Title discrimination

[Guest JMPA]

rant warning

Being a practicing PA for over a decade and having developed rather thick skin, today i reached my limit. I had a punk pharmacist from a large chain pharmacy refuse to fill a script only for the reason being that my title is PA, he demanded that my "supervising physician transmit all my scripts" after delaying communication for over a week. He then attempted to belittle me before abruptly hanging the phone up. So as a responsible PA i filed a complaint against his professional license and submitted a complaint directly to his corporate headquarters. This type of behavior must immediately be checked. As practicing PAs are there any other suggestions for direct action against title discrimination?

[EMEDPA]

send your business elsewhere....folks treat me like that and I go out of my way to recommend other physician specialists, pharmacies, etc

[gcox87]

send your business elsewhere....folks treat me like that and I go out of my way to recommend other physician specialists, pharmacies, etc

Yep, if you redirected all scripts that went there to a new pharmacy they would take notice.

[ventana]

talk to his boss, or if a national pharmacy, to the regional director.....

 

 

have done this a few times over the years.... seems to work...

[CAAdmission]

talk to his boss, or if a national pharmacy, to the regional director.....

 

Do it. If he does not want to do his job they will find someone else who will.

[Reality Check 2]

Agree - talk to head honcho and take it to the top.

If this pharmacist cannot respect the law and licensed prescribers then he is doing a disservice to the patients.

Wonder what other issues he has about meds? birth control?

 

Sounds like he has some chip on his shoulder and thinks he can wield the power - that he doesn't have.....

 

Tell your patients that you believe they would be best served by a different pharmacy due to barriers and inappropriate legal behavior (without naming his name) and advise them to go to a different pharmacy.

 

Best of Luck!!

[rev ronin]

This is weird.  I mean, really, *weird*.  MAs call in scripts to pharmacies all the time.  I'm seriously worried about what might possibly have prompted a younger pharmacist (do you know his age, or were you basing your 'punk' comment solely off his demeanor?) to refuse service to your patients.  What state was this in?  Was the medication in question anything special, like buprenorphine?

[Guest JMPA]

his license shows he was practicing pharmacist for 3 years, i sent a complaint to corporate stating that i will send all my scripts elsewhere and recommend all other providers at my practice to do the same. I also got a response from opm today stating that they will address the matter

no special med, chronic med. he told me flat out on the phone that he will not fill scripts sent by PAs, then hung up on me after stating he "needs to care for real patients" oh and he is the pharmacy manager.

[rev ronin]

 oh and he is the pharmacy manager.

Probably not for long with that attitude.

[Reality Check 2]

Sounds like someone needs a psych eval, a drug screen and an attitude adjustment.......and probably a new job that doesn't require licensure.

 

Where did he get his pharmacy training - correspondence school?.......

 

What a jerk.

[PACdan]

http://khn.org/news/pharmacists-see-clinical-role-expand/

 

“We are not looking to become the primary care provider for all patients,” said Stacie Maass, a senior vice president at the American Pharmacists Association. “We want to be part of the team.”

 

Sure, just take another 24 months of didactic and clinical rotations and you can do that...oh wait.

 

I think PharmDs will be trying to push into the provider fray more and more as pharmacy schools put out all these new grads with poor job prospects. And don't get me wrong, they are GREAT to consult about medications/indications/interactions/alternatives, etc. But they don't have full scope diagnostic training. Sorry. I realize four years of Pharmacy school is a lot, but it doesn't make you a provider. I've been with hospital PharmDs on rotations, and they are great in rounds when you're discussing antimicrobials, drug dosing, etc. But they are bumps on a log for physical exam and diagnosis, history taking, imaging, specialized exams, ddx... you know, all the stuff that goes into medical decision making. 

 

This "kid" sounds like someone who is unfilled in retail pharm. He feels slighted because he's filling your scripts all day when he went to four years of graduate school and you only went to ~2.5

 

Well, I know some people that went to 6 years of school full time for their PhDs, and we don't let them come in and perform neurosurgery. Because it's what you're trained in, not how long it took. I'd cook his behind with all the legal remedies you have available. And then send a few more scripts his way just so he HAS to fill them.

[sk732]

Last problem I had with a pharmacy was very recent - my wife and one of my dogs being the patients.  My wife got 1/3 of the meds she was supposed to get, despite it saying it was a full fill on the bottle and my dog was prescribed one type of insulin and they gave us the wrong one.  I wasn't there at the time...when I found out, I was furious.  When the manager of the pharmacy called back, my wife talked to him and he sort of apologized and then went on to say that there was no difference in the types of insulin concerned, so basically demonstrated no accountability.  I had to put the dog down 2 weeks ago because the poor QC in this dolt's store resulted in his sugars never getting under control.  I filed a formal complaint with the College of Pharmacists and it's going before the investigation committee in 2 weeks.  I wish I could redirect folks, but that pharmacy is the only one open until midnight around here.

