Pay for or knowledge and experience?
There has been discussion about getting paid for our knowledge and experience. OTC counseling comes to mind. Medical advice too. We are the point person of triage for the entire stack. How many people without money come to the pharmacist to see if they REALLY NEED TO SEE THE DOCTOR? I say a lot. If they don’t have money, most will come see you.
Where else can you get the kind of attention we give for nothing?
We really need to figure this out one of these days.
Yesterday, I was called out front. There were 3 people there. Two Hispanic men, 30-something and 40-something. An elderly grandmotherly type who was the interpreter.
This is way south Texas and they were probably illegals. Regardless of your stance on the immigration bullshit going on, stick with me. Listen to this.
The grandmother told me that the older man needed his blood pressure taken and recorded on an employment sheet by a doctor.
I looked at the sheet. “I’m not a doctor, but I’ll do it for him. If they won’t accept it from a pharmacist than we know that doctors have quite a racket going on.”
I sat the guy down and put the cuff on him and pushed the button. That was it. AND DOCTORS CHARGE FOR THIS SHIT?
188/118. “This is not going to help him get the job,” I said, “He really needs to see a doctor and very soon.”
“Really?’ She rattled off something in Spanish. The 40-something guy said something back.
“Really. We are talking about stroke territory here. He better get some medicine and then take the blood pressure if he expects to get hired.”
More Spanish. I shook the hands of all 3 of them and headed back to the pharmacy.
The entire deal took me less than 5 minutes.
“Excuse me. Excuse me.”
It was the younger man. He came up to me and tried to hand me a 20 dollar bill.
“Gracias,” he said.
I couldn’t NOT TAKE IT, you guys. 20 bucks is a hell of a lot of money for him.
Anyway, the way I see it is this: These people wanted to pay for services. They
would make terrific citizens. How many times have you given extended advice
to someone who obviously has money and don’t even get a thank you?
These 3 can stay here as long as they want.
Victoria said, “It has to be cultural thing, Jim.”
Hmmmm. Think about it. That guy tried to compensate me for my time, experience and knowledge at the rate of $240.00 an hour. That is lawyer’s wages.
Think about it. We gotta figure this one out. I want that guy with the Mercedes sportster and the trophy wife to lay a few bucks on me when I do something for him.
34 Comments »
RSS feed for comments on this post. TrackBack URL
Actually, Jim, this may be your most important thread of all. If you combine this thread with my comments about how desperate people are for personal medical services—so desperate that they ferret out the hospital pharmacy because the Walgreen pharmacist won’t come to the phone (I had exactly such a phone call at work last night. Are you listening, Walgreens? I doubt it)—that IT IS TIME FOR US TO CONSIDER INDEPENDENT GROUP PRACTICE AS PHARMACISTS. I already told you all about the National Provider Identifier. There are DVDs available now to teach you how to do medication therapy management. It is time to get into the cash stream! Perhaps our proposed pharmacy alliance could be a conduit, not only for professional respect, but also for remunerative respect–getting paid for our intellectual droppings just like physicians do. Jim just demonstrated it–someone wanted to hand him a portrait of Jackson just for taking a BP and signing a sheet!
Dear Jim… First off, here’s a big hug from me, and a major pat on the back from Dr. D. (whom I just read this post to…)
Let’s leave the politics on the immigration issue on the roadside for a moment and deal with the real issue…
What you did for this gentlemen was potentially save his life.
You did it professionally, politely and honestly. You treated the man with compassionate respect– one human being to another.
You also just provided the best piece of PR for Pharmacists we’ve heard in a long time.
