Stupid Question--> Does having a PharmD make you a Dr.?

[baggywrinkle]

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Originally posted by badxmojo
I guess there more to it then just knowing your drugs inside out. I hope those physicians don't get to mean.. at what point do you think they become the stereotypical low pateince condescedding know it alls? cuase my freinds in med school are as nice as nice can be.

It only takes one, and there seems to be one on every hospital staff. Think of the chief of staff on that stupid sitcom SCRUBS. Now think of the same person throwing temper tantrums and actually throwing things. Verbal abuse is par. Then hang a well earned nickname on him like Dr LD50 or petal-to-the-metal-Paul
and you have your man. When you need to speak with him fasten your chin-strap because you are going to war. This is a job btw which is delegated to newbies just to "share the joy"😀

An insiders technique that is good to remember with one of these guys related to crappy handwritting. You don't want to call him, the charge nurse doesn't want to call him. Everyone is chicken. So you and your nurses put your heads together and "decide" what it says. Decision by consensus. Then when he squawks you must present a united front. It takes a good relationship with your nurses to pull this off. Not kosher but tried and true. It has prevented many butt chewings....

The largest part of your job as a clinical pharmacist is diplomacy. You are the interface between Pharmacy and the medical staff. You must be perceived as making their job easier otherwise you are part of the problem. When you pull their bacon out of the fire it is your job to tactfully be sure they know it. Most are no problem but there will always be that one or two who are unapproachable.

 

[Dr JPH]

Originally posted by jdpharmd?
Isn't it ironic that you make the distinction that she's a PharmD when you're applauding not making a distinction between BS and PharmDs? 😉

The statement I was replying to was one that said those pharmacists possesing the PharmD degree were the ones who were adamant about making a distinction. I agreed with this statement as did my girlfriend who is indeed a PharmD and disagrees with her fellow PharmDs that making a distinction is necessary. Therefore, the reason I included her degree in my post was to make the point that although she has the PharmD degree she disagrees with the idealogy that the original poster was referrign to.

If you cant follow whats going on, dont reply.

 

[jdpharmd?]

Originally posted by JPHazelton
The statement I was replying to was one that said those pharmacists possesing the PharmD degree were the ones who were adamant about making a distinction. I agreed with this statement as did my girlfriend who is indeed a PharmD and disagrees with her fellow PharmDs that making a distinction is necessary. Therefore, the reason I included her degree in my post was to make the point that although she has the PharmD degree she disagrees with the idealogy that the original poster was referrign to.

If you cant follow whats going on, dont reply.

That's what I said, only I used fewer words. It's easier that way.

 

[Dr JPH]

Originally posted by jdpharmd?
That's what I said, only I used fewer words. It's easier that way.

I see.

👍

 

[Pilot]

Originally posted by jdpharmd?
A PharmD would also be an R.Ph, unless he/she didn't have an active professional license, so I can't understand his objection to "RPh", since he IS one. I've seen faculty members (as well as authors) use the distinction "RPh, PharmD" or "RPh, PharmD, BCPS" after seemingly everything with their name's attached.

"since I earned the degree" seems like a somewhat valid complaint if that information is usually included on the forms. Would you be upset if someone wrote "DO" after your name and you were an "MD" or vice versa?

Do you plan to specialize in something that will utilize your skills as both a trained physician and pharmacist? (I guess oncology comes to mind fairly quickly, but there must be other disciplines like infectious disease, etc)

First of all, thanks to everyone for keeping this a courteous discussion.

In response to JD, in my state (OK) the licensure is "Doctor of Pharmacy". Therefore all pharmacists are "doctors", much to the chagrine of Pharm D's (a title by degree, but not licensure). Not a very important point, but I thought I would clarify. I will concede that "earning the degree" is a valid point, but the manner in which the clarification is made is instrumental. I personally wouldn't be upset if MD is written next to my name (as a DO), or vice versa) as the understanding would be that I was a physician. Similarly a PharmD shouldn't be upset with the designation of R.Ph. - the implication being he/she is a pharmacist. Now, if they try to write D.C. next to my name, I would gently correct the person as chiropractors are not fully licensed physicians in my state.

As to whether I will combine my pharmacy and medical training - absolutely. However, I think to more fully utilize pharmacist training would require a FP/IM setting. They have the broadest exposure to pathology, and numerous pharmacuetical intervention options. The more specialized a physician becomes, the smaller his/her medication armament becomes. (just my experience thus far).

Keep the comments coming. I am enjoying this thread.

 

[Dr JPH]

Not to start a big argument, but it is said on here that pharmacists know more about the drugs that physicians.

Well, this may be true for residents (doctors in training) or docs who are prescribing outside their primary field...family doc writing for psych drugs.

But from those I have spoken to in both the medical and pharmacy fields I have yet to hear ANYONE on either side argue with the fact that a Cardiologist knows more about cardio drugs than a pharmacist, Oncologist about CA drugs, etc.

What are your thoughts, Pilot?

 

[baggywrinkle]

So if you are a "Doctor of Pharmacy" in Oklahoma does that mean
in Louisiana you would sign your name John Doe ETHICAL Pharmacist? That's what it says on the license and it cracks me up every time I see it. Perhaps that is why all those Cajuns try to come to Texas....

As far as actual drug knowledge. On graduation, a pharmacy student and a medical student are about equal. From that point on the similarity ends. You will find that the physicians drug knowledge is narrow and deep. He/she will settle on a selection of drugs in their area of expertise and stick with them because they know them like the back of their hand. So a cardiologist will know heart drugs extremely well, but can't tell you squat about antineoplastics. They will also tend to become dated unless they take pains to stay right up on the cutting edge. It is the old farts who still order Aldomet or Mebaral for example.

