Physicians are at the top of the ladder in our healthcare system. They train extensively for the practice of medicine and mastery in direct patient care. Utilizing their authority as leaders within our system, groups of physicians have written statements defining the scope of practice of other healthcare providers, including pharmacists.
One article was written several years ago by the American College of Physicians and American Society of Internal Medicine.
Another article has been put together by the American Medical Association, but it has not been made publicly available. There are a number of news articles and responses to this article, plus a list of recommendations from several pharmacy organizations.
One of the primary methods of expanding pharmacists' scope of practice is through collaborative practice agreements (CPA). To give you some background on what a CPA is, here is a link to an actual CPA from the North Carolina Board of Pharmacy and here is what the VA says should be included in a CPA for one of their pharmacists.
Consider this as you read through the articles and commentary:
Is it appropriate for physicians (or other healthcare providers) to define what other professions should be allowed to do?
Do you find the tone of the articles and papers insulting, complimentary, or neutral?
What are your thoughts about how the original article from the AMA must have looked?
We will initiate discussion of this in class on Wednesday.
59 comments:
I do not think that physicians have the right to determine the scope of operation of the pharmacist. I dont think they have the legal authority to do so.
After reading the article one thing stood out to me. That the pharmacist does not have enough exposure to prescribe. The article also said that this should be under the authority of only the physician. I dont agree with this statement in that, pharmacy is no longer about dispensing. It is so much more. I believe during orientation it was mentioned that pharmacists can now sit for an exam that gives them the right to also prescribe medication.
I think the scope of pharmaceutical care is no where near the end. it has potential and propensity to grow much more than it has now.
Thank you
Jennifer Adjei(P1)
Doctor of pharmacy candidate
WUSOP class of 2015
This is a hands down discussion. As professionals, we should act as we do in our jobs as we do outside of our job. We shouldn't have to live two different lives. As professionals, we should not flaunt any negative aspects of our lives in public, where things could travel back to our work, our boss, friends and family. We want to be looked up to and respected as pharmacists as well as in the community.
No, I don't think it's appropriate for a physician to be able to define what another health care professional can or cannot do. The reason that there are so many different types of health care professionals is so we can work as a team. A physician can't possibly know the best course of action for every patient, every single time. Allowing input from a pharmacist, a nurse, a PA...allows that physician to explore options that they may not have originally considered, or that they may not be familiar with. There has to be a mutual trust between doctors and pharmacists which allows the health care system to function to the best of its ability.
I feel like pharmacists have a responsibility to promote and improve pharmacy within our own profession. I do not feel like it is fair of physicians to dictate to pharmacists what we are able to do. It is not their right to do this. While I understand that physicians may feel that pharmacists are "moving in" on their territory, it is becoming more and more important that all healthcare professionals work together for the good of the patient. I believe it is the responsibility of pharmacists to advance their own profession in the direction that they wish to take. We as student pharmacists have that responsibility as well to make sure that we are steering ourselves towards the future that we want.
Physicians should not have the majority vote so to speak when it comes to deciding what Pharmacists can and cannot do. But as we learned in our lecture on the history of Pharmacy, as a profession, Pharmacy has been pretty passive and reactive. If we as Pharmacists aren't going to speak up and define our role, then someone is likely to do it for us. I think this idea has been occurring to Pharmacists across the country because we are beginning to take a much more active role in the progression of our profession. Hopefully we, as the next generation of pharmacists, will continue to strengthen the voice of pharmacists and be proactive instead of reactive.
Courtney Black
Class of 2015
I believe the American Academy of Nurse Practitioners stated it best that "no medical society has the legal authority or professional expertise to make such determinations for any health care profession." I believe the AMA's Practice Data Series agrees that collaboration among pharmacists and medical teams is a good thing as long as the pharmacist knows his place. I understand the AMA's defensive nature of trying to protect their profession however the focus should always be patient-centered. If better care can be administered with a team or by another healthcare professional then physicians should step down and be open to suggestions. Mentors, what has been your experience with physician interaction? In general, how do most MDs come across to your suggestions?
Question for the mentors:
I have noticed that the level of knowledge and expertise of a Pharmacist have often been underestimated. In class we have been focusing a lot on professionalism and we also have a communications class in which we discussed how to interact with physicians who have made a mistake on a prescription. Some physicians are fantastic to deal with and value us pharmacists. Other physicians are a nightmare and will be condescending and difficult to say the least. The last thing you want to do is deal with an angry physician while a patient is waiting for their prescription. What advice would you give new students when dealing with people in a polite and professional manner when all you want to do is punch them for making YOU feel like the one who did something wrong?
