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| Apparently, Your Pharmacist Can Prescribe, Too… |
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by Kimberly Spering, MSN, FNP-BC - March 28, 2011
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 Provided by Clinician 1
At the risk of having some accuse me of “restraint of trade,” I’m going to make my views known about a recent decision by the DEA to allow certain pharmacists to prescribe controlled substances to patients.
Yes, you read that correctly. PHARMACISTS can PRESCRIBE NARCOTICS to patients if they meet certain criteria. (http://www.pharmacist.com/AM/Template.cfm?Section=Health_Care_Reform&Template=/CM/ContentDisplay.cfm&ContentID=25693)
According to news from the American Pharmacist Association, the DEA allows pharmacists in seven states (California, Montana, New Mexico, North Carolina, North Dakota, Washington, and Massachusetts) who work in institutions under a signed Collaborative Drug Therapy Management (CDTM) agreement to prescribe controlled substances and be called registered as “mid-level providers” with supervising physicians, the same as Nurse Practitioners and Physician Assistants.
Under the ruling, pharmacists working in hospitals, long-term care facilities, inpatient- or out-patient hospice settings, or ambulatory care clinics would be allowed to prescribe controlled substances if they had this CDTM agreement.
Initially, the DEA refused to grant prescriber numbers to pharmacists. According to proponents, pharmacists who have the ability to prescribe themselves will allow for more timely medication management...instead of “waiting” for physicians or other providers to actually decide whether or not the medication change is warranted. Really? How long are patients in these settings WAITING? Maybe one needs to look at those issues first.
David Johnson, Executive V.P. Of the Massachusetts Pharmacists Association, was quoted:
“CDTM is important for the profession because “pharmacists have the knowledge and expertise to effectively manage patients’ medication regimens and CDTM allows pharmacists to help patients at a new level,” Johnson said. He cited pharmacists’ extensive education and training, which allows them to practice at the same level as nurse practitioners and physician’s assistants, who have been able to prescribe for years.”
I read this blurb...in blatant DISBELIEF. In fact, my immediate response was, you GOTTA be KIDDING me!!
Are pharmacists educated about DIAGNOSING and MANAGING diseases and co-morbidities? Have they personally assessed and evaluated patients, managed their health and illness, their outcomes to treatment? Have they counseled patients about anything OTHER than medication management?
I understand that they have education about medication physiology, biochemistry, and a whole bunch of other things. However, we have NP and PA colleagues who cannot prescribe narcotics in several states, despite being educated as the REST of us...to do exactly that. I have yet to meet a PharmD who has worked with patients in the same way as we NP/PAs have. Unless their clinical rotations have changed in the past few years, I think this is a HUGE stretch.
I beg to differ with Mr. Johnson, who apparently doesn’t have a clue about our educational preparation and training compared to pharmacists. I’m all for the idea of CDTM overall. But please...unless this education actually includes more about patient assessment, evaluation, and all of the “meat” that goes into our education, leave the PRESCRIBING to those who do it best.
Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Vinny (Austin TX) |
on 23 Mar 2012 at 3:56 am |
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I am saddened by your view on CDTM. First, it is about authorizing refill, not diagnosing. The patients already have diagnosis and med history should show a consistent drug use pattern. It is not like once in blue moon a CLINICAL, and BOARD CERTIFIED PHARMACOTHERAPY SPECIALIST will authorize some meds that patients have never used before. Patients that a clinical pharmacist see is not your typical population. The existing med condition is already established. I can guess you have never worked with one before. Most of the times clinical pharmacists will only adjust dosage. If some reason the patient is out of refill, maybe on a Friday afternoon, pharmacist refill authorization can sure ease a lot of headache.
Since you have never work in a clinical environment with clinical pharmacists, I am surprised you would publish such negative article.
PS The "Likes" on Facebook doesn't have much meaning since there is no "Dislike" button. |
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| Tar Heel, PharmDc (Chapel Hill, NC) |
on 02 Jan 2012 at 1:17 pm |
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Mrs. Spering,
With all due respect I must disagree with you. The rigors of pharmacy training are not as simple as you have portrayed. You have presented a superficial comparison of the PharmD curriculum at the University of California at San Francisco, and have compared this to the nurse practitioner curriculum. I would caution you that it would be more appropriate to compare the syllabi of the courses. For instance at Ohio State University anatomy and physiology is taught to pharmacy, medical, nursing, and other students in the same classroom (and thus at the same level of breadth and depth). At the UCSF anatomy is taught as a gross anatomy course complete with cadavers. I must also caution you to watch out for classes with deceptively simple names. For instance pharmacotherapy I may actually be cardiology. I am a third year student at UNC Chapel Hill, and my pharmacotherapy course series included (but was not limited to) physical assessment and diagnostics, cardiology, infectious disease, oncology, nephrology, neurology, psychiatry, etc. Every year of my training thus far I have gone through OSCEs (just the same as all of the other health professions). Additionally I recently completed additional training in infectious disease, internal medicine, and pharmacogenomics.
