Why are physicians concerned? AMA scope of practice document

[Jetninjin]

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I am not belittling or insulting the profession. I respect pharmacists and want to shake your hand, give you a hug, and simply say, "Thank you for all of your hard work that is often times behind the scenes and unknown to us, nurses and patients." You guys are important.

But when you disrespect what we do on a daily basis and insinuate you can do it better, I don't respect that pharmacist.

Now which is it? Am I afraid, or egotistical to the point of a god complex? I prefer to think neither and realize the importance of what we do should not lightheardedly be usurped at the broad sword of political scope of practice expansions. I will consider the idea of a huge ego when the people who have spent 4 years studying drugs (pharmacists) are asked questions and the first thing they do is go to epocrates or lexicomp or micromedex. You'll realize this once you are actually out on your 4th year rotations. How can one not?

The previous poster above citing the positive and negative trials of expansion I respect that. If there is good evidence that shows you can markedely do so with either economic or financial improvements, go for it, knock yourselves out. Please don't do it by politics, all that does is cause both professions to waste money on politicians. But from what I know of what goes into doing our job, there will likely be very limited issues for you to claim as your own. You do coumadin and vanc dosing at the moment, am I missing any others?

But to draw attention to the $80-120 office visit is a red herring. A patient who is so healthy that lipids or one other issue are their only problem are usually seen once a year anyways, and an anual physical is performed. You also forget the benefit of the longitudinal patient-physician relationship and being able to know your patient, so when they do come in the future, you know when the are sick, and you when something is wrong behaviorally. When you start throwing in other providers that is gone. That is destroyed and patients feel disenfranchised from being punted every where. Now directly addressing the costs, there are such things as fixed overhead. Retail clinics who are targeting that cost you speak so ill of are actually withdrawing from certain markets. They have found the balance in this market for "low lying fruit" of low acuity patients. If CVS, walgreens, etc feels it is easier to have an NP do it, why do you think you will be able to do it better? Why would you want to spend your day doing that if not for money? You already have a rich intellectual niche, why add more boring repitious management? If any one is money hungry it is those corporations before it would be a physician...

How is it you spent 8 years learning pharmacology? Pharmacy residencies only extend at most to two years. Pharmacy school is 3-4 years. Now if you are upset that pharmacy kicked off the degree inflation and now wants to mandate a bachelors prerequisite, I would be upset too. That's academic highway robbery. And then to consider you guys are trending towards residencies that mostly use as slave labor rather than truly instruct or offer unique unobtainable knowledge (where just a few years ago a fresh grad performed just fine in), I would again be ticked off too. All the while, bachelors RPH pharmacists know just as much, and so I've heard second hand, actually know how to compound better then new grads.

If you are an independent pharmacy practitioner, as you allude to (even though you show as student), you are my hero. That is the type of pharmacist I would like my patients to go to in the future. You are the person who I would love to get phone calls from because I would know you personally. My patients would also know you. That means what you have to say carries more weight and can even be insightful if patients are having behavioral changes, aren't filling the scripts, etc. CVS and walgreens have destroyed what independents still fight for. Please keep up the good fight if that is your goal or actual practice setting.

Really, why are you here? It's tedious to look past your insults of new grads, but I will because it's a red herring.

You keep talking about these physician-patient relationships -- what relationships? That's old school stuff right there. You guys are in and out of the exam rooms these days - you have to be. With few exceptions, you're not making small talk and noticing small variations in patient temperament.

Bottom line: you are expensive, disliked, and there are too few of you especially with health care reform bringing millions of new patients. Nurses/PAs etc are cheaper, rapidly outnumbering you, outlobbying you and do not have NEARLY the horrible PR baggage you have. People are not out for our blood - they are out for yours and that of your perceived Mercedes and perceived vacation homes. We fly under the radar -- you most definitely do not. In the meantime, there are millions of new patients to be treated, and the above professions (as well as podiatrists, optometrists, et al) are lobbying for a bigger piece of the pie. Lobbying very, very, very successfully I might add.

You don't stand a chance. If I were you, I'd be worried too.

 

[Sneezing]

I'm not so much worried for me, but for my family. My aging parents and some day my kids. I worry about the future of medicine that our country is allowing to regress in quality. Being patient centered for medical quality are my beliefs. At your wish, I'll go back to my normal corner of SDN.

 

[aboveliquidice]

Really, why are you here? It's tedious to look past your insults of new grads, but I will because it's a red herring.

You keep talking about these physician-patient relationships -- what relationships? That's old school stuff right there. You guys are in and out of the exam rooms these days - you have to be. With few exceptions, you're not making small talk and noticing small variations in patient temperament.

