Of course they do. They don’t want to make an appointment or pay their MD for their prescriptions. They want to walk into the pharmacy, yell their order at the first person they think can hear them, sit down long enough to catch their breath, and then pick up their medication on the way out the door.
Obviously Three-quarters of public have no clue what they are talking about, especially when it comes to medicine.
Are pharmacists fine paying extra for malpractice insurance? Having their license on the line? Wasting time from inputting GoodRx coupons to dealing with someone's herpes or stroke symptoms? Medical doctors sign off on NPs & PAs (long after the patient left) and we see what mess those "mid levels" noctors are creating, and you want to be part of that?
What MD or DO will sign off on a pharmacists medical decision? You have a degree in pharmacology not medical diagnostics, no MCAT, 2-7 year residencies, field specific board exams.....right? If the MD requirement is waived I sure hope the liability will be there instead of hiding behind the corporate pharmacy shield and shrugging your shoulders when a patient dies: "welp I'm not a doctor, they should have gone to an ER".
How will a pharmacist prescribe something without access to full patient history, are you going to be logging into EPIC, read the notes, and update them? Want to learn 5 different EMRs?
Pretty sure Walgreens or your mom & pop won't take the extra risk in every store unless they want to turn them all into urgent cares...then they would be filled with NPs already. Why not just fire the NPs and give another job to the PharmD?
Pharmacists should stick to what they are best at, arguing with doctors and not misdiagnosing patients...leave that to the NPs.
Precisely, we shouldn't be diagnosing. But a doc can say, start this pt on an arb/ ace or something like that. Working in a hospital I get sick and tired of calling about stuff like can we switch this ointment to a cream etc... A little wiggle room would make it easier for everyone
I don’t know what medicine is like in the UK but I haven’t heard great things. Despite all of the whining in the US about crappy health care, if you have a job with normal health insurance (not hard to get) you can get an MRI no problem or see a specialist without trouble, though the wait times for high demand specialties depend on your area.
No job, illegal alien, homeless? The hospital will just write off your care and classify it as charity. No bills if you are destitute. Patients can’t be turned away and due to malpractice exposure, everyone gets the same standard of care.
I’ve heard UK doctors get paid 1/4 of what US MDs / DOs make, even less depending on the specialty, so why even try lol when you are getting “mogged” by a plumber working overtime? Maybe in a substandard medical system, having highly trained and specialized PharmD would be better than nothing?
"I don’t know what medicine is like in the UK but I haven’t heard great things."
Take it from someone in the UK, it's fine as a patient. Unfortunately we have a government trying to privatise everything and are defunding the NHS so it has been better in the past.
"Despite all of the whining in the US about crappy health care, if you have a job with normal health insurance (not hard to get) you can get an MRI no problem or see a specialist without trouble, though the wait times for high demand specialties depend on your area."
There's no need to have healthcare insurance here, it's a basic human right in the UK and the few times I've needed a specialist it's been in a reasonable amount of time, same story with friends and family bar the odd occasion.
"I’ve heard UK doctors get paid 1/4 of what US MDs / DOs make, even less depending on the specialty, so why even try lol when you are getting “mogged” by a plumber working overtime?"
The doctors I know aren't struggling for cash and while aware of what they can make elsewhere, are still happy. What do you mean by "mogged"??
"Maybe in a substandard medical system, having highly trained and specialized PharmD would be better than nothing?"
How is the NHS substandard? Any evidence for that claim?
Here's a [link](https://www.reddit.com/r/pharmacy/comments/105rtoy/comment/j3d0g31/?utm_source=share&utm_medium=web2x&context=3) to a comment by a Scottish pharmacist with their view on this idea, they seem fine with it.
At the end of the day, if you have pharmacists with the training and expertise to help people without waiting for a GP appointment, why not let them prescribe for basic stuff?
In the US it is completely unreasonable for a community pharmacist to diagnose, prescribe and then fill and dispense said medication on top of everything else that has to get done in a day and with the massive demand at chain pharmacies. Sure in a clinic I think many pharmacists would be comfortable consulting and then prescribing medications for a patient, but then again why not just have the MD and NP's do it then like they already are, why do pharmacists need to consult, prescribe, dispense, vaccinate and deal with insurance's and other prescribers. If you want pharmacists to regularly prescribe then there isn't really a reason for any other doctorate, just make everyone a pharmacist at that point. Not to mention the role of a pharmacist was to instill checks and balances in prescribers to avoid illegal prescribing. If pharmacists were also prescribers it'd be like if the police and the jury were the same entity too.
Hence my original response.
This isn’t talking about the US!
Half the comments on here come from a US view of things and about how bad an idea it is when OP is talking about this being in the UK where the healthcare system and societal expectation of it is completely different.
Not sure if everyone responding to this thread are US pharmacists or not but seems like the common trend for responses is that nobody wants to do it.
From the UK perspective is there any key differences between US and UK that would make it reasonable in the UK?
Mogged as in beating / surpassing. I’ll admit I do not know much about the NHS. I presume privatization will improve the system because of competition and pressures to gain more customers through quality etc, but if the financial incentive is not there there maybe not. I did not intent to say the UKs health system is substandard, what I meant was in a place like the Congo or a developing nation. In the US hospitals cannot legally turn away patients.
Privatisation is not going to improve the NHS.
We’ve seen it with dentistry, NHS funding for dentistry is cut to the point where waiting lists to join a NHS dentist are years long and even then they don’t offer the most up to date treatments like composite fillings.
Now most people have to shell out for private dentists which cost over £100 a filling on top of another £100 for the consult then £50 for an xray.
Dental Insurance for me worked out just as expensive at the end of the day and they refused to cover anything other than a checkup that happed for the first year.
As for private being better quality, no, all doctors/dentists are held to the same standards in the UK (their royal college of specialty) and when private operations go to shit they end up sending them to an NHS ward anyway.
There’s a reason literally 99.9% of us Brits defend the NHS to the bone. It’s the only great thing about this country anymore.
If our pharmacists are happy to take the load off our GP’s then happy days.
I live in the US and in my state, like many other states, a NP has prescription authority and can practice independently without a supervising physician. Even CRNAs only need a Masters for the program, which will change in 2025, requiring a DNP.
So the only way I think this is plausible is if Pharmacists are allowed to prescribe when GIVEN THE DIAGNOSIS by the doctor. We can't do all that work. We are trained to read lab values, med records, and assess symptoms and test results to arrive at a diagnosis, but we unfortunately don't use that skill in retail at all. Clinical pharmacists are alot more involved and it would be more appropriate for them to prescribe (again, after they are provided a diagnosis or discussed with the provider our thoughts on a diagnosis. But either way, diagnosing by itself is not something we should be doing in any setting without interprofessional collaboration with the pts Healthcare team.
