NP/PAs will replace hospital pharmacists?

[PharmD RPh]

This thread is absolutely stupid. A PA will NEVER replace a pharmacist. Curriculums are completely different and a PA program is maybe 2-2.5 years vs. Typically a 4 year pharmd. I have friends that are physicians and they typically know the drugs within their specialty fairly well, but outside of that we have much superior drug knowledge. I catch MD, PA, ARNP mistakes on a fairly frequent basis. No one is more experienced or educated on medication use than a pharmacist. Med students only get 1 semester of actual pharmacology!

As for in office dispensing, I don't really see this catching on nor do I understand why some do it. Most people have insurance and the margins on rx profits for a single practitioner would be horrible. Also if you want to dispense out of the office then you have to meet all the legal requirements of a pharmacy. Not sure how strictly that is enforced.

PA are in demand now. Will we see an influx of new PA schools? In 5 years will the PAs have saturation? I think it's very logical just like law, pharmacy and nursing have done now.

---

Members don't see this ad.

 

[Farmacist2011]

You are wrong, both are true.

PAs make more and employers save $$ because they will be allowed do both what pharmacists do and what doctors do. Their pay will be in between pharmacists and doctors, but less than 1 doctor + 1 pharmacist. Even 2 PAs are less expensive than 1 doctor + 1 pharmacist.

Same idea you buy a fridge w/ freezer.

My aunt is a PA and they don't make more than pharmacists.

 

[All4MyDaughter]

Who is going to hire a PA to run a hospital pharmacy? Train them to run the IV room, compound chemo, check TPNs, etc? Why would PAs even WANT to do those things? They practice hands on medicine.

 

[PharmD RPh]

Who is going to hire a PA to run a hospital pharmacy? Train them to run the IV room, compound chemo, check TPNs, etc? Why would PAs even WANT to do those things? They practice hands on medicine.

If all these students really think PAs will really replace pharmacists then I'd highly advise you to cut your losses and go back to PA school because they are the future of pharmacy.

 

[ucrx]

Yes, NP/PA's and especially MD's get more respect, does it suck? YES! I don't think adding more letters after our names will help that. If you wanted to do a PGY2, or more respect why the hell didn't you just go to medical school, go one more year and make almost double of what a RPh makes????

Because I don't want to be a doctor.

I'm also not a pharmacist and not doing residency for status or to make everyone think I'm amazing because I did XYZ.

There are other reasons to go to pharmacy school and to do residency.

 

[medic25]

Becoming a PA is a better route for students that want to be a PA. If you want to be some type of primary care provider, become a PA, NP, MD, or DO.

I don't think this is what most people applying to pharmacy school want to be, however.

Exactly. As other people have said, PA and pharmacist are two completely different professions; both are highly educated and invaluable in the field of medicine, but neither is suited to replace the other. Anyone suggesting that one replace the other probably hasn't spent much time in the clinical world. I would never presume to have the first clue about compounding medications, and I'm sure our ED clinical pharmacist would feel equally well prepared reading an x-ray or performing a lumbar puncture.

 

[R2pharmD2]

You are wrong, both are true.

PAs make more and employers save $$ because they will be allowed do both what pharmacists do and what doctors do. Their pay will be in between pharmacists and doctors, but less than 1 doctor + 1 pharmacist. Even 2 PAs are less expensive than 1 doctor + 1 pharmacist.

Same idea you buy a fridge w/ freezer.

Surely you're joking.

You don't honestly believe that a single PA can replace TWO people that have a higher level of training in their respective fields than a PA does, do you? Is this super PA going to diagnose patients while inputing orders? I suppose he/she can bake a cake at the same time?

It's not like buying a combo fridge and freezer to replace the separate components, it's like buying a cooler with a bag of ice to replace the two.

I respect PAs for what they are, but what you suggest is ridiculous.

 

[KARM12]

Last time I checked, most PAs/NPs don't want to be pharmacists. If they did, most of them would have gone to pharmacy school.

They don't want to do my job and I have no desire to do their job. It works out nicely!

