Pharmacy School

[aychamo_aycono]

Originally Posted by MrSpitz

Insurance companies want to buy the drugs directly from the manufacturer, have them shipped and filled at centralized locations to decrease the markup and expand automation. Almost every pharmacy now has a machine that fills the most perscribed drugs and does pretty much everything once you input the script and directions in the computer. This can be greatly expanded and would require not only less techs but less pharmacists, just a core staff of constant reviewers. The drugs are then mailed out currently, the delivery method is what's tricky.

And quite honestly they should be cut down. Making 120,000 a year to do what those guys behind the counter of a CVS do? Are you kidding? It's a cost to the system that is totally ridiculous and just gets passed on. I hope they are reduced. Sorry if that was your plan.

I was just going to write about this. I know barely anything about what a pharmacist does, but from my point of view it can't be extremely complicated. I write the prescription, amount and suggested use. The pharmacist or tech takes my written prescription, counts the pills into a bottle and gives it to the patient, translates my written instructions from latin to english, and then deals with the insurance side of paying for drugs. I'm not terribly impressed, and I don't think this is a $120,000/yr job.

I don't know why I'm trusted to walk into a room full of instruments and things, take whatever I want, stick it in the patient, send whatever labs off etc, but I'm not trusted to walk up to a big box of antibiotics and take out 10 pills and put them in a little bottle for my patient. Or, as someone mentioned up above, not have it more mechanized so I input my script into a computer and it does it automatically, completely eliminating the need for a pharmacy. All you'd need is a pharmaceuticals rep to stock the machine.

For any pharmacists, how much leeway do you have in giving alternative drugs to what the doctors prescribe? The other day a resident wanted to discharge a patient on PO Zyvox for LLE cellulitis, but the attending told him to just give the patient PO Vanco because the Zyvox was wayyyyyyy more expensive and the patient likely wouldn't fill the prescription (we all know this story, and anyway, the bacteria weren't Vanco resistant, he was responding fine to IV Vanco while in the hospital) If the attending hadn't caught this problem, and the patient went to fill the prescription and it was like $500, could the pharmacist had said "Ok, would you like to try this cheaper drug that covers basically the same bacteria?" ?

I completely agree with you that the pharmacist's cushy salaries are eating up a lot of costs of healthcare. Just seems a little overpaid.

Does anyone work in a vet? Don't they handle their own pharmaceuticals? I wonder how that works. Maybe that's something to look into in the future.

(By the way, I went to fill my prescription for Azithromycin the other day, 500mg x 5 days, and my insurance would only pay for 4 out of the 5 tablets, I had to pay the 5th tablet, like $20, how fucking retarded is that?)

[aychamo_aycono]

Originally Posted by Designz

A pharmacist's duty isn't just to give medications to patients. A pharmacist is often a patient's first medical resource; sadly, the way drug chains are pushing their pharmacists to fill more and more prescriptions, the patients are losing along with the pharmacists.

How much patient counseling does a pharmacist do? For things like how to treat a cold? I'm sure they can't just go off a give an antibiotic to someone randomly can they

Originally Posted by MrSpitz

Edit: Just one thing, the community pharmacists only goal is to give medications to patients with a clear set of instructions. The physician decides everything else and accepts all liabilities and where necesary is responsible for monitoring side effects. And it is somewhat ridiculous to me that the primary care physician who is responsible for all that and works far more makes less and continues to get shit on. It's not good for anyone in the long run where that position is headed.

Agree

Originally Posted by Snugglebear

The PharmD from the hospital my medical college is associated with does creatine clearance calculations for doctors. And he teaches part of the medical pharmacology class. So if you don't want to just sit around and dispense prescriptions at Wal-Mart, there are other more involved options.

No one has mentioned this (or I missed it), but doesn't pharmacy school require loads of chemistry? It's a major part of the entrance exam, and I'm pretty sure you will need to retain that stuff for the PharmD classes once you get in. Did you get much chemistry in Psychology? Around here, Psychology is basically a bullshit degree.