In contrast, the pharmacist's in depth knowledge deteriorates after graduation and after a few years tends to be very broad and shallow with key points that were hammered home standing out about specific drugs and drug classes. If you walk up to the average pharmacist who has been out of school for five or more years and play stump the star you won't have to dig very deep before you get that blank look. Drug class, primary use, common dose, and an adverse effect or two about almost every doggone drug on his shelf still ain't too shabby. If you need anything more that is why G*D created reference books and package inserts. Where his knowledge really suffers is in the loss of all the therapeutic stuff they hype for the pharm D's. It's a sad fact, use it or lose it. Or else resign yourself to lots and lots of CE.

Quick example. I can tell you right off the top of my head that Vinblastine trade name Velban is an antineoplastic and one of two vinca alkaloids the other being vincristine. Velban is dosed 8-10 mg and vincristine (note I cannot remember the trade name -ONCOVIN!! - two days later) is dosed 1-4 mg. Both are given slow IV push and are not usually mixed with anything. The noteable red flag with these two drugs is DO NOT mix them up. A patient with a vincristine overdose will literally swell up and die screaming with everyone standing helplessly by. Any further information must be looked up. There (pant pant) how'd I do?

I should add that the only reason I KNOW this is because I worked in hospital for ten years. You could approach my manager who has been at WAGS for thirty years with this question and get a blank look. But he will burn you up with diabetic knowledge.

This is why I enjoy hanging out with you guys. You are still sharp,
able to run circles around me and your knowledge is bleeding edge. Now, if you will excuse me I need a motrin, my brain hurts from straining it.

 

[SteveL]

I would have to agree with baggys assesment of phys and pharms knowledge of drugs. Typically, I'll let that one sink in for a minute........TYPICALLY, that is correct. Many (esp retail)pharmacists have forgotten the detailed mechanisms by which many drugs act but can spout off adverse effects, dosages, indications, etc, for almost any drug on their shelf.

Not to exlude the others (outside the typical), there are both phys and pharms that have a detailed knowledge of many diff classes of drugs. It's also common to see PharmDs now a days at my hospital using there therapeutic knowledge on rounds, etc. In fact, a couple of our profs (pharmDs) lecture the med students on 'rapid interpretation of EKG's, etc etc). By the same token, we also have a couple MDs here teaching us on very detailed therapeutics, drugs, etc. Both of them astound me with the amount of info they retain.

It's kind of meanless to argue over "who is the master of what" because as baggy said, you don't use it, you lose it...no matter who you are. Specialization is what makes healthcare work...There is really no one person doing everything...period

peace

 

[baggywrinkle]

Originally posted by SteveL

you don't use it, you lose it...no matter who you are.

peace

Read it and weep.
All that book learnin...
Coulda bought a lot of beers with that money 🙁

[old person sound]

 

[lazgirl24]

what about the 6 year MD program?

 

[jdpharmd?]

Originally posted by lazgirl24
what about the 6 year MD program?

I think I speak for several of us when I say "please elaborate".

 

[lazgirl24]

i meant for those who thinks that Pharmacist don't deserve the "Dr." little b/c they can get their degree in 6 years. There are a lot of med programs out there where you can get your undergrad and MD degree in 6 years. Does that make them less of a doctor b/c they don't go through th 4 years if undergrad and 4 years of med school? just a thought..

 

[Teufelhunden]

Good point. NEOUCOM has a 6-year MD program.

Again, the reason PharmD's shouldn't be called "doctor" in the clinical setting is because that title is reserved for clinicians with a doctorate-level education, i.e. MD, DO, DDS, DMD, DPM, etc.

In the academic setting, however, PharmD's do rate the "doctor" title just the same as anyone w/ a doctorate-level degree, i.e. PhD, EdD, etc.

 

[SteveL]

Originally posted by Teufelhunden
Again, the reason PharmD's shouldn't be called "doctor" in the clinical setting is because that title is reserved for clinicians with a doctorate-level education, i.e. MD, DO, DDS, DMD, DPM, etc.
PhD, EdD, etc.

Who said it was RESERVED for clinicians?? Did I miss the sign on the way into the hospital the other day that said: "unless an MD, please leave behind all other doctorate titles at the door as to not confuse our patients"?

Just to clarify. Being a doctor and being called Dr. are different things. I have NEVER seen a problem in a hospital where a pharmD has been asked what to do in an emergency situation and yet they are still called Dr. so-and-so by almost everyone in the hospital. The only time it becomes a problem is when someone with a pharmD tells people they are a doctor by profession (in a social setting)...that, IS incorrect. They are a doctor...of pharmacy, but again, being a 'doctor' by profession and holding a doctorate leve degree is different. If any pharmD called themselves a doctor by profession I would laugh in their face because that is truly funny. It just makes them soud like they have knowledge they don't and are someone they are not.

The fact is that most people who introduce themselves as Dr. so-and-so are a little to proud of themselves, regardless of their doctorate specialty. If someone else were to introduce you as Dr. so-and-so, its okay though. The thing is, if I were to be introduced like that in a social setting, not only would I feel embarassed (not because of the degree), but I would be sure that they know that I am a doctor of pharmacy...

peace in the middle east...

 

[chitowngyrl]

Originally posted by SteveL
Who said it was RESERVED for clinicians?? Did I miss the sign on the way into the hospital the other day that said: "unless an MD, please leave behind all other doctorate titles at the door as to not confuse our patients"?

