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Consultant Pharmacy: An Important Role

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Darshan

Hey everyone, we have as you guys know, my podcast really deals with life sciences and pharmacy, and things that impact the engagement between the two, and things that impact just the care of patients. This specific podcast I thought was really interesting because

I think groups like ascp come out and actually connect with a unique set of patients, patients who, whose needs are often not being met. So if you are in the pharmacy in this pharmacy, if you are a pharmacist or pharmacy, you want to be talking to someone like Chad, because you might want to find out Well, can I learn from lessons that that ascp has, if you're in the pharmaceutical industry, you may want to talk to Chad because these are pharmacists were frontline workers who are actually learning from patients and they need education. They need to know what your drugs are doing, what your devices are doing. So that's why I thought today's podcast makes sense. My name is Darshan Kulkarni, this is Darshan talks, and we have Chad Morris. So Chad, welcome.

Chad

Happy to be here. A little bit about yourself and escp. Sure. Well, first of all, thanks for having me on. Just from the audience perspective, I think the first time we met was a, a live stage podcasts. We were on stage in front of a group being recorded for a podcast and we had met I think, at lunch like 20 minutes before, and it's still one of the I had the best time. You know, obviously your personality lends to that. But just thanks for thanks for inviting me. Your show is fun. That's going to be a lot of fun today, you'll be good. Yeah. So um, yeah, to your point. asep is a is a unique organization. In pharmacy, we represent pharmacists, and pharmacies that take care of people in older adults setting. So traditionally, that's been skilled nursing facilities, assisted living facilities.

Some states have intermediate care facilities, our pharmacists take care of a lot of individuals that live in group home setting, so developmentally disabled individual, so generally patients with complex medical needs. And it started, you know, 50 years ago, probably because a corner drugstore pharmacist said, How can I better serve these nursing homes that are popping up in the community? And ultimately, what what happened was the pharmacist figured out that there's a lot of things that those kinds of buildings need from efficiencies, like, how do you package medications and nurses can pass them better to how do you manage patients clinically when they start to accumulate medications. So the last 50 years has been this sort of growth and experience in how to take care of older adults that are complex from a medication standpoint. And now we sit at this intersection of sort of the Golden Age of pharmaceutical companies where we've got a lot of options to treat patients. So you've got a lot of demand for medications, and a lot of use of medications. Plus, you've got a population that over the age of 65 is growing faster than any other segment of our population. And even within that the over 85 population is growing the fastest within that over 65 population. So you've got older adults, they're living longer, they're healthier, primarily because of medications, but they're also dealing with the fact that they're they have to take a lot of those medications. So how do we do that safely? And how do we do that with an eye on the fact that they're a very different person than a younger, healthier population? So our pharmacists do that. You'll see them again, in nursing homes, assisted living facilities, and in the community. A lot of them are being embedded in in physicians, clinics and doctor's offices that take care of generally older adults. So let's start with the basics. Because when I talk to pharmacists, the big question I get asked is, how do I stop being a retail pharmacist? How do I stop licking, sticking, counting pouring? Generally speaking, if the big box retailers, I'm not knocking them. But I've worked as a retail pharmacist then I worked before the advent of metrics. So things have changed and things from what I gather have only gotten worse. So if that's true, pharmacists are going I went to pharmacy school not to lipstick on pork, the robot behind me does that. So how, how did you get involved in being a consult pharmacist By the way, SCP stands for the American Society of consultant pharmacists. Thank you. Thank you, and where can they find it? By the way? What's the website ascp calm and that was simple.

Darshan

So how did you get involved? First

of all,

did you come out of pharmacy school going, you know what I want? I want to serve 85 year olds.

Chad

That's a great question. I use that a lot in some of my interests, you know, in 1998. I'm an old school pharmacist, so I was a BS in pharmacy, but I kept going, and got my two year post Bs, MD in a row. So I've got this

Darshan

right there. 1998 is bad old school.