Mary Lu and Dr. D’
While I agree with a portion of this topic, I have take the old fashioned route in the modern day world (and I’m still a baby of the Pharm D. world). First, to address your example. Yes, he was willing to pay for your services. What service was this? Technically, an ILLEGAL service, as it is supposed to be signed by an MD, DO, or qualified practitioner. Now I know we are all qualified, and I agree that this is something that we should be allowed to do. That’s not what I’m getting at. What I’m getting at is that the person you offered this service to probably also “willingly” gave another “service provider” $200 to make illegal documentation (i.e. state id) for him and possibly his family. With that example being scratched, it saddens me to think that I am beginning my career with all these complainers as my colleagues. I dealt with it too much in school, but I thought it would end there. We make a very reasonable salary for what we do (especially if you are in retail- think about all the knowledge you DON’T AND WON’T EVER USE). It’s a shame that people don’t care about helping people anymore without getting something in return.
This is what I enjoy so much about pharmacy–helping those that need it the most (no comment on the illegal aliens). Now as pharmacists we help without expecting anything (and I mean anything)and clearly this needs to change. I work part-time for walgreens (and a law student that will never be wealthy enough for the mercedes…)and let me tell you we get the phones answered–whatever intern pisses me off gets phone and drive through duties.
but I buy them dinner… I take time with the patients despite the fact that all signs on my computer are screaming at me to stand there and verify. Chain pharmacists only hurt our efforts to get reimbursed when they refuse to pull themselves away from the computer and show our patients what we can do BUT maybe it will take some of the chains to finally realize how much money they can make off of our services to allow all pharmacists to be able to be “clinical” pharmacists and be compensated.
Compassion, compassion! As if we will be less compassionate when we get compensated!
Jim M., pharmacists have shown compassion for centuries. I applaud that, and contribute to it. But, why is it that I am tempted to take out my credit card to ask an attorney an impromptu legal question? It is because I expect that these people expect to be paid for their KNOWLEDGE. Their knowledge is often coin of the realm. A word from them, and I can make a decision on a life path, such as the mechanics of a home sale, a divorce, or a civil action. Why isn’t our healthcare knowledge redeemable as coin of the realm if people call upon us to obtain what they perceive to be valuable services? How much longer must we pharmacists, with “compassion” or “professionalism” as our only recompense, give away our store? A plumber will know what size pipe to use, and this is recondite, redeemable information. Why isn’t the information I gave away the other night about Locoid Cream, to a lady who was not even my patient-client, equally redeemable?
It has only been in the last few years that some insurers, Medicare for example, are willing to pay pharmacists for their knowledge. They want to pay us “not to grow crops” (i.e., reduce or avoid dispensing to save the governmetn money by reducing polypharmacy or selecting less expensive alternative therapies), via medication therapy management. We are even authorized to have National Provicer Identifier numbers from HHS for billing purposes. But this model of the independent pharmacy practitioner has not dawned on us en masse. We are still herding outserlves into cages and boilerrooms to follow the pace of the galley-slave hortator, when we are among the smartest people aboard ship.
Jim M.-
I am troubled by your remark about “retail” pharmacists- that “we make a very reasonable salary for what we do (especially if you are in retail- think about all the knowledge you DON’T AND WON’T EVER USE?)”- what are you implying? That retail pharmacists- i.e. “NON-PHARM D PHARMACISTS”- are over-paid? I sincerely hope that you don’t actually think that retail pharmacists are beneath you! I am proud of ALL pharmacists- even clinical/Pharm-D pharmacists- and pharmacy is one of THE most honorable professions, in spite of the fact that pharmacists do not charge $200/hr!
I know that I have busted my ass “in retail” for 22 years- and it ain’t been for the MONEY. Maybe you should think, with all of your Pharm-D knowledge, before you make generalized statements that are not accurate!
True, I may NOT remember how to draw a drug’s chemical structure, or remember some freaky lab values, or remember the names of the cranial nerves, or draw blood, or even WANT to, but I CAN tell you that I went to 2 funerals last weekend- both my customers- ONE YOUNG, AND ONE OLD, and I CAN tell you their names, AND their family member names, and I CAN tell you that I feel as though I DO make a difference, even if on a small scale, to be able to see a smile through tears, to give or get a hug, or a “Thank you so much for all that you do- we don’t know what we would do without you” from my customers.