Just to clarify. Being a doctor and being called Dr. are different things. I have NEVER seen a problem in a hospital where a pharmD has been asked what to do in an emergency situation and yet they are still called Dr. so-and-so by almost everyone in the hospital. The only time it becomes a problem is when someone with a pharmD tells people they are a doctor by profession (in a social setting)...that, IS incorrect. They are a doctor...of pharmacy, but again, being a 'doctor' by profession and holding a doctorate leve degree is different. If any pharmD called themselves a doctor by profession I would laugh in their face because that is truly funny. It just makes them soud like they have knowledge they don't and are someone they are not.

StevenL, I agree with everything you just said. I couldn't of said it better myself. Personally, I don't care if I am referred to as Dr. or not. That really is not important to me at all. But I feel like any PharmD who wants to be referred to as Dr. in the hospital or in social circles or in school or wherever, than they should have that right to be called that. Plain and simple! I think most people know that there is a huge difference between a doctor of medicine and a doctor of pharmacy.

 

[Teufelhunden]

I guess we've just had different experiences. I worked in hosptial pharmacy for > 2 years and never saw a PharmD refer to him or herself as "doctor" nor were they ever addressed as "doctor."

Again...never...ever....not even once.

And now, as an MS-III, in all my dealings with the hosptial pharmacy, I have never heard the PharmD's refer to themselves as "doctor." When you call the pharmacy, they answer, "Pharmacy, (first name) speaking...."

I don't know...maybe in some hospitals PharmD's are called "doctor," but I've never seen it 😕

 

[LSUMED2006]

There are a couple of pharmds here at the hospital (clincal pharmasists) who are addressed/refer to thenselves as Dr. _____. (one also said we could call him Uncle Roy if we wanted...lol odd). Interestingly enough, they also taught at my pharmacy school when I attended via video conferencing.

Originally posted by JPHazelton
Not to start a big argument, but it is said on here that pharmacists know more about the drugs that physicians.

Well, this may be true for residents (doctors in training) or docs who are prescribing outside their primary field...family doc writing for psych drugs.

But from those I have spoken to in both the medical and pharmacy fields I have yet to hear ANYONE on either side argue with the fact that a Cardiologist knows more about cardio drugs than a pharmacist, Oncologist about CA drugs, etc.

What are your thoughts, Pilot?

JP, I certainly agree, and i've made this point since the beginnings of this board. Anyone interested could do a search for some lively discussions. Physicians who specialize in anything have an incredible grasp on the meds that fall into their range of practice, even if they use them only seldomly for the various zebras out there. While pharmacists certainly do have a wonderful grasp on many medications (read baggywinkles great post below), I, as a whole, feel that physicians( oncologists with anti neoplastics, cardiologists with cardiovascular meds, anesthesiologists, nephrologists, etc. etc.), in the majority of cases, truly display a level of expertise and knowledge concerning the medications they prescribe that most pharmacists don't have/need to have, especially in the areas of mechanisms, pharmacology, etc. Of course mistakes are made by both pharmacists/physicians due to busy schedules/carelessness, but this is my honest opinion. I also don't think it fair for many people to assume that physicians don't "keep up" or "stay up to date." In my experience physicians are often on the cutting edge of therapeutics dealing with their areas of practice.

Originally posted by baggywrinkle

As far as actual drug knowledge. On graduation, a pharmacy student and a medical student are about equal. From that point on the similarity ends. You will find that the physicians drug knowledge is narrow and deep. He/she will settle on a selection of drugs in their area of expertise and stick with them because they know them like the back of their hand. So a cardiologist will know heart drugs extremely well, but can't tell you squat about antineoplastics. They will also tend to become dated unless they take pains to stay right up on the cutting edge. It is the old farts who still order Aldomet or Mebaral for example.

In contrast, the pharmacist's in depth knowledge deteriorates after graduation and after a few years tends to be very broad and shallow with key points that were hammered home standing out about specific drugs and drug classes. If you walk up to the average pharmacist who has been out of school for five or more years and play stump the star you won't have to dig very deep before you get that blank look. Drug class, primary use, common dose, and an adverse effect or two about almost every doggone drug on his shelf still ain't too shabby. If you need anything more that is why G*D created reference books and package inserts. Where his knowledge really suffers is in the loss of all the therapeutic stuff they hype for the pharm D's. It's a sad fact, use it or lose it. Or else resign yourself to lots and lots of CE.

This is pretty much accurate, although cardiologists do have to be much more familiar with antineoplastics than you may realize, as there are a variety of tumors that affect the cardiovascular system. Also, physicians often stay VERY up to date dealing with the meds/treatments pertaining to their specialties.

 

[baggywrinkle]

Originally posted by LSUMED2006
Also, physicians often stay VERY up to date dealing with the meds/treatments pertaining to their specialties.

With the legal climate as it is can you blame them?

The glaring area where most physicians are absolute babes in the woods is what things cost. Don't know, don't care and this is as it should be. But it sets them up as easy prey for detailing drug reps pushing combo drugs like Vicoprofen or the latest greatest quinolone when cephalexin really will do just fine. They don't have to deal with poor old ladies bursting into tears because she can't decide to buy her Avandamet or pay her rent......

This is where the pharmacist can really shine. Finding effective therapy which is cost efficient. One of my directors became the administration darling when she stuck her nose into the surgery drug stock. She pared down the physician drug list to lean and mean saving over three hundred thousand dollars in lost patient charges the first quarter her program was in operation. The surgeons bitched. They could no longer just run in and rob the cookie jar, but what could they say? Her program also accidently nailed an impaired anesthesiologist when he replaced 1cc vials of sublimaze with 2cc vials from another hospital. We didn't carry that size and her audit trail traced usage back to individual physicians. That was grounds to open his locker....JACKPOT

Speaking to the primary thread topic. As a lowly B.S. Pharmacist I was touched today when an elderly gent called me Doctor. All I did was tell him not to double up on his NSAIDs, take one or the other. I thought of you guys....