Courtney Black
Class of 2015
I do not agree with MDs thinking they have the right to define the roles of other healthcare providers. From reading the responses to the AMA article I think the article was just pages and pages saying how pharmacists cannot possibly do this or that because our schooling is so inferior to their own.
While I do not think that MDs should be able to push legislation trying to limit the scope of healthcare providers I also think that pharmacists and other healthcare providers need to take action to defend their roles.
--Patrick Netherland
After reading this topic, it reminded me of the situation I witnessed when I was shadowing in the the hospital. The interaction between the pharmacist and the physician was very tense and I could almost see the LACK of level of respect between both HEALTH professions. I remember asking why there was a lot of tension and the response I received was that some physicians do not feel pharmacists receive enough education and are upset that we have the ability to have a 6-year track to a doctorate degree. I was also told it is possible that some are disrespectful because some pharmacist are "young" and don't feel they are knowledgeably enough to be giving advice about a patient's drug regimens. I think what both health-care professions should remember is that we serve a common purpose and that is taking care of the patient. The slick remarks and blatantly disrespect isn't needed and does not help complete the task at hand. I could only imagine what was said in this article from AMA and even without seeing it I feel like our profession under appreciated. All health-care professions should be able to resolve their differences and focus on their main objective, which again is the health of the patients. We are choose this profession to help the community
Leoneisha Williams
P1
Physicians do not have the right to control what pharmacists can or cannot do. I think we should all worry about what we can do ourselves, not what others are doing. It would also make it a lot less likely for physicians to try to control pharmacists if more pharmacists were proactive and didn't wait until something happened for us to react to.
Physicians have always led the way in the medical field and have been seen as the leader by divine right. Granted they were in the top position first and have been for many years, but our profession has grown vastly and has begun to "cross the line" of what physicians see as their territory. I can't blame them for being worried about what we will be legally able to do in the future but with both of us as health professionals we should help each other to succeed rather then have one position be a dictator of roles for everyone in these related fields. We as pharmacist should continue to force our profession forward as far as we can everyday. This way the fate of our careers will be due to our own actions and not due to the ideals of what other professions think of our career.
I believe that physicians have no right to direct the futures and duties of pharmacists or any other professional in the health care sector. In this day and age, pharmacy has evolved into something totally different from the early years of the field. In one of our classes we discussed the history of pharmacies and how it has evolved over the years. One theme that was mentioned and was significant was that of failing to promote what a pharmacist does.
I think that if we as future pharmacists can implement a change in the way we are viewed, physicians and health care professionals, as well as patients, will learn to respect what we do to benefit and help the community.
Hence, reading these articles is definitely insulting and has a condescending tone towards pharmacy professionals. However, it is up to practitioners in the pharmacy field to make a stand and make known what is true and what is not about this field.
The AMA article really offended me and I agree with the others that have posted that physicians should define a pharmacist’s scope of practice. I understand that physicians want to protect their profession and prevent other professions from taking job functions only performed by the physician, but I highly doubt that would improve patient outcomes. I respect doctors and the training and knowledge one must have to become one, but I feel that leaving one person responsible for all the aspects of patient care is foolish and dangerous to patients.
Kirsten Ferguson
P1 Wingate University
While I agree with most of the comments on how physicians should not have the sole right to determine the responsibilities of pharmacists. I do however think that physicians, pharmacists, PAs, nurses and other health care providers should work together as a team to think about what is best for the patients. Pharmacists and physicians need each other to help the patient with disease management.
I think without a doubt it is not appropriate for one healthcare provider to define what another professional is allowed to do. As made apparent by these articles, physicians do not understand the scope of a pharmacist’s knowledge and experiences. I believe that it should be a collaborative effort, so that one can defend themselves and educate the other. The AMA paper clearly fostered quite a bit of tension between the two professions, which could have been prevented had physicians done the proper research or spoken to an actual pharmacist before publishing. While the paper had the occasional complimentary tone, overall I found it very insulting. I don’t even want to try to imagine how the original article must have looked. I wonder if any of the mentors have ever come across a medication “error” of some sort and whether upon contact with the physician for clarification they were belittled or appreciated for their input?