Chad

Well, okay, I feel like I hate saying that I've been in practice for 20 years, I keep wanting to say 19, because somehow that makes me feel better. But But I had a unique, I had a unique growth in pharmacy, I had a friend that worked for an independent pharmacy. So I got started as a, as a 15 year old stocking shelves and a pharmacy and ended up working there all the way through my first years in college. And that's where I discovered, well, maybe I want to, you know, I went from stock person to delivery driver to technician, and then decided this might be a career for me as an intern there. And then eventually, I was a pharmacist there for a few years while I was going to pharmacy school before they eventually sold to one of the big, big chains. But in terms of getting into long term care, it was kind of serendipitous, I wanted to be a clinical pharmacist, I had experienced the retail side, I knew what it was, we didn't have metrics either at that time. But there was something more that I wanted out of my pharmacy degree in terms of helping patients and in doing that clinical work. So the only real place to do that was either a hospital, and after seven years of college, it was do a residency, or there was long term care. And I was able to have a good interview with a long term care pharmacy, and was able to be hired as a as a clinical consultant at that at that pharmacy right out of school, which I think was just super fortunate because clinical jobs did take residencies in sort of a progression at that time that I didn't want to do anymore. I don't want to go to school anymore. I was done. But it was long term care. So you know, people gave you two reactions they either gave you, oh, wow, you're gonna go work in nursing homes, thanks for giving up your career to work with old people or you got, he must not have been that good in school, because he's got to go work in nursing homes. So, you know, there's some vindication in the last 20 years that, you know, made a good decision, and I enjoyed the work, you were able to work directly with patients that had complex medication names, and you can help people, you know, you could tell them what the what would be different about being on a drug three times a day versus once a day, you could identify side effects and say, Well, maybe if we switch from that to this, you know, your life will get better, your quality will get better. And that's what you could do in nursing homes at the time. And that's just continued to evolve as the populations evolved. So I feel very fortunate to be in this and and I feel fortunate to be here in DC working at an association level, because I feel like pharmacists are just supremely positioned to help the health care system in the next 20 years, because they are the ones that can look at somebody's medication profile and make outcome changing decisions for them, working with the physicians, nurse practitioners and nurses, they have people have a better experience with medications get the benefits, but not as much of the risk. So if I'm talking to pharmacist about that, I think the one thing that I would say is just you know, embed yourself in trying to understand more about that population, that older adult population. There are jobs out there, consultant pharmacists jobs, other jobs, even you know, not in older adult medicine, where you can be more of a clinical pharmacist if you want to get away from that dispensing role.

Darshan

So two different comments that came out of it. First of all, before we started talking, I was really commenting about how I love your Star Wars stuff in the back. So I just thought that was amazing. What really upsets me from a privacy standpoint is my eBay thing went off and it's talking about Star Wars markets.

Chad

It's freaky, isn't it? listening to you.

Darshan

But ignoring that part of it. A few different things came up for me though. The first one was, I'll be honest, when I was in pharmacy school, yeah, you know what, going down the whole nursing home route. I loved it when I did it. But I was like, I remember making that time. It was like $42 an hour in retail. And I remember nursing homes or paying like 30 something. Right and and you were like I can't justify

Chad

right. It was kind of similar hospital same way. It was always a little under under retail. For sure. Hospitals

Darshan

used to be I remember because I remember going through all this like it was like 36 to 38 felt worse, but not bad enough.

Chad

Right. Right.