 

[Dr JPH]

Originally posted by baggywrinkle

The glaring area where most physicians are absolute babes in the woods is what things cost. Don't know, don't care and this is as it should be.

Doctors don't know? TRUE

Doctors don't care? FALSE

Actually, the Emergency Medicine Residents Association (EMRA) puts out a little pocket guide to antibiotics that has the average cost of the drug per surveys of several large retail chains.

Doctors do care what medication cost, but as you said, this information is really not part of day-to-day operations for most docs. They dont see (as I have working in pharmacy) the look on someone's face when you tell them how much their meds cost.

But, we do care. Trust me.

 

[profunda]

I have a solution that will eliminate the power trip and patient confusion. How about we change the way people say things?

An MD should be called Dr so so. A dentist should be called Dentist so so. A lawyer should be called Attorney so so. A pharmacist should be called Pharmacist so so.

Therefore, no patient would be confused who's who, and everyone can be referred correctly and be proud of who they are and what they do.

 

[TotalKayOs]

An MD should be called Dr so so. A dentist should be called Dentist so so.

by your own logic an MD should be called physician so and so.

 

[profunda]

that's fine.

although, when i was in elementary school, most people thought a doctor was a physician. i was brought up in america believing that doctors are physicians that care for the sick. but we can get that technical if you like.

Originally posted by TotalKayOs
by your own logic an MD should be called physician so and so.

 

[Modnar]

Originally posted by profunda
that's fine.

although, when i was in elementary school, most people thought a doctor was a physician. i was brought up in america believing that doctors are physicians that care for the sick. but we can get that technical if you like.

Why would you think a physician is anything other than a person that cares for the sick? 😕 Perhaps I misread your post, but it seems to me that you do not know the meaning of the word.

 

[profunda]

You are trying to sound like a literary english expert but instead is just a robot who repeats words of high school teachers.

When one writes anything, one has to choose between being non-redundant or being absolutely clear. I made the choice to sacrifice non-redundancy for absolute clarity. Writing english is not a math formula and it takes diciphering to decide what the author is trying to convey.

Originally posted by Modnar
Why would you think a physician is anything other than a person that cares for the sick? 😕 Perhaps I misread your post, but it seems to me that you do not know the meaning of the word.

 

[SteveL]

Originally posted by Teufelhunden

And now, as an MS-III, in all my dealings with the hosptial pharmacy, I have never heard the PharmD's refer to themselves as "doctor." When you call the pharmacy, they answer, "Pharmacy, (first name) speaking...."

I don't know...maybe in some hospitals PharmD's are called "doctor," but I've never seen it 😕

Yes, there are a lot of hospitals that don't call pharmacists by dr. so-and-so. Also, our pharmacist doesn't answer the phone by Dr. so-and-so either. He does, as you mentioned, just say pharmacy, (name here) speaking." He doesn't care about the title so much. Actually, the only time I see him called dr. so-and-so is when he is talking to a doctor(phys) about something and the phys will thank him by saying "thank you Dr. (Last name)". He prefers to just be called by his first name. He's a very modest guy...but smart as hell. I think he's respected more for that than anything.

 

[Modnar]

Originally posted by profunda
You are trying to sound like a literary english expert but instead is just a robot who repeats words of high school teachers.

When one writes anything, one has to choose between being non-redundant or being absolutely clear. I made the choice to sacrifice non-redundancy for absolute clarity. Writing english is not a math formula and it takes diciphering to decide what the author is trying to convey.

I was just asking you a question. There is no need to be rude.

 

[Dr_Rx2003]

If John Doe has a PharmD and I call him Mr. Doe even though I know he has a PharmD.............would it be wrong/rude thing to do?

BTW... I will never call young PharmDs(especiall those who came straight from high school without getting a bachelor's degree...and/or who works at retail) Dr so and so

Also referring to one of the previous posts, someone forgot to metion that clinical pharmacist is also a clinician.

 

[rutpharm]

I respect clinical pharmacy but the pharmacist who works at CVS play an important role in the healthcare system also. So if you call someone doctor for clinical pharmacist, than by the same token the retail pharmacist deserves the title. I feel no pharmacist should get hung up on having doctors call them doc so so

 

[badxmojo]

Dr.rx2003 makes a good point.. clnical pharmacists are hired predominantly for there clinical skills (i think?) and the clinical training nowadays in pharm school is pretty extensive. (Umaryland atleast) I was talking to fourth years and they told me that there was almost too much..that there clinical skill rivaled those of a 4th year Med student or even first year resident.. however.. when it came to drugs.. they were also in the same boat as a 4th year med student or a first year resident.. pretty strange huh?

 

[LSUMED2006]

Originally posted by badxmojo
Dr.rx2003 makes a good point.. clnical pharmacists are hired predominantly for there clinical skills (i think?) and the clinical training nowadays in pharm school is pretty extensive. (Umaryland atleast) I was talking to fourth years and they told me that there was almost too much..that there clinical skill rivaled those of a 4th year Med student or even first year resident.. however.. when it came to drugs.. they were also in the same boat as a 4th year med student or a first year resident.. pretty strange huh?

