#provider status

Me after spending 45 minutes giving a complete overhaul to a surgeon’s orders to ensure that the end result will be compatible with human life:

Yesterday I posted a story about a fun little interaction with some of my RN co-workers and I mentioned asking a nurse to hold a dose of a medication. This upset a couple of nurses on tumblr, and I deleted the post for a couple of reasons, one of which was that I try to limit the anger directed at me on my downtime. I know people who are angry are just people who are caring loudly, but eh, I want to keep it somewhat light.

Going forward, however, I do want to clarify something. Pharmacists are currently trained as mid-level providers and have been for decades. We are the most over-trained and under-utilized members of the healthcare team simply because we don’t earn a profit for our employers since we usually can’t bill for our time, thanks to the variable laws surrounding pharmacist provider status.

Nevertheless, pharmacists have some kind of prescriptive authority in about half of the U.S. states. This ranges from limited protocols to unrestricted prescriptive authority. I don’t want to identify where I live, but for the purposes of my tumblr, I think it’s worth mentioning that I live in a state where the regulations are more supportive of the potential in pharmacists as providers. These regulations were written by the state medical board. It’s fully legal for other members of the team to accept verbal direction from me.

If I mention that I’ve done something like give verbal directions, I don’t want readers from other professions to think something fishy is going on. I work as part of a team with my physician and NP colleagues. I know it’s important that diagnosticians are kept in the loop since they’re much better at the intricacies of diagnosis than I’ll ever be. As they refer a patient to me for management of a disorder that they’ve diagnosed, I refer the patient back to them if I suspect a diagnosis may have changed or if I think something new is popping up.

So yes, the reader may think “that’s not appropriate for a pharmacist” from reading my tumblr if the regulations surrounding pharmacists are restrictive in the state where the reader lives—when for me, it’s totally appropriate and fully supported by the physicians who I work with, written into the state regulations and my institution’s policy. The other members of the team routinely defer to me in situations of toxicity and adverse drug reactions in particular. I work hard to reduce the burden on other providers and to make things easier for my nursing colleagues.

Quick reminder that I have a bachelors degree, followed by a doctorate; that I was an intern pharmacist, followed by my time in residency. My training was 13 years long in total. And even if your pharmacists where you live don’t have the legal means to manage patient care as I do, they are still fully trained to do what I do and are completely under-utilized in what they’re capable of. You have a doctor in your grocery store pharmacy and they’re of no cost to the patient to talk to.

Imagine how much smoother the day would go if physicians were able to just have a pharmacist on their staff directly manage all of the finicky details of prescriptions, to assess response to treatment, to adjust complicated drug regimens where everything is interacting, and to write detailed progress notes so the whole team is aware of the plan. Think of the reduction in alert fatigue alone.

I know it’s hard to imagine if you’ve never worked like that, which is why it’s so wonderful when our physician colleagues speak up to advocate for pharmacist provider status in their states and federally.

Anyway, thanks for reading through this. It’s wonderful interacting with all of you. I love reading all of your thoughts and exploring my own ideas about healthcare.

This is the universal truth about clinical pharmacy:

Physician who has never worked with one: What’s the point again?

Pharmacist: *explains poorly*

Physician six months later: You can take away my clinical pharmacist when you pry her from my cold, dead hands.

How clinical pharmacists became advanced practitioners at one institution

Years ago, the first board certified pharmacist hired at this institution rolled up to a meeting for physicians and advanced practitioners like, yep, I go here. And the guy was clearly really smart and nobody wanted to dispute something that they weren’t sure about.

Pharmacists are always trying to get respect as real members of the healthcare team. Let’s review.

Methods that work for getting a little respect:

Earning doctorates: ❌

Prescriptive authority: ❌

Provider status: ❌

The American Society of Health-System Pharmacists (ASHP) has been working hard for its membership, which now has topped 40,000, and those efforts are paying off, according to ASHP President Christene Jolowsky.

At the 2014 ASHP Midyear meeting’s opening session in Anaheim, Calif., Jolowsky explained how big wins by pharmacy-friendly congressional candidates in this year’s mid-term elections place pharmacists in a good position to eventually achieve provider status. 

Hey everyone, 

We just wanted to let you guys know that there is a new bill that will "that will pursue legislative and regulatory changes to the Medicare program and relevant sections of the Social Security Act (42 USC and relevant sections, primarily Section 1861) to recognize the direct patient care services of qualified clinical pharmacists as a covered benefit under the Medicare program." 

A link for more information is here

And a petition for support is found here

This is extremely exciting news and please, if you have the time (and I think living in the United States, I'm not sure if they accept signatures from outside the US), please sign this petition.

Thank you,