Bottom line: you are expensive, disliked, and there are too few of you especially with health care reform bringing millions of new patients. Nurses/PAs etc are cheaper, rapidly outnumbering you, outlobbying you and do not have NEARLY the horrible PR baggage you have. People are not out for our blood - they are out for yours and that of your perceived Mercedes and perceived vacation homes. We fly under the radar -- you most definitely do not. In the meantime, there are millions of new patients to be treated, and the above professions (as well as podiatrists, optometrists, et al) are lobbying for a bigger piece of the pie. Lobbying very, very, very successfully I might add.

You don't stand a chance. If I were you, I'd be worried too.

We lose more neighbors this way... We really need to work on our demeanor - The attack now read later mentality is running wild (myself included).

 

[patmcd]

We lose more neighbors this way... We really need to work on our demeanor - The attack now read later mentality is running wild (myself included).

Exactly. If we can't play in the sandbox without kicking it, why should we expect that other professions do?

 

[type b pharmD]

I'm not so much worried for me, but for my family. My aging parents and some day my kids. I worry about the future of medicine that our country is allowing to regress in quality. Being patient centered for medical quality are my beliefs. At your wish, I'll go back to my normal corner of SDN.

there are simply not enough resources. We will need serious and intelligent rationing of care.

 

[Regnvejr]

...So why is it so disturbing to me? It is disturbing that the AMA is yet again putting being political over what is in the best interest of patients (the same thing happened over pharmacist's right to immunize).

There are really good reasons why I am NOT an AMA member. I agree with your observation. They are much more into political favors than actual physician care for patients.

 

[Regnvejr]

I don't think so. With the other medication I was picking up with it, it should have been pretty clear to someone knowledgeable what the doctor had prescribed it for.

Once you're done, you will realize that lots of things are prescribed outside of what they're "made" for.

Not an attack on pharmacists, just saying they are not all walking encyclopedias on every drug known to man, but that can't come as a big shock to you guys, can it?

But they day you get a call from a pharmacist asking if you meant to write what you did, and your reply is "Oh please God, no. Cancel that script," then you see the true value of everybody working together for the patient. Turf wars are stupid crap, we are ALL to busy.

Pharmacists, just like nurses, are your security to make sure that after 20 hrs on and seeing everything blurry, you don't kill your patient.

 

[kbv]

Once you're done, you will realize that lots of things are prescribed outside of what they're "made" for.
But they day you get a call from a pharmacist asking if you meant to write what you did, and your reply is "Oh please God, no. Cancel that script," then you see the true value of everybody working together for the patient. Turf wars are stupid crap, we are ALL to busy.

Pharmacists, just like nurses, are your security to make sure that after 20 hrs on and seeing everything blurry, you don't kill your patient.

After I asked an MA if OB-GYN was aware of the major drug-health condition interaction, I got a phone call from the OB-GYN questioning me why I asked what I asked (how dare me huh?)

Of course not--isn't anybody??? We can't work over 12 hours/d even if we want to. That's why you have DNPs, etc...., isn't it?

 

[Regnvejr]

After I asked an MA if OB-GYN was aware of the major drug-health condition interaction, I got a phone call from the OB-GYN questioning me why I asked what I asked (how dare me huh?)

A physician annoyed that a pharmacist alerts to potential problems? What an ass.

 

[kbv]

Why do physicians feel threatened by the increase in pharmacists' involvement in patient care. Do they believe that we are out there to try to take their jobs/authority? I thought we were there to help them take care of patients and prevent medication errors by making recommendations and interventions. How is this a bad thing?

http://www.pharmacist.com/AM/Template.cfm?Section=Home2&CONTENTID=23151&TEMPLATE=/CM/HTMLDisplay.cfm

I'm glad they are concerned and feel threatened; they are reminded they aren't the ONLY.

 

[Sparda29]

 

[Fridko]

Interesting posts so far. I agree, turf wars end up hurting the patient in the end. However, when it comes to job security, I can understand why certain groups get upset and say its not safe for the patient. A few examples:

Pharmacists can give injections --> Nurses say its not safe!

NPs can see patients and write Rx's --> Docs say its not safe!

And finally...

Pharmacy techs can do the final check on an rx and release it --> Pharms say its not safe!

A poster mentioned increased scope for regulated pharmacy technicians, but from skimming through the posts no one responded to it. What do the pharmacists think about regulated or certified pharmacy technicians who can perform many of the tasks a pharmacist can? Its happening in certain parts of Canada (I believe BC), and it will surely have large effects on pharmacists salaries and job prospects.