I'm sorry, but there is absolutely no way, no how that a 4th year pharmacy student's clinical skill rivals a 4th year medical student or especially a first year resident. That actually made me chuckle. The only people who would make such a claim have no idea what medical students/interns are taught. If 4th year pharmacy students are making such claims, they are either ignorant, in denial, or jealous. The entire focus of pharmd and md training is different. There just isn't the time or the training for a pharmacy student to even approach the level of clinical skill that 4th year med students or interns have. That's certainly not to say pharmacists don't recieve tons of training med students don't; obviously they do.

 

[badxmojo]

they were probably ignorant.. or maybe they were just using it as a figure of speech.. but i think ther epoint was.. they had so much clinical training.. and not that much drug information training.

 

[Teufelhunden]

Pharmacists are NOT clinicians. Clinicians dx and treat disease. Last I checked, no pharmacist is able to (legally) diagnose anyone.

I'm not trying to get into one of these "I'm better than you" type arguments. I have a great deal of respect for pharmacists and appreciate the jobs they do. However, a pharmacist is not a clinician.

For your edification...

Main Entry: cli?ni?cian
Pronunciation: kli-'ni-sh&n
Function: noun
Date: 1875
1 : a person qualified in the clinical practice of medicine, psychiatry, or psychology as distinguished from one specializing in laboratory or research techniques or in theory

 

[LSUMED2006]

In reply to badx, that is somewhat suprising; the pharmacists' advantage in the healthcare realm is their drug knowledge. Their place in the healthcare team (in the hospital...I'm not refering to their obvious roles in the retail real) revolves around this drug knowledge (suggesting optimizations of therapy, DURs, in some cases suggesting the medication therapy, etc.). Obviously, a knowledge of the disease process going on is important for pharmacists, but the focus of a pharmacists training shouldn't revolve around the clinical skills arena. To do so would strongly attenuate the pharmacists role in the healthcare team via decreasing drug knowledge.

 

[baggywrinkle]

Originally posted by LSUMED2006
I'm sorry, but there is absolutely no way, no how that a 4th year pharmacy student's clinical skill rivals a 4th year medical student or especially a first year resident. That actually made me chuckle. The only people who would make such a claim have no idea what medical students/interns are taught. If 4th year pharmacy students are making such claims, they are either ignorant, in denial, or jealous. The entire focus of pharmd and md training is different. There just isn't the time or the training for a pharmacy student to even approach the level of clinical skill that 4th year med students or interns have. That's certainly not to say pharmacists don't recieve tons of training med students don't; obviously they do.

Emphasis please on focus of training. The pharmacist's primary role is to monitor drug therapy both prospectively and retrospectively to ensure safety and compliance with established guidelines and the law. You will find that most pharmacists have an excellent grasp of the law. In the hospital setting as the hospital and patient's advocate we protect patient safety, work to ensure cost effective therapy, make sure the hospital and by extension the medical staff is in compliance with not only state and federal law, but also JCAH guidelines. This is why the position of secretary on the P&T commitee is traditionally occupied by a pharmacist. The thrust of clinical knowledge is different in a pharmacist and comes in handy not only in making recommendations for therapy, but also sussing out procederal problems like the prevention of nosocomial infection in post operative patients, establishing protocols for dangerous or expensive drugs such as TPA, creating and enforcing formulary guidelines for therapeutic substitution, or warning hospital administration when physicians attempt to do things that might threaten the hospital accreditation like "narcotic allergen desensitization"

It is our job as "zookeepers" to take the punch bowl away before the party gets too good. We only need enough clinical backround to realize when something stinks on ice unless the practice is an unusual environment such as an NIH tribal clinic where the pharmacist is actually prescribing as well as dispensing.

Did I mention education? Major role for pharmacy to educate,and inform not only patients, but also nurses and physicians. Trust me, it is an education when I tell a physician I am obliged by Federal law to dob him in to the DEA if he does not send me the promised hand written CII prescription within seven days of the verbal order. How could I? I wouldn't dare! Watch me.....

 

[Dr_Rx2003]

definition of clinician only encompasses medicine, psychiatry and psychology....but aren't psychiatrists MD/DO as well?

You also said DDS, DPM,etc should be considered clinicians as well. Aren't you contradicting what you said in the previous post?

I guess everyone has their own definition of who should be considered clinician....I can't really define one....but I would recognize it when i see one.

Let's change everything so that we don't have to call ourselves Dr anymore (EM:Expert of Medicine, EDS:Expert of Dental Surgery, EP:Expert of Pharmacy). Got a problem with this? Why? After all, you wanted to become physician, dentist, pharmacist b/c you wanted to make a difference in people's lives..not because of what follows you b/f your last name. Many people in now days seem to be infatuated with the title Dr.

 

[Teufelhunden]

Originally posted by Dr_Rx2003
definition of clinician only encompasses medicine, psychiatry and psychology....but aren't psychiatrists MD/DO as well?

You also said DDS, DPM,etc should be considered clinicians as well. Aren't you contradicting what you said in the previous post?

I guess everyone has their own definition of who should be considered clinician....I can't really define one....but I would recognize it when i see one.

No...no contradiction. Clinicians diagnose and treat disease with medicine or surgery...that's the widely accepted definition of clinician and encompasses MDs, DOs, DPMs, DMDs, DDDs, etc. As far as the webster definition:

1 : a person qualified in the clinical practice of medicine, psychiatry, or psychology as distinguished from one specializing in laboratory or research techniques or in theory

The word medicine encompasses dental and podiatric medicine...both whom are physicians who can diagnose and treat disease with both medicine and surgery.