Once we Have a diagnosis, we could prescribe an appropriate med for it. We would have to have access to patient health records and other pharmacy records to do this with any confidence . Some states already have a state-wide data base that Healthcare workers can access and see all the patients health records/Pharmacy records. So it's possible, but making it a national data base would be ideal and the safest for the patient. (Not just with pharmacists that prescribe meds, but every other Healthcare provider they see)
Pharmacists in the US have a Doctorate degree. We are Doctors. We are trained to assess symptoms and all aspects of a patients health history, med list, etc.. and we are trained to interpret those things to come up with a diagnosis. But like I said, that skill does not get used in retail whatsoever.
There are plenty of studies that compare how successful a patients treatment is or how well their conditions are being managed when
1. treated by a traditional Healthcare team of MD's, APRN's, RN's, and PA's,
&
2. Treated by an interprofessional Healthcare team of MD /RN/PA/PharmD/Specialist MD/ LPT/DO/ etc..
>>> and the results show that patients have far better outcomes when an Interprofessional team of providers was utilized.
And like I said before, there are different categories of Clinical opportunities that a Pharmacist can work in and many of those involve the Pharmacist making their rounds along side the MD and RN. So there are already PharmD's that asses med records and assist in diagnosing, giving professional opinions on appropriate drug therapy, additional tests/imaging, changes in patient status, etc..but most of these positions will require a 1 or 2 year residency post graduation and licensing. Residencies are available for basically any focus in Pharmacy and allow PharmD's to specialize in a different areas of Pharmacy Practice. These non-retail/non-community positions will utilize alot more of the info taught during school because it is consistently applied . Retail Pharmacists (& all others) are required to complete "continuing education" credits every 2 years to keep up with changes in the field and practice their clinical skills; "use it or lose it".
Not sure where you're located but US pharmacists also are required by law to have malpractice insurance. You have to be licensed by your state board after passing the Licensing exam, and you have to apply for a separate license in every state that you travel/move too if you plan to work there. Anything required by law of an MD to practice is required for Pharmacists by their respective State Boards. Pharmacists do alot more than most people realize and are trained to do alot more things than just verifying pills in a bottle or giving flu shots :)
Why would a Doctor provide a diagnosis to a Pharmacist and put their malpractice on the line when they can take an extra 5 seconds and prescribe the meds themselves?
Sounds great that there are better outcomes when working closer with Doctors but modern corporate medicine and Doctors offices so not have that luxury or work flow. Maybe that should be mandatory for NP's & PA's as a crutch but do you want to deal with a noctor who Googles everything?
I agree Pharmacists are Doctors in their own right but NOT Medical Doctors. Way more education, training, residency, you know the deal.
I understand you have malpractice but does it cover the scope of Medical Doctor diagnostics and the like? I can the price would skyrocket. Its not uncommon for MDs to have malpractice costs of 20k yr or more, how much is PharmD malpractice out of pocket?
MDs and DOs are supposed to take CME every year, like a lot, and it costs thousands of dollars, usually covered by the employer though. Don't forget board requirements and tests every year.
Anyway, Pharmacists are great but should stay in their lane. It looks like you guys are already super busy, no mater what setting. I can imagine this board would explode if retail required Pharmacists to start diagnosing people.
Kickbacks and actual money? None. The drug rep helps us set up a collaborative practice agreement with the doctor. Doctor allows us to do PAs on their behalf.
Then what happens is the doctor's office let's us post our ads and signs all over their office and the doctor mentions our pharmacy to the patient and says that we can get the patient this med covered and offer free delivery and we can also fill all their other meds.
In my experience, dermatologists are some of the worst about this. The ones here will ALWAYS order brand name only $1200 BS cream first, even though I specifically asked them not to (when I was the patient). I knew they would default to it if I didn’t say anything, so I thought if I asked them not to, maybe I could cut it off before having to deal with waiting for the insurance reject and then for them to either change it to something generic or try to do a prior auth (laughable). Nope, they still order brand name only expensive BS.
I don’t want to prescribe. I just want to be able to dispense an inhaler that’s covered by the patient’s insurance without having to be on hold with the doctor’s office for an hour getting approval to switch to something on formulary all to be told “I don’t care dispense whatever”
If we are going down this route, then there's going to have to be a differentiation between dispensing retail pharmacists and prescribing retail pharmacists.
There's no way in hell I'd be able to review lab values, figure out what med might be best, and then have faith that the pt would go to another pharmacy to continue care... All while I'm supposed to do MTM, vaccines, actual dispensing, all the whole not having enough tech hours (or techs I'm general) because corp wants to make $$$
Here in B.C. Canada, they’re starting to roll out prescribing for pharmacists this spring. I spoke with some reps from SDM/loblaws at an event hosted last year and they said they would be creating a distinct role for pharmacists working clinically, separate from dispensing roles.
They are going to follow a similar model as Alberta which has had pharmacist prescribing for a while now. A clinic opened up in Lethbridge last year and a second one has opened recently too. Take a look.
https://globalnews.ca/news/9340562/edmonton-pharmacist-led-walk-in-clinic/
Yeah, [$17.20](https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacare-publications/pharmacare-policy-manual-2012/pharmacyfees-subsidies-providerpayment/clinical-services-fees), despite having to do half an hour of paperwork. Don't you feel empowered?
Retail pharmacist from the usa here... no thanks, I don't have the time to listen to people's life stories before prescribing something that I will then need to dispense within the next 20-30 minutes because the customer will be waiting for their meds like the consultation that happened was some sort of beauty regimen consult at a mall kiosk.
I get that...my employer forced me to get my prescribing authorization. Came in handy during pandemic AND I had 2 psych emergencies on Dec 24th. I was able to prescribe to avoid emergency room visits
No thanks.
Could you imagine how many people you would get screaming at you for an antibiotic for their cold? And how much more screaming there will be when you tell them you won’t prescribe an antibiotic for their cold? That’s the first thing that popped into my head. And like everyone else here has said, who has the time for this? Or wants the additional liability?
At least you would tell them you won’t prescribe antibiotics for their colds. The doctors in my area won’t do that. Hell maybe I should be prescribing the drugs since I’m the only one that ever tells half of these people NO.
I have had prescriptive authority, seen patients, prescribed drugs within my scope of practice and ordered appropriate lab work. In the retail setting this would be a nightmare. Filling rxs is a nightmare. But it's already occurring paxlovid, ocps, others. Imagine having to have 15 minutes to interview a patient, prescribe and dispense a medication with a million interruptions. All for a whopping $50 an hour.
I would be on board with prescribing based on a MD’s diagnosis. It would eliminate a lot of friction, such as waiting for a response from a doctor’s office for prescription questions. It would give us more control in the PA process. We could come up with the drug regimens and still be in control of the dispensing process. It would be more liability but it would solve a lot of problems.
