Reductio Ad Absurdum by Pat Conrad MD

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In the little towns where I work, the kindly pharmacist will offer the occasional advice to little old ladies or teenage mothers about this rash or that blood pressure, all of it innocuous enough and never overstepping their bounds. Now, intent pharmacist lobbyists have gotten a bi-partisan cabal of congressmen to enlarge and expand this once informal, over-the-counter relationship.

The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/ S. 314) is bipartisan legislation that will amend section 1861 (s) (2) of the Social Security Act to include pharmacists on the list of recognized healthcare providers (It was co-sponsored in the Senate by Sherrod Brown (D) and Chuck Grassley (R). If those two agree on an idea, it is very probably a bad one). According to the American Society of Health-System Pharmacists: “The legislation would help meet unmet health care needs in underserved areas, a significant first step toward broader provider status. This strategy follows a similar successful path taken by other health care professionals to gain recognition under Medicare. Nurse practitioners initially received the ability to provide services in rural health clinics. Later they were granted provider status in any setting.” Ho, ho, yes they were.

According to Cesar Munoz, president of the Lake Houston Pharmacy Assoc., “These companion bills would simply permit licensed pharmacists to be classified as “non-physician health care providers” under Medicare Part B.” The broader scope Munoz celebrates would include:

  • Checking blood pressure and glucose levels.
  • Giving vaccines.
  • Tracking and reporting these activities to the patient’s primary care physician, “allowing the physician’s office to track their patients’ progress without the need to see them in a doctor’s office.”

Isn’t that wonderful? Not only can the busy patient avoid that pesky office visit (less expensive!) and the office wait (less time!), but mark my words, the doctor or other provider of equal distinction will still be held legally liable for whatever data the pharmacy collects and claims to transmit to the office (and any HIPAA violation charges will be an added bonus). Medicare will love this new opportunity to not pay physicians. Politicians will have renewed support from a brand new class of “providers.” Malpractice lawyers will love the chance to sue the doctor and big-pockets pharmacy chain simultaneously. And the importance of an actual physician can be further diminished in the eyes of patients, a development sure to gladden the ranks of NP’s and PA’s who we can be sure will welcome these new providers with open arms. Less Expensive…Less Time. Hmm, sounds familiar…

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Reductio Ad Absurdum by Pat Conrad MD

  1. Pam Piotrowski, RPh, MBA
    March 28, 2016 at 8:57 pm

    As a pharmacist, I’m rather offended by this article…and we have to remember it’s not all about “us” the supposed professional who is empathetic, the one who always wanted to help others, and found a tremendous amount of value in taking care of others. I became a pharmacist over 20 years ago to do just those things, and still strive for that. Does it take commitment to be adaptable to the ever changing healthcare climate? Yes- absolutely. And if you read the pharmacists oath, one that we all take upon graduation and is similar to the Hippocratic oath- we accept that challenge. As we progress toward more service and outcomes related care, versus a transactional one (and trust me, I’ve experienced my fair share of transactional physicians visits both personally and through my, yes, PATIENTS)…the same ones who ultimately feel the pressure of us all trying to meet a bottom line. Provider status is a way for us to all be considered a valuable part of the healthcare continuous of care- how can we ALL work together to take care of the patient, but also be paid for our services. We provide the same immunization, medication review (and can see transactional data of fills from multiple locations and competitors), identify adverse drug reactions, screen for and identify potentially dangerous acute and chronic diseases earlier, among many other adherence activities to allow physicians to manage other sicker patients. As the ACA and star ratings loom over us, we have to recognize each other’s strengths and capabilities to survive, and to ensure that hat our patients survive. We work every day to ensure that our patients can live happier, healthier lives and want to do that NOT to replace other healthcare providers, but to ensure that we can, together, work to keep our patients safe and healthy, as one single healthcare team. It’s ultimately about patient care- to share in those services, and be recognized to the skills we have helps us to so that…that’s why I’m a pharmacist. I dare to ask everyone, why did YOU choose a healthcare career?