Darshan

I wanted the salaries now. I think

Chad

they're pretty consistent with what you see across the board and pharmacy. They're not there isn't a huge gap between what a pharmacist makes as a consultant. I think the harder thing is is finding those consulting slots. You know, some companies say, Well, you know, take a job with us work in the dispensing side and after, you know, I don't know, five years, 10 years, we'll you know, you might get an opportunity to do consulting. Now I went a different route, I worked for an independent, I did work as a consultant, kind of out of the gate, but I did have to rotate through the dispensing portion. When I left there, I started my own company, just doing consulting and was able to create something from that. So I think the one thing that exists if you can get the experience or if you have the wherewithal to go out on your own, it is a profession that you can step into and create a business from there are a lot of pharmacists that asep that just have their own book of business, they have their own eight or 10 nursing facilities that they go to they're paid either individually by those facilities, or by the the chain that they work for nursing facility chain that they work for. And they're able to carve out like a mini business. And I think that's appealing to a lot of people. It also is scary to a lot of people. So we try to do at asep abroad education to pharmacists that work in this area. But a component of that is, you know, business skills, how to how to be entrepreneurial, if you want to, how to find those jobs that are more secure through the pharmacies or, or nursing facilities that are more traditional employer jobs, then then entrepreneur jobs, but those are the things to think about.

Darshan

So so one of the advantages of joining something like ascp is you'll get resources not just on how to be a pharmacist, but how to be an entrepreneur.

Chad

Absolutely.

Darshan

Pharmacists. And here's a question for you. If you are trying to start this and you go, you know what, I wanna be part of ACP? Are these tutorials for lack of a better term? Are they write ups? Are they podcasts? Are they videos? How do you do that? Yeah, we

Chad

have a mixture of things. I think we've we've obviously, like everybody else this past year have moved to a web based formats. We do a lot more webinar based education than then maybe we did even a year ago. We do have live meetings. We have live regional meetings, we have a live annual meeting where we deliver a lot of education. But, you know, they are things that you can do, you know, from your own house, in terms of education, and they vary from podcasts, to video webinars, to audio webinars to journals. There's a bunch of different ways to get that education. I think one thing that's unique about asep is that we do support the board certification in geriatric pharmacy. So, you know, being a BC GP, is something that differentiates you as a pharmacist from another pharmacist, do you have a credential a board certification in geriatric pharmacy, and that lends a lot of weight to how you might land a job as a consultant pharmacist? Well, I think ashp and asep are the only two outlets to get that kind of education. So we we have a boot camp where you can take the education as a prep to take the certification exam. And then we also have education that's specific for re credentialing as a as a BC GP.

Darshan

So so you talk about credentialing. You talked about the advantages that escp gives you. I did have a question of clarification, if you will, which is he talked about long term care pharmacy, and he talked about consulting pharmacy,

Chad

is that the same thing? Are those different? I mean, they're they're the same thing in the sense that, you know, we're taking care of an older adult medically complex population. Because of the way we deliver medications today, you know, you still have operational, what we would call an operational pharmacist, they work at a pharmacy dispensing medications, but there are a lot of rules about nursing homes that have changed. So traditionally, you might say a consultant pharmacist is somebody in the facility, looking at medical charts working directly with patients and clinicians to better manage the patient's medication regimen. And that's very true. But now pharmacists that even work in those long term care pharmacies that do the dispensing and operational side, have a lot more clinical function to their job. They're compounding IVs they're the ones compounding the monoclonal antibodies right now for COVID. They're also doing new admission reviews, where they're looking at the admission information that comes from the hospital for the patient that's going into the nursing facility, and they're making recommendations to the clinical team about what what to do to make that more efficient or how to adjust it now that they're out of the hospital. So it's, it's kind of both but there's a lot more sort of diversity and function in long term care from a pharmacist perspective.

Darshan

Okay. And and it's interesting you talk about this, you mentioned this idea of you going in to help older patients now. They're all the same, right? I mean, it's, it's easy for a pharmacist to go in and go. I've worked with older patients before this is going to be the same exact thing, no big deal. I'm not missing something.

