Should Pharmacists Prescribe?
The FDA recently announced a proposal to allow pharmacists to prescribe some medications. Much to the surprise of no one, a well-known physician organization has issued a statement opposing any such changes. Many reasons are given, ranging from "only licensed doctors" can prescribe medications to "this would cause a breakdown in the relationship between the patient and the physician," "it will lead to fragmented care," and by golly ALL
prescribing should be supervised by a physician. Stop me if you have heard this before (or if you are laughing too hard).
The comments are even more interesting to read than the article I found on this proposal. This is where the usual suspects show up. Accusations of financial motivations on the part of pharmacists are rampant, while ironically quite a few MDs posted about their own fears of losing revenue should prescribing authority be expanded to include pharmacists. And sure as the sun comes up in the east, there are quite a few of what I like to call the "there goes the neighborhood" type remarks. The commenters are complaining that once the door was opened by allowing NPs and PAs to prescribe, it was only a matter of time before other professions would jump on the bandwagon and want in on the prescribing action, too. Sprinkle in a few snide comments about "undermining our authority" with a side of some veiled insults belittling the educational preparation of pharmacists and the audacity of a PharmD using the title "doctor," and things are really starting to sound familiar!
After reading the statement from the physician organization, I thought it would be a good idea to also read the actual Federal Register notice. I quite frankly don't see where they are proposing quite what the MDs fear (unlimited pharmacist prescribing). Rather, they are attempting to open a discussion about the wisdom of requiring an office visit for refills for certain chronic medications and whether or not in some situations, the office visit can actually be a barrier. An example is patients with asthma going without rescue inhalers and ending up in the ER. Also, there is some discussion of patients answering a series of questions on a computer that uses algorithms for diagnosis of some conditions.
The full notice can be found here. The response from the American Academy of Family Practice is here.
Now, it's not my intent to get on the case of the physicians, but rather to ask how we as NPs and PAs feel about this proposal. Do we have the same sort of gut reaction as the MDs, or are we more open to the idea of rethinking the current system? Now that the proverbial shoe is on the other foot, do we feel threatened too?
I welcome your comments and discussion. This could be very interesting.