 

[Its Z]

Last time I checked, most PAs/NPs don't want to be pharmacists. If they did, most of them would have gone to pharmacy school.

They don't want to do my job and I have no desire to do their job. It works out nicely!

I don't know..most of my MD, DDS, PA buddies want my job...

Well, I guess they would rather work from home and not work the weekends...is what they want.

 

[p-rog]

Becoming a PA is a better route for students that want to be a PA. If you want to be some type of primary care provider, become a PA, NP, MD, or DO.

I don't think this is what most people applying to pharmacy school want to be, however.

agree this thread is stupid, but I would think we should point out that some pharmacists do want to do more of a primary care type role, just without the diagnosis. Amb care is primary in my mind.

 

[DoctwoB]

Wait. So while MDs with 4 years of med school/3-9 years of residency/fellowship will consult pharmacists, but somehow people with a magical 2 year NP/PA degree will not? I call shenanigans.

I wouldn't be surprised if there was a decline in the pharmacy profession in the retail sector and somewhat in hospitals due to automated drug interaction warnings, but there will always be a need for individuals that are experts in pharmaceutical dosing/administration.

 

[ValeRx]

Recently had a conversation with my manager about where hospital pharmacy is going. She wasn't too optimistic. In her opinion, eventually pharmacists will be phased out because their dispensing/distributing role will be greatly diminished my technology (which is not new), and whatever clinical we do in hospitals now, can be done by mid-levels. They can do it by law. We unfortunately cannot do what np/pas do (prescribing, diagnosing et.) by law. And in fact, I remembered we have an ortho group, which, for whatever reason, does not want us to dose warfarin for their patients. And guess who does warfarin dosing for them? An np that works for that group.
My manager also mentioned that a while ago (maybe 50, 60 or whatever years ago) pharmacists had 2 paths to choose from: to stay enterpreneurs or to become a part of healthcare team. They chose the first path, and now it's too late to make any drastic changes. Any thoughts?

Quit because your manager is a *****.

 

[group_theory]

Who is going to hire a PA to run a hospital pharmacy? Train them to run the IV room, compound chemo, check TPNs, etc? Why would PAs even WANT to do those things? They practice hands on medicine.

From a more practical aspect, PAs license to practice medicine is through the state board of medicine/osteopathic medicine and their scope of practice is tied to their supervising physician. As far as I'm aware, I know of no physician whose scope of practice includes running and organizing inpatient pharmacies. If you hire PAs for this purpose, who will be their supervising physician, and what physician will want to assume responsibilities for this (who will the PA turn to if there are questions/issues)?

As for NPs, well, they can argue that pharmacy is an extension of advanced nursing practice

 

[TemSirolimus]

The world will end in 2012, remember?

I know, but that needs to wait. We first need to figure out whether NPs/ PAs will make pharmacists obsolete. Thats really important.

 

[Its Z]

NP/PA wont replace pharmacists. Take my word for it. Lock thread delete user ban topic. NOW!

 

[PharmaTope]

I don't know..most of my MD, DDS, PA buddies want my job...

Well, I guess they would rather work from home and not work the weekends...is what they want.

i dont know who brags about themselves more, you or Donald Trump

 

[Its Z]

i dont know who brags about themselves more, you or Donald Trump

Probably me........don't hate tho....im on a rerouted plane getting fueled and wont be home probably til 4am.........that being said I paid my dues. Working every holiday for first 10 years of my career and begging retail druggistz to help me out at the hospital....they used to laugh at me...so I ended up working many weekends even as a DOP. Then again the hardship and the experience got me where I am today along with positive attitude which you lack.

 

[konkan]

Nobody was trying to say that mid-levels are going to completely take over hospital pharmacy and that, in the future, there is gonna be NO pharmacists in hospital whatsoever. What I said was with CPOE coming on-board, hospitals might to need fewer pharmacists (if we are not going to do more clinical stuff). Also I said that whatever clinical stuff we do, mid-levels can also do. And if it will be financially feasible, hospitals might start using mid-levels to do what historically was called clinical pharmacy. But apparently, nowadays, mid-levels make about the same as pharmacists do, so I guess we should be ok.
Nobody was trying to say here that if a physician wants to ask a question about dose/dosing/etc., his call will be redirected to PA/NP pager or something like that. Obviously that's nonsense.