A pharmacist can not legally diagnose someone with a common cold, nor can they prescribe a single medication, nor can they perform any surgical procedure. Pharmacists are not clinicians, they are...well...pharmacists.

Listen, I am by no means bashing pharmacy...I greatly considered this career myself. Pharmacists are an integral part of the healthcare team: their immense knowledge is crucial to physicians.

I agree wholeheartedly that PharmD's are indeed experts, and respect them as doctoral degree holders. I am simply stating that in the healthcare environment (i.e. hospital, clinic), it isn't appropriate to call them "doctor," just as it would be inappropriate to address the hosptial CEO with a PhD in Management as "doctor."

 

[baggywrinkle]

Originally posted by Teufelhunden
No...no contradiction. Clinicians diagnose and treat disease with medicine or surgery...that's the widely accepted definition of clinician and encompasses MDs, DOs, DPMs, DMDs, DDDs, etc. As far as the webster definition:

1 : a person qualified in the clinical practice of medicine, psychiatry, or psychology as distinguished from one specializing in laboratory or research techniques or in theory

The word medicine encompasses dental and podiatric medicine...both whom are physicians who can diagnose and treat disease with both medicine and surgery.

A pharmacist can not legally diagnose someone with a common cold, nor can they prescribe a single medication, nor can they perform any surgical procedure. Pharmacists are not clinicians, they are...well...pharmacists.


I agree wholeheartedly that PharmD's are indeed experts, and respect them as doctoral degree holders. I am simply stating that in the healthcare environment (i.e. hospital, clinic), it isn't appropriate to call them "doctor," just as it would be inappropriate to address the hosptial CEO with a PhD in Management as "doctor."

In the classic sense you are correct. The respective roles are well defined in the law. When you are talking about scope of practice you should refer to the legal definition rather than the popular definition. I have never seen "clinician" defined legally in any of four states that I have studied. The term is too vague. By definition only a pharmacist may DISPENSE [a controlled substance] and only a physician or a nurse may ADMINISTER.

However, in more progressive states these classic roles are changing. A pharmacist is classified as a mid level practitioner along with CRNP or PA which by your definition are clinician's and may enter in to agreements with physicians which allow them to diagnose and prescribe. By entering in to multiple agreements with many physicians they essentially become autonomous within a defined scope of practice - running a coumadin clinic for example. Under collaberative agreement with a physician, on file with the BOP, in Washington state a pharmacist has the same prescriptive scope of practice as a physician including controlled substances and is therefore a "clinician" in that practice setting.

 

[jj99]

Once had a law student tell me they deserved the "Dr" title and thought that the suggestion was pretty ridiculous. Med students probably think the same thing about us.

 

[profunda]

From experience, even ucsf 4th year pharmacy students on clinical internships dont even know the site of actions of the four diurectics (the first line of therapy for hypertension) on the nephron without referring to a book/internet. I am only a second year med student and I've already memorized these pharmacological basics.

Now it is even more ridiculous to imagine any pharmacy student to know how to conduct a full physical exam, be able to differentiate between an emphysema or pulmonary infection through auscultation (stethoscope), and realize the immediate dangers of newborns with tetralogy of Fallot and how to respond to such a finding. There's just no way.

Originally posted by badxmojo
Dr.rx2003 makes a good point.. clnical pharmacists are hired predominantly for there clinical skills (i think?) and the clinical training nowadays in pharm school is pretty extensive. (Umaryland atleast) I was talking to fourth years and they told me that there was almost too much..that there clinical skill rivaled those of a 4th year Med student or even first year resident.. however.. when it came to drugs.. they were also in the same boat as a 4th year med student or a first year resident.. pretty strange huh?

 

[jdpharmd?]

Originally posted by profunda
From experience, even ucsf 4th year pharmacy students on clinical internships dont even know the site of actions of the four diurectics (the first line of therapy for hypertension) on the nephron without referring to a book/internet. I am only a second year med student and I've already memorized these pharmacological basics.

Now it is even more ridiculous to imagine any pharmacy student to know how to conduct a full physical exam, be able to differentiate between an emphysema or pulmonary infection through auscultation (stethoscope), and realize the immediate dangers of newborns with tetralogy of Fallot and how to respond to such a finding. There's just no way.

While I can agree that physical examination skills are essentially non-existant in a pharmacist (or pharmacy student), I'd have to question the idea that you're presenting that you know more about pharmacology, and related physiology, that a 4th year pharm at UCSF. What do you think we do for the same 4 professional years that you endure? If you've already mastered pharmacology by the beginning of your second year of med school, and have a firm grasp on physical exam skills ("clinical skills"), then I'd say you're about ready to graduate, Doctor.

 

[dgroulx]

Originally posted by profunda
culous to imagine any pharmacy student to know how to conduct a full physical exam, be able to differentiate between an emphysema or pulmonary infection through auscultation (stethoscope), and realize the immediate dangers of newborns with tetralogy of Fallot and how to respond to such a finding. There's just no way.

In pharmacy school we are taught the use of a stethoscope, amongst other things, because we have to screen people for disease. At UF, we have the same assignment as the 1st year med students.

In pathophysiology we were taught to differentiate disease states. Pulmonary system was last month. We're on the cardiovascular system now. Tetralogy of Fallot was covered in A&P, a prerequisite to pharmacy school.

We are not expected, as pharmacy students, to conduct a full physical examination. By the 3rd year of school, we've had 2 years of med chem and pharmacology and a med student has had one semester. The opposite is true for med students.

 

[profunda]

I am not implying that I know more than a pharmacist about pharmacology or physio. It was only an observation I made about this incidental issue. To this day I'm still not sure why he didnt know the site of action of diuretics (but he did know other things about diuretics).