I've a big problem with this article. First of all, who gave the right for a physician to define the job description of a pharmacist? And secondly, as a healthcare professional we should be striving to attain the same goal which is patient care. So when these physicians define the scope of pharmacy, are they considering the millions of patients that will be affected by it or is it just an ego thing?
This is very disturbing and an insulting article. I think pharmacists should play their own role in terms of patient care and consultation. Pharmacists should build an outstanding reputation among their patients in order to widen the scope of their practice.
I also think that all healthcare professionals should work hand in hand for the betterment of patients.
EDOM ABEBE
DOCTOR OF PHARMACY CANDIDATE
WUSOP
2015
I'd like to hear from some of the eMentors about situations that you may have experienced, good or bad, when communicating with medical doctors. Have you generally had great experiences or have there been situations where the doctor(s) feel as though you do not have the ability to recommend/monitor drug therapies in their patients?
Desiree Gaines
P1
I agree with Leonisha and Shelley on the issue. Pharmacists and physicians need to work together to provide the best service for patients. If the communication is not there, then the health care system is even more ineffective than it should be. I think the article from the physician should be taken another way. Because this is the way some physicians see pharmacists, pharmacists should see it as an opportunity to redefine our own roles in the issue. With that being said, who is to say that some patients also see us in this same light as the article?
I agree with Coleman's statement that the physicians are feeling as if we are encroaching into their line of work, but physicians need pharmacists and pharmacists need physicians. Therefore I feel that it is not the physicians place to make our job descriptions. Both the professions require doctorate degrees and I believe that we should work collaboratively as professionals. This ideal situation would optimize some aspects of the health care system.
The last job I had in a pharmacy was in my hometown, which is very small. I found the article troubling because every interaction I saw between my pharmacist and the doctor was positive. If we noticed a patient constantly getting their pain medicine, but not their blood pressure medicine, the pharmacist would call their doctor. The doctors were always so thankful we called and encouraged us to do that with any patient that had this habit. I just haven't had the experience of doctors not appreciating the pharmacist and would love to hear any kind of examples the mentors could give.
Bess Urie, P1
Class of 2015
Obviously, other professionals should not have the right to decide what pharmacists can and cannot do. It is not ethical for pharmacy students go to school for as long as we do and then have some other professional try and decide the boundaries of our profession. The fact is pharmacists are much more capable of doing things than only what they do now. Yet, pharmacists and physicians alone do not know everything; together, however, the possibilities of improving pharmaceutical care as well as health care in general are endless. That being said, I think we can all agree on the fact that pharmacists must step up and make their abilities known, instead of just waiting on some other profession to do it for us.
Mentors, do you agree with this? If so, what are some things you are doing to make your voice heard and prove that you bring much more to the table than what society thinks (i.e. the perception pharmacists only count pills)?
Thanks,
Kyle Crisco, P1
Class of 2015
It is important that physicians and other health care providers work together and do their on respective role in assisting with patient care. A pharmacist job should not be outlined by a physicians thoughts but should extend to the length of which the patients needs. As a pharmacist dispensing is not our only job the pharmaceutical care we provide is important and should not be limited. Andrew Helms
Physicians get to make the calls because they have the ultimate authority on the patient. Usually it is the physician's responsibility for the patient and they are the first to be blamed if something terrible happens. The pharmacist can assist with the patient care, but we can only recommend. I agree that physicians shouldn't write the procedures, but since we are dealing with their patients with their diagnoses, we will forever be below the doctor in that respect. Pharmaceutical care isn't where we should be looking for creating a field without doctor intervention. Doctors and dentists can perform specific procedures for patients. As i see it right now pharmacists only have a vast knowledge about drugs but offer no services, but check and fill pills. Therefore, we as pharmacists should develop a specific skill set that we can only do, so that we can stay in control of our profession. Compounding used to be our skill set but the pharma companies have taken that away. My idea would be that we could offer pharmacogenomic services and do DNA tests as a part of our career. Also we need to get involved in groundbreaking biomedical research with the NIH. Only by having a specific skill set will allow us the right to create our own guidelines for our profession. For the mentors I would like to know if any skill set exists for the pharmacist?
John Kastanis
P1
In contrast to the AMA article's main point, I share the same experience as Bess. In fact, in my job, physicians have sought out the pharmacists' opinions. It's not uncommon for the family doctors to call us and get the pharmacist's opinion about what antibiotic is best suited for their patient, or just what's available and what's most cost-effective. It's also my experience that physicians appreciate pharmacists' expertise in hospital settings. I have heard only that pharmacists are so helpful, knowledgeable, and valuable and a major asset to the team. Mentors, what's been the most difficult situation you've experienced interacting with a physician?