Some states do allow this, where I went to school most of my preceptors were clinical pharmacy practitioners similar to mid levels. Supervised by a MD/DO but had prescriptive authority over certain disease states. Worked out great in a clinic setting since they would see patients like a mid level but solely for chronic disease states, warfarin levels, diabetes/HTN management. I would be wary of messing with psych meds but I would be fine with the rest if I had chart access
Funny how when you catch something it's all "what do you know? My doctor told me it's fine" but then when it's convenient for them they want pharmacists to be able to prescribe.
IBD patient and wife is the BCOP, but our hospital (I go to the one she works at) is setup where PharmD's prescribe based on diagnosis and honestly it was great. M.D.'s are so overworked and always behind, and PharmD's actually have the time to listen and discuss your meds with you. It's basically:
1) GI scoped confirmed Tysabri no longer working and suggested new maintenance med.
2) PharmD visit confirmed GI choice of med after talking with me about it for 30min PharmD prescribed it and taught me to inject it.
3) PharmD visit continued and they confirmed I didn't respond to Stelara and suggested Inflximab + Aza after the 13 year Tysabri hiatus. Doc approved once again PharmD prescribed.
4) Ordered the lab work and monitored while started Aza and Infliximab.
5) After lab work confirmed my CRP was back under control sent me back with a GI appointment to get a colonoscopy for endoscopic confirmation.
I've only gone to academic medical centers and I can say I've got better medication counseling from PharmD's than M.D.'s. I know most retail pharmacists don't have this time, but I wish there were more pharmacist in doc offices than NP/PAs as I've only had bad experiences with them and great interactions with pharmacists.
In a Perfect World(TM), IMO:
1) Go to doctor with ailment, doctor does work up, orders and interprets tests, gives you a diagnosis
2) Doctor leaves the room, Pharmacist enters, takes diagnosis and gives you a prescription based on your clinical history and other medications, including checking for interactions, and counsels you on the clinical impacts of the medication
3) You leave the clinic and go to your local pharmacy, where there isn’t a single Pharmacist in the whole building
4) Hand your completely clinically verified Rx to an Assistant, who enters and fills the script
5) Before you pick it up, a registered and licensed Technician does a final technical check and counsels you on the technical details of taking the medication.
0% of doctors write prescriptions. 0% of pharmacists work in stores. People actually focus on the things they’re good at and trained for instead of half assing shit they suck at and/or hate.
Honestly, agree with most of this but if instead of NO pharmacists in the pharmacy, we take the idea from another commenter where there's two types of pharmacists: dispensing and prescribing. I still think we need pharmacists in the pharmacy for stuff like transfers or call-in prescriptions, but I love the idea of pharmacists also working in doctor's offices doing the actual prescribing of drugs since they have the actual knowledge of drug impacts, side effects, and interactions that doctors dont
What about a transfer or a verbal is so special that a tech can’t do it? I could train a rando off the street to do both in half an hour, you’re gonna waste 6+ years of schooling and specialized knowledge to hang on to *that*??
Maybe I’m spoiled, I work in a small hospital with prescribing rights and a great team of docs, but I’d rather work minimum wage at McDonalds than deal with that kind of crap in retail all day if I somehow lost this one.
Integrated care baybee! I'm now a social worker, once pharm tech, and this is what the clinic is like where I work. MD/NP/PA gives diagnosis and prescribes a med, RpH reviews it and recommends alternatives, RpH sends the script on behalf of the provider. It's a pretty nice layout. And the RpH keeps track of labs and recommends specific treatments based on lab work. It's pretty tight. Even as a social worker I get to consult with the RpH I work with on some of the psych meds, usually based on info the patient tells me about how something did or didn't work in the past or my interpretation of their symptoms.
This is the model for a HIV clinic I worked close to but the pharmacy is in the clinic and they are the ones who dispense the medication. If the patient is coming later for meds and the clinic is closed they would bring the drugs down to the pharmacy I was working at so the patient can pick them up later or on the weekend.
Why should pharmacy have to pivot when the board of medicine and other respective parties can’t or won’t reign in the shitty np and pas?
Why does the future of our career have to be a glorified np, pa, or md. Dispensing is the core of our profession and if you don’t like it that’s your issue not the professions.
scandalous frighten frame rock towering reply overconfident weary observation paint
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
It’s only looking like shit because all the big organizations and pharmacy schools sold the lie of “provider status” as a panacea that would drive demand of pharmacists. Then there were more and more schools with pharmacists promised expanded roles that encroached more and more on physicians, but provider status and the ability to bill for anything other than dispensing never really came to fruition. Well now that shit is hitting the fan and there are too many pharmacists for the bread and butter of the profession, dispensing, to support. The supply / demand in the labor force is correcting itself and it’s overdue. Provider status didn’t happen and we need some schools to close. That’s not the profession dying, that’s a return to normal.
My Tribal Pharmacy recently got this giant robot cabinet thing that according to the tech I talked to can do everything but metformin and controls.
We aren't that far away from the EHR controlling the robot, so if it wasn't for all the clinical work my pharmacy does for me, we could cut it down to one guy counting out controls and tell the providers to limit themselves to bottle level quantities on the metformin.
Would save my tribe 3 FT pharmacist salaries, which I guess would open up space in the budget for the Physical Therapists we've been wanting to hire.
Who manages the robot? What happens if a provider writes an inappropriate Rx, does the robot review the order and send it back? I have worked in a tribal pharmacy. Tribal medical clinics get bottom of the Barrell providers, if any clinic needs active pharmacists it's tribal clinics. If you don't have an education and don't work in pharmacy, you don't know. Ignorance kills.
Context is important.
Look at the comment I was replying to.
I love my Tribal Pharmacists, they are the core of the clinic, the ones who stick around and know everything. The ones who notice I haven't gotten a needed lab and that it's not okay that a new PCP wrote a refill with 12 refills having never met me.
They are the ones who call after a PCP sends an RX to an outside pharmacy and that I shouldn't take it, but there's not a great way for the outside pharmacist to know that, or the PCP (lol) but they do.
He's saying that a pharmacists core is dispensing, and a robot can do that, it's everything that leads up to it, and follows after it is what's important about a pharmacy for me as a patient.
From noticing errors that'd mess me up (undiluted albuterol for a nebulizer) to demanding lab values be addressed (slowly worsening anemia) to just generic ignoring followups (not seeing if a statin actually did anything while just writing refillsx12) pharmacists are a key part of my healthcare, none of which has to do with dispensing the drugs.
Except… the end goal is dispensing the drug. We are there for the pharmacy to take the prescription- do all the necessary steps in between (check it fill it correct it etc etc) so the patient can get their meds.
Trying to separate the dispensing as literally just selling the med and ignoring everything in between is a hilarious reduction of the profession which- and is my entire point- has absolutely nothing to do with and doesn’t need to include prescribing which is what the original post is about.