 

[RX CARE]

^^^Thank you for understanding.

As for the others, I'll let you in on the real secret. The job and role of pharmacy is to double check and watch out backs for the few times we slip up and things go wrong. Your job is not to tell us how to choose the right medication. We go to medical school to put the whole big picture together. The biopsychosocial profile of the patient in the context of each and everyone of their diseases. Looking in from the outside thinking you can do our job of prescribing is just ignorance.

Medicine will never split off where we just diagnose and you handle medicines. There is a reason why our degrees say Doctor of MEDICINE, Doctor of Osteopathic MEDICINE, MEDICAL Bachelors and Bachelors of Surgery. That is our job. Not yours. Furthermore the sad truth from what I have seen of clinical pharmacists and pharm students on services isn't very impressive. They get pimped a question and the first thing they do is whip out their iPhone lexicomp or epocrates. I can do that myself. Do you really have some extra magical set of knowledge that we don't, or have access to?

Furthermore to think that patients routinely only show up to visits just for a lipid check is again ignorant. It is a rare patient that shows up without an additional complaint, or simply further work. You are not trained to handle the "more" that comes walking through that door every day. Adding more cooks in the kitchen only spoils the stew.

You guys earn your keep with every day work in hospital pharmacies and retail watching for our screwups. You also earn your keep when involved in residencies to help us get up to speed with lectures and questions we were too lazy to look up or by identifying frequent mistakes we make. You also earn your keep when there are really crazy situations that you just might have a better monograph or insight on from experience - this is the realm of the old seasoned pharmacist burried deep in the hospital basement, or the new grad who busted their rear in school.

You guys are feeling threatened and angry because retail pharmacy is getting kicked around by CVS and others. Your schools are opening up way too fast and now you will have to start competing against yourselves. The glory years are ending. You have lost (for the most part) the ability to have freedom to open your own shop. Because you are trapped in a hard place, you realize the future isn't so bright and you feel the sinking socialized medical ship is the ticket out. So now you want to try and jump on some way to get reimbursed directly by CMS, to be rewarded for your training. This is an illusion being fed to you by your schools faculty telling you can do more. Don't blame us, blame them. Coumadin clinics just don't do it for you, so now you want to be like the third world countries and prescribe what ever you want. There is a reason why they are third world countries letting pharmacists prescribe...

Pharmacy already has a clearly defined role. If you want more go to medical school or become a PA. We respect the pharmacist that acts and works like a pharmacist. But when you have the audacity to say you can do our job, and by default imply you can do it better, you bet we get angry.

Thank you to all the pharmacists out there who do their job and save our rear ends, and ultimately the patients. We thank you. (The others we don't thank)

Not really picking sides in this whole argument. While some of your points are valid and understandable, the very reason we have these misunderstandings in health care inter-relationships is that many people are not open minded. However, I just want to elute to your bolded comments above. You have to admit that just about every profession has phases were people are novices, amateurs and seasoned pros. Pharmacists are definitely exposed to SO MANY drugs in the classroom, and while your expectation is that a student on rotation should be able to spit out everything on demand, you should cut people some slack in being novice practitioners. I am sure it also applies to medicine, and I have seen interns and residents choke on questions and I see it as part of the learning process, and in no way think they are inadequate. EVERYBODY can look ANYTHING up.....heck even WebMD does diagnosis nowadays. But you have to agree with me that it comes down to INTERPRETING information as it applies to and is relevant to a specific situation. That's why our training stresses INDIVIDUALIZING therapy. Now, not sure how much of experienced clinical pharmacists you've been exposed to, and I hope you do, and you would become open minded and retract what you said. Experienced clinical pharmacists are very knowledgeable about drugs, to the extent that you wouldn't be able to fathom if you don't want to acknowledge it. All my role models are people whom when I hear them talk about drugs, I stand in awe. So my point is either you really haven't met clinical pharmacists, whom although are not walking encyclopedias, but will seem to have that ''magical set of knowledge'' , or you are close-minded or limited in exposure, and I challenge you to meet those clinical pharmacists who are invaluable to their teams. One of my preceptors usually gets waited on before rounds begin. If she is not there, they'll ask where she is, and if she's running late they'll hold on for a few minutes. Those are the pharmacists changing the profession through clinical knowledge, and a lot of students are en route to get there. Of course, they can't get there overnight.

 

[Sparda29]

Interesting posts so far. I agree, turf wars end up hurting the patient in the end. However, when it comes to job security, I can understand why certain groups get upset and say its not safe for the patient. A few examples:

Pharmacists can give injections --> Nurses say its not safe!