I'm curious why the pharmacist does the creatinine clearance calculations for the doctors. That's a pretty simple calculation and a lot of computer lab result systems calculate it automatically if you draw a patient's basic metabolic panel.

I had friends who did the pre-Pharm classes while I was doing pre-med classes. They just take the basic 1st and 2nd organic and inorganic chemistries (4 chems total). It's nothing difficult. Not saying pharmacy school is easy, a lot of my friends dropped out cause they couldn't do all the memorization. I can tell you this, memorizing medications is fucking hard, because a lot of the drugs sound the exact same, and then there are multiple trade names for the same generic drug, etc. It's pretty taxing. Even doctors 20 years in practice have to carry a little drug manual arround to look them up every once in a while. I consult my drug manual at least 5-10 times a day for drug names, dosing, etc.

[Snugglebear]

It's the body weight calculation that he does, for certain medications, as well as CrCl calculations for renally excreted drugs. Some doctors up there just do it on their own. I forget the name of the complicated body mass one.

[Designz]

Originally Posted by aychamo_aycono

How much patient counseling does a pharmacist do? For things like how to treat a cold? I'm sure they can't just go off a give an antibiotic to someone randomly can they

Realistically, from what I've learned in class, pharmacists don't do enough patient counseling because either 1, they have too many prescriptions to fill, or 2, they don't know how to counsel correctly. Many times, when someone goes to pick up a new prescription, the pharmacist will simply something like, "this drug is for your back pain, put it under your tongue two times a day and watch out for diarrhea or headaches, do you understand?" - "yes, bye". The patient goes home, takes the pill "two" times a day, which means two for breakfast, lol.

You said that pharmacists are driving up the cost of healthcare, but if you think about the cost of pharmacists vs. the cost of medications, medications cost much more than pharmacists. Part of the reason so much money is spent on medications is because patients don't comply with the therapy or really understand how the medication works. I think the statistic out there is 50+ billion dollars are spent on wasted pills or patient misunderstandings:

Patient Compliance Medication Adherence SATISTICS

Billions upon billions of dollars are wasted because pharmacies like CVS are forcing pharmacists to fill more prescriptions than ever. I think the average retail pharmacist fills 120+ prescriptions a day or something. Anyway, the collective counseling negligence (which is also partly the pharmacist's fault) has led to a medication compliance crisis. I don't know how it will correct itself, but in the long run, it'll hurt the patients and reputation of pharmacists and continue driving healthcare costs up.

Pharmacists are there to drive healthcare costs down, not up. If a patient doesn't take an antibiotic correctly, you'll be seeing him in the hospital again

[Koivu]

I'm wondering how the European/Nordic system would work in the US context.

I'll use my migraine medication as an example. I'll get prescribed 100 pill dose, and I have the option of either buying a 100 pill bottle, or three boxes containing 30 pills each. In both cases the packages are pre-packed and sealed at the drug factory, contain the relevant user information such as side-effects, guidelines etc on a slip of paper inside.

The person behind the counter usually has received a second tier education, comparable to going 3 year high school or trade school. Most of the time their job consists of checking the drug name from the prescription, if they have it in stock, and possibly suggesting an alternative (cheaper generic drug, or a replacement in case of them not having a drug originally prescribed at hand) then fetching the medication from the storage (all drugs are pre-packaged, there's no filling out plastic bottles), printing out the dosage instruction as per prescribed by the doctor and sticking it to the side of the box/bottle and then taking your money.

In the migraine example above, if I opted to buy smaller boxes for whatever reasons, I'd essentially lose 10 pills, as there would be no way for me to get a 10 pill Clotam package.

[aychamo_aycono]

Originally Posted by Designz

Pharmacists are there to drive healthcare costs down, not up. If a patient doesn't take an antibiotic correctly, you'll be seeing him in the hospital again

Well, there's certainly something to be said for patient stupidity. The doctor counsels the patients on how to take the medications, we even go as far as helping them make calendars sometimes to know which pill to take at which times. If the pharmacist advises them on how to take their meds also, and they still fuck up, then damn them anyway!