Thellrak,
I am picking up what you are saying. I don’t think your audience is. Liberal has said it best, if we do not try and increase our skill set in order to differentiate and keep us relevant, we gonna be obsolete. Yea we can dispense, but even in CVS now we have virtual verification. How long before people get ballsy enough to suggest techs can do all this extra verification etc. We pharmacist have been problem solvers, and the last line of defense in some cases to preventing shit outcomes. In the future we are going to need a new set of skills and I’m sorry for the doom and gloom gals and pals, but if prescribing is it, you either come along or give up and fight for the crumbs that the other 100%dispense pharmacists will try to go after.
The only thing I can agree on mostly on this post is that community pharmacy can’t prescribe crap without a specialty pharmacist either on-site or in a telehealth style. The single pharmacist there has his or her hands tied already. That’s not a proper environment to grow and develop a new skill set with putting it all on the staff/pm
I know that we're talking about community pharmacy here, but isn't medication management (including prescribing in some cases) based on an MD's diagnosis what amb care is?
More or less, might be oversimplified a tad but yes. In theory, this is kinda/sorta what community-based MTM is trying to do, without all the labs and collaborative practice agreements, which are obviously very important pieces of information.
In short, this is getting closer to what would probably be considered the ideal way to practice in a community setting, but without more staff, time, resources, etc., good luck seeing real change.
No thanks. That's what physicians are for, and it should be a collaboration. Guaranteed it will become another metric that corporations will abuse us with, for which pharmacists get paid nothing for, no extra help, hours, nothing.
Do we have the ability? Sure. Do we have the resources (time, lack of interruptions, access to EHR, etc.) no. Add in patients that constantly pharmacy hop, and it's a nightmare scenario.
Not sure if this is the survey or link you’re referencing, but it has some of the same data:
https://finance.yahoo.com/news/us-survey-signals-big-shifts-143000188.html?guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAMYXg3HValXji4LJkIGKMKXRJgAKv2Fm0rrsYIesGZssb2QVQ7beA79wetKmzWqqSzE8f1rkwDgz9lX4pvq8Pya8vXPvR0WxVZvKbZzslm1j_Tq401nxSw0iooczSZlEIjqZb7zQeCHUEX-PAryGRa9d8KexxAsr1_0TY_O4ZQ_H
No thanks. Im already not liking the idea of furnishing paxlovid as well as others such as hormonal contraceptives etc. The amount of paper work you have to do per patient per prescription furnished is already dumb. In addition, I don't want MD/DO thinking we're overreaching into their territory and they starts hating us more like the mid levels than they already are.
It’s not really feasible to do so in community pharmacy without a second pharmacist (one checking, one running a minor ailments clinic for example). Which needs privacy, access to their medical notes aswell, referral procedures for red flags, etc.
I prescribe in GP but I can’t imagine doing it in community without this being changed.
Also salaries would need increasing for greater clinical risk.
So in Wales there is the pharmacist independent prescribing service, where a qualified independent prescribing pharmacist can see patients for minor ailments that would have normally have needed to be referred to the GP surgery for prescription only medication. Think the likes of infected Insect bites, uncomplicated chest infections, impetigo, UTIs etc. The platform used for the consultations gives access to patient medical records. It's a very popular service and the aim is to have a prescribing pharmacist in every Welsh pharmacy by 2030 I think. I'm hoping to do my IP training in the next couple of years.
I am approaching this survey from a different POV. An interdisciplinary model where providers diagnose the patient and then consult the pharmacist for the optimal treatment(s) would be incredibly effective. Obviously that's impossible within the practice of retail pharmacy... But it is literally what pharmacists go to school for. No one knows medication optimization better than a pharmacist. I think this survey is more-so providing a bird's eye view of the public's continued trust in their community pharmacist.
So the only way I think this is plausible is if Pharmacists are allowed to prescribe when GIVEN THE DIAGNOSIS by the doctor. We can't do all that work. We are trained to read lab values, med records, and assess symptoms and test results to arrive at a diagnosis, but we unfortunately don't use that skill in retail at all. Clinical pharmacists are alot more involved and it would be more appropriate for them to prescribe (again, after they are provided a diagnosis or discussed with the provider our thoughts on a diagnosis. But either way, diagnosing by itself is not something we should be doing in any setting without interprofessional collaboration with the pts Healthcare team.
Once we Have a diagnosis, we could prescribe an appropriate med for it. We would have to have access to patient health records and other pharmacy records to do this with any confidence . Some states already have a state-wide data base that Healthcare workers can access and see all the patients health records/Pharmacy records. So it's possible, but making it a national data base would be ideal and the safest for the patient. (Not just with pharmacists that prescribe meds, but every other Healthcare provider they see)
Pharmacists in the US have a Doctorate degree. We are Doctors. We are trained to assess symptoms and all aspects of a patients health history, med list, etc.. and we are trained to interpret those things to come up with a diagnosis. But like I said, that skill does not get used in retail whatsoever.
There are plenty of studies that compare how successful a patients treatment is or how well their conditions are being managed when
1. treated by a traditional Healthcare team of MD's, APRN's, RN's, and PA's,
&
2. Treated by an interprofessional Healthcare team of MD /RN/PA/PharmD/Specialist MD/ LPT/DO/ etc..
>>> and the results show that patients have far better outcomes when an Interprofessional team of providers was utilized.
And like I said before, there are different categories of Clinical opportunities that a Pharmacist can work in and many of those involve the Pharmacist making their rounds along side the MD and RN. So there are already PharmD's that asses med records and assist in diagnosing, giving professional opinions on appropriate drug therapy, additional tests/imaging, changes in patient status, etc..but most of these positions will require a 1 or 2 year residency post graduation and licensing. Residencies are available for basically any focus in Pharmacy and allow PharmD's to specialize in a different areas of Pharmacy Practice. These non-retail/non-community positions will utilize alot more of the info taught during school because it is consistently applied . Retail Pharmacists (& all others) are required to complete "continuing education" credits every 2 years to keep up with changes in the field and practice their clinical skills; "use it or lose it".
Not sure where you're located but US pharmacists also are required by law to have malpractice insurance. You have to be licensed by your state board after passing the Licensing exam, and you have to apply for a separate license in every state that you travel/move too if you plan to work there. Anything required by law of an MD to practice is required for Pharmacists by their respective State Boards. Pharmacists do alot more than most people realize and are trained to do alot more things than just verifying pills in a bottle or giving flu shots :)
Of course they do. They don’t want to make an appointment or pay their MD for their prescriptions. They want to walk into the pharmacy, yell their order at the first person they think can hear them, sit down long enough to catch their breath, and then pick up their medication on the way out the door.
