‘Lead by example’: Giberson provides patient care, inspires others

Scott Giberson of USPHS promotes a platform of expanded practice, provider status, and consistent messaging

Giberson presents the keynote speech at the Second General Session of the 2012 APhA Annual Meeting & Exposition in New Orleans.

The primary author of the landmark U.S. Public Health Service (USPHS) pharmacy report, RADM Scott Giberson, BSPharm, PhC, NCPS-PP, MPH, USPHS, promotes a platform that’s known to many pharmacists. His vision revolves around expanded practice, provider status, and the need for more consistent messaging.

In keeping with this vision, Giberson—Chief Professional Officer, Pharmacy; Director, Division of Commissioned Corps Personnel and Readiness; and U.S. Assistant Surgeon General—finds medication therapy management (MTM) to be slightly problematic in terms of definitions, provider status, and broader primary care services delivered by pharmacists in truly progressive roles.

Coming up through the ranks as a pharmacist in the Indian Health Service (IHS), Giberson provided expanded practice in a collaborative practice environment that included MTM, but went beyond it with many additional facets of primary care, such as continuity of care, follow-up care, assessment, and the full patient care process once the diagnosis was made.

“We need to reframe some of the roles of the profession,” Giberson told Pharmacy Today. “We must all understand and communicate that we are providers of patient care and public health professionals. Once a diagnosis is made, we help manage chronic and even acute conditions with our expertise in medication use. This reframes the scope to focus more on our capacity to care for patients.”

Dual USPHS positions

Giberson with RADM Boris Lushniak, MD, MPH, USPHS, the U.S. Deputy Surgeon General and a supporter of pharmacy.

Giberson was tapped by the U.S. Surgeon General to be the first Director of Commissioned Corps Personnel and Readiness (DCCPR), in August 2011, and for a 4-year term as the Chief Professional Officer (CPO) for the pharmacy category, effective March 2010. He became U.S. Assistant Surgeon General with the rank of Rear Admiral and his selection as CPO of USPHS pharmacy.

“In both positions, I have the responsibility to lead, to be a diplomat, and to build consensus,” Giberson said. “That is an honor and a privilege I don’t take for granted.”

As Director of DCCPR, Giberson has operational leadership for the management of all personnel and readiness and response systems for more than 6,600 USPHS Commissioned Corps officers in 11 professional categories such as physicians, pharmacists, and nurses.

As the pharmacy category’s CPO, Giberson said, his customers include nearly 1,200 pharmacy officers. “The needs are vast—from developing pharmacist leaders to mentoring young officers,” he explained. He raises the awareness of the Surgeon General to pharmacy-related initiatives that develop across the country. He stays abreast of pharmacy initiatives across the U.S. Department of Health & Human Services and ensures communication between pharmacists in each agency. He seeks to advance the profession and collaborate with federal and nonfederal partners.

“One principle that I have always used to guide my leadership has been the power of inspiration,” Giberson said. “The ability to relate to others—whether they are the highest level authority or the most junior of new officers—is something that I also believe is critical to be a successful leader. This builds the trust and transparency needed to maximize workplace productivity.”

Professional experiences and mentors helped develop his skill sets, but the life experience that most affected Giberson was personal. “My father passed away at a very early age,” he said. “It taught me to take nothing for granted.” That, and wonderful relationships with his wife, Lynette, and son, Payton, have inspired this pharmacist to navigate his priorities in life. “Once I had that support, I feel like I can do anything,” he added. “They drive everything I do.”

From small town to global health

In Gallup, NM, Giberson sees a patient during a primary care visit. He is auscultating for adventitious lung sounds. This photo was likely taken in 2008.

Giberson was born and raised in West Wyoming, PA, a small town near Wilkes-Barre. By the time he earned his bachelor’s degree from Temple University School of Pharmacy in Philadelphia, he was interested in the progressive pharmacy practice of IHS, in which he could provide direct patient care and help medically underserved and vulnerable populations. He also realized, as a student pharmacist, that he could have the privilege of serving in a uniformed service of the United States. “It was an easy choice at the time,” he recalled.

During 9 years of clinical pharmacy work at three different IHS sites from 1994 to 2003, Giberson also worked on a family practice medical staff (where he still has privileges), developed pharmacist-run disease management clinics, and taught clinical and counseling skills to other pharmacists. “My goal was simply to perform at the highest level of licensure and education to benefit the patients,” Giberson explained. “The needs of the patients were similar to the needs of the nation today. There is a need for more access to primary care, a need to further manage and optimize chronic care, and the overarching ability to contain costs.”

