This is my latest addition to the Kansas Council of Health System Pharmacists. I share it here because it is relevant to every pharmacist throughout the country. I hope you enjoy and share my latest newsletter article to membership.
Advocacy or Irrelevancy: It’s Your Choice- You Decide
“If you dislike change; you’re going to dislike irrelevance even more”. (General Eric Shinseki, 34th Chief of Staff of the United States Army)
It might seem strange to start my final presidential article with a quote from a high-ranking military officer who ultimately resigned under pressure from the recent scandal at the V.A. regarding a cover-up of patient wait times. Regardless of the details and context, General Shinseki’s quote is timeless, and particularly germane to our profession of pharmacy. He was grappling with a decades-old institution that needed desperately to change to keep up with the pressures of two long wars and a tsunami of aging veterans. As pharmacists, we are dealing with our own institutional identity. For far too long, we have been content to stay behind the counter, “count pills,” and collect a healthy paycheck. This is understandable… complacency is comfortable; change is not. But the system around us is shifting rapidly, and others will decide the future of our profession unless we come out from behind the counter and embrace that change head-on. If we don't advocate now for our future vision of pharmacy, we will become irrelevant.
Often when we hear the word advocacy, we think of anyone from a slick lobbyist to a grassroots community organizer marching with a sign. We usually think about advocacy in the context of political action. While that certainly can be part of it, advocate has a much larger meaning that includes all of us, even the most politically shy. The broadest definition is simply “to actively support a cause or principle.” This active support is something you pledged to pursue when you took your Pharmacist’s code of ethics and oath. One of the oaths explicitly directs to “embrace and advocate change in the profession of pharmacy that improves patient care.”
I know many pharmacists are reluctant to talk about change because right now, our status quo is pretty good. We work hard and we get paid well. We have respect from our colleagues and community. But that is today. What will our professional status be in 5, 10, even 20 years? Look at the changes that have happened in just the last five years with the Affordable Care Act and the downstream effect with thousands of hospitals, healthcare systems and industries. No matter what your politics, the ACA demonstrates that change in healthcare is happening at lightning speed. Are you willing to stand up today and advocate on behalf of pharmacist provider status… or will you sit back and wait for the pharmacists’ role to become so diluted that soon a vending machine will be doing your job? Are you ready to help educate the public on what a pharmacist truly does behind the scenes… or will you stay silent because it’s easier, which just allows those misconceptions to flourish?
Finally, will you allow decisions about medication and patient care to be made without your voice at the table? Actually, at the end of the day, this isn’t really about us. Remember the oath is, “to embrace and advocate change in the profession of pharmacy that improves patient care.” You are advocating for your profession as a vehicle to advocate on behalf of your patients.
Over the last couple of years I have spent a significant amount of time promoting the pharmacy profession at our state capitol. While chasing down lawmakers, sitting in committee meetings, and talking in sound bites is definitely part of the advocacy process, it’s not the only part. The most important part doesn’t require a trip to Topeka – you are already doing it every day on the job. You are doing it at the individual patient level every time you intervene or initiate an action to improve a patient’s care. You are doing it every time you interact with another healthcare practitioner, professional, or administrator, with the shared goal of helping the patient. Finally, you are doing it every time you speak about your profession and what it means, whether you are speaking to the general public or those in your inner circle of family and friends.
However, if you do choose to accelerate your advocacy efforts, there are many options at the local, state and national level to engage in.
- At the local level, you don’t need to look farther than your own workplace. How can your own health-system or hospital best create an environment that allows pharmacists to work to their full potential; e.g., inside ambulatory clinics or the emergency department? Start conversations with your health-system CEO or other C-suite professionals, or even members of the board of directors when appropriate. Invite these individuals on a tour of your pharmacy or offer to do a presentation. You don’t need to be a department director to do this (although seeking guidance from your director is probably wise). You just need to be a committed pharmacist who is passionate about the relevance of his or her job.