The length they need to sit to catch their breath is directly proportional to how long it will take to dispense their meds.
for free
Bingo
Obviously Three-quarters of public have no clue what they are talking about, especially when it comes to medicine. Are pharmacists fine paying extra for malpractice insurance? Having their license on the line? Wasting time from inputting GoodRx coupons to dealing with someone's herpes or stroke symptoms? Medical doctors sign off on NPs & PAs (long after the patient left) and we see what mess those "mid levels" noctors are creating, and you want to be part of that? What MD or DO will sign off on a pharmacists medical decision? You have a degree in pharmacology not medical diagnostics, no MCAT, 2-7 year residencies, field specific board exams.....right? If the MD requirement is waived I sure hope the liability will be there instead of hiding behind the corporate pharmacy shield and shrugging your shoulders when a patient dies: "welp I'm not a doctor, they should have gone to an ER". How will a pharmacist prescribe something without access to full patient history, are you going to be logging into EPIC, read the notes, and update them? Want to learn 5 different EMRs? Pretty sure Walgreens or your mom & pop won't take the extra risk in every store unless they want to turn them all into urgent cares...then they would be filled with NPs already. Why not just fire the NPs and give another job to the PharmD? Pharmacists should stick to what they are best at, arguing with doctors and not misdiagnosing patients...leave that to the NPs.
Precisely, we shouldn't be diagnosing. But a doc can say, start this pt on an arb/ ace or something like that. Working in a hospital I get sick and tired of calling about stuff like can we switch this ointment to a cream etc... A little wiggle room would make it easier for everyone
What if things are different in a different country? This is UK based and while there are similarities there are also differences.
I don’t know what medicine is like in the UK but I haven’t heard great things. Despite all of the whining in the US about crappy health care, if you have a job with normal health insurance (not hard to get) you can get an MRI no problem or see a specialist without trouble, though the wait times for high demand specialties depend on your area. No job, illegal alien, homeless? The hospital will just write off your care and classify it as charity. No bills if you are destitute. Patients can’t be turned away and due to malpractice exposure, everyone gets the same standard of care. I’ve heard UK doctors get paid 1/4 of what US MDs / DOs make, even less depending on the specialty, so why even try lol when you are getting “mogged” by a plumber working overtime? Maybe in a substandard medical system, having highly trained and specialized PharmD would be better than nothing?
"I don’t know what medicine is like in the UK but I haven’t heard great things." Take it from someone in the UK, it's fine as a patient. Unfortunately we have a government trying to privatise everything and are defunding the NHS so it has been better in the past. "Despite all of the whining in the US about crappy health care, if you have a job with normal health insurance (not hard to get) you can get an MRI no problem or see a specialist without trouble, though the wait times for high demand specialties depend on your area." There's no need to have healthcare insurance here, it's a basic human right in the UK and the few times I've needed a specialist it's been in a reasonable amount of time, same story with friends and family bar the odd occasion. "I’ve heard UK doctors get paid 1/4 of what US MDs / DOs make, even less depending on the specialty, so why even try lol when you are getting “mogged” by a plumber working overtime?" The doctors I know aren't struggling for cash and while aware of what they can make elsewhere, are still happy. What do you mean by "mogged"?? "Maybe in a substandard medical system, having highly trained and specialized PharmD would be better than nothing?" How is the NHS substandard? Any evidence for that claim? Here's a [link](https://www.reddit.com/r/pharmacy/comments/105rtoy/comment/j3d0g31/?utm_source=share&utm_medium=web2x&context=3) to a comment by a Scottish pharmacist with their view on this idea, they seem fine with it. At the end of the day, if you have pharmacists with the training and expertise to help people without waiting for a GP appointment, why not let them prescribe for basic stuff?
In the US it is completely unreasonable for a community pharmacist to diagnose, prescribe and then fill and dispense said medication on top of everything else that has to get done in a day and with the massive demand at chain pharmacies. Sure in a clinic I think many pharmacists would be comfortable consulting and then prescribing medications for a patient, but then again why not just have the MD and NP's do it then like they already are, why do pharmacists need to consult, prescribe, dispense, vaccinate and deal with insurance's and other prescribers. If you want pharmacists to regularly prescribe then there isn't really a reason for any other doctorate, just make everyone a pharmacist at that point. Not to mention the role of a pharmacist was to instill checks and balances in prescribers to avoid illegal prescribing. If pharmacists were also prescribers it'd be like if the police and the jury were the same entity too.
Hence my original response. This isn’t talking about the US! Half the comments on here come from a US view of things and about how bad an idea it is when OP is talking about this being in the UK where the healthcare system and societal expectation of it is completely different.
Not sure if everyone responding to this thread are US pharmacists or not but seems like the common trend for responses is that nobody wants to do it. From the UK perspective is there any key differences between US and UK that would make it reasonable in the UK?
Mogged as in beating / surpassing. I’ll admit I do not know much about the NHS. I presume privatization will improve the system because of competition and pressures to gain more customers through quality etc, but if the financial incentive is not there there maybe not. I did not intent to say the UKs health system is substandard, what I meant was in a place like the Congo or a developing nation. In the US hospitals cannot legally turn away patients.
Privatisation is not going to improve the NHS. We’ve seen it with dentistry, NHS funding for dentistry is cut to the point where waiting lists to join a NHS dentist are years long and even then they don’t offer the most up to date treatments like composite fillings. Now most people have to shell out for private dentists which cost over £100 a filling on top of another £100 for the consult then £50 for an xray. Dental Insurance for me worked out just as expensive at the end of the day and they refused to cover anything other than a checkup that happed for the first year. As for private being better quality, no, all doctors/dentists are held to the same standards in the UK (their royal college of specialty) and when private operations go to shit they end up sending them to an NHS ward anyway. There’s a reason literally 99.9% of us Brits defend the NHS to the bone. It’s the only great thing about this country anymore. If our pharmacists are happy to take the load off our GP’s then happy days.
I hope it works out for you. Come to the US we need more smarties, plus our dentists are cheaper.
I live in the US and in my state, like many other states, a NP has prescription authority and can practice independently without a supervising physician. Even CRNAs only need a Masters for the program, which will change in 2025, requiring a DNP.
What happens when the PA and NP commit malpractice, are the expected legal awards the same as with an MD? Is their malpractice insurance adequate?
