When I was applying for residencies in 2016, I knew I wanted to practice in an ambulatory care setting.  I matched with a residency at the University of Minnesota that allowed me to train in primary care for the first year and then focus on leadership and practice development in the second year by working in a clinic that had never had a pharmacist; it was a chance for me to create something new.

There was an opportunity in a specialty neurology clinic for a pharmacist. I was chosen to go and start this new practice, to work collaboratively with the neurologists and clinic staff, and to ultimately benefit the patients by having a pharmacist on staff. I partnered with a number of neurology sub-specialists, including Movement Disorders and Headache providers early on.  As of July 2018, I am now full-time as a medication therapy management (MTM) pharmacist in neurology at the University of Minnesota Health Clinics and Surgery Center.

My patients are facing the challenges of Parkinson disease, restless leg syndrome, tardive dyskinesia, amyotrophic lateral sclerosis, multiple sclerosis, Huntington’s disease, and migraines, among other neurologic diseases.  As medications become more complex, I am there to provide both expertise and comfort to providers and patients, as we meet 1-on-1 for comprehensive medication management visits. Oftentimes, patients are hesitant to try new medications; I can help them take this next step, while paying attention to the safety and risk of each new medication.

My background in primary care helps when I am assessing their medications comprehensively. I can connect with a primary care provider or connect 1 specialist with another to discuss a patient’s history and make recommendations for medication changes. There are constantly new medications on the market and providers and patients are bombarded by the options. I am able to provide education on these new medications, while also considering the implications of their high cost. For example, with the new CGRP inhibitors on the market for the prevention of migraines, I have been able to work more closely with the headache providers; they have found it to be valuable to have me on the team.

When you work in a specialized field, it’s important to find people who are doing similar work at other institutions. I have a quarterly call with a group of neurology clinic pharmacists across the country. It’s a great opportunity to talk about practice issues and to share knowledge that we have gained over time. It’s so helpful to have those colleagues to rely on, as well as the support of the entire MTM team in the University of Minnesota/Fairview health system.

I also work closely with our patients with movement disorders, such as Parkinson Disease, to optimize their medication regimens. I do a lot of motivational interviewing, especially when patients are starting new medications or we are changing their daily medication routine. It’s very fulfilling when I can make a patient’s life easier. Some patients with Parkinson disease are taking medications 10-12 times a day. If I can eliminate some of those dosing times, it’s so much better for them.

I see myself as providing hope, too. Even in the face of a neurodegenerative disease, we can provide patients with medications that treat their symptoms, that work in their schedule, that they can afford, and that will be the best and most effective for them. Most patients just appreciate knowing their options, and pharmacists are often the most accessible providers for them; it’s our job to spend as much time as it takes to help patients feel comfortable with the medications they are taking. The no-show rate for MTM visits among the population I work with is extremely low. They are empowered to take care of themselves, and they are invested in coming back.

Natalie Roy, Pharm D, is a Medication Therapy Management pharmacist specializing in neurology care with Fairview Pharmacy in Minneapolis. She spends most of her time with patients and providers at the Neurology Clinic at the University of Minnesota Health Clinics and Surgery Center.


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