Kelly Campbell, P1
In my opinion, physicians, pharmacists, nurses, etc are all working toward one common goal: effective health care. It shouldn't be some great debate about who has the most power. From the pharmacist perspective, I'd want to be able to provide as much patient care as possible. On the other hand, I can understand the physician's stand. As pharmacists, we wouldn't be too pleased to see technicians taking over significant parts of our job, right? I think it's fine that there's some overlap of health care duties. It makes for a better health care team.
Morgan Bourne, P1
It's not appropriate for physicians to dictate the roles of other health professions. The is for each individual profession to decide. Physicians seem to feel that they are on top of the healthcare ladder. What they don't realize is that healthcare isn't a vertical chain. It's more like a web, where each individual profession is linked to many others. Failures or disruptions in any aspect of the web is felt elsewhere.
Members of each profession are specialists in their respective fields. As professionals with specialized training, they deserve respect from other professionals who do not have the same skill set. When physicians overstep their boundaries by trying to dictate the responsibilities of others, they upset the balance of the entire system. Perhaps physicians should work on improving their own profession before attempting to control others.
I think ignorance is at the heart of the opinions expressed in these articles. Physicians and the general public have the mindset that pharmacists just dispense. Time and advocacy alone will further our profession and allow other professionals to accept pharmacists' current and future roles. That being said, this is the not case for all physicians. I have had the opportunity to see wonderful, collaborative relationships between pharmacists and doctors in the hospital at which I work. There is a level of trust in those interactions (which leads to incredibly effective use of CPAs), but this article points out that this trust is not yet the norm. The tension I have witnessed, though, is between nurses and pharmacists. Hopefully all healthcare professions will soon work together in order to best help our patients.
Kim Tooker
P1 Class of 2015
I think that the future of healthcare is changing. Patients won't be seen by just a single person, but by a team of people. Collaboratively, the physician, NP, pharmacist, specialist, etc will come up with treatment plans for every patient that comes into a clinic or hospital. I can see where doctors would start to feel their major responsibilities are changing, but its going to help them spend more time diagnosing patients.
Jennifer Metcalf- I think you did a good job summing up what needed to be said.
I don't think that it is appropriate for physicians to define what other professions should be allowed to do.
Pharmacists and physicians should work together to provide the highest quality care to their patients. A good example on how physicians and pharmacists could work together is blood pressure. A patient may come into his local pharmacy every morning to get his blood pressure checked since he does not have to make an appointment to see his pharmacist. The pharmacist could then call his doctor and to let him know how the medicine is working and recommend any changes that he/she thinks should be made. This shouldn't be a contest about who thinks they know more or who thinks they know better. It should be about providing the utmost care to improve patients lives.
Jessica Farris P1
Class of 2015
I think Sahej brought up a good point. Healthcare is changing. It always will, and it already has. Physicians are not the only ones who prescribe and it has been this way for quite some time. Nurse practitioners and physician assistants also prescribe. The difference in all prescribers is training. We all come from a different background. As pharmacists, we know drugs, but pharmacy schools are now teaching more and more disease state management.
I don't feel like any pharmacist should be allow to prescribe for anything they want, but that is why there are agreements and protocols. As long as a pharmacist has proper training and knowledge, and a physician trusts them to prescribe, then I feel like it should up to them. If other physicians do not want to have a collaborative agreement, then that is their choice, but I feel like the ones behind those articles may be uninformed or overstepping their bounds, not the other way around.
It’s sad that there is such a difference of opinion among pharmacists and physicians as to the limitations of scope of practice. The article from AMA was not surprising to me because I can see how physicians feel that pharmacists are trying to take over their responsibilities in the hospital, but it is also our responsibility to inform them that we are not taking away from them, but trying to add to what they are already doing for patients. It has been proven that the addition of a pharmacist in a patient’s care has been nothing but helpful, so how can physicians warn that this could be harmful? Pharmacists are in no way trying to overstep boundaries, but without effective collaboration from both ends, it can appear that way to many physicians. The key to this dilemma is not deciding who gets to make the rules for what the other can do, but how we can work together to better a patient’s outcome. Although, I have talked to many pharmacists who now work in retail due to the fact that they were ‘tired of arguing with doctors’ in a hospital setting. I believe the relationship between doctors and pharmacists is extremely important to maintain for the best interest of the patient, and that as professionals, we should strive to make this relationship better.
