Imagine yourself back on your first community pharmacy rotation during the first year of school. The chances are your head spun as you watched one thinly spread pharmacist on autopilot where the daily volume was a thousand scripts. The clinical focus in school combined with that first nauseating rotation discourages many student pharmacists from wanting to pursue community practice from the very beginning. Flip the Pharmacy participants must not only strive for practice transformation but also work directly with pharmacy schools to create rotation and work opportunities for student pharmacists to combat this stigma and groom the next innovative leaders of community pharmacy.
To say I was shocked by my rotation in this advanced practice setting would be an understatement. I was forced to shed many of my perceptions and biases of community pharmacy within the first hours. The corporate structure of most pharmacies presents immense barriers to change and their sheer numbers dominate student and public perceptions of community pharmacy.
There is a trend between rural areas and independent practices. Rural areas live by a “one stop shop” kind of culture and this proves beneficial for advanced practice community pharmacies with adaptive structures. For many patients, the pharmacist may be one of the only healthcare providers seen on a regular basis. As a result, I witnessed an amazing level of collaborative practice agreements between local physicians and the pharmacists. These allow for more continuous patient care and more advanced responsibilities delegated to the pharmacist.
Before my rotation, I always pondered how a pharmacy could possibly offer patient care services given the classical product driven workflow. The answer lies in staffing. I became so used to seeing only one pharmacist working at a time that I laughed in surprise upon realizing I was working along four pharmacists (one being a resident) concurrently.
The next challenge was comprehending how this was financially stable. The pharmacy relies on numerous services as revenue sources. Responsibilities delegated by collaborative practice agreements, comprehensive medication reviews for Medicare/Medicaid patients, diabetic foot exams, medication bubble packing, durable medical equipment sales, and more allow for greater pharmacist FTE. This model also allows the pharmacists to follow best practices that they are often not compensated for like new prescription follow-ups, e-care plans, and therapy modification recommendations to physicians. All these services and excellent staffing make the pharmacy a one stop shop to care for patients on numerous levels. In the end, they left me off with telling me they are ambulatory care pharmacists working in a community setting, that was a powerful statement.
Many student pharmacists will never have the opportunity to experience a rotation like this. They either do not understand the opportunity or remain hesitant to travel a significant distance away from school grounds for a rotation. APPE students were even offered free housing. Participants of Flip the Pharmacy must work closely with schools to promote rotations and work opportunities. When student pharmacists have just as many close-minded perceptions about community practice as the general public, the progressive momentum fades.
Hunter J. Furley
Doctor of Pharmacy Candidate | 2023
University of Wisconsin – Madison, School of Pharmacy
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