Perhaps not a life-saving medical-emergency pharmacist-doctor-hero stuff, but THAT is worth more to me than ANY amount of MONEY or extra initials behind my name. My name is too damn long anyway…
Seriously, it saddens ME to think that people like YOU are “saddened” because they have no clue as to what “real retail pharmacy” is about- the Hippocratic Oath ring a bell? Maybe it is old fashioned and therefore not taught to Pharm-Ds, but even a little “BS” RETAIL PHARMACIST, like me, knows that the true meaning of pharmacy is in helping others, not “SHOW ME THE MONEY”- money comes and goes, friends are for life, and that is what my customers are to me.
There is no price for one’s sanity. No salary to compensate for one’s sense of self.
I actually had a good day in the pill room today…I got to talk to a few of my favorite customers and really help out a cancer patient I had never laid eyes on before. It felt good. These days are precious because they are rare. I’ve had days when the public is so heinous to me that if someone says something nice (not even particularly squishy) or says “Thanks” I don’t even know what to do. The niceness makes me want to cry. I think that’s sad.
Salary is nice. It’s not everything, even though corpo-pharmacy would have you believe it. Do I want to help people? Sure, who doesn’t? Do I want to stab some people in the eye with a spork for being total dumbasses? Sure, who doesn’t? I think the key words, Jim M., in your comment are “beginning my career”. I hope for your sake you’re starting out in a nice fellowship/residency environment. Retail is pharmacy in the trenches. It’s physically and emotionally draining. It’s doing your damndest to help and being frustrated at every turn, by doctors, insurerer, and the patient’s themselves. Retail can be very rewarding, it can also be soul crushing. We’re not complainers. We’re the hardest working, most self-sacrificing people you’re likely to meet. We’re venting to people who understand where we’re coming from so we don’t stick sporks in people’s eyes for being dumbasses.
Kudos to JP for helping steer the patient to much needed medical help, and kudos to him for respecting that help enough to want to compensate him for it.
YOU GO GIRRRRLLLLLL !!!!!!!!!!!!!!
One time, I read or heard that the word “retail,” although commonly descriptive of the community pharmacy setting, is considered to be a pejorative term by some pharmacists. I use it only because it is recognizable. But, I agree that it is poor word to describe what is really outpatient, ambulatory-care, or community pharmacy practice, as opposed to inpatient, institutional-care, or healthsystem (newer word) pharmacy practice. I think outpatient or community would be preferable to describe it.
Thank you Kathy and vicodin fairy for expressing what I felt. I didn’t respond immediately to Jim M., because I feared my post would be too long and contain a lot of “F” words. I was EXTREMELY offended and hope that all of the current grads aren’t looking at us BS’ers in the same way as Jim. I agree with vicodinfairy that I don’t kow how to respond when someone is nice, because it is so rare. I don’t know why that one one statement “DON’T and WON’T” rubbed me the wrong way. Maybe I read too much into what he wrote(although I can’t see any other way to interpret that we are complainers), but thanks Kathy and fairy for very eloquently defending us retailers. Let’s see how he fairs in the real world for 15 or more years and then see if he has any complaints.
annpharm-
I felt exactly as you did- I could not believe what I was reading. I wasn’t going to respond, because I thought that I had surely mis-interpreted that comment! But I waited for quite a while, and went back and read every comment again. Since it still pissed me off (after my supposedly “cool-down” time), and no one else had responded, I knew that I would be pissed until I did something. So, as usual (not that it means it is “good” or “right”), I fired back. Right or wrong, good or bad, I don’t know, but as my father always used to say “Bad things happen when good men do nothing” … so at least I try to do something.
If nothing else, it makes ME feel better to get it off my mind, so that I can go on to the other 10,000 things that I have to get done! So jump in with us- the water may be warm, or even hot, but so what!