Last summer I had the opportunity to work with one of these prescribing pharmacists on rotation, and I am proud to say I think we have been able to make improvements in the lives of patients Additionally pharmacists that undertake these advanced practice endovenous are almost always residency trained (yes pharmacists undergo residency as well). What a lot of people do not realizes is that in order to understand how a drug works effectively you need to have a firm understanding of pathophysiology and ultimately how disease states progress, how they are diagnosed, and ultimately how pharmacotherapy may effect these disease states. Furthermore considerations are made to drug and comorbid disease state interactions. Pharmacists in the federal system have held independent prescriptive authority for decades. In 1973 the Indian Health Services (HIS) have coordinated the Pharmacist Practitioner Training Program which provides more advanced training in compilation of a complete medical history, physical examination, diagnosis, and treatment of outpatients with acute and chronic illnesses.
There is a general misunderstanding as to why pharmacists are prescribing. Generally, it is not to eliminate the patient’s primary care provider(s), but rather to take care of specific pharmacotherapy issues that arise in clinics and hospitals. For instance, John Doe is a 45 year old man newly diagnosed with A fib and has been prescribed warfarin. He was started on the usual 5 mg dose, and titrated upward. After the patient was on 15 mg of warfarin q day for two weeks with an INR of 1.1, he was referred to an advanced practice pharmacist to adjust therapy as needed. Of course diet could be an issue, but in reality there are a myriad of potential problems. For instance VKORC1 and CYP2C9 polymorphisms are also a possibility. What about a patient in chronic pain who also has end stage renal disease? Many quicker acting opioid analgesics form toxic metabolites that can accumulate during renal failure. In fact there is an entire new field being born which is referred to as “theranostics” (therapeutic diagnostics). In short pharmacists are trying to become to drugs as dentists are to teeth.
For more on Pharmacist diagnostic training see:
http://www.sciencedaily.com/releases/2010/02/100215130336.htm
PMID: 22102746
See PMID 22135061
Thank you,
Tar Heel PharmD Candidate
University of North Carolina at Chapel Hill |
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| Comment Moderator |
on 29 Apr 2011 at 10:19 am |
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| Comments on this article have been closed, but keep your eyes peeled for more on this and other intriguing issues! |
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| Kim Spering |
on 28 Apr 2011 at 11:44 pm |
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Well, obviously, the blog has generated lots of discussion...and at the current count, 58 "likes," so not EVERYONE is against my commentary. Spirited discussion is a great thing...even if there is disagreement.
In fact, is this one of the first times that ANYONE has challenged or questioned what a PHARMACIST does? I haven't seen or read about it before...Not that I wanted to be that person...but I digress.
Truly, I sincerely appreciate those who have commented with thoughtful discourse and respect. I have researched the PharmD curriculum at no less than 10 different programs. I stopped after that, because many of them were similar. However, interestingly, I noted that several programs have been in transition, depending on the year entered. Guess some programs are changing as well...this is a good thing, I would suspect.
Yes, I have surveyed my patients, initially showing them the initial article that provoked the blog. I have not found anyone who is comfortable with pharmacist prescribing...but I will add a disclaimer...the initial article probably lacked FULL disclosure as to what PharmDs could do. I fully respect what those with this education have gone through, and what they add to the team. Thank you for your insight on the program requirements.
Those PharmDs who state they have taught in NP programs (PharmD from NYC) obviously did not teach in mine...nor in others that I have precepted for. I would never state my pharmacology course was "dumbed-down." Ever. Our textbook was written by PharmDs and we were tested as such (at least, 14 years ago...can't speak for now). We maintain continuing education credits in pharmacology for the state yearly. Sorry if you felt your program was so poorly done. Mine was not.
So if the majority of the responders' intent was to broaden our perspective of what a PharmD does, you have succeeded. I maintain that prescribing narcotics is not in this realm. It is MY opinion, and shared by many. Others in medicine--yes, PHYSICIANS (and believe me, there are many who have NOT posted here) feel there should be NO prescribing at all.
I feel PharmDs add a tremendous amount of knowledge, and apparently, patient "assessment" is part of a PharmD's patient care. This is a GREAT thing for patients. As previously stated, EVERYONE adds to patient-centered care. The description of the patient assessment course was a bit vague in the curricula I looked at...what EXACTLY was "patient assessment" in these courses?
