What do clinical pharmacists do?

[Mcpickle]

I am just confused because they can't prescribe medications. So what is their role in a clinical setting? Do they speak to patients? Just tell them how to use their medications properly? Are they just a walking LexiComp? Gate keeper of a patient's insurance?

My school feeds us a lot of false expectations, so I'm just wondering what it's actually like.

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[mentos]

Some do rounds with the rest of the medical staff, some speak directly to patients to counsel and do MTMs. Others stay in the pharmacy and enter/verify orders, go thru the med rec and make sure everything makes sense (often there are discrepancies cause patients don't know what they take and you have to call CVS to confirm current dosing), adjust dosages for antibiotics and renal impairment, give recommendations to the prescribers (like help with vanco dosing), answer questions from nurses, do therapeutic interchanges and clinical interventions. Then there are menial tasks like sending up narcs, inventory, C2 discrepancies, refilling code carts, making IVs if there's no tech, dealing with dumb nurse calls like "where's my IV that was ordered 30 seconds ago" or "the Pyxis drawer won't open" or "I can't find this med" (did you check the fridge?). IMO all pharmacists are "clinical" it's just a dumb title people like to put in their email signature. They don't deal with insurance, that's only in retail.

 

[Pharmacy is a Scam]

Some do rounds with the rest of the medical staff, some speak directly to patients to counsel and do MTMs. Others stay in the pharmacy and enter/verify orders, go thru the med rec and make sure everything makes sense (often there are discrepancies cause patients don't know what they take and you have to call CVS to confirm current dosing), adjust dosages for antibiotics and renal impairment, give recommendations to the prescribers (like help with vanco dosing), answer questions from nurses, do therapeutic interchanges and clinical interventions. Then there are menial tasks like sending up narcs, inventory, C2 discrepancies, refilling code carts, making IVs if there's no tech, dealing with dumb nurse calls like "where's my IV that was ordered 30 seconds ago" or "the Pyxis drawer won't open" or "I can't find this med" (did you check the fridge?). IMO all pharmacists are "clinical" it's just a dumb title people like to put in their email signature. They don't deal with insurance, that's only in retail.

Here’s my take:

1. Round with medical team - You are a walking “fake Lexicomp” that provides little value to the healthcare team because it is the MD driving the discussion when discussing cases. Usually it would be the doc that says “I’m going to do XYZ pharmacotherapy for the patient”, as opposed to “hey pharmacist, what would you recommend I prescribe for the patient given their comorbidities?” There might be situations here or there where you might be asked dosing questions based on renal or hepatic issues with the patient, in which case you will likely say that I will confirm the dose with you and promptly go look it up on the real Lexicomp. For the “seasoned” clinical pharmacists, they will have looked up the exact same things a billion times so they can recite dosing recommendations on the spot and therefore look like they are an “active participant” in rounds.

2. Speaking directly to patients and doing counseling, MTMs, med recs etc - I’ve literally had nurses and PAs done med recs for me when I go to the hospital and literally anyone can do this. What they teach you in school is definitely not what happens in real practice. Med rec is literally bringing a list of meds you have on record and going down the list with the patient, asking them “are you on this medication?” “what is the spelling of the med you’re on that’s not on this list?” etc — notice this does not require any clinical acumen at all. For MTMs, the irony of this is that most hospital pharmacists do not want to do discharge MTM counseling to patients because they don’t want to talk to people, so these tasks are often relegated to students or residents.

3. Enter/verify orders and dose vanco/anticoagulants - oH hEy LoOk At Me I rEaD fRoM a ChArT aNd FoUnD tHe RiGhT dOsE fOr VaNcO i’M “cLiNiCaL”. Also, enter/verify orders is the same function as verifying in retail — a task that will be automated in the future because a tech can do it once they get an expanded scope of practice.

4. “Sending up narcs, inventory, C2 discrepancies, refilling code carts, making IVs if there's no tech, dealing with dumb nurse calls like ‘where's my IV that was ordered 30 seconds ago’ or ‘the Pyxis drawer won't open’ or ‘I can't find this med’”- Again, basically more tech duties that you can pay someone $15/hr to do.

5. Doing other “clinical interventions” - well guess what you’re not the MD so you can pretend to say you can do this but all your “interventions” are “recommendations” at best which will need MD authorization to implement. What a misnomer of a word.

The bottom line? “Featherbedding” is what I think of when I think about what a typical hospital clinical pharmacist does.

 

[pharmBear]

Sad but true.

Although, sometimes you get lucky and a md resident truly are dependent for the first few months while they get their feet wet.

In general, clinical pharmacist looks at patient charts alot and make reccomendations. If there are collaborative agreement in place, then they make decisions.