NPs can see patients and write Rx's --> Docs say its not safe!

And finally...

Pharmacy techs can do the final check on an rx and release it --> Pharms say its not safe!

A poster mentioned increased scope for regulated pharmacy technicians, but from skimming through the posts no one responded to it. What do the pharmacists think about regulated or certified pharmacy technicians who can perform many of the tasks a pharmacist can? Its happening in certain parts of Canada (I believe BC), and it will surely have large effects on pharmacists salaries and job prospects.

Here's the thing about pharmacy technicians doing final checks, they do not know about the millions of drug interactions out there.

 

[MountainPharmD]

Here's the thing about pharmacy technicians doing final checks, they do not know about the millions of drug interactions out there.

Neither do the majority of Pharmacists.

I wouldn't say there are millions. There are only a handful of really serious ones that would require any action. I would say the biggest thing that pops up most often is drug allergy conflicts. A Doc in a box prescribes PCN and the patient forgot to tell them they were allergic. Warfarin antibiotic interactions come up often as well.

 

[Sparda29]

IMO, instead of expanding scope of practice, perhaps the best thing would be for healthcare providers to use a linked computer system database that has the patients complete medical history, drug history on it.

 

[MountainPharmD]

As for the others, I'll let you in on the real secret. The job and role of pharmacy is to double check and watch out backs for the few times we slip up and things go wrong.

No, that is not the job and role of a Pharmacist. I would say dealing with Doctor mistakes accounts for less than 1% of my time. I certainly would characterize this as my job.

You guys are feeling threatened and angry because retail pharmacy is getting kicked around by CVS and others. Your schools are opening up way too fast and now you will have to start competing against yourselves. The glory years are ending. You have lost (for the most part) the ability to have freedom to open your own shop. Because you are trapped in a hard place, you realize the future isn't so bright and you feel the sinking socialized medical ship is the ticket out. So now you want to try and jump on some way to get reimbursed directly by CMS, to be rewarded for your training. This is an illusion being fed to you by your schools faculty telling you can do more. Don't blame us, blame them. Coumadin clinics just don't do it for you, so now you want to be like the third world countries and prescribe what ever you want. There is a reason why they are third world countries letting pharmacists prescribe...

There is a lot of truth here. CVS and Walgreens own the profession and are systematically destroying it everyday. We will soon have a glut of Pharmacists because schools are still cranking out graduates as if it were 2004 and Walgreens and CVS still had plans to open 10,000 stores each.

I think the future is bright for pharmacy as long as you are not in retail. There are a lot of opportunities out there to do some good. The collaborative practice arrangement the Veterans Affairs has is a model for our future. Pharmacists working in conjunction with physicians to best take care of the patient. Imagine applying the VA’s system in the civilian world. The out comes for all would be greatly improved.

What I feel is being lost in the debate is that there are gray areas, such as the monitoring aspect, that have no firmly established caretaker of those areas in health care. In the example that I posited above, my point was that you don't need a doctor's visit to check a person's blood pressure and run a lipid panel. A patient does not need to spend $80 every 6 months to a year only to receive the exact same prescription. In these cases, another healthcare professional can monitor those values for the patient, and if there is no change, then they can tell the doctor that the values are at baseline and that they can fax in a new refill for the patient.

I sort of see the point you are trying to make but it doesn’t really make sense. The “monitoring aspect” isn’t a gray area. It falls under the responsibility of the prescribing physician to monitor therapy. You could argue that a physician with 4000 active patients doesn’t have the time to properly monitor his patients. A pharmacist is certainly qualified to help the physician do this. So is a nurse and they could do it for a third to half the cost of a pharmacist.

Your statement bemoaning the fact patients have to pay $80 every six months to see the Doctor doesn’t make much sense either. You suggest another healthcare professional could do this. Is the other healthcare professional going to do this for free? The Doctor sees the patient every six months so they can monitor their condition, see if anything has changed and decide to continue therapy or change it. Is it unreasonable for them to charge for this? If they didn’t charge for this they would be out of business or the initial visit would be $2,000.

 

[Pharmacy Kid]

^^^Thank you for understanding.

As for the others, I'll let you in on the real secret. The job and role of pharmacy is to double check and watch out backs for the few times we slip up and things go wrong. Your job is not to tell us how to choose the right medication. We go to medical school to put the whole big picture together. The biopsychosocial profile of the patient in the context of each and everyone of their diseases. Looking in from the outside thinking you can do our job of prescribing is just ignorance.