In 2001, Giberson responded to the anthrax attacks in New York and later was chosen as the Coordinator for both the National Nurse and National Pharmacy Response Teams to prepare for similar events under the then-new U.S. Department of Homeland Security for 2 years. From 2003 to 2006, he was detailed to the U.S. Department of Defense, serving in leadership roles on international health deployments for the U.S. Pacific Command involving more than 23 countries, with a focus on HIV/AIDS. After serving in the Pacific, he transitioned back to IHS, becoming its National HIV/AIDS Program Director. In 2006, he received his MPH from the University of Massachusetts.

Giberson’s focus has evolved from individual health to national public health to global public health. “It seems a natural progression to me,” he mused. “I want to have the most impact possible, yet maybe it was simply a matter of evolving interests.”

His MPH education had a global health emphasis, including his thesis, which he wrote while working abroad. “As I learned more about population health, I was fascinated with other cultures and broader health issues,” Giberson said. “To this day, I find that my global health experiences assisted me most in becoming a better decision maker. They gave me a greater depth and breadth of experiences and perspectives.”

Report to the Surgeon General

From left: Benjamin Bluml, BSPharm, APhA Foundation; Janet Wright, MD, Million Hearts Initiative; VADM Regina M. Benjamin, MD, MBA, U.S. Surgeon General; Giberson; Mindy D. Smith, BSPharm, APhA Foundation.

On January 9, 2012, the USPHS Office of the Chief Pharmacist, led by Giberson, released a 95-page, evidence-based report advocating for provider status that the Surgeon General, VADM Regina M. Benjamin, MD, MBA, backed in a letter of support. Both the report, Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General 2011, and the letter are available online (www.usphs.gov/corpslinks/pharmacy/sc_comms_sg_report.aspx).

“It’s a very well-done report,” Benjamin told Today in an interview the next day, standing outside a Health Affairs event on diabetes in Washington, DC. “It’s very well thought out. It was years in development. And I just received it and was pleased with it, and I think that it can serve as a model for others to do.”

The report’s four focus points discuss the existing integration of pharmacists into primary care as health care providers, how to sustain pharmacist-delivered patient care services through provider status and compensation through additional mechanisms commensurate with the level of services provided, and the “numerous articles, systematic reviews, and meta-analyses of positive patient and health system outcomes that have been published in peer-reviewed journals that validate this model as evidence-based,” according to the report.

Giberson believes the pharmacy community can use the report as the final consolidated document to factually support and finally sustain expanded practice, including provider status. He is confident the profession is ready to move forward.

“There are many demands on the health care system. Pharmacists can have a positive impact on many of these needs,” Giberson said. “Given our extensive level of education, vast accessibility, and cost-effectiveness, we need to be acutely aware of what we can do to help. It is not a guess or a projection of our abilities. It is from personal experiences in health systems that are already successful. Call it being a bit stubborn, but I know pharmacists can be a part of the solution.” Others agree, he added, including many physicians who have collaborated in a team environment.

‘Drive and commitment’

From all his years as a pharmacist, various patients stand out for Giberson. In particular, he remembers a Navajo Code Talker who described his World War II experiences and service in uniform. “There are so many stories to be shared from our patients,” he said. “That sort of relationship was always beneficial in building the trust needed to provide the best care.”

As a USPHS pharmacist, Giberson feels he is part of something intangible and unique, and can serve others. On a 24–7 basis, he stands ready to respond to anything from a day-to-day health need to an emergent public health situation, and won’t let himself simply abandon an issue.

Giberson believes that he must “seize any opportunity” to inspire others—giving a speech, authoring an article—and that he must “lead by example.” Even a brief encounter with him affords a glimpse of a tremendous work ethic, but he notes that the most inspiring and successful leaders balance their work and their life. “Keeping this in my mind seems to give me the drive and commitment I need to help inspire others and be productive,” he said.

Giberson won’t guess at what is next for his career, but hopes his impact continues to be “positive and sustainable.” His personal vision is to lead. “People are too observant and intelligent to allow someone to influence them simply because of their position,” he said. “I am committed to bringing my A-game every chance I get.”