So...I ask those of you who chose to post the following comments...why the brow-beating of NPs as a group? If your argument is that YOU are sufficiently trained to do as this article states, why "knock" other groups in your defense? You have no basis for it, as proven by multiple research studies:
http://www.aanp.org/NR/rdonlyres/34E7FF57-E071-4014-B554-FF02B82FF2F2/0/QualityofNPPractice4pages.pdf
I have been a nurse for 20 years, an NP for almost 10 years, and I know my strengths and limitations. Like any physician PCP, I will refer when necessary. I collaborate with my physician when needed.
Just like, I would expect, a PHARMACIST would.
And this WILL be my last post on the topic. New things to blog about. (smile) |
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| Jacquelyn (Detroit, MI) |
on 28 Apr 2011 at 10:23 pm |
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Mrs. Sepring
The only comment I can make is about how you're not aware of what the actual DOCTORATE of pharmacy is.
A doctorate actually is a higher level degree than the one you have to have to be a nurse practitioner. Secondly, many nurse practitioners BARELY pass or even remotely excel at one or two pharmacology classes that you have to pass.
Give the pharmacist credit the profession it deserves. It is DOCTORATE for goodness sakes. Pharmacists do not want to prescribe narcotics without good reason and most hospital doctors trust the judgment of their pharmacist (who routinely save their butts) so why not extend them the responsibility?
If they have the charts, the labs, etc-who better to make an assessment on drugs than someone who has spent over 6 years or MORE earning the knowledge?
And you wonder why people talk down to nurses TUH! |
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| Cheryl (TX) |
on 28 Apr 2011 at 9:22 pm |
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When you conduct your informal poll please clarify that pharmacists would be part of a CDTM and not prescribing on their own. I'm a bit suspicious that you are asking this in a very leading way that would sway your patients to say no.
Also, how is this sentence worthy of a 'are you kidding me': "CDTM is important for the profession because “pharmacists have the knowledge and expertise to effectively manage patients’ medication regimens and CDTM allows
pharmacists to help patients at a new level"
I am currently at the end of my second year of residency after my pharmD program. So I have completed a total of 8 years of extensive training and education about the TOTAL scope of health practice- not only medicine. You REALLY need to be more educated about the changes in the pharmacy curriculum over the past decades. My last year of pharmacy school consisted of case studies, where hundreds of cases were presented and we were taught how to diagnose, treat, prevent, educate and monitor the patient- based on chief complaint, signs and symptoms, MRIs, Xrays, some lab values. And we covered practically every disease state- from cancer, hiv, pain management, alcohol withdrawal, cardiovascular, DVT, hormone replacement, diabetes, adrenal insufficiency, smoking cessation, COPD, psychiatric issues, MI, infectious disease, and countless more. And the 5 years before that year provided intensive training for this task. And after graduating with my Doctorate in Pharmacy, I did a PGY1 and PGY2 in VA hospitals. I worked alongside doctors, residents, PAs, NP, all sorts of specialists. I cannot begin to tell you how valuable a pharmacist is in all aspects of patient care- not just telling you about medication.
“pharmacists have the knowledge and expertise to effectively manage patients’ medication regimens and CDTM allows pharmacists to help patients at a new level" is, in fact, an unbelievable statement. Unbelievable because it has taken this long for health care professionals to recognize our value.
I'm grateful for you blog to open a topic like this and room for us to voice our opinions as well- but it is a bit disheartening for a fellow healthcare professional to attempt to discredit us pharmacists in any way.
I'm sure you were not calling us worthless or anything like that, but I do hope this helps open your mind a bit to the fact that healthcare is, slowly but surely, headed towards a more patient focused field. We are all trained differently but if we can work together - as a CDTM would allow us to do- health care would be unimaginably better. Regardless of our profession, the bottom line of our oath is to always ensure patient safety and optimal treatment and care.
Thanks for listening |
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| Dr. John, PharmD Clinical Ambulatory Care Specialist (MA) |
on 28 Apr 2011 at 8:02 pm |
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Every healthcare professional plays an important role in providing quailty medical care to patients. Regardless of training our end out come is all the same. With in our current healthcare model the best interest of the patient is not always taken into account but instead the patient is placed in a middle of a "turf war". We each play an important part as members of the "healthcare team" but this team will never be successful if we do not expand our knowledge about what each individual member of the team can bring to the table. So before everyone starts to say why their individual profession is better than others I suggest that people take the time to learn what it is that each professional actually does. In PA it is not hard to find a pharmacy college (http://www.usciences.edu/) so why not go and chat with some one from your local pharmacy college to get informed.