Pharmacy already has a clearly defined role. If you want more go to medical school or become a PA. We respect the pharmacist that acts and works like a pharmacist. But when you have the audacity to say you can do our job, and by default imply you can do it better, you bet we get angry.

I know you don't like other professions prescribing and I don't blame you. However, it's already happening. The pharmacist I work with prescribes for chronic disease states (BP, DM, high chol). He pimps me on what drug therapy the pt should get and if I'm right, I get to write the A&P and call in the scripts.

Also, I know I've said this before but people need to realize there are well-trained pharmacists who can diagnose and prescribe. The thing is to make sure they are well-trained and undergo constant education to maintain their knowledge/skills. Here are some links of these Pharmacy Practitioners.

Pharmacist Clinician / Practitioner
http://www.usphs.gov/corpslinks/pharmacy/clinpharm/practices/pcp.html
"Training for this type of practice and scope is certainly unique. Although our pharmacy degrees prepare us for clinical work, there is more physical assessment and diagnostics involved. For this practice, we have had extensive accommodative training through both preceptorships and one-on-one training – more similar to a Physician Assistant or Certified Nurse Practitioner externship"


Multiple Disease Management Clinics
http://www.usphs.gov/corpslinks/pharmacy/clinpharm/practices/mdmc.html

" All the pharmacists practice in an expanded role and have some level of prescriptive authority, laboratory authority and limited physical assessment."

http://www.ascp.com/publications/tcp/1996/sep/collab.html

New Mexico
State recently broadened the scope of pharmacy practice by creating a new category of practitioner called "pharmacist clinician," who are allowed to prescribe medications under written guidelines or protocols. Pharmacist clinician is defined as a pharmacist who has at least as much training as a physician assistant.
**This was from 1996, I believe this has spread to Arizona, South Carolina, North Carolina, Texas, and Alaska.

 

[Pharmacy Kid]

Coumadin clinics just don't do it for you, so now you want to be like the third world countries and prescribe what ever you want. There is a reason why they are third world countries letting pharmacists prescribe...

I didn't know European countries and Canada were considered third world.

 

[spacecowgirl]

I didn't know European countries and Canada were considered third world.

Have you been to the slums of Toronto lately? Horrifying.

I have no desire to diagnose nor do I have the knowledge. I do have the training and knowledge to adjust and monitor therapy and I'm doing that right now. I live in an area that is forever short on PCPs; we are nearly constantly recruiting and accessibility is always an issue for patients. Until this shortage is resolved (never) midlevels, including pharmacists with CPAs, are going to have to fill the gap. I wonder how AMA has addressed that issue? Not snarky, I truly don't know their stance on the FP/PCP shortage.

To be honest, I have had few circumstances in my personal health where I gained any new knowledge from seeing a doctor. My favorite provider I've had was a CNM I saw while I was a student. She spent more time with me and was more caring and invested than any gyno I have ever seen. For every "House" there are a thousand FP doctors who know less about pharmacotherapy than I do.

 

[CanPharm]

Interesting posts so far. I agree, turf wars end up hurting the patient in the end. However, when it comes to job security, I can understand why certain groups get upset and say its not safe for the patient. A few examples:
Pharmacists can give injections --> Nurses say its not safe!
NPs can see patients and write Rx's --> Docs say its not safe!
And finally...
Pharmacy techs can do the final check on an rx and release it --> Pharms say its not safe!
A poster mentioned increased scope for regulated pharmacy technicians, but from skimming through the posts no one responded to it. What do the pharmacists think about regulated or certified pharmacy technicians who can perform many of the tasks a pharmacist can? Its happening in certain parts of Canada (I believe BC), and it will surely have large effects on pharmacists salaries and job prospects.

To clarify, the pharmacy technicians will perform many of the pharmacists' TECHNICAL tasks. Tasks that no pharmacist should be spending most of their time doing.
From the BC college of pharmacists:
Scope of Practice:
Specifically, regulated pharmacy technicians will have independent authority, responsibility and liability (required by HPA Bylaw 78 to have liability insurance) to prepare, process and compound prescriptions, including:
receive verbal prescriptions from practitioners,
ensure that a prescription is complete and authentic,
transfer prescriptions to and receive prescriptions from other pharmacies,
ensure the accuracy of a prepared prescription,
perform the final check of a prepared prescription, and
ensure the accuracy of drug and personal health information in the PharmaNet patient record.
Pharmacists will continue however, to be involved in every new and refill prescription as they remain solely responsible for assessing the appropriateness of drug therapy (patient assessment, confirm dose and interval, check PharmaNet profile, and identify drug interactions) and for providing patient consultation. A prescription cannot be released to a patient without a pharmacist having performed these cognitive functions.
"The final check" is basically making sure the right drug is physically in the right labelled bottle and that it is going to the right patient. Again, a task that a pharmacist doesn't need to do. I think that's great!
I don't know how this will affect salary and positions, but I do know that pharmacists will still need to be in every pharmacy (unless its a rural satellite), and will have much more time doing cognitive work and potentially expanding the profession's role in patient care.
If anything, I think this change will make the pharmacist position more secure. Since pharmacists are no longer stuck doing "pharmacist only" technical tasks, there is no longer a strong reason to consider technicians to do counselling, OTC recommendations, etc (hypothetically/potentially). With this legislation, employers will only want technicians to do technical things, limiting their expansion due to the large technical workload. Only time will tell.