 

[researchpharma]

Here’s my take:

1. Round with medical team - You are a walking “fake Lexicomp” that provides little value to the healthcare team because it is the MD driving the discussion when discussing cases. Usually it would be the doc that says “I’m going to do XYZ pharmacotherapy for the patient”, as opposed to “hey pharmacist, what would you recommend I prescribe for the patient given their comorbidities?” There might be situations here or there where you might be asked dosing questions based on renal or hepatic issues with the patient, in which case you will likely say that I will confirm the dose with you and promptly go look it up on the real Lexicomp. For the “seasoned” clinical pharmacists, they will have looked up the exact same things a billion times so they can recite dosing recommendations on the spot and therefore look like they are an “active participant” in rounds.

2. Speaking directly to patients and doing counseling, MTMs, med recs etc - I’ve literally had nurses and PAs done med recs for me when I go to the hospital and literally anyone can do this. What they teach you in school is definitely not what happens in real practice. Med rec is literally bringing a list of meds you have on record and going down the list with the patient, asking them “are you on this medication?” “what is the spelling of the med you’re on that’s not on this list?” etc — notice this does not require any clinical acumen at all. For MTMs, the irony of this is that most hospital pharmacists do not want to do discharge MTM counseling to patients because they don’t want to talk to people, so these tasks are often relegated to students or residents.

3. Enter/verify orders and dose vanco/anticoagulants - oH hEy LoOk At Me I rEaD fRoM a ChArT aNd FoUnD tHe RiGhT dOsE fOr VaNcO i’M “cLiNiCaL”. Also, enter/verify orders is the same function as verifying in retail — a task that will be automated in the future because a tech can do it once they get an expanded scope of practice.

4. “Sending up narcs, inventory, C2 discrepancies, refilling code carts, making IVs if there's no tech, dealing with dumb nurse calls like ‘where's my IV that was ordered 30 seconds ago’ or ‘the Pyxis drawer won't open’ or ‘I can't find this med’”- Again, basically more tech duties that you can pay someone $15/hr to do.

5. Doing other “clinical interventions” - well guess what you’re not the MD so you can pretend to say you can do this but all your “interventions” are “recommendations” at best which will need MD authorization to implement. What a misnomer of a word.

The bottom line? “Featherbedding” is what I think of when I think about what a typical hospital clinical pharmacist does.

The way you’ve described the hospital pharmacist’s role sounds about right, but this “featherbedding” saves a hospital about $400k/year. I would liken having pharmacists on board to hiring consultants, because it feels like what the hell do consultants even do? But they are hired to save a company time/money. If you break down each activity of the job, it seems menial and “outsourceable”, but you are downplaying the value of expertise. For all the readmissions that pharmacists prevent, they are worth what they are paid.

 

[Pharmacy is a Scam]

The way you’ve described the hospital pharmacist’s role sounds about right, but this “featherbedding” saves a hospital about $400k/year. I would liken having pharmacists on board to hiring consultants, because it feels like what the hell do consultants even do? But they are hired to save a company time/money. If you break down each activity of the job, it seems menial and “outsourceable”, but you are downplaying the value of expertise. For all the readmissions that pharmacists prevent, they are worth what they are paid.

Yes, a consultant is a good analogy but that is the exact problem with the value proposition of a pharmacist — you bring value through “cost avoidance” vs. “generating revenue” so it is much harder to justify new FTEs and demonstrate incremental ROI. So when hospitals are looking to trim dollars, they will be expecting MORE ROI from their existing pharmacists than look to add new FTEs, whereas revenue generating personnel such as PAs, NPs and MDs aren’t going to have “value proposition” issues because they can bill directly and so revenue can be directly attributed to who provided the reimbursable service. In addition, a $400k/year (or whatever value hospitals say it is) value prop for pharmacists is made up through extremely exaggerated estimates from literature around cost savings from impacting “avoidable adverse drug events” or “frees up FTE hours for other practitioners like nurses.” Such arbitrary calculations read like research papers and are inherently biased as the assumptions are likely cherry-picked to maximize proof of ROI dollars for pharmacists. This is an example of a “business case” for a pharmacist FTE and let me tell you, my head hurts just trying to figure out how they come up with these numbers:

WA Patient Safety

www.wapatientsafety.org

To drive home the point, if an average pharmacist FTE saves $400k/year at a hospital, then the incremental ROI of adding a new pharmacist FTE is much less than $400k unless the hospital gets a proportionate increase in patient volume (opportunities for cost savings) to go with that. Otherwise, if each pharmacist saves a hospital $400k and the hospital spends $50m in healthcare costs each year, then why don’t they hire 100 new pharmacists to close that gap? That logic doesn’t make sense.

Furthermore, many of the cost-savings activities are turned into standardized protocols, baked into workflow or improved by automation/technology, and once those processes are in place then you’re back to square one in terms of having to prove your value (because at that point you won’t be able to say “I save you $400k/year, I should have job security”. They can fire you easily and hire a fresh grad for much cheaper and give them the “cost-savings” protocols you built and not skip a beat. So the way I see it is that the future of hospital pharmacy is in IT/informatics as they are the personnel who will be able to generate novel methods of cost-savings for years to come, not a Med Rec pharmacist whose value is tied to what a research paper from 20 years ago says.