 

[Praziquantel86]

Nobody was trying to say that mid-levels are going to completely take over hospital pharmacy and that, in the future, there is gonna be NO pharmacists in hospital whatsoever. What I said was with CPOE coming on-board, hospitals might to need fewer pharmacists (if we are not going to do more clinical stuff). Also I said that whatever clinical stuff we do, mid-levels can also do. And if it will be financially feasible, hospitals might start using mid-levels to do what historically was called clinical pharmacy. But apparently, nowadays, mid-levels make about the same as pharmacists do, so I guess we should be ok.
Nobody was trying to say here that if a physician wants to ask a question about dose/dosing/etc., his call will be redirected to PA/NP pager or something like that. Obviously that's nonsense.

What clinical stuff do we do other than this? Everything we do, in some way or another, is medication related. Primarily optimal drug/dosage selection. Sure, we may every once in a while point out an adverse drug reaction for the DDx, but that is the exception rather than the rule.

 

[KARM12]

Nobody was trying to say that mid-levels are going to completely take over hospital pharmacy and that, in the future, there is gonna be NO pharmacists in hospital whatsoever. What I said was with CPOE coming on-board, hospitals might to need fewer pharmacists (if we are not going to do more clinical stuff). Also I said that whatever clinical stuff we do, mid-levels can also do. And if it will be financially feasible, hospitals might start using mid-levels to do what historically was called clinical pharmacy. But apparently, nowadays, mid-levels make about the same as pharmacists do, so I guess we should be ok.
Nobody was trying to say here that if a physician wants to ask a question about dose/dosing/etc., his call will be redirected to PA/NP pager or something like that. Obviously that's nonsense.

I don't think you understand the role of a clinical pharmacist.

 

[konkan]

I don't think you understand the role of a clinical pharmacist.

Really? So why don't you teach me, because, I assume, you understand it very well.

 

[KARM12]

Really? So why don't you teach me, because, I assume, you understand it very well.

Being a clinical pharmacist isn't just answering drug information questions, rounding, and doing PK. Yes, that is and important part of the job, but there is so much more. We do a lot to optimize medication use and promote medication safety in the hospital. We do a lot with making protocols/ordersets to improve safety and monitoring of medications. We evaluate the cost effectiveness of regimens and formulary issues. I monitor cultures/antibiotics and make recommendations with the ID service and especially to those not being followed by ID to promote stewardship in the hospital. I rotate the code pager with the other specialist and we run the med cart during codes. We work in a decentralized/hybrid model so we also verify the orders for our services. I presented at medical grand rounds and teach for our ID fellows during their weekly lecture series. I represent pharmacy on hospital committees.

These jobs do exist. They don't interest everyone because they are a lot of project work, but I like project work. It sin't a perfect job, but I like this soooo much better than when I was in retail. I work at a teaching hospital, but not an academic medical center with a college of pharmacy.

 

[All4MyDaughter]

Being a clinical pharmacist isn't just answering drug information questions, rounding, and doing PK. Yes, that is and important part of the job, but there is so much more. We do a lot to optimize medication use and promote medication safety in the hospital. We do a lot with making protocols/ordersets to improve safety and monitoring of medications. We evaluate the cost effectiveness of regimens and formulary issues. I monitor cultures/antibiotics and make recommendations with the ID service and especially to those not being followed by ID to promote stewardship in the hospital. I rotate the code pager with the other specialist and we run the med cart during codes. We work in a decentralized/hybrid model so we also verify the orders for our services. I presented at medical grand rounds and teach for our ID fellows during their weekly lecture series. I represent pharmacy on hospital committees.

These jobs do exist. They don't interest everyone because they are a lot of project work, but I like project work. It sin't a perfect job, but I like this soooo much better than when I was in retail. I work at a teaching hospital, but not an academic medical center with a college of pharmacy.

Great post!