    • Pat
      March 29, 2016 at 10:15 am

      Pam, you have some excellent points – but why were you offended? I did not criticize working pharmacists, but rather the pharmacist-lobbyists and their politicians who are trying to further devalue physicians. Expanding “provider status” is about equating non-doctors with physicians for political and money-stealing purposes; it is certainly NOT about patient care. Did you not already feel you were a ” valuable part” of the health care team? Do you really need the label “provider” to feel validated, or is there something more at work here? I want you to be paid for your efforts, just as I want to be paid for mine. This is about – among other things – stroking your ego to get your support in diminishing the value to patients of actual physicians.

      The egalitarian “we’re all providers” movement is not about promoting others, but about demoting physicians. I cant stop it, but I’ll be damned if I acquiesce to it.

  2. Perry
    March 27, 2016 at 5:47 pm

    Which prompts me to continue to ask? Why become a physician, and why for goodness’ sake even think about primary care?

  3. Steve O'
    March 27, 2016 at 10:12 am

    Here it comes again.
    This has been the direction of “reform” that American Retail Healthcare has been all hot on for twenty years, and it picks up willing collaborators wherever it needs, by shaking a little change at them.
    It has happened in a number of states already – “pharmacist providers” arose from the posture of “assisting providers” to subspecialists managing complex medical problems. All it takes is a little hubris, a few dollars, and the Internet.
    The “argument” is trotted out by the business leaders to fret the puppets – the same argument that came out with nurse practitioners and IPA’s. Get them fighting among themselves, and wear out their energy. After the pharmadocs get all comfy with their new and expanded role, the next wave will be rolled out, and the pharmadocs scream about it.
    Why is it happening? There are massive pharmaceutical companies, and their are massive pharmacy companies. The friendly ol’ pharmacist is about as real as Mr. Whipple.
    These InstaClinics are part of a strategy of the captured provider – and the big corporation doesn’t care what letters are after the captured provider’s name. All that matters is that the prescriber is in the same building as the pharmacy, and is “incentivized” by the corporate pharmacy to prescribe profitably.
    Anyone innocent enough to deny this should go down the Cough and Cold section of the retail pharmacy. It is full of useless and dangerous nostrums, many of which are advertised openly on the television. They are crap – doctors know they are crap – and they are a multi-billion dollar industry.
    In process-oriented medicine, as opposed to product-oriented medicine, there is little profitability. Rest sprains. Recover from seasonal viral infections. Take the cheapest aspirin for cardioprotection. Those are opinions; the corporate world HATES them, because there is no billing involved.
    All it takes is a website filled with pseudo-scientific hokum from some university, and everyone’s an expert. One needs to go to the pharmacy and stock up on YaySupermab, the monoclonal antibody that, well, does something – this century’s Tincture of Mercuric Chloride.
    We are being reduced to a health system very familiar in Guatemala, in Tanzania and Bangladesh – a small local pharmacy that peddles drugs, without any unpleasant filters between the corporation and the sufferer. That is the goal of American Retail Medicine. It works for garden hose sales, why not breast cancer?

    • Pam Piotrowski
      March 29, 2016 at 1:50 pm

      I have cases of, when contacting a local physician concerning the pitential for a severe drug interaction, only to have the physician tell that pharmacist, and I quote, “I would rather poke my eye out with a sharp stick than to accept a recommendation from you, a pharmacist.” We speak of if I feel like we are a valuable part of the healthcare team at times, yet these types of responses to inquiries occur within the community pharmacy more often then you may think. When pharmacists began providing Imz, physicians began to worry about the possible removal of the opportunity of discussions around other issues, like childhood obesity. When we began inquiring about controlled substance prescribing (because the DEA somewhere read that pharmacists also make great police officers), we were constantly pushed back on. The same kind of responses go for ADR, drug interactions, and other checks to ensure the patient is getting the best care they can. The ACA will soon be filling up your schedules and waiting rooms, with star ratings and dwindling reimbursement coupled with increased regulation following close behind…community pharmacists (yes I mean the retail pharmacist over there behind the garden hoses, massive amounts of emergenC, and second class Sudafed) are ready to help you, if you’ll allow us to. So buy your neighborhood pharmacist a cup of coffee and stop by and say hello the next time you are shopping- we’d love to meet you!

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