The biggest mistake I see doctors make is dosing drugs that require a loading dose (ie, a full gram on day 1, then whatever lower milligram dose on the subsequent days), because the patients have no understanding of pharmacokinetics (and they shouldn't, honestly.)

[Designz]

Originally Posted by aychamo_aycono

Well, there's certainly something to be said for patient stupidity. The doctor counsels the patients on how to take the medications, we even go as far as helping them make calendars sometimes to know which pill to take at which times. If the pharmacist advises them on how to take their meds also, and they still fuck up, then damn them anyway!

The biggest mistake I see doctors make is dosing drugs that require a loading dose (ie, a full gram on day 1, then whatever lower milligram dose on the subsequent days), because the patients have no understanding of pharmacokinetics (and they shouldn't, honestly.)

Damn, doctors have time to thoroughly counsel patients on meds?!?

Anyway, we learned that the correct way to counsel patients is to ask them questions (on the stuff that doctors said), fill in the blanks, then ask them to repeat the information including what we added.

A lot of people can't read the instructions on the label Someone should figure out a standardized pictorial method of showing patients how to correctly take pills.

[Loki]

One of the things that pharmacists do is provide a safe-fall for their customers. Patients seeing a doctor may not always tell them all of the medications they are taking, which could easily lead to the doctor prescribing something that has a negative interaction with an existing therapy. The vast majority of patients use the same pharmacy to fill all of their prescriptions, and with the patient's drug history saved in their profile,
the pharmacist can make sure there are no negative interactions between drugs that the patient may have forgotten to tell the doctor they are taking.

Something else that pharmacists do is to make sure that the dosing on medications is correct. You'd be very surprised how many physicians prescribe infants and children full, adult dosages because they aren't paying attention.

[Dethfang]

Originally Posted by aychamo_aycono

I was just going to write about this. I know barely anything about what a pharmacist does, but from my point of view it can't be extremely complicated. I write the prescription, amount and suggested use. The pharmacist or tech takes my written prescription, counts the pills into a bottle and gives it to the patient, translates my written instructions from latin to english, and then deals with the insurance side of paying for drugs. I'm not terribly impressed, and I don't think this is a $120,000/yr job.

I don't know why I'm trusted to walk into a room full of instruments and things, take whatever I want, stick it in the patient, send whatever labs off etc, but I'm not trusted to walk up to a big box of antibiotics and take out 10 pills and put them in a little bottle for my patient. Or, as someone mentioned up above, not have it more mechanized so I input my script into a computer and it does it automatically, completely eliminating the need for a pharmacy. All you'd need is a pharmaceuticals rep to stock the machine.

For any pharmacists, how much leeway do you have in giving alternative drugs to what the doctors prescribe? The other day a resident wanted to discharge a patient on PO Zyvox for LLE cellulitis, but the attending told him to just give the patient PO Vanco because the Zyvox was wayyyyyyy more expensive and the patient likely wouldn't fill the prescription (we all know this story, and anyway, the bacteria weren't Vanco resistant, he was responding fine to IV Vanco while in the hospital) If the attending hadn't caught this problem, and the patient went to fill the prescription and it was like $500, could the pharmacist had said "Ok, would you like to try this cheaper drug that covers basically the same bacteria?" ?

I work management at Walgreens and a great number of my friends are pharmacists so I can throw out some inside perspective. Basically pharmacy salaries are skyrocketing because EVERY store feels it needs to get in on pharmacy. Grocery stores and big box retailers (Walmart, Target, Kmart, etc) are getting into pharmacy mostly as a loss-leader. Meanwhile, Walgreens and CVS are basically opening a store every 18 hours or so non stop. Each store will be staffed by 2.5 full time pharmacists minimum. So competition is really driving the salary of pharmacists through the roof. Even hospitals are starting to raise pay to match / beat retail positions.