 

[StevePerry]

Being a clinical pharmacist isn't just answering drug information questions, rounding, and doing PK. Yes, that is and important part of the job, but there is so much more. We do a lot to optimize medication use and promote medication safety in the hospital. We do a lot with making protocols/ordersets to improve safety and monitoring of medications. We evaluate the cost effectiveness of regimens and formulary issues. I monitor cultures/antibiotics and make recommendations with the ID service and especially to those not being followed by ID to promote stewardship in the hospital. I rotate the code pager with the other specialist and we run the med cart during codes. We work in a decentralized/hybrid model so we also verify the orders for our services. I presented at medical grand rounds and teach for our ID fellows during their weekly lecture series. I represent pharmacy on hospital committees.

These jobs do exist. They don't interest everyone because they are a lot of project work, but I like project work. It sin't a perfect job, but I like this soooo much better than when I was in retail. I work at a teaching hospital, but not an academic medical center with a college of pharmacy.

You left out the part about Clinical Pharmacy having the highest number of "ego-driven self-fart sniffers engaging in incessant verbal diarrhea while wildly overestimating their importance" per capita of any branch of pharmacy BY FAR. Still love clinical pharmacy for reasons Karm says above and not sure how my point factors into the argument, but felt the need to add it anyway.

 

[dingerx]

From a more practical aspect, PAs license to practice medicine is through the state board of medicine/osteopathic medicine and their scope of practice is tied to their supervising physician. As far as I'm aware, I know of no physician whose scope of practice includes running and organizing inpatient pharmacies. If you hire PAs for this purpose, who will be their supervising physician, and what physician will want to assume responsibilities for this (who will the PA turn to if there are questions/issues)?

As for NPs, well, they can argue that pharmacy is an extension of advanced nursing practice

They can't argue that pharmacy is an extension of ANP because it is written into law under a completely different section of law ledgers.

 

[KARM12]

You left out the part about Clinical Pharmacy having the highest number of "ego-driven self-fart sniffers engaging in incessant verbal diarrhea while wildly overestimating their importance" per capita of any branch of pharmacy BY FAR. Still love clinical pharmacy for reasons Karm says above and not sure how my point factors into the argument, but felt the need to add it anyway.

Seriously useless... why do pharmacists feel the need to put down eachother? I feel sorry for you.

Can you tell me what important things you are doing to advance the profession in your job? These clinical pharmacists are doing a lot to enhance the image of pharmacy in the world of healthcare.

 

[Its Z]

Seriously useless... why do pharmacists feel the need to put down eachother? I feel sorry for you.

Can you tell me what important things you are doing to advance the profession in your job? These clinical pharmacists are doing a lot to enhance the image of pharmacy in the world of healthcare.

There are pharmacists who just want a job.

Then there are ones who want a very specific position and a career and receive training to prepare themselves.

They both can fall into a repetitive day to day work mode.

But innovation comes with inspiration. Some of us are inspired and some are not.

In the end, not everyone is capable of leading.

 

[spacecowgirl]

There are pharmacists who just want a job.

Then there are ones who want a very specific position and a career and receive training to prepare themselves.

They both can fall into a repetitive day to day work mode.

But innovation comes with inspiration. Some of us are inspired and some are not.

In the end, not everyone is capable of leading.

I completely agree with that and that's fine with me if you just want to punch in and out and bide your time. But you forfeit your right to complain about the direction of the profession and to be disparaging to those who are trying to be innovative then.

 

[All4MyDaughter]

I completely agree with that and that's fine with me if you just want to punch in and out and bide your time. But you forfeit your right to complain about the direction of the profession and to be disparaging to those who are trying to be innovative then.

It just feels like SDN has had a massive influx of whiners and haters lately. And it's not enough (apparently) for them to just make their own "I hate pharmacy" threads. They have to crap in every other thread too. It's annoying.

 

[aboveliquidice]

It just feels like SDN has had a massive influx of whiners and haters lately. And it's not enough (apparently) for them to just make their own "I hate pharmacy" threads. They have to crap in every other thread too. It's annoying.

They come and go... thankfully, they seldom stay for long.