Although it seems unfair that doctors are determining what a pharmacist's scope of practice is, pharmacists aren't doing enough to determine this for ourselves. If we feel like this is unfair, then we have to do something to change it. If we attempt to forge a strong relationship between other health care providers, then we will be better justified in saying, "This is what I am trained to do, this is what I'm equipped to do, and this is what I am willing to do." We have be more willing to do whatever it takes to get in touch with a doctor or nurse in order to help a patient instead of getting frustrated that it takes too long. If we take responsibility, then we can determine our own responsibilities. It's about setting an example that we are competent and we are a vital part of the health care team.
Physicians have no right to define the scope of practice for any other healthcare profession. All healthcare occupations should define what they do within their own practice, not what anyone else does. We should all work together to improve the health care system.
I for one do not think that physicians should have the right to decide on what other health care professionals have the ability to do. I think that this is a decision that should be made higher up on the food chain, and not from the biased view of a physician. I’m not saying that physicians haven’t earned their place in the health care profession. I am saying that, typically, physicians do not fully appreciate the importance in having a fully functional and concerted health care system from all fields of health care. It is imperative that all health care professions, including pharmacists, nurses, and PA’s, play a major, synchronistic, role in helping to diagnose and treat each individual patient. This will minimize errors significantly, but is very hard to achieve because of the tension that can sometimes be found in between health care professions. I feel as if pharmacists over the history of the profession have sat on the sidelines while others dictate their professional role in the health care system, and today this is slowly changing, as pharmacists are getting more involved. I do see a formidable change in the pharmacy profession over the next 40-50 years, and it is up to this generation of pharmacists to make sure that the changes made move in a positive direction to benefit both the profession itself as well as the patients directly associated with it.
My impression from the response letters is that the AMA is used to being able to dictate to the other medical professions how everyone will do their jobs. Now, with so many changes in health care, they are loosing their strong hold. It is ridiculous to think that one profession would dictate the whole world of medical professions. Doctors, nurses, and pharmacists will all need to eventually come together for the good of the patient.
With health care reform the scope of practice for pharmacist will definitly change, especially in the hospitals. Hospitals will have a more integrated health care team and will rely on pharmacists much more due to the new "packaged payments". Payments to the hospitals will be based on quality vs quantity requiring more time from physicians and nurses. Some of thier responsibilities may have to be shared or split up between other providers. I see this gap being bridged by the pharmacists.
I want to comment on a particular issue that has arose during these discussions. I agree with the idea that pharmacists together with other health care professionals are working towards a common goal, to provide optimum health care for patients. In this sense, professionals of all types should be willing to work together with others in their field and avoid any negative judgements on another individual based on their occupation. Every health-care worker should be without feelings and connotations of professional superiority based on occupation. I have learned to respect the role of every individual in this life, whether it be an MD or something as simple as the receptionist working at the front desk of the doctor's office. Everyone deserves respect for what they do, and in the grand scheme of things, all kinds of individuals collaborate to make things happen and make a common goal a reality. A few years of school especially makes no difference to me when comparing a pharmacist and a doctor. Everybody has strengths and weaknesses, everybody has certain things they are more knowledgeable about than others, everyone has specialization in one thing or another. Health-care workers should willingly recognize their own abilities and welcome those of others in order to ensure the common good.
I will have to agree with majority of the class on this one! No other profession should be allowed to dictate what another profession can or can not do. When caring for others, its not more important to protect yourselves and your job, but to protect the patient and give the best care possible. I cant lie, it does get me a bit flustered when reading some parts of the AMA. No medical professional should tell another professional to know their limitations. Taking advice and working together should be implied.
sage reddy, p1
I personally believe it is still true for health professionals in each of disciplines possess unique expertise to serve certain roles in the health care field. However, as pharmacists have no exclusive authority for matters related to medication, all health professionals (physicians, nurses, PA ...) should understand and compromise possible overlap between each of their scopes of practice while working together as a team.
Yeo-hoon Yoon, P1
WUSOP, Class of 2015
The primary goal of all practicing health specialists should be patient care. Specifically, the outcome and effect of patient care is what should be analyzed. This is best achieved through proper monitoring and analysis of empirical evidence. Based on the responses and criticisms, the AMA seems to have neglected empirical evidence on several occasions when preparing their report 'Scope of Practice Data Series: Pharmacists,' in addition to referencing several outdated resources. As anyone in the scientific community should know, bias should be avoided and all statements should be backed up by evidence and up-to-date research. The AMA appears to be acting solely to protect the interest of its members and not the interest of patients. The article put out by the ACP-ASIM provides a much more thorough analysis of the changing role of pharmacists, and includes a good deal of positive feedback, criticism, optimism, and concern--all supported by well-cited data.