 

[MountainPharmD]

....to prepare, process and compound prescriptions, including:
receive verbal prescriptions from practitioners,
ensure that a prescription is complete and authentic,
transfer prescriptions to and receive prescriptions from other pharmacies,
ensure the accuracy of a prepared prescription,
perform the final check of a prepared prescription, and
ensure the accuracy of drug and personal health information in the PharmaNet patient record.

"The final check" is basically making sure the right drug is physically in the right labelled bottle and that it is going to the right patient. Again, a task that a pharmacist doesn't need to do.

I think it is only a matter of time before we see most if not all of this. It does not take a PharmD to make sure the pill in the bottle matches the picture of the pill on the screen. Yet as retail Pharmacists we spend 90% of our time doing just that. I like the transfer and new prescription part. I do not understand why the Doctor can designate any idiot they want to call in prescriptions yet a Pharmacist is the only one who can take a verbal order for a new prescription.

Pharmacists will continue however, to be involved in every new and refill prescription as they remain solely responsible for assessing the appropriateness of drug therapy (patient assessment, confirm dose and interval, check PharmaNet profile, and identify drug interactions) and for providing patient consultation. A prescription cannot be released to a patient without a pharmacist having performed these cognitive functions.

I don't know how this will affect salary and positions, but I do know that pharmacists will still need to be in every pharmacy (unless its a rural satellite), and will have much more time doing cognitive work and potentially expanding the profession's role in patient care.
If anything, I think this change will make the pharmacist position more secure. Since pharmacists are no longer stuck doing "pharmacist only" technical tasks, there is no longer a strong reason to consider technicians to do counselling, OTC recommendations, etc (hypothetically/potentially). With this legislation, employers will only want technicians to do technical things, limiting their expansion due to the large technical workload. Only time will tell.

There are a couple of things you need to consider. Technicians would love to have the increased responsibility. They would be crazy to accept it without a big increase in pay. As a consequence Pharmacists hours will be cut to compensate and any Pharmacist overlap would be eliminated. It sounds good but I fail to see how this would make a Pharmacists position more secure.

 

[StaviZFingerZ]

There are a couple of things you need to consider. Technicians would love to have the increased responsibility. They would be crazy to accept it without a big increase in pay. As a consequence Pharmacists hours will be cut to compensate and any Pharmacist overlap would be eliminated. It sounds good but I fail to see how this would make a Pharmacists position more secure.

If techs can dispense without pharmacists, it will create great opportunities for indys to comback. If I can pay techs $45,000 per year instead of $150,000 (salary + benefits) for a pharmacist, I can get rich owning retail joints.

👍

 

[Silvermist]

This is Australia, but it is new law and pertinent to the discussion ...


http://www.6minutes.com.au/articles/z1/view.asp?id=516442

AMA slams new pharmacist prescribing rights

by Michael Woodhead

The AMA has slammed moves to give pharmacists the power to issue repeat prescriptions for oral contraceptives and lipid lowering drugs.

In the latest Community Pharmacy Agreement, the government has agreed to explore "medication continuance" by which pharmacists will be allowed to supply a single standard pack of continuous therapy medicine to a patient without a prescription, under specific circumstances.,

While the move will require ratification by all states and territories, AMA president Dr Andrew Pesce says it represents a dangerous policy shift that has been introduced without any consultation with the medical profession.

"The Government's decision to allow pharmacists to dispense prescription medications without a prescription is a threat to patient safety by ignoring the skills and expertise of family doctors and the importance of the doctor-patient relationship," Dr Pesce said in a statement today

"Current arrangements allow pharmacists to dispense emergency supplies of medications where a patient has inadvertently run out of necessary medication, so there is no reason to introduce these changes on the basis of patient safety,".