Chad

No, they're not all the same. I think the experience level that you get from dealing with multiple complex patients over and over again, is similar. Those are things that, you know, you get a lot of gain from from an experience standpoint, but they're not all the same. And I think when you look at again, let's go back to COVID. One of the difficult things from the perspective of COVID was, it was hitting our nursing home patients and assisted living patients hardest. So a lot of the strategy was, well, let's, you know, how do we protect them? How do we get vaccines to them faster and first, and, you know, the some of the decisions we made about how to do that relied on a understanding of that population that wasn't very deep are very good. So you might think that CVS retail and Walgreens retail, and they are tremendous pharmacies, they are great at vaccinating, but they don't really vaccinate individuals that live in nursing homes. So there's the learning curve there. These are not people, these older adults are not walking into the drugstore and saying, Can I have a flu vaccine. These are individuals with cognitive disorders, they have multiple comorbidities, some are bedridden, they look a lot more like hospitalized patients than they do community dwelling patients. So when you when you have to address them with a with a strategy, like getting vaccines, you need to think about that they're not going to line up, put their mask on and stay six feet apart from the person in front of them, primarily because a lot of them don't understand that. So you're gonna have to go room to room. What does that mean from an infection control perspective? What does that mean from how long you anticipate it taking to provide vaccinations to 100 bed nursing home. And those are things that we had to really spend a lot of time educating on so that we could get to the even to the point that we're at now. And I think most people would argue that we're, we're not, we haven't delivered as many vaccines as we would have liked to at this point. That has to do with, you know, trying to put our hands around who we're dealing with in those congregate care environments.

Darshan

Um, so let's talk a little bit about these unique pieces of information that IT consultant pharmacists get, because of ABA consultant pharmacists, being part of ACP, you talked about a few things you talked about. packaging, you talked about preventing nursing accumulation. Could you talk a little bit more about that? What what are some tips you give already? And and sort of? I'm gonna take that I'm gonna let you jump into the second part of the question, which is that talks about today? What does the consultant pharmacist look like in the future? When you're talking about Amazon? You're talking about telepharmacy? What What is that difference?

Chad

Well, I think, you know, to start with your second question, first, maybe I think what what pharmacy has at its advantage is that we're not a physical assessment discipline, we don't have to touch you. To determine something about you, from a from a disease standpoint, or a condition standpoint, are Aquaman is how does this med work? How does it work in a person like you, and how do this array or cocktail or trail mix or whatever you want to call it work together to deliver what we want from a from a health standpoint. So we can do it like we're doing it right now. I could be going over your medications over video conference and be able to deliver what I need to deliver as long as you're receptive patient. And you know, you can listen or if you can't, if you're in a nursing home patient, maybe I'm talking to the family, maybe I'm talking to the daughter or the son, about their mom or dad's medications. But ultimately, we can do it with technology. So I think that that gives us an advantage of the Amazon of the future. It's not just about drowning a medication to your front porch. It's about what are you as a patient need from that medication? Maybe the one we drone to the porch isn't the right one, maybe you need to be on a different one because of a variety of reasons that you might benefit from a drug that has different characteristics than another drug even in the same class. So I think we have that we have that accurate as pharmacists, what asep does is it tries to collect the individuals out there that are doing it on the on the edge of the envelope and put that in front of the membership and say here's what this pharmacist has been doing in diabetes management. And it's effective because they're thinking about the older adult and the episodes of hypoglycemia and how these drugs cause that less likely than other drugs and because of what they're doing, they're seeing better outcomes for their patients. So we're trying to identify within our network of pharmacists, what the best practices are, and then be able to expose those to the general membership so that they can adopt them into their practices and give them another value add to their client, whether it's an individual or a nursing home or a health system. How can we do that? So we continue to move the ball forward and make better decisions about medication use.

Darshan

So that's, there's an interesting thing you said right there, which is you learn from your own community? It's one of those things, I'm part of several communities. But that is a continuing problem. How do you do that effectively?