I feel that physicians are entitled to their opinions on the role of pharmacists, but their opinions alone should not govern the role of pharmacists. The effects on patient care should be taken into much stronger consideration. If evidence suggests that cooperation of physicians and pharmacists benefits the patient, then perhaps physicians aren't as omniscient as some claim to be. Physicians are extremely well-trained, but cannot be expected to fulfill all of the needs of every patient. Meeting the requirements of patient care is not a one-man job--hospitals and clinics generally employ more than one physician, don't they? This is not just to cover more hours, but also to aid in performance of specific duties. Of the multiple physicians, it doesn't make sense to employ a homogeneous team of doctors; specialization is likely ideal. When you are building a home, you don't expect the plumber to lay the shingles on your roof to ensure protection on rainy days, or the electrician to make sure you have a sturdy foundation. Likewise, a group of specialists should form the team that provides a patient the all-encompassing care they deserve. Pharmacists, with their specific knowledge of medicine, surely have a place alongside physicians. If physicians feel otherwise, then they need to support their claims with evidence.
As one of the responses to the AMA article explained, the expanding role of pharmacists is not about taking over the job or title of physician, it is about filling a void that physicians have left open. If a physician performs the role of a nurse, it does not make them a qualified nurse, nor does a pharmacist performing one of the jobs of a physician grant them the respective title. The questions are: Does pharmacist input help the physician? Does it benefit the patient? If the answer to either of these questions is in the affirmative, then collaboration makes sense and pharmacists should be allowed to continue to grow the scope of their practice in order to meet the goals expected of a world-class healthcare system.
Ryan Neal, P1
Class of 2015
In 2000 the World Health Report ranked the US 37th in the world based on improving performance although the US is number 1 in in terms of spending per capita in the health care system. I feel that physicians should not have authority over other professions though their input should be considered. I feel as if physicians have had the spotlight in the health care system for so long and are looked upon by the general population as being the authoritive figure when it comes to healthcare. This is a trend that we as professionals should be aware of and be willing to prove to the public our importance to the health care system. According to the report the world sees our health care system to not be as progressive as we all would assume which means that something must be wrong. Physicians should be more willing to work hand and hand with pharmacists for the general good of the public. Isn’t this why we all got into health care to be able to provide people with a better quality of living? I don’t understand why physicians feel as if we are impeding on their territory when they should welcome a profession that wants to share responsibility of keeping the public healthy. In my opinion doctors that do not share this view are greedy and they need to be reminded the reason they choose the career that they did. Also I don’t understand why they don’t want more help from pharmacists because we can play such a powerful role in patient care and compliance. Though the physician is the one that makes the diagnosis it is the pharmacist that has more interaction with the patient on a day to day basis and has the potential to be very effective in promoting good health behaviors and compliance. Plus we as pharmacist are trained more in depth of the medications that physicians rely on to help the public stay healthy so it would not make sense to me on why they wouldn’t want our input and help in providing a service for the good of humanity as the oath they all take states. If you go to a general practitioner for chest pain does he not refer you to someone that has more knowledge than him in the area? Why are we not viewed in the same light? It is up to us as a professional field to show the rest of the public why we deserve to share more responsibility of the physician and we can best do this by improving and providing the best pharmaceutical care possible. We have to remember that it is not the physicians that decide who the primary caretakers should be and how big of a role they should play it is the consumer, the public. If we can show them we belong on the same level as the physicians they will have no choice but to treat us as equal healthcare providers.
Nick Vlahos
P1 Hendersonville
I agree with my what most of my classmates have stated in terms of authority a physician has in determining pharmacy practice. However,there should be equal input from all health care professional to be able provide quality and continuous care to patients.
Parth Thakkar P1
Class of 2015
I believe that physicians have some say so over their patients,but I believe that pharmacist should primarily be the one's consulting patients on specific medications. I believe there should be a relationship between each physician and pharmacist to ensure appropriate patient care. With us working with our medical counterparts we would better serve our patients, thus our patients would be more likely to ask questions.