AND good for PAUL T! (I would have replied “you go boy”- but it just doesn’t have the same groove)! We ALL have to stand together, because if even one falls, eventually we will ALL go down.
OK, I’m going to take a stab at defending Jim M. for just a minute. I understand where Jim is coming from in that a huge number of community pharmacists are merely selling pills and not actually practicing as pharmacists. You know them, the ones who never leave their computer screen. I have worked along side them and it is discouraging to see the lack of initiative these pharmacists have in keeping themselves current. I don’t think the people who frequent this website are this type of pharmacist, but we can’t deny that they exist.
I agree with all of you that there is no pay check that can satisfy like helping another human being that is in need of the education we have worked so hard to acquire. In a day when practically everyone has some type of 3rd party coverage and will pay the same copay at any pharmacy, cost isn’t the factor it once was. The heathcare consumer will gravitate toward the pharmacist who will provide the pharmaceutical services he needs. We MUST keep the standard high and preserve the image of pharmacy within the healthcare industry.
I have worked in community pharmacy for 25 years and am now in a hospital. I LOVE COMMUNITY PHARMACY and much like Jim M. am a little ticked off to hear all the complaining about it. I hope every now and then you take a couple of steps back and take a good look at your profession and realize that it is like no other. We have been blessed with the brainpower to get an education that will not only provide a good income but will also allow us to directly help our patients/customers.
As for compensation for our services, we must be careful. Imagine that you recommend a change in therapy from Levaquin to ciprofloxacin that saves the insurance company and the patient money. If your compensation for the ciprofloxacin results in a greater profit, you may be accused of impropriety. I’m not saying it won’t or can’t be done, but I see it happening in a different way. The insurance companies will provide pharmacists via phone to advise their customers on OTC and Rx therapy as a free “benefit” of their insurance coverage. Of course, they will always steer the patient to OTC rather than Rx medication and to the least expensive Rx medications (or the ones with the greatest copay for the patient and greatest kickback from the manufacturer). With this free service available it would become a rare thing for anyone to pay for it in the drugstore.
Well Jim M, I do believe you have touched a nerve. Yeah, a lot of us will speak up about our profession when we feel things are not as they should be. But, I don’t consider us to be complainers. I have been in “retail” for 30 years and have seen a lot of change in our profession. Sometimes for the better and sometimes not. I just happen to believe that it is our responsibility to speak up and let those in the front office and Washington know how we feel.
I know that this is just a fourm to communicate our feelings to others in our profession but it sure helps to get it off your chest sometimes.
Do we get frustrated at times? Sure, we all do. It would benefit you to listen to those like JP, vicodinfairy, Paul T, annpharm, Kathy, and others. They bring an awful lot of experience to the table and are always entertaining. And they are not complainers, just Pharmacist who love their profession and are willing to speak up when they see a need for change, or when they are frustrated, or when they are discouraged, or when they just need to get something of their chest. Just listen to them. Who knows, you may feel the same way after 20 or 30 years.
Jim M,
Relax, man. When I was a brand new pharmacist my ass was so tight that it was disgusting. I was way over the top. I expressed my unbendable opinion. You see, Jim, I WAS RIGHT. And that my friend, is the essential game that human beings play.
Being right and making others wrong. That’s what people do. I contend that being right is not nearly as important as HAVING IT WORK. Right now, pharmacists are making it work under the worst conditions ever. The USA population is now 300 million, with a huge number of baby boomers. The number of prescriptions to be filled gets larger and larger, by the day. We do what we have to, Jim. We make it work even if the conditions that we work under want to guarantee failure.
When Vicodinfairy, days from delivering a baby, goes out front to assist a young mother who really can’t understand that her baby is in danger from diarrrhea…. THAT is
the profession WORKING. Vicodinfairy may just be too damned pregnant to carry herself out there when the old lady wants to know the difference between geltabs and caplets.