 

Personally, if people are like that with me on the phone, I just hang up and wander over and have the little one way face to face - people don't tend to be as fucktarded in person as they are on the phone in my experience.

[Poetsiren]

..... he sort of apologized and then went on to say that there was no difference in the types of insulin concerned, so basically demonstrated no accountability.  I had to put the dog down 2 weeks ago because the poor QC in this dolt's store resulted in his sugars never getting under control....

I'm sorry about the loss of your pet.

[2234leej]

http://khn.org/news/pharmacists-see-clinical-role-expand/

 

“We are not looking to become the primary care provider for all patients,” said Stacie Maass, a senior vice president at the American Pharmacists Association. “We want to be part of the team.”

 

Sure, just take another 24 months of didactic and clinical rotations and you can do that...oh wait.

 

I think PharmDs will be trying to push into the provider fray more and more as pharmacy schools put out all these new grads with poor job prospects. And don't get me wrong, they are GREAT to consult about medications/indications/interactions/alternatives, etc. But they don't have full scope diagnostic training. Sorry. I realize four years of Pharmacy school is a lot, but it doesn't make you a provider. I've been with hospital PharmDs on rotations, and they are great in rounds when you're discussing antimicrobials, drug dosing, etc. But they are bumps on a log for physical exam and diagnosis, history taking, imaging, specialized exams, ddx... you know, all the stuff that goes into medical decision making. 

 

This "kid" sounds like someone who is unfilled in retail pharm. He feels slighted because he's filling your scripts all day when he went to four years of graduate school and you only went to ~2.5

 

Well, I know some people that went to 6 years of school full time for their PhDs, and we don't let them come in and perform neurosurgery. Because it's what you're trained in, not how long it took. I'd cook his behind with all the legal remedies you have available. And then send a few more scripts his way just so he HAS to fill them.

 

I agree with the article; pharmacists know more about medications than the vast majority of physicians or other health care providers. They should be part of the primary care team to manage patients and their medications. They spend 4 years just learning about pharmacotherapeutics and pharmacology. No one comes close to their knowledge of drugs. It's not even close. 

 

In my opinion, they shouldn't have to take an additional 24 months of school to do what the pharmacists in the article are doing. I agree that they don't have full diagnostic training, but they are still restricted more than they should be. Their clinical decision-making should go into anything related to the patient's medications. I think prescribing certain drugs would appropriate (within reason of course). I don't know how many times that my wife (who is a pharmacist) has had to advise physicians-PA's-NP's to change drugs based on inappropriate drug selection. 

 

Also, I personally don't think "slighted" is the right word. Pharmacists can dispense medications; nurses, physicians, PA's, and NP's cannot. Conversely, physicians, NP's, and PA's can prescribe, pharmacists cannot (in most places). Like you said, different roles and responsibilities. I don't think a lot of pharmacists feel slighted against a lot of health care providers considering they make great money and have a variety of good perks. 

[cinntsp]

 Pharmacists can dispense medications; nurses, physicians, PA's, and NP's cannot. 

 

This is state/location/situation dependent.  Providers can dispense meds in some circumstances.

 

 

 I don't know how many times that my wife (who is a pharmacist) has had to advise physicians-PA's-NP's to change drugs based on inappropriate drug selection. 

 

 

 

As invaluable as their knowledge is, that doesn't mean they should have the ability to start prescribing.  It's better as a team sport.  I've had to fix orders that pharmacists changed because the context of the situation wasn't taken into account, so it goes both ways.  I prefer them to call me and say 'hey, I see you chose X drug -- what do you think about changing it to Y drug?" I call them all the time as well and say "Here's the situation I'm dealing with - what drug do you think would work best here?" The pharmacists at my hospital are awesome about keeping that line of communication open and I have a great deal of respect for them.  

[PACdan]

In my opinion, they shouldn't have to take an additional 24 months of school to do what the pharmacists in the article are doing. I agree that they don't have full diagnostic training, but they are still restricted more than they should be.