While retail pharmacists do less in terms of actual healthcare than other positions, it comes down to regulations requiring a pharmacist oversee the dispensing of medication AND be available to consult with patients regarding their medications. They are actually beginning to take advantage of some gray areas with remote verification of drugs and remote consultations (think total recall style video phones) where a central hub of pharmacists would oversee / consult numerous locations.

As far as doctors dispensing meds themselves ... it really comes down to a checks and balances sort of thing. Would it be in the doctor's best interest to prescribe medication to patients if he was to profit from it? How would the insurance company feel about doctor's prescribing medications then? There are some major conflicts of interests for all parties involved.

Pharmacists can recommend cheaper drugs that are just as effective but cant make the switch without your doctor's approval. In general pharmacists are going to be more familiar with the medications than the doctor so often times they can really help out in this department.

[Everlast]

I worked at a mail order pharmacy for two and a half years (drugstore.com). I was a pharmacy tech. and worked side by side with the pharmacists, although I imagine that with the volume of sales we did, our system was a bit different. All of our staff was incredibly over worked and stressed out, 60 hour work weeks were the norm for techs. 80 for pharmacists.

We were also closely monitored for performance like it sounds CVS was, we had to do at minimum 19 calls for clarification (i.e; incorrect sig, dosage, misspellings, etc.) and/or 35 prescription entries (we would enter our prescriptions into a digital sort of filing cabinet so the pharmacists could access them much quicker then with the hard copies, obviously with schedule II drugs we still needed the hard copy). This lead to a ton f multitasking which in turn produced the stressed out pharmacists.

Dealing with doctors (19 an hour at minimum) was beyond painful, when they find out they did something wrong a lot of the pitch a bitch fest.

Overall I loved the job and am considering taking some classes in it after I knock my gen. eds out of the way. If it is something you ENJOY then you will excel if not, then you will get burnt out quickly. You get a pretty nice salary and I got amazing health benefits and prescription plan.

[MrSpitz]

Originally Posted by Dethfang

As far as doctors dispensing meds themselves ... it really comes down to a checks and balances sort of thing. Would it be in the doctor's best interest to prescribe medication to patients if he was to profit from it? How would the insurance company feel about doctor's prescribing medications then? There are some major conflicts of interests for all parties involved.

Pharmacists can recommend cheaper drugs that are just as effective but cant make the switch without your doctor's approval. In general pharmacists are going to be more familiar with the medications than the doctor so often times they can really help out in this department.

There's conflict of interests on every side though. Community pharmacists simply represent their retail company, which has its own preferential relationships with manufacturers and if you have noticed the number of pharmaceutical reps. visiting the community pharmacy and pushing their drugs has sky rocketed as well. That's not really limited to doctors.

The role of the pharmacist is to bring costs down, but when you have so many different pharmacies with such high salaries AND so many different locations to ship and stock drugs to you end up injecting more cost into the system which simply is made up by the retail store having a higher mark up on the drug which gets passed to the insurance reimbursement which gets passed to premiums or copays. There is a huge need for maintenance and making sure complications do not arise, but retail pharmacies are more of assembly lines then counseling stations and the current outlook doesn't see that changing.

[Designz]

Originally Posted by MrSpitz

There's conflict of interests on every side though. Community pharmacists simply represent their retail company, which has its own preferential relationships with manufacturers and if you have noticed the number of pharmaceutical reps. visiting the community pharmacy and pushing their drugs has sky rocketed as well. That's not really limited to doctors.

The role of the pharmacist is to bring costs down, but when you have so many different pharmacies with such high salaries AND so many different locations to ship and stock drugs to you end up injecting more cost into the system which simply is made up by the retail store having a higher mark up on the drug which gets passed to the insurance reimbursement which gets passed to premiums or copays. There is a huge need for maintenance and making sure complications do not arise, but retail pharmacies are more of assembly lines then counseling stations and the current outlook doesn't see that changing.

Pharmacists are getting high pay because there is a shortage of them.