The link above is to one of the oldest colleges of pharmacy in the country and that has a great nursing program their as well. After reading up on how pharmacy has changed please provide a more educated post. |
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| Pharmacy Resident (Boston, MA) |
on 28 Apr 2011 at 6:50 pm |
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Ms. Spering, I am going to have to strongly disagree with you on this one. The Doctor of Pharmacy program is not what you think it is. It has greatly evolved over the recent years and is now a minimum of six years. During this rigorous schooling a Pharm.D student is exposed to courses such as, but not limited to, Organic Chemistry, Biochemistry, Anatomy & Physiology, Pathophysiology, Pharmaceutics, Virology/Immunology, Disease State Management and Advanced Therapeutics. In addition to this course load one must also undergo a full year of clinical rotations. These clinical rotations usually are broken up into various learning environments. For example as a student I was exposed to general medicine and Intensive Care at a major teaching hospital in Boston, MA. During this time I rounded on medical teams and gave advice regarding medications, dosing, drug interactions, drug monitoring, etc… I also had the pleasure of working in a primary care clinic that mainly focused in on diabetes management. During this time I worked closely with the Clinical Pharmacist to adjust and manage pharmacotherapy for many patients. This was all done without the supervision of a physician since the diagnosis was already made. It was during this time that I began to realize exactly how critical a pharmacist can be to the “medical team model”.
In addition to this schooling I have made the decision to continue my professional development in a PGY-1 residency program. During this one year residency program I have worked in a variety of settings focused on both internal medicine and ambulatory care. During my residency program I have worked closely with physicians in the primary care setting to assist in managing a variety of disease states. We as pharmacists possess the clinical expertise to help manage patients in a wide variety of settings. These settings include primary care, cardiology clinic, mental health clinic, anticoagulation clinic and many others. In addition to my clinical practice I have worked on various research projects, gave several professional presentations and CE presentations. During this time I have gained the trust and respect of physicians, nurses, NP's, PA's and other health care professionals. As a result of this rigorous training, I am asked with 100% confidence by MD’s every single day for assistance in the management of a variety of disease states.
With this being said, I think your very “biased opinion” is extremely uneducated. It is unfortunate that you have not had the experience of working with one of the thousands of clinical pharmacists that exist. Just one more thing to point out; keep in mind that you are arguing against Pharm.D.’s to perform clinical duties they have proven to be successful at for many years. As a healthcare professional I don’t think you should ever argue against any change that has been shown to improve patient safety, improve patient outcomes, reduce medication errors and last but not least decrease healthcare costs. |
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| MRoddicks (Georgia) |
on 28 Apr 2011 at 5:54 pm |
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MSN Curriculum Requirements at DeSales University
Core Courses
NU 512 Nursing Theories in Practice - 3 credits
NU 513 Application of Nursing Research - 3 credits
NU 514 Christian Ethics in Practice - 3 credits
Advanced Core Courses
NU 505 Epidemiology - 3 credits
NU 700 Advanced Health and Physical Assessment - 4 credits
NU 701 Pathophysiology - 3 credits
NU 702 Advanced Pharmacology - 4 credits
Specialty and Clinical Courses
The FNP courses provide specialty concentration from a clinical and didactic perspective. FNP Specialty and Clinical courses include:
NU 602 Family Dynamics in Diverse Populations - 3 credits
NU 606 Concepts in Family Practice - 3 credits
NU 716 Advanced Family Nursing I - 6 credits
NU 718 Advanced Family Nursing II - 6 credits
NU 720 Advanced Family Nursing III - 6 credits
This is what our author studied. Not the credits, its sad, so sad how they can be allowed to DIAGNOSE or PRESCRIBE, scary!!!!
Noww....
This is pharmacy:
http://pharmacy.ucsf.edu/pharmd/curr/core/
Not the difference. It cannot be compared. Let us not mention the additional training in residency.
Folks, which professional would you rather go to for selecting your therapy? Don't think too hard! |
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| Clinical Pharmacy Specialist (New Hampshire) |
on 28 Apr 2011 at 2:58 pm |
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@ NYC Pharmacist: Exactly right and a great evidence based response ;). Last I remember, there were no NPs before the 1950's. It is shocking you, as a NP, would judge someone who is significantly trained more than you.
I like the Hippocrates statement as well and its true, pharmacy and medicine were one but no where does it state that Hippocrates was a NURSE. I believe nurses have their place and provide exceptional comfort and care to their patients, but lets not confuse that role with that of a physician or pharmacist, they simply lack the higher order analytical capacity (as mentioned above by the significant educational gap in courses) to make critical diagnostic and therapeutic decisions. I surely would not want nor do I ever remember a NP running a code, it will NEVER happened, unless they revamp the entire curriculum.....but wait: that would mean you need to go to medical school and also complete a 4-12 year post-MD training....something called cardiology.
