.

I have never ever denied vacation to any pharmacist ever past 7 years. Of course I've always worked hospital.

It sounds like she's working for a wrong company. I think the pharmacist vacancy nationwide is about 2 to 3 %. I wouldn't call that a shortage.

The problem with retail is that it's usually a 2 to 3 pharmacist show..and one takes off, the coverage gets screwy. At a hospital setting, it's much easier to cover a shift.

So, if pharmacists are not in Philly..where are the going? I would think many are moving to South and/or Southwest.

 

[Priapism321]

Yearning for professional satisfaction and sacrificing time and money for professional growth will in the end result in a better outcome in the future.

Excellent statement.

 

[sdn1977]

Comparison of airline pilots to pharmacist is extreme. There is an abundance of pilots who can fly a jet. But it's the US military trained pilot who I would trust to fly me across country instead of a young man who went through your local flight school to get a pilot license just to get in flight attendent's pants. Hence the salary range of airline pilot can stretch from $35,000 to $200,000+ per year. Also, the demand for airtravel is affected by many different factors including geopolitical affairs whereas we see a steady increase in demand for healthcare until the boomers die off.

I agree that the shortage of pharmacist will not last forever nor will it last as long as we think. I do believe the shortage is coming to an end where I really didn't have trouble hiring pharmacists for the past 3 years. And I also see more and more retail pharmacists who float instead of having a store. Even though I still see a shortage in extremely remote areas of the country, I do think the shortage of pharmacist in major cities in the US over. And the wave of new grads from new schools are spilling out faster than we can contain.

As a pharmacist in position to hire specialized clinical pharmacists in hospitals, it's easy for me to shuffle through a stack of resumes to weed out unqualified candidates. Everything being equal, residency trained pharmacist with a pharmacoeconomics sense will always be on the top of my list. And they won't have to worry about oversupply of pharmacist nor a paycut.

Epic - I'm not sure if I'm agreeing or disagreeing, but there is a definite shortage of QUALIFIED pharmacists.

We're not talking about specialized, board certified pharmacists - altho there are those...but, just pharmacists with good JUDGEMENT.

I mean - look at some of the responses on here. I have had 10 applicants for a position & I've turned down all 10 - why? They don't want to work weekends, they want the same 2 days off every week, they don't want to have to cover holidays or rotate thru chemo......

It goes on & on & on. Who are these kids (people) who think that hospital or healthcare goes on M-F 9-5:30????

Get daycare, get your SO to do his/her part, know you have to do the awful shifts when you're young & learn....learn lots & lots.

That's why your wife wasn't counseled on her rx! She had just a so-so pharmacist putting in his/her time & really couldn't be bothered to tell your wife how she should take the med.....plus - the tech never said anything, which compounded the issue.

Then....we have these students on the licensing forum complaining about how hard & tedious the NAPLEX is. Please - this is a NOTHING test compared to the old CA state board exam - in fact - the current NAPLEX test was a compromised version of the CA state board exam - but - its too tedious & wondering why they aren't allowed to make all that $$$ they were promised as a sign on bonus (I laugh everytime I think of this!).

Sorry - I've come off a very, very bad week with no end of pharmacists who don't feel they have a responsibility to even maintain refrigerator temperatures (NO KIDDDING - I had a pharmacist tell me this!!!!!). Now we've got a pre-pharm telling us that we are devalued if we communicate & collaborate with physicians, yet that same physician wants to know more about how this whole mechanism works so he can understand it better????

OMG - I can't believe what I'm reading!!!!! Yep - these kids need to memorize the top 200 drugs 'cause that's what's important - NOT!.

(I apologize for the rant - I've had a week of >75 hrs of work - for more reasons than I can enumerate here..)

 

[Dr JPH]

Who are these kids (people) who think that hospital or healthcare goes on M-F 9-5:30????

They should spend a week as a Surgical Resident!

 

[bananaface]

The problem with retail is that it's usually a 2 to 3 pharmacist show..and one takes off, the coverage gets screwy. At a hospital setting, it's much easier to cover a shift.

So, if pharmacists are not in Philly..where are the going? I would think many are moving to South and/or Southwest.

http://www.pharmacymanpower.com/index.html
http://www.pharmacymanpower.com/state.html

PA is below the national average on the aggregate demand index. My guess is the root of the problem is systematic understaffing at specific chains.

 

[Epic]

Epic - I'm not sure if I'm agreeing or disagreeing, but there is a definite shortage of QUALIFIED pharmacists.

We're not talking about specialized, board certified pharmacists - altho there are those...but, just pharmacists with good JUDGEMENT.

Oh..no kidding. 12 years out of pharmacy school, there has been only 1 pharmacist who could tell me the Vd of Vancomycin and Aminoglycoside. I gave him a high five.

QUALIFIED pharmacists...is a whole another topic.

 

[Epic]

SDN...

And y'all really should look into automated thermometers for temp log.

 

[Priapism321]

It goes on & on & on. Who are these kids (people) who think that hospital or healthcare goes on M-F 9-5:30????

These kids need a little post graduate training if you ask me. Give a 24 year old a doctorate degree and they may get a little confused, in my opinion (I am currently 24, by the way). You may say you know plenty of residency trained pharmacists that do not want to work weekends, or rotate through chemotherapy or want certain days off, but I know I work with 5 individuals who would never consider such a thing. an option. A small dose of reality is all I am calling for before handing people 100,000 dollars a year; then perhaps you would be able to hire most pharmacists who apply for a job as a healthcare professional.

 

[Epic]

These kids need a little post graduate training if you ask me. Give a 24 year old a "doctorate" degree and they may get a little confused, in my opinion (I am currently 24, by the way). You may say you know plenty of residency trained pharmacists that do not want to work weekends, or rotate through chemotherapy or want certain days off, but I know I work with 5 individuals who would never do such a thing. A small dose of reality is all I am calling for before handing people 100,000 dollars a year; then perhaps you would be able to hire most pharmacists who apply for a job as a healthcare professional.

Y'all got nothing on me.

I'm still working. I'm drawing a UTI treatment algorithm! so much fun😴

 

[sdn1977]

SDN...

And y'all really should look into automated thermometers for temp log.

uuuuuhhhh - we have 'em. The problem comes when the plug gets knocked out of the wall & someone reaches in & notices the light off. Nope - they said.......thats all they noticed the light.....didn't think to look at the plug. Aaaaarrrhhh!

I need an alarm system (which we have on the large freezers downstairs), but simple common sense would make one look at the thermometer if the light was off.