Mike Schuh, PharmD, MBA, FAPhA, FFSHP, a medication management pharmacist at the Mayo Clinic in Florida, discusses his journey into the pharmacy profession and the evolution of pharmacists from product-oriented to clinical professionals.
In this conversation, Mike Schuh, PharmD, MBA, FAPhA, FFSHP, a medication management pharmacist at the Mayo Clinic in Florida, discusses his journey into the pharmacy profession, the evolution of pharmacists from product-oriented to clinical professionals, and the challenges they face in getting adequate reimbursement for their clinical services. He emphasizes the value of pharmacists in improving patient outcomes and expresses his hope for the profession to gain financial independence from product-related services. Schuh also shares his perspective on American Pharmacists Month, stating that he celebrates the importance of pharmacists year-round by actively promoting the profession and its services.
Q: Can you introduce yourself?
Mike Schuh: I'm Mike Schuh. I'm a medication management pharmacist, clinical coordinator, and assistant professor of family medicine, palliative medicine, and pharmacy here at the Mayo Clinic in Florida. The services we provide are many, actually. We have mainly console services, some longitudinal, but we do polypharmacy, we do pharmacogenomics, we do primary care, we service inflammatory bowel patients, and solid organ transplants. We're pretty busy. We do a lot of different things, and we serve as probably more than 20 different departments in the clinic, total, maybe up to 25, if I actually sat down and counted them all.
Q: How did you get into the pharmacy profession?
Mike Schuh: it was sort of by accident. I applied to veterinary school, and it was, at the time, they were only taking about 1 out of 16 applicants to veterinary school at the time, way back in the “Middle Ages” when I went to pharmacy school the first time. I applied to pharmacy school to since I had all the prerequisites out of the way for both. I applied to pharmacy school, didn't make it to veterinary school that year. I applied to both, pharmacy school was my plan B, and so I got accepted to pharmacy school, went to pharmacy school, actually not knowing anything other than pharmacists counted by 5s, and I've spent most of my career trying to convince other people that we know more than that. So that's kind of how I fell into it, and actually, I graduated so long ago, that I actually went back after 24 years of practice and community practice and got a post-back PharmD and enabled me to do the clinical stuff that I do now.
Q: How have you seen the pharmacist change and evolve throughout your career?
My career has been a long one, it's been 40 something years so far, and I've seen us become more less of a produc dispensary, product oriented profession to more of a clinical one. So we're now really highly trained as clinical true clinicians, and with the added training, and so forth, unfortunately, we didn't ask for or seek strongly enough payment. For what I do is limited and we can't really do a lot of clinical stuff widely because we can't adequately bill for services, especially in the [ambulatory] care setting. Therefore, we're not able to deliver our services to as many people that really, really need them. We're highly trained underutilized, because we can't build to pay our way, and we're really considered extra overhead by a lot of our non-pharmacy colleagues who make decisions like whether they're going to hire a pharmacist or not, or open a pharmacy department. That's the sad thing I've seen is that we progressed so much clinically, we all have so much to offer, but what we really, really do not have a way to support our services, so we ended up being overhead.
I would like to see that change before I retire in our profession that we can pay our own way, and by doing that, and being financially supported, through reimbursement from third party payers that everybody will have access to our services and to get there because we've shown time and time again over the years that have a pharmacist involved in patient care that the patients generally do better, we save money, and we have better outcomes. We've shown that time and time again, but we haven't been rewarded yet to be able to even support ourselves in a clinical setting. So that's been the focus of anything that I can do either on the job or off the job for probably 20 years or so.
Q: What is the value of the pharmacist?
Mike Schuh: It means a lot to me because I see the good that we do, and I see the reaction from the patients after we delivered true high-quality services. At the services, the patients actually love the services, and they get a lot out of it, and I think they do a lot better with us. Again, the only way we can be viably financially stable is when we tie services to product. I would really like to cut that cord, if we could, and for us to get reimbursed for services without having to be joined at the hip to product. If we ever managed to do that and to be able to financially support ourselves away from product, I think that ambulatory care what I do can be the fastest growth area in our profession and would be widely used by many, and we would see a lot better results, especially for the indigent community that they really can't afford to pay for services. Fortunately for me, I see a population of folks who see the value in pharmacy services and would pay out of pocket for them and have in the past; we had a different model here.
However, if you don't have money, you can't do the services, but you still need health care and in our particular case, if we ever got third-party payment, if we ever got [Centers for Medicare and Medicaid Services] to authorize payment in this in the Social Security Act, if we ever got third-party payers, at a state level to pay adequately for services, we can do so much more good than what we do now. We just have not been able to do it, and it's been a tough slog, but we haven't stopped trying.
Q: How are you celebrating American Pharmacists Month?
Mike Schuh: To be quite honest with you, I feel the way to really stay in tune with your profession is to celebrate pharmacist month, every month. I have sort of a personal crusade since I went back to school to try to spread pharmacist services as much as I can every single day. I'm always trying to show the value in what we do with the physicians that I interact with, with the administrators I interact with, and anybody who will listen, including patients. I sort of celebrate it year-round. It's a nice thing to have this month. We're doing a few things here in the clinic. We have a table out in the hallway, our department bought us lunch and so forth, which was very nice. But to me, pharmacy week is every week, pharmacist month [sic] is every month for me because I'm always trying to get us recognized and always trying to move us forward. That's my personal little crusade. It may not be others, but it's mine.