As for the pharmacist not being able to assess, this is simply not true. All Pharm.D.'s are trained in assessment and disease state management, at a very advanced level, much more in depth than any nurse or anyone for that matter when it comes to pharmacotherapy initiation, modification or decision making. As I mentioned, NPs and nurses are great as part of the team to "comfort and counsel" but they CERTAINLY DO NOT possess the training or intellectual capacity to function at the level of a highly trained and competent physician and pharmacist. In terms of pharmacists counseling other than medications, if you, as mentioned above, simply took the time to do some basic investigation there are plenty of pharmacist run weight management, diabetes education, etc, programs that have demonstrated far superior outcomes than any nurse run program.
Also, pharmacists have the capacity to be PI (Principal Investigators) such as the CAPTION trial, in a prescribing capacity and have demonstrated efficacy in disease state management and improved outcomes. Last time I looked, NPs are not qualified to be PIs on NIH sponsored research because they are "mid-levels" not experts.
Physicians (and many PAs who are trained by MDs and the medical model) are experts in diagnosis, pharmacists are experts in medication therapy and disease state management. Your reasoning of diagnosis having anything to do with the ability to select the appropriate pharmacotherapy post-diagnosis does not make any sense at all!
In terms of the NP curriculum, I have also educated in a NP program here in NH. How can anyone, after only 2 years of schooling be safe to independently practice, diagnose or PRESCRIBE, it is pathetic and dangerous to the public. You criticize pharmacy laws which will actually improve outcomes, but fail to see how dangerous NP scope of practice laws are to the general public. Direct Entry Programs are scary, 2 years of training in which the first year is spent in RN training (bed baths, bedpans....alll important and very necessary functions for patient care BUT NOT MEDICINE!!!!) and the last year only being geared towards, "advanced practice" utilizing the "BIOPSYCHOSOCIAL" model which, like the above blog states, is a made up reason to allow these dangerous MD want-to-be's to take care of patients.
The role of the NP was designed to do a in-office strep test and pick out of a protocol (all of which are mostly designed by pharmacists all over the world including your local hospital) a antibiotic and even that is a far stretch based on the lack of training. The Doctor of Nursing practice is a oxymoron: how can you be a Doctor Nurse? And the DNP program curriculums are a joke.
Lastly, NPs require ONLY 500 clinical hours for the advanced practice portion, PAs and Pharm.D.s are required to complete over 2000. Does anyone else see something dangerous about that one? NPs have never taken advanced pharmacotherapy and therapeutics and many cant even correctly pronounce drugs. Also, how about the fact that just 2 years ago, there was a national issue with NURSES and NPs making mistakes left and right with insulin dosing, such as the North Shore University Hospital in Long Island, and gputting patients at risk for hepatitis C because they were resuing one insulin pen for multiple patients. This is the part of higher order intellect that MDs and PharmDs have and simply would never make such stupid mistakes.
If the United States has any hope at all, it will require more Pharm.D.-MD-PA collaboration and the NP needs to be a nurse, stick to taking care and comforting the patient. The role is just as important as the high level scientific decision making of the MD and Pharm.D. but lets not confuse who is trained to do what. After looking at ALL OF THESE FACTS, Mrs. Spering: lets leave the PRESCRIBING to those who do it BEST based on evidence, time spent in school, curriculum design, intellectual capacity, NOT opinion form someone who was clearly a med school reject and feels the need to compensate being a high-horse NP who cant function at the capacity of a pharmacist. No these are facts, not opinion. What do you think about the facts?? |
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| PharmD (New York City) |
on 27 Apr 2011 at 10:41 pm |
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Dear Ms. Spering: This is the absolute most ignorant commentary I have ever read from a "educated" professional. There are so many errors in your writing that it is hard to even begin addressing your ridiculous comments. For one, there is no such course as "medication physiology" that is simply a ridiculous statement and clearly demonstrates your ignorance in the matter.
Secondly, from the beginning of "medicine" Hippocrates was a physician AND pharmacist. In the 1400's pharmacy and medicine split: one focusing on diagnosis (medical doctor) the other focusing on the study of medicines and treatment of disease (pharmacy). Today, the Doctor of Pharmacy degree is a 4 year professional graduate program, same in length as the Medical Doctor Degree. Additionally, clinical pharmacists, like physicians, complete residencies and fellowships spanning one to three years in length. Medical (including PA Schools) AND Pharmacy schools require organic, physics, calculus and other high-level science pre-reqs before even being considered for admission and there is good reason for that: if you can cut the mustard in intellectually demanding analytical reasoning, you have NO business having any decision making power in either the true diagnosis OR pharmacoetherapeutic management of patients. Unfortunately, NO NURSING school or "NP" program requires these courses and the fact is, most RNs can not make it through these courses. What is even more disturbing is that NP programs do no have medical biochemistry, "real" pharmacology (not the 10 fold dumbed down nursing version of basic and "advanced" pharmacology) and Gross Anatomy. How can one EVER know what she/he is doing when they don't even know what the body looks like inside. How can one "assess" properly when you don't even know where things are? This is why PAs are 10 fold more qualified in diagnostic reasoning.