I could give you a lot of examples, Jim, but you are a smart kid. You get the message. There are times when you will need to tell the store manager, “Mind your own business,” when she complains that you get a little behind because you go out front to give counsel (for free) to a patient who really needs it. I would tend to say, “Mind your own FUCKIN’ business,” but I am out of that grinder loop these days. The point is: IT IS YOUR CALL, man.
There are no rules. Kathy makes up her own
rules. As does Vicodinfairy. Nic06 too,
FDPharmD, Paul T, the whole bunch of them. This is not a team, we are talking about. You are pianist, a skater, a golfer. Man, you are all on your own. Create your practice of pharmacy exactly as you want it to be because YOU CAN! You are an ARTIST, my man. Get used to it. Your canvas is the pharmacy. Create!
JP
As an aside from Jim M’s comment (and the subsequent comments), I think the renumeration model needs to be looked at. I don’t appreciate spending 15 minutes explaining the difference between Zantac/Gaviscon/Tums and then have the patient go, “Thanks for the information. I’ll go pick them up at Wal-Mart since I’m going there anyway.” (P.S. I don’t work at Wal-Mart.) In those 15 minutes, I was unable to verify prescriptions.
Speaking of verifying prescriptions, we need to be compensated for our knowledge. Right now, it seems that a lot of times I’m getting paid to sign off on hard copies. I know, I know, signing off on the Rx is not just to make sure that the right pill is in the right vial, but perhaps the renumeration model could include some sort of recognition for cognitive services.
In here in Ontario, the Ontario government has started a new program that will give pharmacies $50 to perform basically a medication review for each eligible patient. It basically entails having a one-on-one conversation for at least 15 minutes on all the medications the patient is taking and ensuring that they’re taking it correctly (e.g. the right drug at the right time, etc). It’s certainly a step in the right direction. Where it goes from here, I’m not quite sure…
Dogg, some huge questions, at random:
If you work for someone else, who gets the $50?
If you work for someone else, and the company gets the $50, does the company ensure you get the time to do the medication management to earn it?
To what extent are Ontario pharmacists going to demand, or are now demanding, the $50 for themselves?
Or, does the Ontario Government guarantee that only the pharmacists doing the medication management get the $50?
What makes a patient “eligible” for this service in Ontario?
Hey everyone wake up and smell the coffee as a pharmacist both in europe and in this wonderful country LET ME INFORM YOU ALL THIS IS COMMON PRACTICE TO GIVE A FEW DOLLARS- THEY DO IT TO NURSES AND PHARMACISTS….IT IS LIKE A TIP. But, we call this bribing in our country!!!!!!!
In europe it is expected (especially eastern europe and if you do not do it you are looked down upon).
Instead what we get from these wonderful “americans born and bred in the USA” is something called High Class Verbal Abuse- I have been yelled at for giving too much information and frankly we need to ban together because pharmacists have become lazy. I have called police officers for disturbance of the peace on this issue. I have also contact Obama Barack about setting a bill in motion- afterall, airline attendents have rights and we DON’T!
If you are interested in pursuing and attaining recognition we have to take pharmacy back! Please contact me at geopharma@earthlink.net IF YOU ARE INTERESTED IN CREATING AN ORGANIZATION TO IMPACT OUR PROFESSION.
regards,
Olga Spathis RPh, BSPharm, MBA
GeoPharma Clinical Consulting
geopharma@earthlink.net
PS>>>> in other countries pharmacsits are legally allowed to help diabetics with injections and to take blood pressure….but let us face facts a lot of pharmacists I know are afraid to touch the syringe…so guess what we never fought for this right.
Though it was a right before 1952- the glory years of pharmacy.
olga
Olga,
In which country are you practicing?
Welcome to this site! Jim Plagakis and others of our group have discussed forming an organization called the Pharmacy Alliance, for the purpose you stated. It appears now that it can be international in scope.