The "4 professional years endured" are not "the same" for a pharmacy and a medical student. The selectivity to enter schools, the amount of concepts understood, the memorization skills, the frequency of exams, the demands/expectation of faculty, the amount of time used to study for boards and other exams, are completely "different."

Physical exam is a small part of medicine that should be mastered by all 2nd years, if not definitely by 3rd years. Conducting physicals is only for guidance and documentation but it cannot be used for differential diagnosis of any disease. There is much more to learn than the physical exam (lab results, markers, toxicity, biopsies, differential diseases, therapies [surgical, chemo, diet, laser,etc] and alternatives).

I respect pharmacists and am not downgrading the profession. I am only stating this to refute the earlier statement that 4th year pharmacy students have the same clinical knowledge as residents, after seeing both in action many times.

Originally posted by jdpharmd?
While I can agree that physical examination skills are essentially non-existant in a pharmacist (or pharmacy student), I'd have to question the idea that you're presenting that you know more about pharmacology, and related physiology, that a 4th year pharm at UCSF. What do you think we do for the same 4 professional years that you endure? If you've already mastered pharmacology by the beginning of your second year of med school, and have a firm grasp on physical exam skills ("clinical skills"), then I'd say you're about ready to graduate, Doctor.

 

[rutpharm]

I agree with certain points but I have never met a medical student who knew more about drugs than me on my rotations. In fact I am teaching medical students and residents mechanism of actions, spectrum of activity for antibiotics, etc. To tell you the truth every school has bad pharamcy students who barely get by, of course those students are not going to know the mechanism of action for diuretics.

 

[profunda]

And you think while you are rigorously studying these drugs and systems, the respective med students are sitting on their anuses watching tv?

Pharmacology is generally about 1 semester depending on which med school. However, all the other classes taught (anatomy, physio, microbio, immuno, path) emphasize the therapy needed to treat each disease, and that includes drugs. A med student has been studying pharmacology the first day of school.

Maybe I was being too general with the tetralogy. Does pharmacy school teach how to find a tumor on CT scan and which organ it is on, identify subdural hematoma under MRI, chronic lymphocytic leukemia under a microscope (local private clinics might not have its own radiologist/pathologist to read biopsies)?

Originally posted by dgroulx
In pharmacy school we are taught the use of a stethoscope, amongst other things, because we have to screen people for disease. At UF, we have the same assignment as the 1st year med students.

In pathophysiology we were taught to differentiate disease states. Pulmonary system was last month. We're on the cardiovascular system now. Tetralogy of Fallot was covered in A&P, a prerequisite to pharmacy school.

We are not expected, as pharmacy students, to conduct a full physical examination. By the 3rd year of school, we've had 2 years of med chem and pharmacology and a med student has had one semester. The opposite is true for med students.

 

[profunda]

Ok scratch all that i've just said, because i dont want to argue about this and it's not important and doesnt answer the OP question. Seriously, it's a waste of time arguing over MD and PharmD, because there are always excellent physicians and pharmacists and bad physicians and pharmacists, and the two routes are intrinsically similar yet different.

Here's what I really think, in a way kind of blunt:

A layman in the hospital will think a pharmacist who demands that he be called doctor so so is a physician-wanna-be. If being called doctor is the most important thing, then he should've (couldnt have?) gone to med school, because he'd be called a doc for sure. In real life, no one calls pharmacists or social workers or lawyers doctors because they are just not called that, regardless of the professional degrees they got.

As for me, when I become a physician, I dont care if I am not called doctor. As a matter of fact, I'd prefer to be called my first name. The only thing that matters is that my patients are healthy and happy, because that was my primary reason for choosing this field. I just wished all health care providers share the same attitude and forget about the titles.

 

[SteveL]

Originally posted by profunda

A layman in the hospital will think a pharmacist who demands that he be called doctor so so is a physician-wanna-be. If being called doctor is the most important thing, then he should've (couldnt have?) gone to med school, because he'd be called a doc for sure. In real life, no one calls pharmacists or social workers or lawyers doctors because they are just not called that, regardless of the professional degrees they got.

Bingo. Agree completely...(this, coming from a pharmD student). The only thing I care about is doing MY job, not someone elses. The professions are different yet, HAVE TO run parallel in order for healthcare to work. In the real world, this discussion pretty much never happens, with the exception of course, being a couple jackass physicians and pharmacists. I don't care about being called dr, being a doctor, nor the clinical skills they have that I don't. Please don't mistake that for me not APPRECIATING those skills they possess and the hard work they have done to get those skills. I think it stands to reason that a lot of pharmacists who truly wanted to become physicians could have, and of course, vis versa. But it is those different roles we play and the seperate knowledge we gain that has brought us into our fields (at least, I hope). Personally, for me, I find pharmacology very interesting and I want to know all I can about as many things as I can. What I don't care so much about is long doctor hours, internships, and a lot of the knowledge they posses about certain things. (CT scans, biochemical screening, etc.). Personally, I don't care a whole lot about how to dx problems (in terms of the job)...and I would hope that most of our pharmacology students here wouldn't either. The truth is, if you do, you ARE most likley one of those wanna be doctors and should be made fun of and probably ARE jealous. Now, again, this is not to say that you don't find dx interesting...cause I do as well...what can I say, I have a thirst for knowledge. What I care about MORE though, is pharmacology/med chem. Let the physicians do their part, and you do yours...trust me...if you try to pull some hot shot know-it-all **** on their turf, all you will have is ****...

peace...