 

Honestly, I really think it would need to be full PA school. It's not only the content but the manner and order in which the content it is presented. Med schools/PA schools follow a very similar progression of teaching. We start with the physiology of the human body, in both normal and abnormal states, proceeding to disease pathology (med school more in-depth of course) while step-wise building the art of physical exam, laboratory/investigative modalities, diagnosis and differential diagnosis and finally treatment decisions and execution. Many modern programs do this as a systems based approach (I believe this is the dominant practice now vs. "traditional") and certainly how my school does it. Either way, it's not really a process you can cherry pick and say "well we don't need to cover this" "or we can skip that". Since pharmacy schools differ in what and how they cover material, it would be quite difficult to say "all you need is XYZ to be competent in primary care'.

 

In fact, this is one reason that PA programs won't accept credits from any other PA or Medical school program. And why medical schools don't give advance standing to PA school graduates. I would argue that our programs are much more similar to each other than Pharmacy school is to either.

 

Likewise rotations, no matter their order, build inexorably on one another. What you learn in general surgery brings in skills and nuance to OB/GYN and ortho. OB/GYN and ortho provide primary care skills. IM and FM lay foundations applicable to surgery, peds, EM and psych. EM has skills applicable to all; psych as well. You can jumble them up, but the board exposure is necessary for medical and PA students to become well developed providers. How can we say that Pharmacists in Primary Care can can skip this one but not that one? I don't think we can, hence the full length program... I think if you want to be a provider, you have to go and do the minimum requirements for such. Just as if I wanted to be a pharmacist, I wouldn't expect all my pharmacology knowledge to date to give me any advance standing in pharmacy school.

 

Pharmacists can dispense medications; nurses, physicians, PA's, and NP's cannot. 

 

As Cinntsp pointed out, this is not universally true. A provider can go to the cabinet and fill a med, and dispense or administer it to a patient in their care. I get that it's a dose and not a 30/60/90 day supply, but it's dispensing (pill in hand) or administrating through some other route. We're not filling their monthly supplies, because it's a different job. But FM docs/PAs certainly dispense samples in quantities to cover 7/14/21 days. It's not a unique skill to pharmacy.

[sk732]

As a military trained PA, I'm required to be able to dispense, since in some independent duty situations, you're the doc, padre, social worker, lab geek and drug dealer all rolled into one...one of my specialty courses as a medic was medical supply and pharmacy tech, so got stuck doing a lot of the baby dope dealer stuff too.

 

Sorry, inside voice safety catch is at full auto today...

 

SK

[Febrifuge]

Yeah, my group has workplace clinics where the provider runs UAs and some blood tests, and also has the key to the inventory cabinet. They dispense plenty of meds, from Tylenol to antibiotics to beta-blockers and insulin. Maybe it's a state thing, but it's simply not true that only pharmacists may dispense.

[Cideous]

Everyone has a boss.  I would go straight over his head, and then file a complaint with the pharmacy board in that state.  And of course tell all patients to never go there again.

[BruceBanner]

I'd send them a nice letter saying you will no longer be sending them any prescriptions and that the state board of pharmacy as well as their regional manager has been contacted for unlawful refusal to fill a script from a licensed provider.

[Reality Check 2]

There are signs at the local grocery pharmacies in my town that tout Rapid Strep screening and UTI testing.

 

So, they test someone - what happens to the result? How much does it cost? Who prescribes? Does anyone actually examine the patient?

 

The lines between practice of medicine and drive through medicine are rapidly blurring and I don't sense anything good to come of it.

 

Between bacterial resistance and C.Diff - how much can we afford as far as freelance antibiotic prescribing? Much less any other class of meds........

[db_pavnp]

Honestly, I really think it would need to be full PA school.

 

You are eloquent and rabidly pro-PA, but asking a PharmD to slog through your pharm isn't worth it.

[2234leej]

Honestly, I really think it would need to be full PA school. It's not only the content but the manner and order in which the content it is presented. Med schools/PA schools follow a very similar progression of teaching. We start with the physiology of the human body, in both normal and abnormal states, proceeding to disease pathology (med school more in-depth of course) while step-wise building the art of physical exam, laboratory/investigative modalities, diagnosis and differential diagnosis and finally treatment decisions and execution. Many modern programs do this as a systems based approach (I believe this is the dominant practice now vs. "traditional") and certainly how my school does it. Either way, it's not really a process you can cherry pick and say "well we don't need to cover this" "or we can skip that". Since pharmacy schools differ in what and how they cover material, it would be quite difficult to say "all you need is XYZ to be competent in primary care'.

 

In fact, this is one reason that PA programs won't accept credits from any other PA or Medical school program. And why medical schools don't give advance standing to PA school graduates. I would argue that our programs are much more similar to each other than Pharmacy school is to either.