I apologize for the behavior of some of my fellow U.S. citizens. I have a dear friend in Berlin who makes the same complaint. She has worked as a hotel restaurant waitress and can usually tell the Americans from their boisterousness. When I visited Germany in 2005, I behaved as one would expect from one who is a guest in someone else’s country.
No, I am not interested in seeing pharmacists get tips or gratuities. I want us to be paid for our professional service knowledge. This is what has been proposed in the U.S. and Canada.
Oh,Olga, it sounds like you used to practice
in Europe and are now working in the U.S. Is that right?
Why were you criticized for giving out too much information?
Dogg and Olga,
IF I had the time to spend 15 minutes with each customer- well, let’s just say that there would be plenty of really pissed-off customers waiting.
If I had the time to spend 15 minutes with each customer, then I would damn sure have more than 3-5 minutes to take a break for lunch (or as I call it- “My lunch minute”), and I would have time to go to the bathroom (oh yeah, I go- but in a hurry)!
If I had the time to spend 15 minutes with each customer, I would be HOME by now. I would not be re-submitting claims,ordering computer supplies, opening my mail, changing BIN numbers on my BCBS customers to shitty Caremark’s BIN numbers, printing Medicaid’s latest monthly formulary changes, paying the bills, e-mailing Humana about one of my customers that they have screwed, transmitting my C-II order, etc.
I am the ONLY pharmacist in my family’s pharmacy, therefore, I don’t know how I can possibly give my customers the attention that they need and deserve, while also doing all of the insurance, drug companies’, and the government’s, bullshit work for them.
Until something is done to stop the insurance/drug/mail-order companies from running, and ruining, our health care system by all of their attempts to stop us at every turn- changing formularies every month, “tiered” drugs, early refill edits, monthly PDLs on state Medicaid, prior authorizations, quantity limits, DUR edits, etc, are eliminated- I can’t do what I wanted to do in the first place- help my customers! There is not enough time in a day- and THAT is why it is so frustrating, infuriating, and down-right maddening to those of us who are working ourselves to death, just to be told “to be recognized- and therefore paid- you MUST prove your worth by COUNSELING”- bullshit. Some call it “complaining”- well they can just take a stroll in my size 4 shoes, betcha they COULDN’T do it.
As we all know, if the the MMA of 1995 is not changed by Congress, as of July 1st, pharmacies will be reimbursed an average of 36% BELOW COST ON EVERY GENERIC RX DISPENSED. BRANDS ARE NOT AFFECTED- guess who is paying who off?
Why can’t we get paid for what we are ALREADY doing, without having to jump through another hoop or perform new tricks? Have you ever noticed, that they keep raising the bar (expectations, workloads, law suits, etc) HIGHER AND HIGHER, while our so-called reimbursement just gets LOWER AND LOWER?
It gets old after YEARS of hard work and high hopes being thrown in your face. The NCPA has been working on this for as long as I can remember (over 20 years) and it hasn’t happened yet. “JUST ONE more thing ya gotta do, THEN we’ll show them that WE are worth it, and they MIGHT THINK ABOUT PAYING us instead of SCREWING us” … yep.
A START would be to “reimburse” us- PERIOD. I don’t see “AWP-30% + $1.25″ as reimbursement- I see it as punishment for trying to hang in there for my customers.
I guess I am just trying to say that it seems like we are putting the cart before the horse.
[...] Jim Plagakis » Pay for our knowledge and experience? “There has been discussion about getting paid for our [pharmacists] knowledge and experience. OTC counseling comes to mind. Medical advice too. We are the point person of triage for the entire stack. How many people without money come to the pharmacist to see if they REALLY NEED TO SEE THE DOCTOR? I say a lot. If they don’t have money, most will come see you. Where else can you get the kind of attention we give for nothing?” [...]
Kathy,
I hear ya on the getting reimbursed decently for what we already do. I am currently working on the AMP issue which is loads of fun research let me tell you as we wait for the final rule to come out.
