One of the mantras I have been pushing in relationship to the PPMI is the notion that change will happen whether or not we are on the bus with it. It will either happen because of our efforts, or it will happen to us in spite of our efforts. Me, I'd rather have it be change we want that we have worked for than something handed to us that places us in a corner.
I was reminded of this recently in an LA Times story
that was highlighted in the SICP Newsletter. This article highlights changes being considered in California to deal with what appears to be a growing shortage of primary care physicians in that state. What I found interesting in this article is that there was independent and public consideration of pharmacists as healthcare providers, but our proposed scope of practice was limited to a few chronic diseases.
Talk about damning someone with faint praise. Nurse Practitioners and Physician's Assistants, neither of whom have our level of training or expertise, were being proposed as broad alternatives to physicians for rendering primary care, but pharmacists were to be invoked only for a narrow segment of the population. It's better than it could be, but it is far from a ringing endorsement of our profession.
Of course, the medical lobby paints us all with the broad brush of not being physicians and therefore not competent to render primary care. But then they set up their practices so that most of the primary care is rendered by non-physicians which seems to be okay as long as the physician continues to derive income from their efforts. In California (more, perhaps, than other states) pharmacists already enjoy practice roles within the confines and context of established medical practices. So the question is not whether or not we are competent or valuable in that role.
The reality is that in virtually every community there is at least one chain drug store where a nurse of undisclosed skill renders primary care to anyone who comes in, and who is even reimbursed by most insurances for that effort. I have been the beneficiary of one such service and it was rendered well, in my opinion. What appears to be telling is that these services are not staffed by pharmacists, even though our clinical education likely exceeds that of the nurses who provide this service.
This is not to say that nurse practitioners or physician's assistants lack competence. Far from it. It just seems that, given the ongoing shortage of nurses in roles that only nurses can fulfill, it seems strange from a public policy point of view that we would further decimate the ranks of nurses to provide primary care roles, especially when we currently have what appears to be a glut of pharmacists who could just as easily fulfill those roles.
In any event, and back to the main point, we are likely to find ourselves painted into a corner if we do not come to the table and argue compellingly for our professional role. Nobody is going to take care of us, or recognize our role. There is no guarantee that there is a rightful place for us that we do not make for ourselves.
So who is arguing for us and our role in California? Hopefully, it is the ASHP state affiliate. But one wonders if this is not an opportunity for our national organization to come to the table in that state and set up a demonstration project that could be used to spur similar efforts in other states.
Just one man's opinion. What do you think?
Dennis A. Tribble, Pharm. D., FASHP
Daytona Beach, FL
The opinions expressed are my own, and not necessarily either those of my employer or of ASHP.