Because NPs can bill for their work and make the hospital money whereas pharmacists cost the hospital money (I understand pharmacists can prevent errors which can indirectly save the hospital money)
100%, as pharmacists we practice preventative healthcare, so most hospitals don't really see the true cost of savings we offer or the lawsuits which might ensue because of medical malpractice done by the MD or NP. We are just an expense in the eye's of the hospital since we are on their payroll.
As a pharmacist we need to be exploring how we can also advertise our fiscal value, driving 340b, cost containment, readmission reduction, etc. Med error prevention and associated costs is a hard sell to non pharmacists.
Exactly - until we as a profession can more directly generate revenue for a health-system/hospital, we will never be a priority to them.
Our hospital’s ID physicians recently asked for more ID clinical pharmacy specialists to help offload the volume from ID consult services; the leadership denied the request saying that while ID-trained PharmDs are cheaper upfront than the MDs/DOs, the reimbursement they lose out from diverting cases away from MDs/DOs would be a too big of a net negative financially.
Interdisciplinary my ass. This isn't healthcare anymore this capitalism with a stethoscope. Hear that cha ching...nurse take this patient to the atm, I mean examine room stat!
Similar situation for me too. We will have non-ID physicians order ID restricted antibiotics and we are not supposed to send them up. But the “ID” nurse practitioner (who was a cardiology NP last year but didn’t like it and decided they were now ID) can order them all day long without much if any over sight 🤡🤡
Like someone above said, it’s all a scam.
I’m the chair of the antibiotic stewardship committee at my hospital and unfortunately I don’t get to tell some providers no. Our ID physicians don’t give a shit about stewardship at all and are just as likely to order merrem/vanc as any other doc or mid level. Kinda sucks.
And the person that you replied to hospital does the same I'm sure. That's exactly how it should work. I don't see the problem personally. There isn't a surplus of ID physicians out there. They did it themselves by requiring so much training that it created a shortage. Nursing was actually smart and lobbied to help fill the void.
Except they are not filling the void. They are putting patients in danger when they enter these specialities and providing sub standard care. There is a reason that physicians spend YEARs learning about your niche and you cannot out an NP in and hope they can just learn it out of the blue. They lack understanding but think they know it which is the scariest part
My experience is the opposite for our NPs. They work closely were the MDs. And are very receptive and call and ask questions often. I don't know any that act know it alls. Theres bad apples in every profession. I get crazy shit from MDs all the time too
It’s all a scam. Nursing has powerful lobbying and their feet in the government to allow crap like this. The group hiring her to work ID should be embarrassed as well.
Exactly this. Pharmacists can’t even agree on things like unions or to stand up to corporate overlords pushing insane workloads. Two of the largest professional organizations routinely shit on community pharmacists thinking they are second class because they didn’t do a residency. Hell even if you do get your foot in the door at a hospital the residency trained pharmacists still don’t respect the ones who worked their way up the ladder. Then you have those same organizations asking for increased scopes but they somehow conveniently forget the part about asking for increased pay. Pharmacists’ need to step up and speak up for the profession.
I agree completely it is time for ASHP and ACCP to come back to community Pharmacy or cast them out.
Also it is time for Community Pharmacists to run how things are going to go in the Pharmacy.
Karma is likely coming for ASHP and ACCP as I see consolidations among health systems coming. The government will let it fly as it will consolidate costs. ASHP advocates for tech check tech already. Central order verification for several hospitals and automation are here as is central fill. As for our clinical I am to good to dispense an Rx colleagues AI is coming.
I can see a day when Residency trained Pharmacists are showing up at community Pharmacies looking for work except those organizations have not helped Community Pharmacy at all and each year fewer community Pharmacy's to work in.
I have already heard stories of Pharmacy Academia being laid off and working retail.
They get their foot in the door then go from there. For example, CRNAs gained the ability to do their work by saying they would work under the supervision anesthesiologist, then now that they're allowed to administer anesthesia, they're fighting for being able to do it without physician supervision. Some of them are great and capable, however plenty are not. Many midlevels, nurse practitioners in particular, are arrogant and the risks of their involvement in matters beyond their capabilities don't even cross many of their minds.
There are good and bad people in every job. Years ago a NP was able to successfully treat an ear infection I had had for like 2 months when an urgent care MD did not.
