One way to ease physician shortage: Extend authority to pharmacists, others
| Tuesday, Oct 20 2009 09:21 PM
Last Updated Tuesday, Oct 20 2009 09:21 PM
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No matter what side of the political fence you sit, you should be terrified by the raw numbers associated with the shortage of medical practitioners, not just physicians, facing the U.S. today. And the dire predictions we're hearing about practitioner shortages are based on current numbers. Think how much worse the shortage will be when the people now without health insurance start seeking medical attention in a universal-care setting, as Robert Price pointed out in his Oct. 12 column, "We've got to find more doctors, expert says."
While I agree with nearly everything Dr. Art Caplan, the prominent medical ethicist, said in Price's interview, I want to emphasize the importance of extending the authority and increasing the utilization of mid-level practitioners, namely clinical pharmacists.
I am a clinical pharmacist and pharmacy consultant who sees and treats patients with prescriptive authority based on physician referral. In our largest health systems in the U.S. (i.e. Veterans Affairs, Kaiser and county medical centers), physicians have utilized clinically trained pharmacists to see and treat patients with prescriptive authority for many acute and chronic diseases such as diabetes, hypertension, anticoagulation, oncology, psychiatric illness, heart failure, etc.
The key for meeting the rising demand for health care is to get "all hands on deck" by including more "physician extenders" like clinical pharmacists, etc. Many think that physicians might be nervous about "giving up ground" in regards to increasing the scope of practice of mid-level practitioners, but in my experience, this is not the case. Physicians want to do what is in the best interest of the patient. Physicians' hesitation to expand roles of mid-level practitioners is not fear of competition, but doubts about appropriate care for their patients. When they have been exposed to the capabilities of clinically trained pharmacists, physicians are grateful and thankful for the help.
Another set of eyes on the patient greatly reduces the liability of all involved. One of the greatest liabilities for primary care doctors comes from medication use. Patients seen by clinical pharmacists are seen strictly based on physician referral. All of my clinics are booked and overbooked for the next two to three months, and physicians constantly ask me to open new clinics for things like pain management and heart failure. Trying to meet the demand of patient care, however, even with utilization of mid-level practitioners, is like digging a hole in the sand. There's just not enough of us.
Physicians are and should always be the quarterback, the captain of the ship, when it comes to overall responsibility of care for the patient, but physicians (and patients) need an arsenal of highly trained and capable mid-level practitioners to refer patients to help with the management of chronic diseases. With medication costs soaring, new medications coming to the market every day and medication regimens becoming more and more complex, I strongly feel that clinically trained doctors of pharmacy are best trained and suited to participate in the direct medication management of patients. There are literally hundreds of articles illustrating that when clinical pharmacists are involved with direct patient care, health care costs, including medication, ER visits, etc., go down, and health outcomes improve. I am associated with two pharmacist-managed diabetes clinics and have publications pending showing dramatic improvements in outcomes and a 78.9 percent reduction in hospital admissions and ER visits.
The problem remains, however, that pharmacists are not uniformly nor consistently recognized as direct patient care practitioners and are therefore not reimbursed as such. I and my fellow clinical pharmacists literally take pay cuts to work in direct patient care roles, versus working in the retail/community sector, but we love our jobs, passionately care for our patients and wouldn't have it any other way.
Ryan Gates of Bakersfield is an adjunct assistant professor of pharmacy practice at the University of Southern California, president of Frontline Pharmacy Consulting Services and chairman of the Diabetes Coalition of California guidelines committee.
