Standard of Care Means Pharmacists Must Control Their Own Practice

Most who read my blogs know that I don’t shy away from controversy. Indeed, I hope that these lines will be catalysts for conversations.

Let’s face it: Most of the challenges we face in our profession today are complex. Pulling one lever may help solve a problem, but it’s likely pulling several levers in the right sequence and over time that will lead to the transformation that we want.

But let’s forget transformation for just moment. When I graduated from pharmacy school my goal was simple: let me take care of patients the way I’d been trained. My wife, also a pharmacist, and I were just talking about this. She went to work in one of the busiest pharmacies in northern Virginia back at that time while I finished up training in Washington. By the time we moved back to Alabama to work in our independent pharmacy, Heather was already frustrated because she’d not had the staffing she really needed (yes, back in the mid-1990s) to take care of patients. She’d been trained to use a new point-of-care device for cholesterol monitoring and was ready to start helping her patients—only to be told by her employer that if it couldn’t be done in all their pharmacies, it wouldn’t be done in any of them. She was disenfranchised only a year into practice, and we were hopeful as we entered our own practice that we could control our own destiny.

Something has changed. Not everywhere, but in lots of places. As I travel around the country visiting pharmacists in their practices, they do not feel as though they have the autonomy within their practice to make decisions or to practice in the way they feel is best for their patients. They feel they have a prescribed list of things (protocols) that must get done, and that without the staffing to do the must things, they have no time to do the things that their professional oath tells them they should be doing to truly care for patients. And I'm talking about pharmacists in all patient care settings, not only big box pharmacies that the public most commonly sees. While this is a problem in those settings, there are some incredibly bright spots in community pharmacies large and small where I hear the opposite—pharmacists who feel they have the support and autonomy that I felt early in my career.

A pharmacist not being able to make decisions and do what they know needs to be done for the patient is a serious problem.

Pharmacists provide care.

Not pharmacies.

Not hospitals.

Not corporations.

Not venture capitalists.

Pharmacists.

We are talking about health care—individualized, personalized, customized, every-person-needs-something-different kind of care.

The business of health care does involve corporations. And we need corporations and businesses to find that balance and recognize pharmacists as health care practitioners with the autonomy to lead their own practice. 

Standard of care laws and regulations are gaining acceptance across states. These laws and regulations are quickly enabling pharmacists to lead their own practices. This means that pharmacists' practices simply can’t be the same in every location. Every pharmacist in these models will be challenged to provide care for every patient to meet the standard of care. It’s the license of the individual that is ultimately on the line. And it’s the reputation of our profession that is also on the line. It’s time for our profession to come to grips with this dilemma and collectively take action to create an environment where pharmacists can thrive regardless of the setting in which they provide care.

Feeling a little spicey. For all of pharmacy.