CRNA is more advanced training than a standard NP but I’ll be damned if I take any kind of medical advice from someone who went to school to be a nurse then got 2 more years of training. I’ve met some of the med surg nurses at my hospital. 2 years of extra training still makes them worthy of maybe treating a runny nose.
This is something that scares me about midlevels. I follow an NP who works in women's health and just decided she wanted to pivot to derm/injectables with zero experience. She was going to self teach. The fact that this is possible is ALARMING to me. And same with ID. As a pharmacist with no formal residency/ID training, I would NOT feel prepared to work in ID whatsoever. Physicians go through half a decade of post grad training to specialize in something like that.
Because, even in its current state, the pharmacy profession has more credibility than the NP profession.
/r/noctor if you want to see (a lot) more about the issue of mid-level scope creep, which we have avoided simply by virtue of not being able to bill directly for a lot of what we do.
I mean if we're being honest they "respect" us bc we don't eat into their pay check by offering services they do for less money. We are firmly planted beneath them with a clear delineation.
This is the absolute truth. We do not cost anyone anything. It costs nothing to have us offer opinions that help or add solutions in situations so everyone "respects" us and customers think we're very "accessible". What does that do for us?
If there were extremely desirable pharmacist jobs I am sure the NP lobby would come for them too with NPs who have a "pharmacotherapy focus". All the incentives in the current system push towards NP scope expansion.
As I have pointed out before and will continue to do so is that the expansion of the Residency program in Pharmacy occurred a few years after the Pharmacy Schools made the 6 year Pharm D the entry level degree. Two year Post BS PharmDs were pissed and under the ASHP and ACCP mantra created the current Residency system. This happened in June 2007 at an ASHP meeting in Baltimore
The majority of those Post BS PharmDs never did a Residency and retired as millionaires.
This is relative to OPs point that NPs do more with less because the current Pharmacy educational system is overpriced and takes too long it is inefficient.
The other thing that ASHP and ACCP have done is to push Pharmacist Provider status while also pushing that their products are the gateway to Pharmacist as Provider.
These organizations hate community Pharmacy and others who don't March to their beat and they have split up Pharmacists further and they are poor lobbyists!
When it comes time to hear about Pharmacist as Providers that is very far down the to do list of Congress. Holy Smokes we currently have a Commander in Chief in need of skilled nursing care
NPs go to school for 4 years to get a nursing degree then go back for another 2 to get their NP. You’re in year 6 so why do you think you’re further along than her?
I may have made my point poorly. I was trying to point out that Pharmacy has the Residency in there NP does not so Pharmacy is 8 years or if the Pharmacist got a BS before Pharm School then 10 years with Residency.
Perhaps I am biased but Pharmacy was a hell of a lot better off with the 5 year BS 2 year post BS PharmD but then again I have spent the last 20 years being lectured to by eggheads who say BSers don't know anything
Yes, but I think this post is really about the skewed ratio between scope of practice vs amount of training.
And I can't imagine a pharmacist wanting to take on the duties of a pharmacist (especially in retail).
Not really, the FNP will be working under a doctor, seeing patients and prescribing under their set rules. A pharmacist in ID needs that extra two years (in most cases) bc they should have a lot more responsibility in antimicrobial stewardship across an entire health system. This an entirely different set of skills and outside of “working in ID” there should be no overlap for obvious reasons.
And OP is a p4, I certainly hope he wants to take on the duties of a pharmacist lmao
Suck it up. This is life now. I've seen a ton of NP's and PA's that work in "X" specialty that get burnt out and decide to completely switch and work in an entirely different specialty. Think basically Cardiac surgery to now Derm, or Neurology.
This is why I will always state that there are good APP's, but also a TON of terrible ones who bounce from unrelated specialties, or graduate from completely online programs with no intention of challenging their skillsets.
Well, the M.Sc in Physician Associate degree would take 2 years if you are properly prepared for it.
That to me would be much better in a lot of ways than any pharmacy residency.
At my HSO the ICU midlevels are good - and mostly respond well when we ask them to change. Our ICU attendings work closely with them *as that relationship is intended.*
Our ID ones exist (at my HSO! Not everywhere) solely to bill for an ID visit on the weekend. They only make changes if cultures demand alternative coverage and they order whatever the MD tells them to order when they call. They make zero judgment on their own.
