PHARMACY TIMES RECENTLY held a student roundtable on ?The Future of Pharmacy? at the National Community Pharmacists Association annual meeting in Fort Lauderdale, Fla. Students talked about the direction of community pharmacy, how well-prepared they felt entering the field, and new legislation affecting reimbursement levels for cognitive services.
The panel was moderated by James McAllister, then director of the University of North Carolina Hospital?s department of pharmacy, and included 8 pharmacy students from schools throughout the United States.
Above all, the students had fresh ideas about what makes a good pharmacy practice, and they were determined to become valuable players on the health care team. Many of the students believed that community pharmacy was moving away from a product-based profession to a service- or patient-based profession, and serving patients was very much on their minds.
Brian Hose, a fourth-year student at the University of Maryland who wants to practice in an independent community setting, said he believes his career path will allow him to influence his own practice and enable him ?to do things the way that I think they should be done. I want to be able to take that extra step to help the customer,? said Hose. ?If I want to help out a customer who can?t afford the medication, I want to be able to do that.?
Although students were concerned about declining fee-for-service rates, they recognized that counseling services are becoming more important in a competitive marketplace.
Students believe pharmacists should be reimbursed for many services they routinely perform. ?If someone comes in to you and asks??I can?t use my blood glucose meter. Can you show me how???you?re going to take the 10 minutes and 15 minutes to show them how to do it, but you?re not going to bill them,? said Hose. ?And I think we, as a profession, should step back and say, ?Listen, we can?t do it for free anymore. You?re cutting our reimbursement rates for dispensing. You?re going to have to start paying for our knowledge.??
Clinical Experience will Drive Profession
Students believe that pharmacists? clinical expertise will drive the profession going forward. Although students felt that they are better trained to meet the changing needs of the marketplace, some felt that pharmacy schools need to work even harder at helping pharmacy students develop the communications skills needed to counsel patients.
?Ideally, in 15 years, we?ll never have to touch a pill, and automation will do everything for us,? said Jeff Roeder, a student at Duquesne University. ?Mail order is pretty streamlined and they can pump out thousands of prescriptions in a minute. It doesn?t make sense for us to even do that work.?
Eugene Medley, a student at the University of Colorado, suggested that pharmacists need not even operate a traditional pharmacy to add value to a patient?s health care and cited an example of a pharmacist who offers counseling services only. ?He has about 400 patients that he follows and doesn?t deal with any insurance or anything like that. It?s all cash work and he charges them $1000 a year for his services. That person is making $400,000 a year to be available by phone whenever that person needs them,? he said.
Laura Marran, a student at the University of Arizona, agreed that patients would be willing to pay for consultations with pharmacists who are experts in specialized areas, such as transplant or bioidentical hormone therapy. ?There are so many opportunities for pharmacists pursuing more education or a more individualized focus of patient therapy,? she said.
To realize payment for services, Medley said that pharmacists will need to be vigilant about documenting the services they provide. ?I think the pharmacist will be able to overcome the drop in filling prices by documenting their interactions in patient advocacy as a consultant to a patient?s health care,? he said. ?The bottom line is if you do it, document it.?
Students felt that new medication management legislation could be a turning point for measurable reimbursement. ?As soon as that model exists, and the public or the pharmacy profession has access to it, then people will begin to incorporate MTM [medication therapy management] much faster, and MTM will become the standard of practice,? said David Sedrak, a student at the University of Southern California.
Greater Voice in Government
An active professional lobbying voice is something the students were proud of. ?Pharmacists had to fight really hard to get included even remotely into that Medicare legislation,? said Jessica Nonnemacher, a student at the University of North Carolina, Chapel Hill. ?We have a lot of really active voices in our profession that I think are making our voices heard, and I hope that that continues because that?s what?s going to keep affecting our profession as well.?
Jennifer Johnson, a student at the University of Washington, thinks it is important that pharmacists become even more active in government and legislation. ?I think that a lot of people in our nation don?t understand pharmacy, they don?t understand what pharmacists do, and they are making legislation that affects our future, our job, our profession,? she said. ?I think at an increasing rate, students are getting more and more involved at the legislative level to get their voice heard to help influence the direction of their profession.?
Jim McAllister, a student at the University of North Carolina, Chapel Hill, agreed, ?We were thought of as, and still are in some places, an ancillary profession behind the counter, counting by fives. But, I think with the RPhs and PharmDs promoting our clinical abilities and our cognitive services, we?ve now created this legislation.? Jill Loser, a student from the University of Connecticut, added, ?I think it?s our job to prove to physicians that we?re a necessary part of providing what they provide to our patients.?
Technology Wish List
Looking ahead, panelists hope that advances in technology will not only make their jobs easier, but will lead to improved patient care. One panelist said he would like to see a password-protected smart card that included a patient?s medical history. ?I want them to have their chart with them at all times so that I can take a look at it and know what they?ve been on,? said Roeder.
Medley would like to see technology that eliminated the need for invasive procedures to get lab work done. ?If you could maybe do a salivary swab, you wouldn?t have to stick their finger for their blood glucose,? he said.
?I think that technology can also be used for the patient,? said Nonnemacher. ?It gives them a sense of being involved in their disease. And I think technology, on that aspect, can also help us with our cognitive services.?
When it comes to beginning their careers, panelists felt their curriculum prepared them for the challenges they will face once they begin to practice. ?I think each year?s class is better qualified to do the job than the previous year. It?s just because the curriculum is constantly changing,? said Roeder.
Students also discussed the benefits of residencies and junior partnership opportunities. ?If you?re fortunate enough to know a pharmacist that has a pharmacy that you want to be part of when you graduate, I think a junior partnership is a wonderful option, especially since you make more money,? said Johnson. She said that community residencies give students another option for making contacts and gaining on-the-job experience.
Future of Profession Looking Good
Panelists were eager to begin their careers. Sedrak already had a junior partnership nailed down in California and felt his training allowed him to bring fresh ideas and valuable skills to the business.
?We?re graduating with a lot of enthusiasm, and we?re graduating with the most updated clinical knowledge,? said Sedrak. ?Together with someone who is experienced, we can be on the front lines with our ears open...as well as drive new ideas. This generation is going to be the generation that drives pharmacy forward. We are going to be the generation that carries pharmacy to another level.?
Students felt the profession offered many possibilities and avenues for growth. ?Every day I go to work, there?s more to do as a pharmacist,? said Marran. ?We?re becoming, I think, more respected, and even though there are still some misconceptions about what we can and cannot do, I think that everyday people are becoming more aware that we are capable of really taking good care of them. When I?m studying with medical students, and we?re talking about disease states, and we?re talking about lab readings, I can keep right up with them.?
?When I got to pharmacy school, I came in thinking everybody is going to be a pharmacist when they graduate, whether they go into a hospital, whether they go into research, whether they go into community pharmacy?they are just going to be a pharmacist,? said Nonnemacher. ?But now, I?m so excited to hear everyone has a different passion through pharmacy. You can?t give one definition of pharmacy. Each of us in this room, I am sure, will go a different route somehow, some way. And that?s what is so exciting about the future of pharmacy?that there are so many things you can do with it.?
?You can do whatever you would like with this degree, and I think that?s what we all see. It?s a fluid world that we are living in, and so much can come from just having a dream and carrying it out,? said Medley.
Ms. Sax is a freelance writer based in Chevy Chase, Md.