But Kathy, seems to me like you need a well trained technician at your store. yes, you will still have to do the C2 stuff and DURs, but well trained techs are amazing at working the insurance companies and the crap that doesn’t require and rph and work at 1/4 of the cost. I believe counseling is a HUGE part of why we are around…
e,
Please don’t misunderstand me- I am a firm believer in pharmacists getting paid for counseling. I totally agree and think that is why we ARE still around. That should have been a “given” years ago. Huh, maybe that’s the problem- we “gave” our knowledge freely, because we wanted to help people, not just because it was our “job”!
However, I think that the issue of reimbursement from dispensing still needs to be addressed, and here’s why: I can already see it- the insurance companies- “OK- you pharmacists win- we will pay you $60/hr to counsel, etc” … then a couple of years down the road, the same with counseling reimbursement happens as with the current dispensing reimbursement- “OK- now we’re just gonna pay you pharmacists $30/hr for counseling” … and before we know it, WE will be paying THEM to counsel our customers!
The insurance/PBM giants are just like cockroaches- they will be here long after we are- because of sheer greed- they have investigated every factor possible to get every penny that they can get. Somehow, there has to be a way to stop the erosion of the reimbursement from ANY third party, and not allow it to ever happen again.
And yep- I definitely need a good tech, but that’s another story- so I am just doing the best that I can do with what I have!
Sorry to be so late in getting back to the questions posed…
Just to answer some questions (and perhaps clear the air a bit about this “Meds-Check Review” thing going on here in Ontario being run by the Ontario government, which is the largest third party payer in Canada):
The $50 per med review is paid to the PHARMACY, not the PHARMACIST. Now because this is such a new program, and no other third-party payer has ever (to the best of my knowledge anyway) paid for this before, many different places are doing it in different ways.
So how do you split up the $50 per review? Does the pharmacy get to keep it all? Does the pharmacist? Do they split it 50/50? I can’t speak for all the other places out there, but where I work (a small, independent pharmacy), my boss has said that we would split it 50/50. I see this as a somewhat fair compromise: I get compensated for my time, they get the rewards of running a business.
I don’t know what other pharmacists are doing at other places. To be perfectly honest with you, I don’t know too many pharmacists who have done this. And this ties into Kathy’s comment: no one has the time to do this. There’s only one me at my place. We have no overlapping pharmacists. The time I would’ve spent with a patient doing a one-on-one review, ten people are waiting for this Rxs and four people want to ask OTC questions.
Now I may be (slightly) exaggerating, but in a retail environment, it’s pretty much damned near impossible to guarantee 15 uninterrupted minutes to spend with a patient.
What I was trying to do was to get all my patients to commit to appointments (like how they do with their doctors) and have it arranged such that I could come in on my off-day, line up these appointments for 2-3 hours, and make coming into work worth my while. (Otherwise, why come in on your off-day to just do one 15-minute session?) I still haven’t gotten around to doing this yet though…
Oh, and to answer the question as to who is eligible for this service, basically the Ontario government said they will pay for this service for a patient to have this done once a year provided that they are taking medications for 3 or more chronic conditions (e.g. asthma, hypertension, glaucoma). And just to make sure I cover all the bases, only patients 65 years and older, on disability, on welfare, or have “extraordinary” costs (e.g. patients with no other third party insurance plans and have high prescription costs) have their prescriptions covered by the government.