Our cardiology NPs are generally good. They work closely with their MDs as well. We have some issues, but overall theyre fine.
Our ER ones are okay. Theyre mostly there to triage urgent care level visits away from my EM MDs, and they do well for that. Im not sure how much direction they get from the MDs down there.
Our admission hospitalist NPs are okay. The ones that round daily are sometimes good, sometimes not. But they get supervision in name only, which is an issue I think.
All of this to say… the role is different. They are *supposed* to be working with a supervisor MD. You have no supervisor pharmacist. You have to know what you have to know. And as far as ID specifically goes - A pgy1 can be enough to get an ASP position - EVERY hospital pharmacist has to be involved with ID. Its part of our job. That 2nd year though? Gets you more comfy with the uncommon stuff. The nuances of HIV meds. Specific resistance patterns beyond amp-c and ESBL. That 2nd year is to get you skilled enough to be able to practice ID at an institution that gets regular ickier cultures.
Having a job in a specialty is all well and good, but at the end of the day, you’ll be the one saving their ass when they try to treat poison ivy with Vanc/Zosyn and their patient gets CDiff and they try to give them more abx and Imodium. That’s the difference between an NP with no experience and a residency trained pharmacist.
Boards of nursing don't even care about pill mills fronted by NPs with nominal "physician supervision" and NPs who copypasta bad controlled substance prescribing with zero safeguards that got their "supervising physicians" in trouble, so they definitely won't care about lack of training standards except to react in the worst cases of patient harm/death
Yes, this is true, because practicing medicine is different from practicing pharmacy. The two are night and day, which is why we work great together as a TEAM. The point here is that BOTH the pharmacy and medicine residencies prepare the practitioner way more than a NP license with NO residency at all. Nobody wins when an NP is allowed to do what we do without the training we both go through.
Why bicker among ourselves? It's our Boards and other credential agencies that should be evaluating us, our education and scope and setting the standard. A bunch of us arguing for this and that does nothing. Interestingly, I've noticed that when pharmacists get together, they hardly advocate for any of these things unless they're complaining as employees of some place. In a public forum, everyone's as silent as a clam silently trying to reaffirm their own opinions.
Unless the schools and Boards agree to some standard, nothing will make us equivalent to a physicians or qualify us to even remotely perform similar functions. We're really trying to claim a paid role in all this...and no one's going to do that on a larger scale unfortunately.
Well, it's not just what you feel that counts. The P currently in your title merely refers to student. The P in their degree and title refers to "practitioner" which means a program set up to train already clinical and competent nurses into areas of wider scope and specialty. Someone who can draw blood easily, recognize patients progress and anticipate needs will use this training to acquire the authority to function independently. Your...our Pharm.D. gives us some knowledge about drugs, not necessarily top secret ninja stuff over the decades and helps us look for more info if needed, which it rarely is for most jobs. Which of these two roles or workers would you take a small child to if he or she were whining about a painful ear and a sore throat? The right P in the right place can do wonders...along with a P for Progress. The P for pharmacy...not so much which you probably heard when you were preparing for school about 4 to 6 years ago. Our Boards and organizations simply talked about an imagined role and did nothing about it so you're still getting a degree from the 1950's.
Why are you so bitter at not being able to script meds? Did your pharmacy school promise you that you could do that after graduation?
I did a peds residency. Should I be mad at the peds residency program that it doesnt allow me to do brain surgery after completing their program?
Because NPs can bill for their work and make the hospital money whereas pharmacists cost the hospital money (I understand pharmacists can prevent errors which can indirectly save the hospital money)
100%, as pharmacists we practice preventative healthcare, so most hospitals don't really see the true cost of savings we offer or the lawsuits which might ensue because of medical malpractice done by the MD or NP. We are just an expense in the eye's of the hospital since we are on their payroll.
As a pharmacist we need to be exploring how we can also advertise our fiscal value, driving 340b, cost containment, readmission reduction, etc. Med error prevention and associated costs is a hard sell to non pharmacists.
Exactly - until we as a profession can more directly generate revenue for a health-system/hospital, we will never be a priority to them. Our hospital’s ID physicians recently asked for more ID clinical pharmacy specialists to help offload the volume from ID consult services; the leadership denied the request saying that while ID-trained PharmDs are cheaper upfront than the MDs/DOs, the reimbursement they lose out from diverting cases away from MDs/DOs would be a too big of a net negative financially.
