‘We’ not ‘me:’ Putting turf aside for better patient care
“Dispensing Doctors: Should Physicians Sell Drugs to Patients?” is the provocative title of an October article in Undark, a digital magazine that explores the intersection of science and society. It highlighted the pros and cons of physicians in dispensing medications, and the blurring lines and turf wars between physicians and pharmacists.
It’s important to take a step back and assess the bigger picture — the “who” and “what” of patient care activities. We can establish ownership for those activities, but the best response to these questions is “yes and” rather than “either or.”
Taking this approach will yield better outcomes for all involved, most importantly patients. Drawing battle lines around activities, such as prescribing and dispensing, yields fragmented care and silos, which have plagued our system for decades.
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Traditional role delineations tell us that physicians and other providers prescribe and pharmacists dispense. On top of the march towards value-based care, the global pandemic is challenging that thinking. The new “normal” in health care is fluid and dynamic, and roles should adapt to meet patients where they are.
Undoubtedly, pharmacists have remained accessible to patients throughout this pandemic, providing immunizations, testing services and management of chronic conditions. Further, the scope of pharmacist-provided care has been expanded at the state and national levels through legislation and federal declarations to allow pharmacists to provide a variety of non-dispensing services to patients.
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Beyond the pandemic, the rise of collaborative practice agreements has integrated pharmacists as key providers of patient care in partnership with physicians and other clinicians, including the authority to prescribe and optimize medication therapies. Limiting discussion to who is doing the prescribing or dispensing loses sight of the end goal: better patient care.
Pharmacists are uniquely trained in medication therapy, and the authority to prescribe is a critical step forward in optimizing care. However, unleashing the full capabilities of pharmacists should acknowledge that physician dispensing also can be done in the best interest of patients. However, the two functions are not mutually exclusive, and neither should be performed without collaboration and coordination between providers.
Even when physician dispensing makes sense, the quality and safety of medication use can be greatly enhanced by partnership with pharmacists, who are focused experts on medication dosing, the prevention of errors and adverse drug interactions, as well as helping patients use medications safely and effectively.
Traditional education and training pathways in medicine have focused on individuals’ expertise and establishing their practice territory. However, team-based approaches to care are expanding, as is interprofessional education.
Engaging the right individuals to strengthen the team is more essential than establishing scope and turf. In the words of Pro Football Hall of Fame quarterback Peyton Manning, “The most valuable player is the one that makes the most players valuable.” Great teammates recognize that they are just one of many players that must execute at their highest level, and there are a plethora of players in other phases of the game that must do their jobs well to achieve the desired outcome. The best teams are fully aligned and deliver exceptional results when they have solid support, good communication and a collaborative mindset.
In a high-performing team, the success of the team is only realized when all roles are performed synergistically and cohesively. Inevitably, there is a need to assign key roles to individuals to be held accountable and to reap the rewards of good institutional management, but individuals must transform their thinking from “mine” to “ours.” With this shift in mindset, ownership of results becomes a team function rather than an individual quest for recognition.
The next time you’re faced with a perceived turf battle, think “yes and” rather than “either or.”
Micah Cost, PharmD, MS, is CEO of the Pharmacy Quality Alliance.
