Health Care Reform: Funding for Specialty Residencies

James C. McAllister III, MS
Published Online: Thursday, September 24, 2009
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Mr. McAllister is a health systems consultant based in Chapel Hill, North Carolina.


As our president, legislators, and a variety of Senate and House committees work on health
care reform legislation, pharmacists have an opportunity to help shape the specific elements of a “new” health care system.

I have encouraged pharmacists to contact their legislators in numerous Pharmacy Times columns in the past.I understand the assumptions of many of my colleagues who believe that individual efforts to influence “big government” at the state or national level cannot compare to the efforts of paid lobbyists or other well-connected insiders. We are also daunted by the process of communicating with legislators
beginning with identifying who they are, where to send the letter, and what to say in terms of presenting
a compelling argument for our representatives to support our recommendations.

I have had the good fortune to become actively involved in the legislative process with the encouragement
of colleagues and associations and guidance of others. Perhaps the most eye-opening experience I
have had is actually visiting legislators and discussing the issues with them. During those visits, I have come
to realize how few individuals even bother to contact their representatives (especially at the state level), and
how relatively easy it is to “educate” lawmakers regarding issues important to pharmacy. The effectiveness
of individual efforts becomes even more influential when they are a part of an organized initiative (usually by
professional associations) to present a consistent message simultaneously to a large number of legislators.

I believe that one of the most important issues we should be contacting our representatives in Washington
about now is the restoration of funding to help hospitals offer postgraduate year 2 (PGY2) residency programs. Hospitals can currently receive financial support to offset some of the expenses associated with their general hospital pharmacy residencies (PGY1). Similar support for PGY2 residencies was lost several years ago. Postgraduate training programs enable pharmacists to increase their individual and organizational effectiveness in optimizing drug therapy outcomes. PGY2 residencies enable pharmacists to focus their learning in a specific area and become a thought leader who can be even more effective and influential in drug therapy management.

Fundamental to presenting our argument is that health care costs related to drug therapy can be minimized
through optimal utilization much more significantly than by any other means. PGY2-trained pharmacists can
lead their colleagues, with or without specialty training, to improve utilization through effective intervention
strategies, which influence prescribers. This message, that pharmacists can and do optimize drug therapy
while minimizing costs, is as important for legislators to understand and appreciate as supporting funding for
PGY2 residencies. Many other related messages can be included in presenting your argument that benefit the entire profession.

The American Society of Health-System Pharmacists (ASHP) has been encouraging a grassroots effort
to restore this funding for several years. Lately, the association has been promoting an organized effort during the health care reform debates. ASHP members can go to the ASHP Web site (www.ashp.org) and click the “advocacy” button to access a wealth of information regarding this and many other issues. Included in the resources is an online advocacy center, which will help identify your senators and congressional representatives, and even offers a letter for you to use to present your compelling argument. Copies of letters written by ASHP to various committees on selected topics, including restoration of residency funding, are also available.

I think we should all be writing our legislators about health care reform and the specific issues we think would
benefit our patients the most. What do you think?



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