CERTIFIED PHARMACIST
Since 1989, when my first “JP at Large” column appeared in Drug Topics, I have had a pretty good eye at what is coming up. I wrote about the baby boomers 18 years ago and predicted a monumental surge in the volume of prescriptions. Back when third parties were involved in 15% of Rx payments, I suggested that it would be 90% before too long.
I told you that PBMs were not our friends ten years ago. I put forward the idea that Pharmacy Benefits Managers were profit-making enterprises and that they were going to screw you and the patient every chance they had. My idea was that you had to say, “No Frikkin’ More” as a group. The more you let them, the more they will take. Walgreens actually said NO to one PBM a few years ago. Patients complained to their benefits coordinators when they could not get their Rxs filled at WAG. Walgreens got the deal they wanted.
I have something new for you to consider, especially you uber-educated young people. You are sitting in the driver’s seat. You just have to pay attention and be ready to act.
Not very long from now, when you need to have medical attention for a regular, every day malady, you will NEVER see a doctor (MD or DO). It is that way already in urban clinics. Your family’s Primary Care Provider will be an ARNP, PEDIATRIC NP, PSYCHIATRIC PA…Keep naming them. It looks like there is an opening for you.
Let’s call you a CERTIFIED PHARMACIST. It may take a process to get certified, but right at this very minute, 90% of RPhs (and that includes old guys like me) can competently diagnose nasal rhinitis and prescribe fluticasone nasal spray. 90% of us can listen to a young woman’s complaint and tell if she has a bladder infection. We can prescribe the appropriate drugs.
The poster girl for a condition that should never have OTC drugs available is vaginal monoliasis. It is damn near criminal that Ortho put out Monistat OTC. After that, you have 4 feet of shelving loaded with creams and suppositories.
A Certified Pharmacist (actually any of us) will ask the right questions. Is there a discharge? Is it colored or is it white and like cottage cheese? Is there an odor? After these questions are answered, we can prescribe that Monistat that is now behind the counter or we triage and tell her to get her bottom to a doctor because a bacterial infection could ruin all her chances to ever be a mother.
I’m probably never going to do this because I don’t think that I will be willing to give up 8 or 12 or 16 consecutive weekends to get CERTIFICATION.
But, what about you? You are 34 years old and here is an opportunity that will be lost if Pharm Ds do not step up and take it.
Play with me. I named three conditions that I believe we could be PCProvider for. We are at the bottom of the funnel, remember? We are the go-to medical providers for poor people. Give me more conditions that could reasonable be added to our lexicon.
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I agree with you on this. But we need the Boards to step up and say that we can and should be doing this. We need the insurance companies to pay us for this. And most importantly of all, we need our retail overlords to allow us to do this rather than just requiring that we fill ever larger numbers of scripts with ever lower numbers of tech hours.
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Something like this could make pharmacy a worthwhile profession rather than just overpaid pill counters.
i know conjunctivitis when i see it. how about some polytrim for that. and why not some diphenoxylate for your diarrhea? and i could give you a higher dose of ibuprofen, too.
This is a slippery slope. Remember, we don’t have full access to patient medical records and we all know how patients lie or tell half-truths about their conditions. Do you really want to take on the responsibility of prescribing when you don’t have the whole story? While it may be a good idea for simple complaints, it could lead to a whole other set of problems. Furthermore, we all know that this new-found authority would just be additional work added onto an already overloaded work day. Thanks but no thanks, not unless alot changes.
Without the time slots and plus compensation, Rx Slave, I will tend to agree with you. What about the Nurse at the WAG Take Care Clinic. She does not have full access to anything. You comment about the lies and half-truths. Does anyone have full access to the truth? The middle-aged teacher who goes for treatment of an “itch” after an education convention in Vegas. Does he/she tell ANYONE the truth? Possibly, her/his priest, in the confessional. This is Jay Pee’s site. Our job here is to dream and brainstorm. You have presented a couple barriers to the idea of a CERTIFIED PHARMACIST. How do we get by them? What needs to happen? We must be proactive or we’ll be screwed….. again.
Rxslave is correct for now, but it will change later. The CMS is trying to change reimbursement rates for hospitals and clinics to get into CPOE and EMR, and will allow for easier access to that information. It will be a matter of time that an NPI or DEA number will allow access the health records of any particular patient.
Public EMR’s (Microsoft’s HealthVault and GoogleHealth) are starting to grow and HealthVault is in active use in Hawaii.
JP is right in that with an exponentially growing population vs a linear growth in health professionals will cause strain on the doctors (and many other health professions). This is excluding the fact that more are specializing rather than going into family practice or general medicine. The state boards of pharmacy need to get onto a certification for “triage service” at local pharmacies and assign what we can and cannot do.
DKLA, this conversation needs to continue right now in a much larger arena than Jay Pee where 500-600 readers visit during a good day. I like it if it STARTS with me, BUT IT HAS TO MOVE FORWARD. Faster than slower. It is very easy to get your personal NPI. Get it today!
pharmacyslave2000 makes a good point about us not having access to medical records. But, DKLA is probably correct. It may not be too long before we can get access to patient medical records. The need to share information between physicians, nurses, and hospitals is growing. Everything is being computerized and access is going to become easier. I see a growing specialization in the healthcare system. There are more nurses and nurse practioners that are gaining a subspecialty within their specialty. For pharmacists that want to provide, what DKLA calls “triage service”, the state boards need to become active in certification.
Hi
I am a prescribing psychiatric pharmacist in California. I am also board specialist through BPS which required 3 years of supervision (or residency). It is state law that I have a signed protocol and access to all medical records. My role is medication optimization based on my clinical assessment (i.e. diagnosis). Patients are triaged to me based on whether it will be a medication only patient or to MD if there is more psycho-social-medical aspects. I am paid through the same process as a physician. I wanted to add a few points based on my experience. As pharmacists we have significant therapeutic training. Clearly more than any other health care provider. But additional clinical supervision is needed when prescribing. There are tons of variables when someone presents with a symptom. It protects the patient, yourself and the profession as this trend moves forward. Physicians are already looking for excuses not to allow pharmacists to be able to prescribe. It would take just one mishap shown in the media for our reputations to be hurt. Lastly, independent of how we or physicians define ourselves, when you begin to diagnosis and prescribe you do (functionally) assume the role of a physician (for me it is a psychiatrist). Thank you for your blog and allowing me to share.Thank you, Chris. I’d bet that one out of ten visitors had no idea that there was such a pharmacist as YOU. These comments are a significant contribution to the conversation. Your comments caused a quantum leap, beyond MTM, to an entirely new paradigm for most of us. Psychiatric Pharmacist, I’ll be darned.