Chad

Well, I think, you know, we, we convene, you know, we're a convening organization. So we bring people together people, you know, we, I would have told you a year ago, we do that by having live meetings in that physical networking and being in the same place and talking to each other about your practices. That was the thing that we do best. And it probably still is the thing we do best, but we've learned to recognize that it can still be done to some extent, electronically. So we started COVID webinars at noon, on Fridays, really early on in March. And every Friday, we would just try to find somebody that was an expert that could talk about COVID, from a, you know, a vaccine standpoint, or what are we seeing in the hospitals for patients that are in the ICU? And what we realized was we were getting 1000 people a Friday to chime in and listen to those because we realized we became a megaphone for what should we be doing? Like what we don't know COVID? Any more than anybody else? Does? This is scary for everybody? How can we get information so that we can better help our patients? How is it changing our practice, we can't go in nursing homes right now, because they want to restrict access as much as possible. And because as pharmacists, we don't have to be physically present with a patient, we could do a lot of our work outside the nursing home. So as long as we had access to medical records, electronic medical records and data, we could do a lot of that work. How does that change our approach? What should we be telling our facilities? How often should we be calling? What should we be looking for all those things became, you know, we became a conduit for that. And I think that's our job as an association, that's our job is to make sure that we can get information broadly out to pharmacists that are that are connected to us, so that they can in turn, do a better job for their patients. And I think that's, that's, that's what we're here for, you know, whether that's pushing through a regulation or, you know, working on a piece of legislation to identify and clinical leaders that can deliver the most accurate up to date information on a product.

Darshan

So when you're trying to to be a proponent for the members, for your members. Now, how many members do you have, by the way,

Chad

we have over 6000 active members.

Darshan

Okay, so So when you're trying to be a proponent for your members, how do you do that with, with other pharmacy groups, sort of competing for your attention? So whether it's ashp, or someone else, they're all looking to make sure that their members have a fair voice? Do you think you have a unique voice? And if so, what is that? And how do you put that out there?

Chad

Well, I think we do have a unique voice. And I know that a lot of people will say, well, there's so many pharmacy organizations, there's too many they should they should consolidate, there should be one. I think when you look at it from the standpoint of how complex our healthcare system is, how complex patients are, there does need to be some focus on certain segments. So if you look at a PHA, you know, they're trying to represent all pharmacists, regardless of where they practice, regardless of who their patient is, and there's there's room for that there, they we have to have that sort of top of the pyramid organization that represents pharmacist ashp is the same way on the hospital side ascp fits that, you know, we've we've been part of that long term care environment, that older adult environment since 1969. So we bring a lot of experience and acumen to taking care of older adults, which makes it easier to operate in partnership with a PHA in partnership with ashp. And some of the other organizations because we're really not competing with them. We're we're we're an add on to them. We're providing a layer of expertise. A PHA may do a pediatric pharmacy webinar, they might be looking at a completely different population that we would look at, they may look to us and say how can we partner because we want to bring our members some very focal expert pharmacists, that that work in geriatrics. And so the I think the organization's work well together from that perspective, but we certainly have built a reputation over that 50 years of being the pharmacists that deal with older adults that have medical complexities,

Darshan

but but how do you address the concern which you kind of alluded to a few seconds ago, which is a too many pharmacists organizations. I don't know Know how to like, be part of one and get everything from it, as opposed to this organization and that organization? How do you deal with that? And that sort of, yeah, I

Chad

mean, it's hard because you, you know, I think any membership organization would say the goal is to have as many members as possible. And I don't know that we look at it that way. We want members that are getting value from what we're delivering. So if you're, if the predominant part of your practice is that you work with older adults, we think we're the professional home for you. If you don't, if you're a retail pharmacist, and you know you have a subset of your patients that are older, and you're a member of a PHA, then it's our job to partner with a PHA and get access to you that way through that relationship, maybe we have a deal with a PHA that if you're a member of a PHA, you can be a member of us for a less dollar amount, because we recognize that not only does that happen at a national level, but it also happens at a state level, most state states have one organization that represents pharmacy. So we want you to be a part of that state organization, we want pharmacists engaged so that we can push the the envelope of regulation and legislation and improve the practice of pharmacy. But we don't want you to have to decide, well, I can only be a member of this, this or this, we want to kind of find ways to partner. So we do look around and try to find ways to partner not just amongst pharmacy organizations, but even amongst long term care. So we have an agreement with the medical directors that work in nursing homes, we have agreements with some state pharmacy organizations to try to create less of a burden financially on a pharmacist that wants to be engaged across their state and national level.

Darshan

So this is gonna sound like a weird question. But I was always curious. Do you do associations fight?