There are so many different types of healthcare and speciality jobs out there that I do not think that physicians should be allowed to determin what the other healthcare jobs inquire. I think that since there are so many speciality jobs out there that it is almost impossible for physicians to control every aspect of every job out there. I think that every healthcare job should be on there own and not have to worry about the physicians and if they are controling your job or not.
I also do not believe that physicians have the right to decide the scope of operation for pharmacists. I think that all health care providers and professionals should work as a team so that the best care is provided to the patient because this is the ultimate goal. It almost seems that physicians are trying to be selfish and stubborn that their final decision should not be questioned. However, we have had examples in class where pharmacists have corrected a physicians orders, resulting in the saving of someone's life. I think the health care system should work as a system of checks and balances and physicians should not decide the what pharmacists can and cannot do. Pharmacists should be more proactive in deciding their own future to ensure that we can decide our own scope of practice.
Justin Crump
P1
I think Ryan's comment about building a house and specialized roles is the best example I've heard that defines the problem we find ourselves facing. Many physicians see themselves as the contractors, responsible for managing everything that is done. Just like electricians and plumbers have strong organizations and push for laws and regulations that protect their profession I feel we too need to be proactive in protecting our profession by educating others about the profession and lobbying to protect our profession as WE define it.
Jonathan Graham P1
I agree with what others have said about physicians not being allowed to control our scope of practice. However, from reading this article I do not see it as an attack on pharmacists. The reason I believe this is because the health care field is constantly changing and evolving so we do not know how the health care field will be in four years when we graduate. Hopefully by then, communication among professionals will increase to where patient care is the number one priority. On the other side of things, pharmacist need to make sure that when they offer drug changes or suggestions to doctors that they do not come off as if they are smarter then them. From working in a pharmacy I have noticed that a lot of doctors do not know that some generics are not on the market yet because they inform the patient that they can get a certain drug as a generic. Not that the patient is always correct, but if there was more communication among health care professionals, these type of things would not happen. Another important part of this improvement should include doctors having the ability to see all the drugs that the patient is currently on and has received recently. This is where a pharmacist can come into play to monitor drug-drug interaction. Hopefully over the next four years, the health care system can improve so that there is a better relationship among professionals.
I agree with most of my classmates that no one in the healthcare system has the right to dictate what other profession should do. We all are part of a big family and this family will only run if their is great understanding between all members. All members are equally important in the family. But after saying that we all should aslo accept that Physicians is the leader of our family. And to change that we should first accept this and should do something to change it. It all depends on us where we wanted to see us in the health care system. It depends on us what role we wanted to play in health care system.
Varun Patel
P1,Class of 2015
I think it's really important for all health care providers to remember that pharmacists are not trying to replace them, but rather work as a team, providing our strengths (drug mechanisms, interactions, therapy, etc) to provide optimum care for patients. Combined with mutual respect and the initiative to learn from one another, healthcare providers will be better able to provide a heightened level of patient-centered care that is necessary to promote the quality of health care in this country.
I think the scope of pharmacy practice is in a state of expansion at the moment. There are a lot of new things going on such as pharmacists who can write prescriptions and change medication regimens. As future pharmacists we need to break the crippling tradition of being passive and responsive and step up as professionals and assume a role in the healthcare profession that is often portrayed as a collaborative team of healthcare professionals instead of being viewed as someone who just fills prescriptions and follows a doctors orders. Diagnosis is a big part of healthcare but it isn't the only part, medication and care are equally important.
I do not find it appropriate for physicians or other healthcare professionals to define to define what pharmacists should be allowed to do. I feel that because they diagnose and provide first contact direct patient care, they should have a say in what nurses and PA’s do. However, because a pharmacist is not the first point of contact for a diagnosis, this proves that pharmacists play a different role in healthcare than doctors. With that being said, I do think physicians can give input on where they would like pharmacists to stand in healthcare, with the same respect that I feel pharmacists should be able to give their input on where doctors stand in healthcare. All in all, I believe final decisions should be negotiated between pharmacists and doctors.
I do not think the articles are degrading in any way. Physicians are simply expressing how they feel about different roles in health care, and with good reason. Physicians believe in the collaborative potential between themselves and pharmacists, and I believe it is our role to expand our roles, based on their given standpoints. If we prove the advancement of the general welfare of patients, we will see advancement in our roles. The AMA article seems to me that it may have insulted the pharmacy profession. I would like the AMA to keep in mind that pharmacists play a vital role in patient care as well as the field of healthcare as a whole.