Dr Pesce said ‘medication continuance' was another name for pharmacist prescribing, but pharmacists did not have the training to prescribe, and most did not even have adequate examination rooms for full assessment of a patient.

"It would be inappropriate to have … a conversation [about oral contraception] with a patient over a shop counter. Even under the current arrangements, if emergency contraception dispensing is necessary, the pharmacist should ensure an appointment is made with the patient's GP."

Dr Pesce said the decision sends a clear signal that the Government intends to carve up the traditional role of the local family doctor.

"This is a bad decision by the Government and the AMA will be protesting loud and long to the Minister and the Prime Minister. If this is a taste of the primary care reform the Government has planned, the future of quality health care in this country is under serious threat," Dr Pesce said.

4 May 2010

 

[Socrates25]

I'll make a deal with you guys (I'm an MD)

I'll gladlly give you guys full prescription rights to whatever drug you want. In return, you agree to let pharmacy techs do all drug dispensation, mediction interaction checks, compounding, drug counseling SOLO without your "supervision" or "collaboration"

I suspect none of you would accept that offer, which shows that you are hypocrites just like everybody else who wants to bring down teh big bad MDs. You all say that you are just as good or more cost effective than we are, but when it comes to your subordinates like pharm techs, all of a sudden the tune changes.

What goes around comes around. If the deal I describe above came to fruition, I suspect about 90% of you would be without a job in about 5 minutes. The bottom line is that the VAST majority of the work you guys do is dispensation related. A handful of you would actually become successful pseudo-MDs with your full prescription ability, but in most places you wouldnt be able to pull it off successfully, even with the same script rights as an MD.

 

[p-rog]

I'll make a deal with you guys (I'm an MD)

I'll gladlly give you guys full prescription rights to whatever drug you want. In return, you agree to let pharmacy techs do all drug dispensation, mediction interaction checks, compounding, drug counseling SOLO without your "supervision" or "collaboration"

I suspect none of you would accept that offer, which shows that you are hypocrites just like everybody else who wants to bring down teh big bad MDs. You all say that you are just as good or more cost effective than we are, but when it comes to your subordinates like pharm techs, all of a sudden the tune changes.

What goes around comes around. If the deal I describe above came to fruition, I suspect about 90% of you would be without a job in about 5 minutes. The bottom line is that the VAST majority of the work you guys do is dispensation related. A handful of you would actually become successful pseudo-MDs with your full prescription ability, but in most places you wouldnt be able to pull it off successfully, even with the same script rights as an MD.

 

[WVUPharm2007]

I'll make a deal with you guys (I'm an MD)

I'll gladlly give you guys full prescription rights to whatever drug you want. In return, you agree to let pharmacy techs do all drug dispensation, mediction interaction checks, compounding, drug counseling SOLO without your "supervision" or "collaboration"

I suspect none of you would accept that offer, which shows that you are hypocrites just like everybody else who wants to bring down teh big bad MDs. You all say that you are just as good or more cost effective than we are, but when it comes to your subordinates like pharm techs, all of a sudden the tune changes.

What goes around comes around. If the deal I describe above came to fruition, I suspect about 90% of you would be without a job in about 5 minutes. The bottom line is that the VAST majority of the work you guys do is dispensation related. A handful of you would actually become successful pseudo-MDs with your full prescription ability, but in most places you wouldnt be able to pull it off successfully, even with the same script rights as an MD.

Sounds great. I'll open a pain management clinic. As long as I stay legit and crack the whip on my patients so the DEA doesn't get pissy...move out to one of those declining rust belt towns...I'll have it made. Push that legislation through, playa, I gots some Vikies to push...

---

Also, I don't think your proposal correlates too well with what we are talking about, anyway...

 

[MountainPharmD]

Sounds great. I'll open a pain management clinic. As long as I stay legit and crack the whip on my patients so the DEA doesn't get pissy...move out to one of those declining rust belt towns...I'll have it made. Push that legislation through, playa, I gots some Vikies to push...

---

Also, I don't think your proposal correlates too well with what we are talking about, anyway...

Health care providers with 1/10 the training of an MD being allowed to prescribing perfectly correlates with pharmacy technicians being allowed to fill, verify and counsel patients without a pharmacists supervision.

 

[Garfield3d]

Health care providers with 1/10 the training of an MD being allowed to prescribing perfectly correlates with pharmacy technicians being allowed to fill, verify and counsel patients without a pharmacists supervision.

Erm, don't nurses and PA's all have to go through a formally accredited tertiary school (as in, a college of some sort) education to get their title?