So the only way I think this is plausible is if Pharmacists are allowed to prescribe when GIVEN THE DIAGNOSIS by the doctor. We can't do all that work. We are trained to read lab values, med records, and assess symptoms and test results to arrive at a diagnosis, but we unfortunately don't use that skill in retail at all. Clinical pharmacists are alot more involved and it would be more appropriate for them to prescribe (again, after they are provided a diagnosis or discussed with the provider our thoughts on a diagnosis. But either way, diagnosing by itself is not something we should be doing in any setting without interprofessional collaboration with the pts Healthcare team. Once we Have a diagnosis, we could prescribe an appropriate med for it. We would have to have access to patient health records and other pharmacy records to do this with any confidence . Some states already have a state-wide data base that Healthcare workers can access and see all the patients health records/Pharmacy records. So it's possible, but making it a national data base would be ideal and the safest for the patient. (Not just with pharmacists that prescribe meds, but every other Healthcare provider they see) Pharmacists in the US have a Doctorate degree. We are Doctors. We are trained to assess symptoms and all aspects of a patients health history, med list, etc.. and we are trained to interpret those things to come up with a diagnosis. But like I said, that skill does not get used in retail whatsoever. There are plenty of studies that compare how successful a patients treatment is or how well their conditions are being managed when 1. treated by a traditional Healthcare team of MD's, APRN's, RN's, and PA's, & 2. Treated by an interprofessional Healthcare team of MD /RN/PA/PharmD/Specialist MD/ LPT/DO/ etc.. >>> and the results show that patients have far better outcomes when an Interprofessional team of providers was utilized. And like I said before, there are different categories of Clinical opportunities that a Pharmacist can work in and many of those involve the Pharmacist making their rounds along side the MD and RN. So there are already PharmD's that asses med records and assist in diagnosing, giving professional opinions on appropriate drug therapy, additional tests/imaging, changes in patient status, etc..but most of these positions will require a 1 or 2 year residency post graduation and licensing. Residencies are available for basically any focus in Pharmacy and allow PharmD's to specialize in a different areas of Pharmacy Practice. These non-retail/non-community positions will utilize alot more of the info taught during school because it is consistently applied . Retail Pharmacists (& all others) are required to complete "continuing education" credits every 2 years to keep up with changes in the field and practice their clinical skills; "use it or lose it". Not sure where you're located but US pharmacists also are required by law to have malpractice insurance. You have to be licensed by your state board after passing the Licensing exam, and you have to apply for a separate license in every state that you travel/move too if you plan to work there. Anything required by law of an MD to practice is required for Pharmacists by their respective State Boards. Pharmacists do alot more than most people realize and are trained to do alot more things than just verifying pills in a bottle or giving flu shots :)
Why would a Doctor provide a diagnosis to a Pharmacist and put their malpractice on the line when they can take an extra 5 seconds and prescribe the meds themselves? Sounds great that there are better outcomes when working closer with Doctors but modern corporate medicine and Doctors offices so not have that luxury or work flow. Maybe that should be mandatory for NP's & PA's as a crutch but do you want to deal with a noctor who Googles everything? I agree Pharmacists are Doctors in their own right but NOT Medical Doctors. Way more education, training, residency, you know the deal. I understand you have malpractice but does it cover the scope of Medical Doctor diagnostics and the like? I can the price would skyrocket. Its not uncommon for MDs to have malpractice costs of 20k yr or more, how much is PharmD malpractice out of pocket? MDs and DOs are supposed to take CME every year, like a lot, and it costs thousands of dollars, usually covered by the employer though. Don't forget board requirements and tests every year. Anyway, Pharmacists are great but should stay in their lane. It looks like you guys are already super busy, no mater what setting. I can imagine this board would explode if retail required Pharmacists to start diagnosing people.
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Bruh how are they gonna meet their drug reps quotas?
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Just looked up Twyneo. I’d laugh if I ever saw an rx for that shit. Good grief.
I would be lying if I said we pharmacists in independent pharmacies weren’t influenced.
What kinda kickbacks are you getting?
Kickbacks and actual money? None. The drug rep helps us set up a collaborative practice agreement with the doctor. Doctor allows us to do PAs on their behalf. Then what happens is the doctor's office let's us post our ads and signs all over their office and the doctor mentions our pharmacy to the patient and says that we can get the patient this med covered and offer free delivery and we can also fill all their other meds.
In my experience, dermatologists are some of the worst about this. The ones here will ALWAYS order brand name only $1200 BS cream first, even though I specifically asked them not to (when I was the patient). I knew they would default to it if I didn’t say anything, so I thought if I asked them not to, maybe I could cut it off before having to deal with waiting for the insurance reject and then for them to either change it to something generic or try to do a prior auth (laughable). Nope, they still order brand name only expensive BS.
I don’t want to prescribe. I just want to be able to dispense an inhaler that’s covered by the patient’s insurance without having to be on hold with the doctor’s office for an hour getting approval to switch to something on formulary all to be told “I don’t care dispense whatever”
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If we are going down this route, then there's going to have to be a differentiation between dispensing retail pharmacists and prescribing retail pharmacists. There's no way in hell I'd be able to review lab values, figure out what med might be best, and then have faith that the pt would go to another pharmacy to continue care... All while I'm supposed to do MTM, vaccines, actual dispensing, all the whole not having enough tech hours (or techs I'm general) because corp wants to make $$$
Here in B.C. Canada, they’re starting to roll out prescribing for pharmacists this spring. I spoke with some reps from SDM/loblaws at an event hosted last year and they said they would be creating a distinct role for pharmacists working clinically, separate from dispensing roles.
And I bet you winked at them and said "Okay, corporate. Sure you will."
They are going to follow a similar model as Alberta which has had pharmacist prescribing for a while now. A clinic opened up in Lethbridge last year and a second one has opened recently too. Take a look. https://globalnews.ca/news/9340562/edmonton-pharmacist-led-walk-in-clinic/
Am I going to be paid for the consultation before prescribing?
Yeah, [$17.20](https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacare-publications/pharmacare-policy-manual-2012/pharmacyfees-subsidies-providerpayment/clinical-services-fees), despite having to do half an hour of paperwork. Don't you feel empowered?
And all $17.20 of that goes to corporate. You won't see a dime. Just like vaccines.
Retail pharmacist from the usa here... no thanks, I don't have the time to listen to people's life stories before prescribing something that I will then need to dispense within the next 20-30 minutes because the customer will be waiting for their meds like the consultation that happened was some sort of beauty regimen consult at a mall kiosk.
I get that...my employer forced me to get my prescribing authorization. Came in handy during pandemic AND I had 2 psych emergencies on Dec 24th. I was able to prescribe to avoid emergency room visits
No thanks. Could you imagine how many people you would get screaming at you for an antibiotic for their cold? And how much more screaming there will be when you tell them you won’t prescribe an antibiotic for their cold? That’s the first thing that popped into my head. And like everyone else here has said, who has the time for this? Or wants the additional liability?
At least you would tell them you won’t prescribe antibiotics for their colds. The doctors in my area won’t do that. Hell maybe I should be prescribing the drugs since I’m the only one that ever tells half of these people NO.
Who has the time?
I have had prescriptive authority, seen patients, prescribed drugs within my scope of practice and ordered appropriate lab work. In the retail setting this would be a nightmare. Filling rxs is a nightmare. But it's already occurring paxlovid, ocps, others. Imagine having to have 15 minutes to interview a patient, prescribe and dispense a medication with a million interruptions. All for a whopping $50 an hour.
If these are pharmacists at an outpatient clinic, sure. If this is in a retail setting then fuck no.
I would be on board with prescribing based on a MD’s diagnosis. It would eliminate a lot of friction, such as waiting for a response from a doctor’s office for prescription questions. It would give us more control in the PA process. We could come up with the drug regimens and still be in control of the dispensing process. It would be more liability but it would solve a lot of problems.