What is even more laughable is that virtually ALL NP programs, including the one I used to teach in 3 years ago, have Pharm.D.'s teach the pharmacology portion of the program. Funny thing is, you MUST dumb it down significantly. I teach MD and Pharm.D. pharmacology and trust me, 90% of all NPs would not make it past the first exam. Secondly, have you even looked at a Pharm.D. curriculum. Courses such as pharmacology, medicinal chemistry, therpaeutics, advanced pharmacotherapy, virology, immunology, evidence based medicine (something you clearly do not know the meaning of). The Pharm.D. is more qualified, in training and experience, than ANY other healthcare professional to make decisions on what medication would be appropriate for any patient.
In other countries across the world, the pharmacist is and has always been known in a prescribing role following a MD colleagues diagnosis. Many countries in Europe today allow the pharmacist to prescribe if the patient comes in with a physician diagnosis. Funny thing is, only in the United States is a ridiculous role made for a "advanced nurse" who can diagnose. In the US, we have the WORST statistics in healthcare spending and outcomes and 98,000 people die each year from medication errors and as NPs continue to be "PCPs" these will surely sky rocket. I have seen the NCLEX-RN and it is laughable compared to Pharm.D., MD or PA boards. The FNP certification exam is equally alarming and ridiculous.
Why would you target a profession with a history spanning back to history itself when you are not even a MD and not remotely qualified to make diagnoses based on your severe lack of advanced scientific and medical courses? The "bio-pyshco-social" model is nothing but a fluff excuse to get lobbying power and fool ignorant politicians to vote for a ridiculous scope advancement for a nurse who is not trained in length or quality as compared to a physician or pharmacist. I find it funny you write a blog when the NP degree is laughable in other countries and you claim you learn "the meat" of physician diagnosis and assessment when in fact you did not even take gross anatomy or radiology, it is ridiculous. Furthermore, you did not spend 80 hours a week for 4 years in a residency program that actually qualifies you to practice family medicine. There is a reason why MDs spend so much time in training: unlike the NP, they actually know how to assess and diagnose.
In terms of evidence for pharmacists, I wouldn't expect a nurse to know how to operate PUB MED, its too complicated, maybe you can create a "bio-psycho-social" version of this that claims to be superior to the over 2000 year history of medicine and pharmacy. Publications such as TEN CITY CHALLENGE, The Ashville Project and HUNDREDS of others demonstrate how clinical pharmacists, in a prescribing role, have significantly improved outcomes and reduced costs.
Additionally, I have worked with many NPs and UNLIKE you, they are not ignorant and arrogant and actually admit to their many limitations, particularly in drug therapy management and selection. One thing you need to understand is: you cant put a roof on a house without finishing the basement. 21 month Direct Entry Nursing programs are a example of POOR quality of education. Not only do these DEN student not understand medicine because they have not taken high level science courses, but in 21 MONTHS, they, according to your genius reasoning, are safe to DIAGNOSE AND PRESCRIBE??? Give me a break. Get real, a nurse is a nurse is a nurse and will ALWAYS be just that, a NURSE. Stop trying to be a physician when you are not even remotely qualified. Also, before humiliating yourself in the eyes of thousands of healthcare professionals (I have forwarded you blog to all, ASHP, APHA, ACCP), do some basic research. I feel bad for your students, patients and practice. Its a shame. |
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| McM (Boston, MA) |
on 27 Apr 2011 at 8:40 pm |
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This writer seems to have no updated knowledge on the role of pharmacists in today's world. Pharmacists DO possess extensive knowledge in the area of medication and disease state management. We DO see patients in the practice setting. We DO manage, treat, and maintain patient's health and specific disease states. DOCTORS of pharmacy take multiple courses on disease management and patient care (not to mention the anatomy, physiology, pathophys of the body, therapeutics, etc...). On clinical rotations a Pharm D sees patients continuously in clinical practice settings. Once working in their clinical field, the pharmacists sees patients independently of doctors. Also, one needs to look at the change and understand it pertains to certain pharmacists in particular practice settings. It also has specific stipulations. We are not talking about your local community pharmacist prescribing random drugs for patients. We are talking about pharmacists who see, treat, and adjust medications for a patient based on recommendations of a clinical patient care team. There is no flat out DIAGNOSING involved, only adjustments of medications and medication prescribing for disease states the patient already has diagnosed by a physician.