bi polar disorders
bi polar, bi polar disorders, bi polar disorder, manic depression
online poker
online poker, poker online, texas hold em, poker, video poker, casino poker, world series of poker, wsop
wsop
online poker, poker online, texas hold em, poker, video poker, casino poker, world series of poker, wsop
world series of poker
online poker, poker online, texas hold em, poker, video poker, casino poker, world series of poker, wsop
texas hold em
online poker, poker online, texas hold em, poker, video poker, casino poker, world series of poker, wsop
Jim, where will it all end? Everyone and I mean everyone has a different idea how things get done the most efficient way. With Medicare part D and double eligibility among others, who ends up with the tab? Put it though this time-until the paperwork clears the eligibility requirements. So next time bring in your script a few days early,OK?….OK here it is 30 days in advance OK?-No, we won’t hold it that long it might get misplaced,it’s a schedule II. No coverage on the Cialis? try so and so. No dice. That’s OK. Prior exception still goes? It has for over two Yrs hence. Call the urologist for the OK on the Andro-(if he’s still alive). It’s enough to schuffle the paperwork. Postdate it. Come back on Monday, the computers are down. Pay cash and get reimbursed after the approval. What? Why don’t you take VISA? only Mastercard, Discover, debit or cash? Bill Blue Cross they can afford it. Try this it’s just as good! NO! Brand name only, no substitutions! Really it’s just as effective and one-fifth the cost. -No the tablet doesn’t look right. Might be inert or a placebo. Samples, here you go-big boxes of 4 Tbs each from the Pharm Rep. (looks like alot!) Head ‘em up move ‘um out Rawhide! Hewyah!!!
Rollin’ rollin’ rollin’ keep them doggies moven’ though there dis-approvin’ rawhide! Don’t try to understand ‘em…. stampede! “Rowdy Yates” (Clint Eastwood)…Was it 5 or 6 ?… in all this excitment, I lost count! “Make my Day”!
LIKE MOST I HAVE A HUMOROUS SIDE. WITHOUT SOME SENSE OF HUMOR, WE WOULD HAVE A TIME KEEPING A GRIP ON REALITY AND GO “BONKERS”…NO,REALLY, YOU HAVE TO LAUGH SOMETIMES AT THE PRECARIOUS SITUATIONS PEOPLE END UP IN. NOT TO RIDICULE THEM OR MADE FUN OF THE MESS THEY MAKE, BUT JUST HOW IN THE WORLD SOME FOLKS WHO GERERALLY HAVE COMMON SENSE AND SAVVY END UP IN RUIN VIA POOR JUDGEMENT OR BAD ADVICE AMAZES ME.
AT ANY RATE THE FORECLOSURE RATE IN CALIF IS SKYROCKETING. THE SUBPRIME MORTGAUGES HAVE RUINED >300,000 EASY(JUST IN CALIF). IT’S A CRIME THE WAY THE BROKERS HAVE BILKED UNSUSPECTING HONEST FOLKS OUT OF THEIR LIFE SAVINGS. A HOME WORTH $300,000.00 5 YRS AGO IS VALUED AT $200,000.00. “THERE OTTA BE A LAW” THE LIVING EXPENCES ARE HIGH, THE MEDICAL AND INSURANCE FOLKS ARE GOUGING, AS ARE THE OIL CO’S. THE BANKRUPTCY LAWS ARE CHANGED, AND THE SICK, THEY ARE AS GOOD AS WELL, AS A POOR INFERMED PERSONS THAT CAN’T AFFORD THE MEDICINE TO AT LEAST GIVE HIM SOME REST TO WONDER HOW HE’S GONNA MAKE IT UNTIL NEXT WEEK THEY ARE DOWNING SSRI’S LIKE THERE IS NO TOMORROW. ARNOLD IS GOING TO REDUCE COVERAGE AND PAYMENT TO DR’S AND RPH’S AND $8.00/HR AIN’T GONNA DO IT. CRIME? WELL, IF STAYING ALIVE IS LEGAL, IT EXPENSIVE ENOUGH TO CROAK TOO. THE PRISON SYSTEM IS FLORISHING THOUGH- IT’S SPENDS MORE THAN THE UNIVERSITY SYSTEM. THE ANSWER IS IN THE NEXT PRESIDENTS AGENDA…… A SURE CURE FOR FINANCIAL BUDGET CUTS IN CALIF IS TO RELEASE 28,000 PRISONERS. WHOMEVER RUNNING THE SHOW MAYBE OUGHT TO RETHINK THE PACKAGE.