Ambulatory Care Pharmacy Viable?

[nampa]

I have an interest in ambulatory care, but is it viable? It seems to exclusively be in either academia or the federal government. Another thread post mentioned that this job may be reduced in the federal government in the future, as they are hiring less MDs and more PAs, NPs? If this is true, this is a risk for people wanting to transition to ambulatory care, even with government stability. It seems worrisome to do something and have only one employer, the government, available. Is going to outpatient in the government an escape hatch?
Is hospital pharmacy better, work conditions or just because of the stability? Thanks!

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[nampa]

what do these pharmacists do on a daily basis? Anyone out there with knowledge?

 

[vinapharm]

what do these pharmacists do on a daily basis? Anyone out there with knowledge?

Form what i heard ( during the interview), the pharmacist will see the patient and collect their info. Then base on the info to refer to their doctor for specific medications or plans. Or the Rph has a collaborative agreement with a specialist do perform duty as a provider with a special populations ( psy, warfarin...); they can see the patients, collect info and initiate or adjust meds. So like PA, NP stuff.
I did not get the positions though. So no real experience.

 

[nampa]

I wonder what metrics and how hared appointments are. Furthermore, how much does MTM, as opposed to the algorithmic adjusting go?

 

[bacillus1]

At the VA, ambulatory care pharmacists function as a mid level provider (so, like a PA would), and the push currently is for a broad scope of practice and prescriptive authority that would allow for management of multiple disease states. Only difference is that in most states, pharmacists cannot prescribe CSs. Things that providers would refer patients to for pharmacist care are generally things that they're too busy for taking care of themselves (e.g. uncontrolled diabetic where a lot of time is needed reviewing insulin dosage/food, etc, uncontrolled HTN, CHF that requires home telehealth involvement, etc...). AC clinics are of course also generally pharmacist managed, but those jobs are starting to get reduced due to less need to monitor DOACs. At my old VA, we even had an endocrine pharmacist that mostly worked with setup and monitoring of patients on CGMs. Outside of the federal government, depends on state law whether you can do this.

 

[bacillus1]

Looks like CPPO has some resources here VA.gov | Veterans Affairs

 

[croquemonsieur]

I want to be an ambulatory care pharmacist! Also, what does an ambulatory are pharmacist do?!

Nice.

 

[nampa]

Military vs. VA, seems to have less unhealthy, elderly patients. Seems that most people are stuck doing smoking cessation, etc.
army, it sounds fairly strict with metrics, something called a Relative value units—return investment per encounter, quality outcome metrics, etc.

How does the MD and his PA staff factor in? Most patients are healthy, so what will I be doing at the 6 patient appointments per day?
Thanks!

 

[baronzb]

At the VA, ambulatory care pharmacists function as a mid level provider (so, like a PA would), and the push currently is for a broad scope of practice and prescriptive authority that would allow for management of multiple disease states. Only difference is that in most states, pharmacists cannot prescribe CSs. Things that providers would refer patients to for pharmacist care are generally things that they're too busy for taking care of themselves (e.g. uncontrolled diabetic where a lot of time is needed reviewing insulin dosage/food, etc, uncontrolled HTN, CHF that requires home telehealth involvement, etc...). AC clinics are of course also generally pharmacist managed, but those jobs are starting to get reduced due to less need to monitor DOACs. At my old VA, we even had an endocrine pharmacist that mostly worked with setup and monitoring of patients on CGMs. Outside of the federal government, depends on state law whether you can do this.

How does that differ with healthy soldier populations?