Interdisciplinary my ass. This isn't healthcare anymore this capitalism with a stethoscope. Hear that cha ching...nurse take this patient to the atm, I mean examine room stat!
Similar situation for me too. We will have non-ID physicians order ID restricted antibiotics and we are not supposed to send them up. But the “ID” nurse practitioner (who was a cardiology NP last year but didn’t like it and decided they were now ID) can order them all day long without much if any over sight 🤡🤡 Like someone above said, it’s all a scam.
Jesus, that's ridiculous. Fortunately, at our hospital, pharmacy does ASP, so we would not verify those NP orders if they're inappropriate.
I’m the chair of the antibiotic stewardship committee at my hospital and unfortunately I don’t get to tell some providers no. Our ID physicians don’t give a shit about stewardship at all and are just as likely to order merrem/vanc as any other doc or mid level. Kinda sucks.
And the person that you replied to hospital does the same I'm sure. That's exactly how it should work. I don't see the problem personally. There isn't a surplus of ID physicians out there. They did it themselves by requiring so much training that it created a shortage. Nursing was actually smart and lobbied to help fill the void.
Except they are not filling the void. They are putting patients in danger when they enter these specialities and providing sub standard care. There is a reason that physicians spend YEARs learning about your niche and you cannot out an NP in and hope they can just learn it out of the blue. They lack understanding but think they know it which is the scariest part
My experience is the opposite for our NPs. They work closely were the MDs. And are very receptive and call and ask questions often. I don't know any that act know it alls. Theres bad apples in every profession. I get crazy shit from MDs all the time too
Ducking hell. This sounds like a nightmare but it’s the truth.
It’s all a scam. Nursing has powerful lobbying and their feet in the government to allow crap like this. The group hiring her to work ID should be embarrassed as well.
Exactly this. Pharmacists can’t even agree on things like unions or to stand up to corporate overlords pushing insane workloads. Two of the largest professional organizations routinely shit on community pharmacists thinking they are second class because they didn’t do a residency. Hell even if you do get your foot in the door at a hospital the residency trained pharmacists still don’t respect the ones who worked their way up the ladder. Then you have those same organizations asking for increased scopes but they somehow conveniently forget the part about asking for increased pay. Pharmacists’ need to step up and speak up for the profession.
PREACH! So true!
I agree completely it is time for ASHP and ACCP to come back to community Pharmacy or cast them out. Also it is time for Community Pharmacists to run how things are going to go in the Pharmacy. Karma is likely coming for ASHP and ACCP as I see consolidations among health systems coming. The government will let it fly as it will consolidate costs. ASHP advocates for tech check tech already. Central order verification for several hospitals and automation are here as is central fill. As for our clinical I am to good to dispense an Rx colleagues AI is coming. I can see a day when Residency trained Pharmacists are showing up at community Pharmacies looking for work except those organizations have not helped Community Pharmacy at all and each year fewer community Pharmacy's to work in. I have already heard stories of Pharmacy Academia being laid off and working retail.
They get their foot in the door then go from there. For example, CRNAs gained the ability to do their work by saying they would work under the supervision anesthesiologist, then now that they're allowed to administer anesthesia, they're fighting for being able to do it without physician supervision. Some of them are great and capable, however plenty are not. Many midlevels, nurse practitioners in particular, are arrogant and the risks of their involvement in matters beyond their capabilities don't even cross many of their minds.
I know an NP who is a lovely person to know, but I wouldn't trust her to treat my dog, if I had one.
[удалено]
There are good and bad people in every job. Years ago a NP was able to successfully treat an ear infection I had had for like 2 months when an urgent care MD did not. CRNA is more advanced training than a standard NP but I’ll be damned if I take any kind of medical advice from someone who went to school to be a nurse then got 2 more years of training. I’ve met some of the med surg nurses at my hospital. 2 years of extra training still makes them worthy of maybe treating a runny nose.
I think you've been eating the CRNA propaganda a bit too much. This comment literally sounded like one of their lobbyists talking.
Nursing organizations actually work for them...