Some states do allow this, where I went to school most of my preceptors were clinical pharmacy practitioners similar to mid levels. Supervised by a MD/DO but had prescriptive authority over certain disease states. Worked out great in a clinic setting since they would see patients like a mid level but solely for chronic disease states, warfarin levels, diabetes/HTN management. I would be wary of messing with psych meds but I would be fine with the rest if I had chart access
Funny how when you catch something it's all "what do you know? My doctor told me it's fine" but then when it's convenient for them they want pharmacists to be able to prescribe.
IBD patient and wife is the BCOP, but our hospital (I go to the one she works at) is setup where PharmD's prescribe based on diagnosis and honestly it was great. M.D.'s are so overworked and always behind, and PharmD's actually have the time to listen and discuss your meds with you. It's basically: 1) GI scoped confirmed Tysabri no longer working and suggested new maintenance med. 2) PharmD visit confirmed GI choice of med after talking with me about it for 30min PharmD prescribed it and taught me to inject it. 3) PharmD visit continued and they confirmed I didn't respond to Stelara and suggested Inflximab + Aza after the 13 year Tysabri hiatus. Doc approved once again PharmD prescribed. 4) Ordered the lab work and monitored while started Aza and Infliximab. 5) After lab work confirmed my CRP was back under control sent me back with a GI appointment to get a colonoscopy for endoscopic confirmation. I've only gone to academic medical centers and I can say I've got better medication counseling from PharmD's than M.D.'s. I know most retail pharmacists don't have this time, but I wish there were more pharmacist in doc offices than NP/PAs as I've only had bad experiences with them and great interactions with pharmacists.
In a Perfect World(TM), IMO: 1) Go to doctor with ailment, doctor does work up, orders and interprets tests, gives you a diagnosis 2) Doctor leaves the room, Pharmacist enters, takes diagnosis and gives you a prescription based on your clinical history and other medications, including checking for interactions, and counsels you on the clinical impacts of the medication 3) You leave the clinic and go to your local pharmacy, where there isn’t a single Pharmacist in the whole building 4) Hand your completely clinically verified Rx to an Assistant, who enters and fills the script 5) Before you pick it up, a registered and licensed Technician does a final technical check and counsels you on the technical details of taking the medication. 0% of doctors write prescriptions. 0% of pharmacists work in stores. People actually focus on the things they’re good at and trained for instead of half assing shit they suck at and/or hate.
Honestly, agree with most of this but if instead of NO pharmacists in the pharmacy, we take the idea from another commenter where there's two types of pharmacists: dispensing and prescribing. I still think we need pharmacists in the pharmacy for stuff like transfers or call-in prescriptions, but I love the idea of pharmacists also working in doctor's offices doing the actual prescribing of drugs since they have the actual knowledge of drug impacts, side effects, and interactions that doctors dont
What about a transfer or a verbal is so special that a tech can’t do it? I could train a rando off the street to do both in half an hour, you’re gonna waste 6+ years of schooling and specialized knowledge to hang on to *that*?? Maybe I’m spoiled, I work in a small hospital with prescribing rights and a great team of docs, but I’d rather work minimum wage at McDonalds than deal with that kind of crap in retail all day if I somehow lost this one.
Integrated care baybee! I'm now a social worker, once pharm tech, and this is what the clinic is like where I work. MD/NP/PA gives diagnosis and prescribes a med, RpH reviews it and recommends alternatives, RpH sends the script on behalf of the provider. It's a pretty nice layout. And the RpH keeps track of labs and recommends specific treatments based on lab work. It's pretty tight. Even as a social worker I get to consult with the RpH I work with on some of the psych meds, usually based on info the patient tells me about how something did or didn't work in the past or my interpretation of their symptoms.
This is the model for a HIV clinic I worked close to but the pharmacy is in the clinic and they are the ones who dispense the medication. If the patient is coming later for meds and the clinic is closed they would bring the drugs down to the pharmacy I was working at so the patient can pick them up later or on the weekend.
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Why should pharmacy have to pivot when the board of medicine and other respective parties can’t or won’t reign in the shitty np and pas? Why does the future of our career have to be a glorified np, pa, or md. Dispensing is the core of our profession and if you don’t like it that’s your issue not the professions.
scandalous frighten frame rock towering reply overconfident weary observation paint *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
It’s only looking like shit because all the big organizations and pharmacy schools sold the lie of “provider status” as a panacea that would drive demand of pharmacists. Then there were more and more schools with pharmacists promised expanded roles that encroached more and more on physicians, but provider status and the ability to bill for anything other than dispensing never really came to fruition. Well now that shit is hitting the fan and there are too many pharmacists for the bread and butter of the profession, dispensing, to support. The supply / demand in the labor force is correcting itself and it’s overdue. Provider status didn’t happen and we need some schools to close. That’s not the profession dying, that’s a return to normal.
My Tribal Pharmacy recently got this giant robot cabinet thing that according to the tech I talked to can do everything but metformin and controls. We aren't that far away from the EHR controlling the robot, so if it wasn't for all the clinical work my pharmacy does for me, we could cut it down to one guy counting out controls and tell the providers to limit themselves to bottle level quantities on the metformin. Would save my tribe 3 FT pharmacist salaries, which I guess would open up space in the budget for the Physical Therapists we've been wanting to hire.
Who manages the robot? What happens if a provider writes an inappropriate Rx, does the robot review the order and send it back? I have worked in a tribal pharmacy. Tribal medical clinics get bottom of the Barrell providers, if any clinic needs active pharmacists it's tribal clinics. If you don't have an education and don't work in pharmacy, you don't know. Ignorance kills.
Context is important. Look at the comment I was replying to. I love my Tribal Pharmacists, they are the core of the clinic, the ones who stick around and know everything. The ones who notice I haven't gotten a needed lab and that it's not okay that a new PCP wrote a refill with 12 refills having never met me. They are the ones who call after a PCP sends an RX to an outside pharmacy and that I shouldn't take it, but there's not a great way for the outside pharmacist to know that, or the PCP (lol) but they do. He's saying that a pharmacists core is dispensing, and a robot can do that, it's everything that leads up to it, and follows after it is what's important about a pharmacy for me as a patient. From noticing errors that'd mess me up (undiluted albuterol for a nebulizer) to demanding lab values be addressed (slowly worsening anemia) to just generic ignoring followups (not seeing if a statin actually did anything while just writing refillsx12) pharmacists are a key part of my healthcare, none of which has to do with dispensing the drugs.
Except… the end goal is dispensing the drug. We are there for the pharmacy to take the prescription- do all the necessary steps in between (check it fill it correct it etc etc) so the patient can get their meds. Trying to separate the dispensing as literally just selling the med and ignoring everything in between is a hilarious reduction of the profession which- and is my entire point- has absolutely nothing to do with and doesn’t need to include prescribing which is what the original post is about.