Someone in class said that we shouldn't be able to prescribe because that is the doctor's job. And, how would we feel if they were dispensing. But, doctor's do dispense. They administer drugs in their office by giving shots and samples. So, essentially, they are "doing our jobs" already.
The only way we can have better healthcare is if we all work together, we all have specialties and should use that to our advantage. It could also bring down the cost of healthcare if pharmacist can prescribe simple things, like antihistamines.
In the future I would like to see the healthcare system go in a direction where physicians see patients and diagnose them, that diagnosis can be sent to a pharmacist, the pharmacist then decides the appropriate medication and dispenses/counsels the patient on that medication. Physicians are experts in diagnosing the cause of health related problems and pharmacists are experts in the use, effects and interactions of drugs. Both have knowledge of the others specialty but that does not mean they should be practicing that part of healthcare. A team approach in community pharmacy where the physician diagnoses and the pharmacist makes the medication decisions would be optimal for providing the best overall care for patients. Approaching patient care as a team would make it easier for both professionals to follow the progress of a patient and then quickly address any issues that arise either from the pharmacist's side of things with drug interactions or side effects or from the physician's side with the progression of a disease or possible alternative possibilities if the appropriate medications for the suspected disease are not making any positive impact on the patient's health. It would be in the best interest of patients if all healthcare professionals, not just physicians and pharmacists, so that there will be complete care given and coordinated to effectively diagnoses, treat, and manage the health of patients.
Kai Jones
Class of 2015
The following comment comes from Dr. Lori Edwards, PharmD., CPP, a consultant pharmacist for Neil Medical Group in the Greensboro area:
As a PharmD, CPP practicing in an ambulatory care setting there are some things I agree with and disagree with in the position statement. At this time the physician's are at the top of the chain of command. They have the higher reimbursement rates and we do not. This dictates much of the process. At present, we can't practice without their license. Great progress has been made though. Md's now expect PharmD's to dose antibiotics, anticoag, make formulary and clinical substitutions....where once this was not the case. As the reimbursement rates decrease for physicians, medication costs increase and access to healthcare becomes increasingly difficult, PharmDs will be stepping in to contain costs and mitigate risks associated with medication misadventures...it's happening now. The article is also a few years old ...in the office where I work the PharmDs do have the complete medical records available to them just as the MDs do. Many healthcare systems are electronic now and cross over into practices outside of the hospital settings. I think some of the position statements are based on the older models and ideas of pharmacy and pharmacists.
The scope of pharmacy to me is about how it is regulated. The one of the top regulatory agency is the Food and Drug Administration (FDA). This organization runs what drugs a pharmacist can and cannot use. It seems to me a pharmacist should run this agency, but in its existence not one pharmacist has run it. This is a problem and I do not know how to fix it.
I agree with all my classmates as well. Doctor's should not dictate how other health care providers function. We all have the same goal, and that is to provide the best help we can to the patients. I also believe that every field in health care should work together, but in my experience that is not the case. I've watched pharmacists get talked down to by MD's and nurses, and had nurses blame pharmacists for their mistakes to patients. As several have mentioned already, until we work together the patients are going suffer from this petty quarrel.
Ryan Tucker, P1
WUSOP class of 2015
While I would love to come out and say that physicians have no right to say how a pharmacist can and cannot perform his job, I believe that they do have the right to at least make recommendations about the scope of operation of a pharmacist. Physicians are very intelligent people, and while I do believe that they are mostly looking out for themselves, since they have the authority and power to do so, I believe they have the right to make recommendations towards our practice. However, we should have the same authority towards them. If every field of healthcare providers set their own rules and regulations, I do not think our healthcare system would work. I believe that if physicians gave more power to other professions in healthcare to make rules and regulations, that in the long run our healthcare system would be much more efficient and effective.
I don’t think that it is appropriate for physicians to define what other healthcare professions should do. However, I would welcome their thoughts and ideas on what they think we should be doing. As healthcare providers, we need to work together with other professions to help take care of the patients better. Pharmacists need to step up and make sure their voice is heard. People need to realize that there are certain things that physicians have an expertise in while there are things that pharmacists have an expertise in. This goes for all of the healthcare fields. There is obviously going to be some overlap in certain areas but all these different professions are still needed and there will always be more duties to add that haven’t even been used in practice yet. The more professions that are able to be in contact with the patient the better because I believe that means that the patient should get the optimal care.
Nathan Batchelder, P1
Class of 2015
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