I personally worked under a Pharm D who worked in a primary care setting specializing in diabetes management. She saw her own patients for up to an hour one-on-one to manage and manipulate patients's diabetes medications without MD intervention at all except for the simple authorization of the prescription AFTER the Pharm D WROTE it (MD never saw pt after diagnosis - they TRUST the Pharmacist - sometimes admitting the pharm D knows more about the meds and treatment plans than the MD themselves!) Refills on narcotics and pain management has much more regulation than this under this law.
I'm sorry you have not had the experience of knowing how modern Doctors of Pharmacy practice in medical settings. If you did I'm sure you would not react the way you did. Remember - a majority of these medications are REFILLS or slight adjustments to medications and the Pharmacists are the experts when it comes to medications.
I feel your "opinion" is a bit overreacted and uneducated. You need to look into current schools of pharmacy - doctor of pharmacy programs and curriculum. Sit down and meet pharmacists that practice in the clinical setting on a daily basis with their own patients. When you do this, i think your eyes will be opened up to the importance of passing a law such as this one.
I understand that Nurses, MD's, as well as pharmacists are all vital parts of the patient's "care team". We all have one main goal - to care for and treat our patient. To be "belittled" by your "opinion" is not something I would be putting out there without the proper education and research. |
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| Dr. K. Lynum (VA Clinical Pharmacist- Psych) |
on 25 Apr 2011 at 2:13 pm |
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| This writer seems to be upset and set in the 1800\'s. I do know of pharmacists that already manage patient\'s pain (for example) to the point where their recommendations are accepted by the physician and a script is then written. This would cut down on having to wait for a script from the provider, since the PharmD is alrady managing the patient. I do agree that the PharmD has to show they are capable in whatever area it be to \"prescribe\", but please do believe that a pharmacist is capable. If they are not necessarily \"diagnosing\" the patient, they can still \"manage\" the patient in where additional therapies may be warranted. Due to our extensive medication knowledge, this can occur. I would still not use the term \"diagnose\" yet \"manage\" therapy or continuing the current therapy based off of the diagnosis would be a more appropriate term. Get some love and Jesus in your heart! |
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| Tara (Va pharmacist) |
on 25 Apr 2011 at 8:52 am |
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Excuse me... I was typing fast.
...know nothing about. :) |
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| Tara (Va Pharmacist) |
on 25 Apr 2011 at 8:41 am |
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| There is definitely a place for pharmacist as mid-level practitioners. In the Va system this is nothing new. Pharmacist have been functioning as such for over 30 years now. Guess what? They are extremely effective and it is a better use of an FTE. Pharmacist have the clinical knowledge and ability to diagnose, evaluate laboratory data, and prescribe just as ARNP's and PA's. Pharmacy is no different than any other health care profession. Pharmacist that practice at this level have more extensive training. No different than nurses. To question whether pharmacist have the aptitude to handle this level of practice is ridiculous. Of course they do. What do you think pharmacist learn the drugs without pathophysiology, diagnosis, patient assessment, and treatment? Check out any pharmacy school's curriculum. The real issue here is fear. Pharmacist do not want to take away nursing or PA jobs. Pharmacist just want to be included as a member of the healthcare team. We have a lot to offer and are often times under utilized. Futhermore, pharmcist that practice at this level are usually used to manage the more challenging patients. Our practices are more disease state specific. We can also be used along with the primary provider to do closer follow up on patients that need this type service. Please do not be afraid of pharmacist. We have been working hard to get rid of ignorance towards our profession. Please be sure to do some research before writing a blog about an issue you no nothing about. With love....A Clinical Pharmacist. |
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| Dave (Livingston, NJ) |
on 20 Apr 2011 at 10:55 am |
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I am sorry but there is no jealousy here from what I read. Just one professional saying that pharmacists do not practice at the level of an NP or PA (and that's what the pharmacist said they did) . Sorry but we do completely different things. Also for me, I get to decide on what medications my patients go on. Call that anything you feel good about, but it's my ass on the line in court, my diagnostic ability, my gut feelings, my patient, my responsibility-no one else. I am also willing to talk about those choices and to learn more at anytime.
Dave |
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| Kim Spering (Emmaus, PA) |
on 18 Apr 2011 at 11:44 pm |
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@ Carol~
Thank you for your information. Perhaps the original article needs to specify more information as well to educate the reader. I worked with PharmDs in a critical care trauma/open-heart unit. They worked closely with physicians, nurses, and the rest of the team to coordinate medications and care. NONE of them were determining which patients needed narcotics or refills. Perhaps that was a different arena, however.
Of course medicine has evolved. NPs and PAs weren't around 50 years ago...I understand that. Medicine must evolve in order for things to run smoothly.
I plan to conduct an informal poll for my patients out of my own curiosity to see how many think their pharmacists should be able to prescribe. I also will be asking some of my pharmacist patients their opinion of this article. Hopefully I get enough responses to post it here. My unofficial questioning has been soundly NOT in favor of pharmacist prescribing so far...