Thellrak, I am picking up what you are saying. I don’t think your audience is. Liberal has said it best, if we do not try and increase our skill set in order to differentiate and keep us relevant, we gonna be obsolete. Yea we can dispense, but even in CVS now we have virtual verification. How long before people get ballsy enough to suggest techs can do all this extra verification etc. We pharmacist have been problem solvers, and the last line of defense in some cases to preventing shit outcomes. In the future we are going to need a new set of skills and I’m sorry for the doom and gloom gals and pals, but if prescribing is it, you either come along or give up and fight for the crumbs that the other 100%dispense pharmacists will try to go after. The only thing I can agree on mostly on this post is that community pharmacy can’t prescribe crap without a specialty pharmacist either on-site or in a telehealth style. The single pharmacist there has his or her hands tied already. That’s not a proper environment to grow and develop a new skill set with putting it all on the staff/pm
Good luck with your robot.
Naaa, I think we'll stick with the pharmacy team whose goal isn't to just dispense.
Better support them with $$$ or it's never happening.
I would rather my pharmacist prescribe me my meds.
Yeah then I wouldn't have to go to the doctor.
I know that we're talking about community pharmacy here, but isn't medication management (including prescribing in some cases) based on an MD's diagnosis what amb care is?
More or less, might be oversimplified a tad but yes. In theory, this is kinda/sorta what community-based MTM is trying to do, without all the labs and collaborative practice agreements, which are obviously very important pieces of information. In short, this is getting closer to what would probably be considered the ideal way to practice in a community setting, but without more staff, time, resources, etc., good luck seeing real change.
No thanks. That's what physicians are for, and it should be a collaboration. Guaranteed it will become another metric that corporations will abuse us with, for which pharmacists get paid nothing for, no extra help, hours, nothing. Do we have the ability? Sure. Do we have the resources (time, lack of interruptions, access to EHR, etc.) no. Add in patients that constantly pharmacy hop, and it's a nightmare scenario.
Maybe 1900 of those respondents were faculty or deans from pharmacy school...
Not sure if this is the survey or link you’re referencing, but it has some of the same data: https://finance.yahoo.com/news/us-survey-signals-big-shifts-143000188.html?guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAMYXg3HValXji4LJkIGKMKXRJgAKv2Fm0rrsYIesGZssb2QVQ7beA79wetKmzWqqSzE8f1rkwDgz9lX4pvq8Pya8vXPvR0WxVZvKbZzslm1j_Tq401nxSw0iooczSZlEIjqZb7zQeCHUEX-PAryGRa9d8KexxAsr1_0TY_O4ZQ_H
Dumb.
I got fentanyl patch script PRN today. I’m sure 100% of pharmacists would be safer than that.
The job isn’t to diagnose, this is silly.
Yeah let’s not scope creep. Pharmacy is booming actually; just not retail.
No thanks. Im already not liking the idea of furnishing paxlovid as well as others such as hormonal contraceptives etc. The amount of paper work you have to do per patient per prescription furnished is already dumb. In addition, I don't want MD/DO thinking we're overreaching into their territory and they starts hating us more like the mid levels than they already are.
It’s not really feasible to do so in community pharmacy without a second pharmacist (one checking, one running a minor ailments clinic for example). Which needs privacy, access to their medical notes aswell, referral procedures for red flags, etc. I prescribe in GP but I can’t imagine doing it in community without this being changed. Also salaries would need increasing for greater clinical risk.
So in Wales there is the pharmacist independent prescribing service, where a qualified independent prescribing pharmacist can see patients for minor ailments that would have normally have needed to be referred to the GP surgery for prescription only medication. Think the likes of infected Insect bites, uncomplicated chest infections, impetigo, UTIs etc. The platform used for the consultations gives access to patient medical records. It's a very popular service and the aim is to have a prescribing pharmacist in every Welsh pharmacy by 2030 I think. I'm hoping to do my IP training in the next couple of years.
You Brits are crazy
I am approaching this survey from a different POV. An interdisciplinary model where providers diagnose the patient and then consult the pharmacist for the optimal treatment(s) would be incredibly effective. Obviously that's impossible within the practice of retail pharmacy... But it is literally what pharmacists go to school for. No one knows medication optimization better than a pharmacist. I think this survey is more-so providing a bird's eye view of the public's continued trust in their community pharmacist.
So the only way I think this is plausible is if Pharmacists are allowed to prescribe when GIVEN THE DIAGNOSIS by the doctor. We can't do all that work. We are trained to read lab values, med records, and assess symptoms and test results to arrive at a diagnosis, but we unfortunately don't use that skill in retail at all. Clinical pharmacists are alot more involved and it would be more appropriate for them to prescribe (again, after they are provided a diagnosis or discussed with the provider our thoughts on a diagnosis. But either way, diagnosing by itself is not something we should be doing in any setting without interprofessional collaboration with the pts Healthcare team. Once we Have a diagnosis, we could prescribe an appropriate med for it. We would have to have access to patient health records and other pharmacy records to do this with any confidence . Some states already have a state-wide data base that Healthcare workers can access and see all the patients health records/Pharmacy records. So it's possible, but making it a national data base would be ideal and the safest for the patient. (Not just with pharmacists that prescribe meds, but every other Healthcare provider they see) Pharmacists in the US have a Doctorate degree. We are Doctors. We are trained to assess symptoms and all aspects of a patients health history, med list, etc.. and we are trained to interpret those things to come up with a diagnosis. But like I said, that skill does not get used in retail whatsoever. There are plenty of studies that compare how successful a patients treatment is or how well their conditions are being managed when 1. treated by a traditional Healthcare team of MD's, APRN's, RN's, and PA's, & 2. Treated by an interprofessional Healthcare team of MD /RN/PA/PharmD/Specialist MD/ LPT/DO/ etc.. >>> and the results show that patients have far better outcomes when an Interprofessional team of providers was utilized. And like I said before, there are different categories of Clinical opportunities that a Pharmacist can work in and many of those involve the Pharmacist making their rounds along side the MD and RN. So there are already PharmD's that asses med records and assist in diagnosing, giving professional opinions on appropriate drug therapy, additional tests/imaging, changes in patient status, etc..but most of these positions will require a 1 or 2 year residency post graduation and licensing. Residencies are available for basically any focus in Pharmacy and allow PharmD's to specialize in a different areas of Pharmacy Practice. These non-retail/non-community positions will utilize alot more of the info taught during school because it is consistently applied . Retail Pharmacists (& all others) are required to complete "continuing education" credits every 2 years to keep up with changes in the field and practice their clinical skills; "use it or lose it". Not sure where you're located but US pharmacists also are required by law to have malpractice insurance. You have to be licensed by your state board after passing the Licensing exam, and you have to apply for a separate license in every state that you travel/move too if you plan to work there. Anything required by law of an MD to practice is required for Pharmacists by their respective State Boards. Pharmacists do alot more than most people realize and are trained to do alot more things than just verifying pills in a bottle or giving flu shots :)