Also, retail pharmacies are not supposed to be assembly lines, but over time, pharmacists have gotten used to feeling like they're working in a drug store because there's little incentive to try to help the patients; there's more incentive in filling as many prescriptions as possible to increase revenue. Plus, some people simply don't have the patience to listen to a pharmacist's advice.

I think there is still a lot of unfulfilled potential in the pharmacy profession. Unfortunately, in the retail setting, pharmacists are turning into educated McDonalds workers.

And about the drug rep thing, drug reps try to and do influence doctors much more than pharmacists. If anything, doctors are driving up the overall of medications!

[chu]

Pharmacists have to follow the prescription to the letter. They can suggest and huff and puff, but to change it they must get doctor's approval.

As far as drug complications go, yes I agree. But all of that doesn't really require a pharmacist and can be automated by a computer which will flag it to a cheap labor tech on his monitor.

The real problem is shortage of pharmacist because as someone mentioned everyone store WANTS a pharmacy because it attracts people who also may buy shit on the way since they're already there.

[MrSpitz]

You guys need to better define the term shortage of pharmacists.

There is a shortage of pharmacists only in so much as that so many new employers are popping up. If you want to talk Alaska or some rural communties, there is a true shortage there in terms of population served. In most places the shortage is simply because the new Walgreens, CVS, Rite Aid, Tops, and Wegmans all built new pharmacies and are hiring to syphon away competition from the other.



And all the redundant service costs (like salary) get directly translated to the patient and actually serve as a nice bargaining chip for manufacturers who now have more major clients. As for 'potential' you speak of, you seem to be on the wrong end of things. Pharmacies used to be true members of the community, you used to have local stores with extensive compounding and home delivery and intimate relationships with clients. But as the big chains realized the business and insurance money they could get and started consolidating and buying them up, it totally took the independents out of the industry. And not to take cheap shots but pharmacists were eager for this shift at the time because this is what intially lead to the explosion in salaries, and as the money train left the station more and more people got on. It pisses me off personally, and I'm truly sorry I offend you on this, but all this expansion has increased costs per script which hurts everyone. Except for the actual pharmacist who is making out like a bandit.

[Designz]

Originally Posted by MrSpitz

You guys need to better define the term shortage of pharmacists.

There is a shortage of pharmacists only in so much as that so many new employers are popping up. If you want to talk Alaska or some rural communties, there is a true shortage there in terms of population served. In most places the shortage is simply because the new Walgreens, CVS, Rite Aid, Tops, and Wegmans all built new pharmacies and are hiring to syphon away competition from the other.



And all the redundant service costs (like salary) get directly translated to the patient and actually serve as a nice bargaining chip for manufacturers who now have more major clients. As for 'potential' you speak of, you seem to be on the wrong end of things. Pharmacies used to be true members of the community, you used to have local stores with extensive compounding and home delivery and intimate relationships with clients. But as the big chains realized the business and insurance money they could get and started consolidating and buying them up, it totally took the independents out of the industry. And not to take cheap shots but pharmacists were eager for this shift at the time because this is what intially lead to the explosion in salaries, and as the money train left the station more and more people got on. It pisses me off personally, and I'm truly sorry I offend you on this, but all this expansion has increased costs per script which hurts everyone. Except for the actual pharmacist who is making out like a bandit.

If being a retail pharmacist is a walk in the park, why do I hear of so many pharmacists who hate it or talk about how much crap they have to put up with?

I'm all for pharmacy being easy. I don't mind getting paid 100k for sitting around and picking my nose, but from what I hear, retail pharmacy is more than what I see. When I first heard that retail pharmacy was a PITA, I was surprised because when I saw chain pharmacies, I didn't see anything happening.

Oh, and for the OP, I've read some statistics where 60% of pharmacists who work in hospitals are "extremely satisfied" with their jobs, and 39% are "somewhat satisfied", so basically, you're guaranteed to like pharmacy if you work in the hospital. Of course, 70% of those pharmacists also said that hospital pharmacy is "very challenging".