To become a Pharmacy Technician, you only need to have either a high school diploma or a GED along with passing the pharmacy technician exam.

I understand the analogy on the sense of having less specific education in a certain area, but the analogy falls apart on the level of standardizing education (ie: accreditation). I have to agree with the guy from West Virginia.

--Garfield3d

 

[Socrates25]

Also, I don't think your proposal correlates too well with what we are talking about, anyway...

Sure it does. This thread is all about how pharmacists are supposedly superior/equal to docs in terms of scripting drugs. I'm throwing that logic back in your face regarding pharm techs and exposing those of you who believe that as hypocrites.

For the same reason that you think pharm techs arent qualified to dispense is the same reason that MDs dont believe you are qualified to script.

Like I said, what goes around comes around. You want to poach on other professions turf, you're setting a precedent that will come back and bite you in the ass -- you'd better be damn prepared to defend your backside.

 

[Carboxide]

Sure it does. This thread is all about how pharmacists are supposedly superior/equal to docs in terms of scripting drugs. I'm throwing that logic back in your face regarding pharm techs and exposing those of you who believe that as hypocrites.

For the same reason that you think pharm techs arent qualified to dispense is the same reason that MDs dont believe you are qualified to script.

Like I said, what goes around comes around. You want to poach on other professions turf, you're setting a precedent that will come back and bite you in the ass -- you'd better be damn prepared to defend your backside.

I hope you can understand the difference between someone with a high school education being responsible for peoples' lives and a fellow DOCTOR who specialized in medications prescribing.

If you can't, then you're either being deliberately obtuse or you're really not that bright (Caribbean med school, maybe? )

 

[genesis09]

With techs, there is no standard of education and regulation. Most states just require a high school diploma, but here in Wisconsin, nothing is required. You don't even have to be licensed. That is not true for pharmacists, MDs, DOs, RNs, etc.

 

[WVUPharm2007]

Sure it does. This thread is all about how pharmacists are supposedly superior/equal to docs in terms of scripting drugs. I'm throwing that logic back in your face regarding pharm techs and exposing those of you who believe that as hypocrites.

For the same reason that you think pharm techs arent qualified to dispense is the same reason that MDs dont believe you are qualified to script.

Pharmacists have advanced degrees...and study years of dedicated pharmacotherapy. Technicians are high school grads (or maybe a certificate) that count by 5s or load up Pyxis machines. It does't correlate at all. You may as well claim that plumbers will one day be able to take a pharmacists' dispensing job.

NOW, if you were to introduce some sort of new degree where technicians get an associates where they aren't educated in the use of drugs therapeutically, but just on the basic properties of drug action...and ONLY do dispensing...I could see your point. Essentially, give a degree equivalent to the B.S. Pharm from the 40s that only lasted 2 years. I could see that...and I wouldn't have a problem with that...being as though I don't work retail, anyway.

 

[Silvermist]

I didn't spend 8 years total of my life to dedicate myself to protect the sorry behind of an incompetent PCP who haphazardly prescribes statins to 25 year old pregnant patients because their LDL was "a little high." What in gods name, this should never happen and yet it has happened multiple times in my short career.

This reminds me ... a couple of years ago I was a few months pregnant and went to my PCP. I was pretty congested from a cold (nose, ears, etc) so she gave me some Debrox for my ears during the course of my visit. I did not have an ear infection -- she told me this specifically -- but she said that sometimes people develop them after using things like Debrox, so she wanted me on an antibiotic. Seemed like overkill, but whatever, she's the doc, right? Don't remember which antibiotic it was - but it was expensive, brand-name and applied directly into the ear. I filled the prescription she ordered, got home and luckily before using it read the product insert -- which specifically said pregnant women should NOT use it because it was linked to congenital deafness when tested in lab animals. Niiiice, huh?

 

[thedrunkenpharm]

Pharmacists have advanced degrees...and study years of dedicated pharmacotherapy. Technicians are high school grads (or maybe a certificate) that count by 5s or load up Pyxis machines. It does't correlate at all. You may as well claim that plumbers will one day be able to take a pharmacists' dispensing job.

NOW, if you were to introduce some sort of new degree where technicians get an associates where they aren't educated in the use of drugs therapeutically, but just on the basic properties of drug action...and ONLY do dispensing...I could see your point. Essentially, give a degree equivalent to the B.S. Pharm from the 40s that only lasted 2 years. I could see that...and I wouldn't have a problem with that...being as though I don't work retail, anyway.

I have heard this very suggestion floating around the Board of Pharmacy i.e. mandatory formal Pharmacy Technology programs. It has caused a little controversy.