 

[dgroulx]

Originally posted by profunda

Pharmacology is generally about 1 semester depending on which med school. However, all the other classes taught (anatomy, physio, microbio, immuno, path) emphasize the therapy needed to treat each disease, and that includes drugs. A med student has been studying pharmacology the first day of school.

I'm not trying to argue, but you have a misconception about what's involved in pharmacy school. I can only look at the school that I attend and try to give you a picture of the curriculum.

UF med school has a higher incoming math/science GPA than their pharmacy school. However, unlike the COP, they do not need to take the prerequisites of calculus, organic II, human anatomy I or human anatomy II.

In the 1st year of pharmacy school, we learn clinical correlations between biochemical events and disease states, physiology and pathology by organ system to recognize specific disease states, we do research on specific diseases and make class presentations, etc. We also take classes in microbiology and immunology. There is even one class just on nucleotides and their basis for therapy. The future is in designer drugs for individuals. True pharmacology isn't taught until the 2nd year. They want us to understand disease states before applying drug therapy to those disease states. On top of all of that, we have the chemistry involved in each individual drug.

I have to do community health screenings and I am assigned a family to look after. I need to keep track of their health (or lack of), medications, lifestyle that can affect their health, etc.

Rotations don't start until the 3rd year, then we specialize in oncology, cardiology, pediatrics, etc. There is only one 6 week rotation in community pharmacy (ie retail).

No, we don't learn how to read MRI's in detail, though we do use them to recognize disease states. The physician's job is to diagnose, but the pharmacist needs to know that disease in detail and the drug therapy that accompanies that disease. There are many drugs and that is why pharmacists specialize in a particular area, just like a physician. We can choose to work retail, just like a physician can choose to be a general practitioner.

As for study time and tests, I can tell you that in my senior year of undergrad I took 21 credit hours - all sciences with labs. The amount of studying was a piece of cake compared to pharmacy school. We have an exam in any one subject about every 2-3 weeks depending on the class. At that point, my stack of notes is a couple of inches high for that class.

I'm not trying to say that pharmacy school is more intense than medical school, as I am sure it is not. It just seemed that you were unaware of the type of classes we take. I didn't mention the easy classes, such as learning patient skills. Those don't require any study time. They just want to teach bedside manner, since we will be dealing with patients on a day-to-day basis.

As for the original theme of this thread, I don't expect to be called doctor when I am working. I think that confuses the patient and our primary concern is the patient. However, I will use the title in a professional capacity if I am making a presentation, etc.

I chose to go to pharmacy school, just like most everyone else on this board. Could I have gone to medical school? Absolutely. I preferred pharmacy.

 

[TotalKayOs]

why doesn't anyone ever mention the money. everyone keeps saying how they do this becasue they care about the pateint. that's bull. i'm willing to bet most people in MD/DO or pharm d perograms becasue they want to get paid well and becasue their parents or someone pushed them in that direction.

 

[baggywrinkle]

Originally posted by dgroulx
I'm not trying to argue, but you have a misconception about what's involved in pharmacy school. I can only look at the school that I attend and try to give you a picture of the curriculum.


I'm not trying to say that pharmacy school is more intense than medical school, as I am sure it is not. It just seemed that you were unaware of the type of classes we take. I didn't mention the easy classes, such as learning patient skills. Those don't require any study time. They just want to teach bedside manner, since we will be dealing with patients on a day-to-day basis.

I chose to go to pharmacy school, just like most everyone else on this board. Could I have gone to medical school? Absolutely. I preferred pharmacy.

What you said ... back in the day, and I am confident it has only
become more rigorous. University of Iowa COP students attended
all of the general hard science classes with the med students including micro/biochem/pharm-tox. Then while the med students were off studying the art of the diagnostician we were plyed with a year and a half of medicinal chemistry, two years of therapeutics which was drug-disease oriented (Koda/Kimble) and two years of pure pharmaceutics. Not counting clinical rotations. A
pharmacist graduates with more chemistry than a chemistry major with most of the liberal arts core stuff deleted in favor of the chemistry load.

I rather prefer the term diagnostician to clinician. That turf
is reserved for the guy that makes the big bucks and he can have it. But with the diagnosis safely on the chart, the physician can delegate pharmaceutical management to the properly trained PharmD of today. One of the goals hospital pharmacy strives for is for medical staff to feel confident enough to write for a parental nutrition consult by pharmacy services, or a specific aminoglycoside per pharmacy protocol, then turn his attention to other things knowing it will be taken care of.
That is what the healthcare team is all about

IMHO, and in actual practice, the effective PharmD will not and should not be called Doctor. If he is effective and accepted by medical staff/nursing/patients it will be first name only please. Think about it. Who would nervous Mrs Smith prefer to speak with about the coumadin she is being sent home with? Someone who puts her at ease or another white jacket?

 

[profunda]

Have you been on a med school admissions committee, and know the exact factors they select students? If not, then you wouldnt know if you would ever get in or not. Stats dont tell it all because there are a lot of ECs and experiences that enhance one's CV. I can easily say I could've gotten in the top ivy league PhD program with my stats, but of course, it's easier said than done. Dont make these statements until you have proven it.

All I know is, a lot of my friends got into ucsf pharm (#1 pharm school?) and didnt get into any med school, and didnt even get an interview at any california med school. It doesnt really prove anything but that was my observation. And if you were confident about your choice of career, you wouldnt be making claims like that. I dont go around saying I could've gone to ivy league PhD program but chose to do something else (medicine).

Originally posted by dgroulx
I chose to go to pharmacy school, just like most everyone else on this board. Could I have gone to medical school? Absolutely. I preferred pharmacy.