- At the state level, remember, the state senators and representatives are there to represent YOU – not just you as a voter, but you as a pharmacist. Help them understand what you do by inviting them to shadow you for a day at your workplace. Share your concerns with them during events such as KCHP’s legislative receptions or at the Kansas Hospital Association’s (KHA) legislative day. It’s equally important to reach out to other statewide healthcare organizations such as the Kansas Health Care Collaborative or the Kansas Association of Health Care Executives. Offer to do presentations at their association meetings on topics with mutual alignment. Not only do such presentations allow you to share more about the relevance of health-system pharmacists, it also offers diverse opportunities for networking.
- Getting involved at the national level is critically important right now – but easier than you think. Two bills have been introduced that will directly affect patient care by allowing pharmacists provider status nationwide in underserved rural areas (House Bill 592 and Senate Bill 314- http://www.ashp.org/menu/Advocacy/GrassrootsNetwork ). Gaining provider status will not only solidify the relevance of pharmacists as healthcare professionals, it will also increase much-needed patient access to the cognitive and education skills of pharmacists – not just our ability to count pills correctly! The phone number and email address for every Kansas representative in Congress is public information and easy to obtain online or through your local newspaper http://www.contactingthecongress.org/ . Sending an email is good; calling is even better. Call and speak to their staff, and give your pharmacist colleagues a suggested script and the number to call as well. When these elected officials come back to Kansas and hold town hall meetings, show up and let your voice be heard.In both Washington and life, the squeaky wheel (or persistent pharmacist) gets results!
Everything I have described is an opportunity to advocate, and once you have that platform, you need your “elevator speech” ready. It’s helpful to have some key talking points at the ready, such as the ones provided by Scott Giberson, PharmD, during his 2012 lecture to the American Society of Health-System Pharmacists entitled “Transform Health Care: A Call to Action for Pharmacy.” (http://www.ashpfoundation.org/GibersonLecture). I have found his points to be particularly effective when explaining the value of provider status for pharmacists:
- Chronic diseases account for about 78% of health care spending in the United States and 76% of physician visits. Medications are involved in an estimated 80% of all treatments.
- Pharmacists are the second most highly trained health care professional (behind only physicians) based on years of formal education.
- The focus of our curriculum is mainly “post diagnosis,” including treatment of multiple chronic conditions where medications are the primary form of treatment.
- Pharmacists are a primary key to cost containment and have demonstrated an average return on investment of 4:1 over the last two decades.
- Pharmacists are accessible just about everywhere, as 270 million people visit a pharmacy each week, and pharmacies can be found in just about every city, county and state in the nation.
- The pharmacy profession has evidence demonstrating that when given the chance to expand the scope of work within licensure, pharmacists consistently deliver and contribute to the triple aim of health care;
- And yet… pharmacists are likely the most underutilized health care practitioners in the nation.
I hope you when you read these talking points, you will feel as proud of our profession as I do – but also fired up about advocating on its behalf. Pharmacy is a critical part of the health care system, and unless we speak up now, our role could be diluted just because the decision-makers haven’t had the chance to understand our value. And although such changes would be disappointing for pharmcists, the end party that will suffer the most isn’t us – it’s the patient. And that’s really the point of all of this.
As KCHP president, I didn’t knock doors and meet with lawmakers at the state capitol to boost my ego and feel important. I didn’t invite legislators and journalists to tour my pharmacy department just show off my workplace. I didn’t persevere to build bridges and collaborate with the many other healthcare organizations in the state just to make KCHP look better. While the present and future of KCHP is vitally important to me, it is trumped by one thing, the most important thing, and the reason each one of us should be going to work every day. Remember, at the end of the day, it’s for our patients. Lifting up your voice for our profession is one of the best ways we can lift our voice for our patients of today, tomorrow and in the days of change to come. Are you ready to meet those changes with a cloak of advocacy, or will you stay complacent and allow irrelevancy to creep in before you know it.
As I said almost a year ago in my presidential address – you get to decide; it is your choice. If you don’t speak up for you, speak for your patients. They are counting on you. The time is now.