Chad

it? You know, I haven't seen it. I think one of the things that I did last year that, you know, I don't think anything of these things. But I picked up the phone and called Tom minigun and a PHA in March and said, Tom, we need to set up a phone call. And we need to meet twice a week with all the pharmacy organizations and talk about what is the professions response to COVID. And he was like, that's a great idea. And all of a sudden, we had 20 organizations on the phone, we still have that call every Thursday, all the organizations are on the phone talking about how we can work together and find places where there's synergy that we can push the profession forward. So that's been that's been my experience. I've been here for three years. I don't look at it like competition. You know, I don't think a lot of my colleagues look at it like competition. So there is this sort of movement that hey, we're all in this together. Now occasionally. Do we have issue with insurance company pharmacists, you know, occasionally there's some, there's some issues that really, we are on opposite sides of, but But honestly, even in those environments, there's a there's a professional respect. And yeah, we know that you're gonna look at it that way. And that's okay. Because on this issue over here, whether it's racial equity, or how do we get more vaccines, the more pharmacists, we're all on the same page. So we know how to move in and out of working with each other to push the profession forward. And I think, ultimately, everybody does have that in the pharmacy Association world, that that the pharmacist and the profession of pharmacy is what we're fighting for. And once you get to that level, you know, there's little, there's little risk of, you know, being in conflict.

Darshan

Very cool. So let me do a quick recap, we spoke a little bit about escp. We spoke about its role, we spoke about the types of members, you have over 6000 active members, we talked about how the patient populations different we talked about how patients themselves are not a homogenous group, we talked about their needs being different. Everything from packaging needs to the ability not to walk, the inability to walk into a drugstore, or masking being a problem. We talked about vaccinations being an unusual situation. We spoke about your story coming into being a consultant pharmacist. Did I miss anything yet?

Chad

I don't think so. There's a lot. We're busy. We can't we can't I mean, I kind of knew that when I came here to take this job. But I think it's intuitive that, you know, where the population is now. And the use of medications, those both positively and negatively. Like I said, I mean, it's a great time to be a pharmacist. I mean, pharmacists have an opportunity to really affect healthcare and in a positive way. And it's that way for at least until 2060 when the top of this baby boomer population peaks. So we have a lot of opportunity.

Darshan

That right 2016 for baby boomers.

Chad

2016 grows until 2016. It's about I think it's about 52 million people right now and then 2060 it's gonna top out at about 98 million. It's a big, big difference.

Darshan

I I thought the next one is millennials, which is even bigger. I hurt. So

Chad

yeah, they backfill pretty well. But I don't know if there's a if there's another bump, looking down the road or not, I don't know, I have to look at that little more closer. I know it backfills it's not, it's not like they're gonna peek and we're gonna drop off.

Darshan

Well, there's the Generation X. Yeah, but anyways, this was wonderful. Chad, Chad, where can they find you talk to you or learn about ASAP?

Chad

Well, anybody can email me my email is seawards. So c w or z at ascp. com, our website is ascp calm. That's the easiest way to get in touch with us. If anybody's interested in becoming a member, you can do it through ascp comm there's a there's a discount code floating around out there that I'll go ahead and broadcast but ascp cares. So ascp ca, r s 50. And it takes $50 off a new membership. So

Darshan

and then how long was that good for just because it's so far, it's

Chad

good. It's good. You know, it's something we started with COVID I mean, eventually, we'll probably disable it. But for now, while people are kind of struggling with COVID We're leaving it up.

Darshan

Okay, um, this was great. Thank you again, Chad for having it on. My name is Darshan Kulkarni, you can reach me at Darshan talks on Twitter. And by the way, Chad, do you guys have any kind of social media accounts?

Chad

We do? I don't know if I can rattle them off right now. But we do have a Twitter account. We do have a Facebook account. We've got an Instagram account. Most of them are ascp Farm so asep h AR M.

Darshan

There you go. Thank you again, Chad. And this was great.

Chad

Yep, thanks.

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