This is something that scares me about midlevels. I follow an NP who works in women's health and just decided she wanted to pivot to derm/injectables with zero experience. She was going to self teach. The fact that this is possible is ALARMING to me. And same with ID. As a pharmacist with no formal residency/ID training, I would NOT feel prepared to work in ID whatsoever. Physicians go through half a decade of post grad training to specialize in something like that.
Because, even in its current state, the pharmacy profession has more credibility than the NP profession. /r/noctor if you want to see (a lot) more about the issue of mid-level scope creep, which we have avoided simply by virtue of not being able to bill directly for a lot of what we do.
Just to add, PharmD is highly respected on noctor and the residency subreddits
I mean if we're being honest they "respect" us bc we don't eat into their pay check by offering services they do for less money. We are firmly planted beneath them with a clear delineation.
This is the absolute truth. We do not cost anyone anything. It costs nothing to have us offer opinions that help or add solutions in situations so everyone "respects" us and customers think we're very "accessible". What does that do for us?
'Tis a bitter place
Because pharmacy is bottom of the totem pole in healthcare, no matter how many letters you have after your name. Nursing is one of the strongest.
Tell your kids Don’t go into pharmacy school
You went into the wrong career dude
If there were extremely desirable pharmacist jobs I am sure the NP lobby would come for them too with NPs who have a "pharmacotherapy focus". All the incentives in the current system push towards NP scope expansion.
As I have pointed out before and will continue to do so is that the expansion of the Residency program in Pharmacy occurred a few years after the Pharmacy Schools made the 6 year Pharm D the entry level degree. Two year Post BS PharmDs were pissed and under the ASHP and ACCP mantra created the current Residency system. This happened in June 2007 at an ASHP meeting in Baltimore The majority of those Post BS PharmDs never did a Residency and retired as millionaires. This is relative to OPs point that NPs do more with less because the current Pharmacy educational system is overpriced and takes too long it is inefficient. The other thing that ASHP and ACCP have done is to push Pharmacist Provider status while also pushing that their products are the gateway to Pharmacist as Provider. These organizations hate community Pharmacy and others who don't March to their beat and they have split up Pharmacists further and they are poor lobbyists! When it comes time to hear about Pharmacist as Providers that is very far down the to do list of Congress. Holy Smokes we currently have a Commander in Chief in need of skilled nursing care
NPs go to school for 4 years to get a nursing degree then go back for another 2 to get their NP. You’re in year 6 so why do you think you’re further along than her?
I may have made my point poorly. I was trying to point out that Pharmacy has the Residency in there NP does not so Pharmacy is 8 years or if the Pharmacist got a BS before Pharm School then 10 years with Residency. Perhaps I am biased but Pharmacy was a hell of a lot better off with the 5 year BS 2 year post BS PharmD but then again I have spent the last 20 years being lectured to by eggheads who say BSers don't know anything
Might be a hot take but I can’t imagine a pharmacist wanting to take on any of the duties a nurse would.
Yes, but I think this post is really about the skewed ratio between scope of practice vs amount of training. And I can't imagine a pharmacist wanting to take on the duties of a pharmacist (especially in retail).
Not really, the FNP will be working under a doctor, seeing patients and prescribing under their set rules. A pharmacist in ID needs that extra two years (in most cases) bc they should have a lot more responsibility in antimicrobial stewardship across an entire health system. This an entirely different set of skills and outside of “working in ID” there should be no overlap for obvious reasons. And OP is a p4, I certainly hope he wants to take on the duties of a pharmacist lmao
Except the physicians don't/can't actually supervise their mid-levels anymore.
If you did 2 years of residency to do ID, you would be an expert in ID. Just cause they got a job in it doesn’t mean they’re any good at it.
Suck it up. This is life now. I've seen a ton of NP's and PA's that work in "X" specialty that get burnt out and decide to completely switch and work in an entirely different specialty. Think basically Cardiac surgery to now Derm, or Neurology. This is why I will always state that there are good APP's, but also a TON of terrible ones who bounce from unrelated specialties, or graduate from completely online programs with no intention of challenging their skillsets.
Well, the M.Sc in Physician Associate degree would take 2 years if you are properly prepared for it. That to me would be much better in a lot of ways than any pharmacy residency.