@ Surgeon2015: Of course pharmacists do more than "medication management." I stated that above. In the role stated in the article, they round with physicians and offer their opinions about medications, which I fully support. Again, this is different than making an individual choice to refill narcotics. Again...perhaps the article that was initially referenced needs to be more detailed.
As for your comments, thanks for the laugh. Really...kindergarten? :) I am always amused at what anonymous posters will put on a website.
Let me get this straight...and perhaps you are not a member of the multiple organized medicine groups who claim that NPs and PAs cannot safely practice, nor prescribe, yada yada yada. Where is organized medicine looking at the pharmacist-prescribing aspect? Hmmm...
I am not jealous. I can and DO prescribe narcotics safely and judiciously, when other non-narcotic measures have not worked. My primary concern is patient safety and pain control.
Your own words speak volumes as to your sense of "well-being" and professionalism. No point in adding to your own diatribe. |
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| carol (PA) |
on 18 Apr 2011 at 9:45 am |
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Yes, your knowledge of pharmacy practice is a bit outdated, let me enlighten you.
Pharmacists (PharmD) are doctors of pharmacy. For those who specialize in clinical pharmacy, there is a hospital residency required. These pharmacists round with patients with MDs and DOs and assist with drug recommendations for patient cases. They DO NOT diagnose, this is the doctors role. What they DO, is assist the medical team in deciding the best pharmaceutical interventions for patients. They work as a part of a TEAM for the benefit of the patient.
I have known pharmacists who have made life saving interventions on behalf of patients by counseling the MDs and DOs on the intricacies of choosing a pharmaceutical product over another.
I understand the confusion as 50 years ago, pharmacists were not trained in this capacity. But in 2011, PharmDs are more that trained to work in this capacity and will be a huge benefit to patient care. |
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| Surgeon2015 (Baltimore MD) |
on 17 Apr 2011 at 5:25 pm |
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@ Kim
Yes, you writing makes you seem very "jealous". Your insinuation that PharmDs do cannot make educated decisions on prescriptions because all they do is "Medication Management" is completely biased and unfounded. Yes this blog is your opinion, you are entitled to it, and we, the readers are entitled to believe that you are spoiled brat who is mad that another child got a new toy and you didn't. So now you are going around talking about how 'unworthy' and 'undeserving' they are. Go back to kindergarten maybe someone will listen to your whining there. |
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| Kim Spering (Emmaus, PA) |
on 08 Apr 2011 at 3:23 pm |
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@ Heather...
I'm not sure to whom you are referring as being "jealous." If you're referring to me, well, I'm not sure how you got that from by reading the blog. I'm also not sure what kind of provider you are (assuming you are one), so it would help me and others understand where you're coming from if you include your credentials. Thanks.
My OPINION (which of course, IS the purpose of a blog) is that there is a lot more to prescribing than merely knowing about medications, their physiologic/pharmacologic effects, drug interactions, etc. If it was such a standard of care for pharmacists to prescribe, then why isn't this a universal standard? Where are the research studies looking at pharmacist prescribing? (And if there are some, please share.)
Every single provider offers something to patients in a collaborative way. Pharmacists are a key part of that team. We each have our roles...some overlap...some do not.
As I always say, everyone is entitled to his/her opinion, as are you. However, if you respond with terms like being "jealous," you can expect a response. (smile)
Have a great day~ |
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| Heather Hendrick |
on 08 Apr 2011 at 1:05 am |
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| Wow! Jealousy is very ugly. So please be careful with what you're writing. You might want to go back and update your information and back it up with evidence. |
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| TP PA-C/SA, MPAS (Texas) |
on 05 Apr 2011 at 1:34 pm |
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| Having been exposed to this type of practice previously, these contracts are overseen by a "supervisory MD" who is responsible for care of these patients. Based upon the "protocol guidelines" established in the contract, the Rx's are refilled. As such, a patient in a "Pain Management Clinic" who needed a refill and was just seen in the clinic, but no refill was prescribed, these are filled by the PharmD. Cry foul play given this scenario?? Don't think so. They're are many time consuming scenario's that occur on a daily basis that can be handled in this way. In fact, many controlled (non-narcotic) are called into pharmacies by non-licensed personnel daily with minimal paper trails and no contract. I think the PharmD's can handle these situations adeptly. I'm sure there are many eyes watching to see if they jump outside the contract boundaries as is usually the case in institutions. |
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| sonya montgomery (Chapel hill, nc) |
on 30 Mar 2011 at 10:10 pm |
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| I agree! To compare the clinical skills of a pharmacist to NP/PAs, is oranges-to-apples. |
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