 

Likewise rotations, no matter their order, build inexorably on one another. What you learn in general surgery brings in skills and nuance to OB/GYN and ortho. OB/GYN and ortho provide primary care skills. IM and FM lay foundations applicable to surgery, peds, EM and psych. EM has skills applicable to all; psych as well. You can jumble them up, but the board exposure is necessary for medical and PA students to become well developed providers. How can we say that Pharmacists in Primary Care can can skip this one but not that one? I don't think we can, hence the full length program... I think if you want to be a provider, you have to go and do the minimum requirements for such. Just as if I wanted to be a pharmacist, I wouldn't expect all my pharmacology knowledge to date to give me any advance standing in pharmacy school.

 

 

As Cinntsp pointed out, this is not universally true. A provider can go to the cabinet and fill a med, and dispense or administer it to a patient in their care. I get that it's a dose and not a 30/60/90 day supply, but it's dispensing (pill in hand) or administrating through some other route. We're not filling their monthly supplies, because it's a different job. But FM docs/PAs certainly dispense samples in quantities to cover 7/14/21 days. It's not a unique skill to pharmacy.

 

You make a lot of good points PACDan. I don't agree with all of it but you raise good arguments. I am not going to undermine the training of a PA; I think it's overall really solid. I just think that pharmacists, given their training, can do more in the context of managing the medications (compared to what they are doing now in most states). It's similar to physical therapists in the military who prescribe musculoskeletal medications for pain relief; they've been doing it for a LONG time and have been shown to be competent in that capacity. I think the same can be said for pharmacists, even more so if they did a residency or had continued advanced training (again, within reason. Not certain class medication that's abusive. I don't think they should have the same prescriptive authority as MD's/DO's/PA's/NP's).

 

https://www.pharmacist.com/california-provider-status-law-effective-january-1

 

I approve of what California did by expanding the scope of practice in California; it's something I hope other states do as well. 

[PACdan]

You are eloquent and rabidly pro-PA, but asking a PharmD to slog through your pharm isn't worth it.

 

Okay, so they get to leave 1.5 hours early on Tuesday & Thursday?...

Just because PA school pharm should be easier for them doesn't negate the enormous amounts of non-pharm training it will entail.

And to be fair, foreign-trained MDs that choose so, have to "slog" through all of PA school to become PAs. There is no advanced standing.

 

And the rabidness is rational interest for the future of the PA profession. Which compared to NP lobbies, we are sorely lacking in...

 

 

You make a lot of good points PACDan. I don't agree with all of it but you raise good arguments. I am not going to undermine the training of a PA; I think it's overall really solid. I just think that pharmacists, given their training, can do more in the context of managing the medications (compared to what they are doing now in most states). It's similar to physical therapists in the military who prescribe musculoskeletal medications for pain relief; they've been doing it for a LONG time and have been shown to be competent in that capacity. I think the same can be said for pharmacists, even more so if they did a residency or had continued advanced training (again, within reason. Not certain class medication that's abusive. I don't think they should have the same prescriptive authority as MD's/DO's/PA's/NP's).

 

https://www.pharmacist.com/california-provider-status-law-effective-january-1

 

I approve of what California did by expanding the scope of practice in California; it's something I hope other states do as well. 

 

 

What you're stating is not unreasonable. But I'm once-bitten, twice shy in terms of inviting (or inventing) broader scopes/practice without likewise advancement of the PA profession in the same arena. FNPs have done so much to advance their position as PCPs in recent years, that the introduction of APPs (Advance Practice Pharmacists) makes me question where the future of FM/primary care lies for PAs. It has been my continuing interest both before and during PA school to work in Family Med, but I feel that the role for which we were specifically conceived has been slowly pulled away from us (and somewhat abandoned). Despite my reservations with NP training overall, they do have the FNP specific track. If APPs begin to fill some primary care functions; how long until someone proposes they fill most or all? Just my thoughts.

[db_pavnp]

Okay, so they get to leave 1.5 hours early on Tuesday & Thursday?...

 

This is a start.  I think you can go further.  PharmD's dominate Step 1 handily from what I have read.  I doubt they need the PA version of "basic science" coursework.

 

Realistically, the proposed scenario is kinda ridiculous.  Few PharmD's have any interest in picking up an MMS.  They will design an assessment curriculum to tack on as a post-cert if this is a major roadblock.  Potentially 6 months didactic and 6 months of clinical.  Less if they specialize.  Not terribly different than every PA who pipe dreams about a bridge to MD.