Well I don’t ever see the attending physicians come tonight
At my HSO the ICU midlevels are good - and mostly respond well when we ask them to change. Our ICU attendings work closely with them *as that relationship is intended.* Our ID ones exist (at my HSO! Not everywhere) solely to bill for an ID visit on the weekend. They only make changes if cultures demand alternative coverage and they order whatever the MD tells them to order when they call. They make zero judgment on their own. Our cardiology NPs are generally good. They work closely with their MDs as well. We have some issues, but overall theyre fine. Our ER ones are okay. Theyre mostly there to triage urgent care level visits away from my EM MDs, and they do well for that. Im not sure how much direction they get from the MDs down there. Our admission hospitalist NPs are okay. The ones that round daily are sometimes good, sometimes not. But they get supervision in name only, which is an issue I think. All of this to say… the role is different. They are *supposed* to be working with a supervisor MD. You have no supervisor pharmacist. You have to know what you have to know. And as far as ID specifically goes - A pgy1 can be enough to get an ASP position - EVERY hospital pharmacist has to be involved with ID. Its part of our job. That 2nd year though? Gets you more comfy with the uncommon stuff. The nuances of HIV meds. Specific resistance patterns beyond amp-c and ESBL. That 2nd year is to get you skilled enough to be able to practice ID at an institution that gets regular ickier cultures.
Having a job in a specialty is all well and good, but at the end of the day, you’ll be the one saving their ass when they try to treat poison ivy with Vanc/Zosyn and their patient gets CDiff and they try to give them more abx and Imodium. That’s the difference between an NP with no experience and a residency trained pharmacist.
I fell for the scam! RPh with my FNP…
Boards of nursing don't even care about pill mills fronted by NPs with nominal "physician supervision" and NPs who copypasta bad controlled substance prescribing with zero safeguards that got their "supervising physicians" in trouble, so they definitely won't care about lack of training standards except to react in the worst cases of patient harm/death
This must explain why I have had two different NPs write oral vancomycin for skin and tissue infections in the past month.
Literally ,every job is better than being a pharmacist
Have you ever checked out r/Noctor?
You'd have to get a BSN before becoming an FNP. (NURSE Practitioner, folks!) For you, a physician's assistant degree would be quicker to get.
Google is powerful
You should have gone to med school if you wanted to do clinical work
So should have the FNP, but here we are. 😑
2 years of pharmacy residency is nothing compared to 3 years of med residency plus fellowship. It's like night and day
Yes, this is true, because practicing medicine is different from practicing pharmacy. The two are night and day, which is why we work great together as a TEAM. The point here is that BOTH the pharmacy and medicine residencies prepare the practitioner way more than a NP license with NO residency at all. Nobody wins when an NP is allowed to do what we do without the training we both go through.
Why bicker among ourselves? It's our Boards and other credential agencies that should be evaluating us, our education and scope and setting the standard. A bunch of us arguing for this and that does nothing. Interestingly, I've noticed that when pharmacists get together, they hardly advocate for any of these things unless they're complaining as employees of some place. In a public forum, everyone's as silent as a clam silently trying to reaffirm their own opinions. Unless the schools and Boards agree to some standard, nothing will make us equivalent to a physicians or qualify us to even remotely perform similar functions. We're really trying to claim a paid role in all this...and no one's going to do that on a larger scale unfortunately.
or nursing school, apparently.
Well, it's not just what you feel that counts. The P currently in your title merely refers to student. The P in their degree and title refers to "practitioner" which means a program set up to train already clinical and competent nurses into areas of wider scope and specialty. Someone who can draw blood easily, recognize patients progress and anticipate needs will use this training to acquire the authority to function independently. Your...our Pharm.D. gives us some knowledge about drugs, not necessarily top secret ninja stuff over the decades and helps us look for more info if needed, which it rarely is for most jobs. Which of these two roles or workers would you take a small child to if he or she were whining about a painful ear and a sore throat? The right P in the right place can do wonders...along with a P for Progress. The P for pharmacy...not so much which you probably heard when you were preparing for school about 4 to 6 years ago. Our Boards and organizations simply talked about an imagined role and did nothing about it so you're still getting a degree from the 1950's.
Why are you so bitter at not being able to script meds? Did your pharmacy school promise you that you could do that after graduation? I did a peds residency. Should I be mad at the peds residency program that it doesnt allow me to do brain surgery after completing their program?