 

[KARM12]

I completely agree with that and that's fine with me if you just want to punch in and out and bide your time. But you forfeit your right to complain about the direction of the profession and to be disparaging to those who are trying to be innovative then.

Agree. I don't care if you want to go to work, put in your time, and leave. That is fine. I have plenty of friends who are brilliant pharmacists who want to do just that. I can respect that.

Just don't try to put down those that want to do other things...we are all pharmacists.

 

[confettiflyer]

of course the problem with PA, is that you have to be able to look at blood. from my experience, a lot of people became pharmacists to avoid the whole body contact thing (examining, needles, body fluids, etc)

yeah hell no i don't want to have anything to do with touching people at all. eff that.

 

[RX CARE]

On that note, it is interesting to say the least. I saw this thread a few days ago and had no opinion. However, I just got one of my regular ASCP listserve updates and something is indeed brewing in Oregon. I immediately remembered this thread. It may not necessarily be hospital-based, but we shouldn't just shrug it off. Here is the abstract:


Oregon Action Alert: Oregon Pharmacists, Oppose SB 952 and Protect Your Patients and Your Profession

Please oppose legislation currently under consideration in Oregon that would increase the profit of private clinics participating in on-site dispensing at the cost of patient safety. If adopted, SB 952 will grant physician assistants (PAs) the unrestricted authority to dispense drugs with limited physician oversight. The legislation permits a supervising physician or a supervising physician organization to apply for dispensing authority for a PA from the Oregon Medical Board. This bypasses the medical authority of pharmacists, and removes the crucial element of pharmacist review of dispensing.

The Oregon House version of this bill (HB 2386) is stalled in committee, but the version before the Oregon Senate (SB 952) will be up for a floor vote soon. Protect your patients and your profession: write to your state legislators and ask them to oppose SB 952. Take action now! (Oregon residents only: the tool will not permit residents of other states to write in.)

* Click here to download background information about SB952
* Click this link to use ASCP's online tool to write an e-mail to your Oregon legislators

 

[drift]

On that note, it is interesting to say the least. I saw this thread a few days ago and had no opinion. However, I just got one of my regular ASCP listserve updates and something is indeed brewing in Oregon. I immediately remembered this thread. It may not necessarily be hospital-based, but we shouldn't just shrug it off. Here is the abstract:


Oregon Action Alert: Oregon Pharmacists, Oppose SB 952 and Protect Your Patients and Your Profession

Please oppose legislation currently under consideration in Oregon that would increase the profit of private clinics participating in on-site dispensing at the cost of patient safety. If adopted, SB 952 will grant physician assistants (PAs) the unrestricted authority to dispense drugs with limited physician oversight. The legislation permits a supervising physician or a supervising physician organization to apply for dispensing authority for a PA from the Oregon Medical Board. This bypasses the medical authority of pharmacists, and removes the crucial element of pharmacist review of dispensing.

The Oregon House version of this bill (HB 2386) is stalled in committee, but the version before the Oregon Senate (SB 952) will be up for a floor vote soon. Protect your patients and your profession: write to your state legislators and ask them to oppose SB 952. Take action now! (Oregon residents only: the tool will not permit residents of other states to write in.)

* Click here to download background information about SB952
* Click this link to use ASCP's online tool to write an e-mail to your Oregon legislators

Oppose why? Docs have been dispensing like that for years. It would make sense for our PAs to be able to do that under the supervision of a physician. Hows that encroaching into pharmacists territory?

 

[genesis09]

A lot of states allow MDs to dispense, but very few do so. Most physicians do not want to deal with the hassle of all the regulations and inventory.

 

[meister]

Handing patients free samples is pretty convenient and effective in getting them to follow your treatment recommendations.

 

[ucrx]

Oppose why? Docs have been dispensing like that for years. It would make sense for our PAs to be able to do that under the supervision of a physician. Hows that encroaching into pharmacists territory?

I don't think physicians are allowed to do that (outside of samples) in CT.

 

[delano2000]

Aren't there specific rules regarding physicians dispensing? I read somewhere that they can only dispense and charge for the meds if they are practicing in a rural area where pharmacy access is limited (>15 miles). I think this was regarding TX.

 

[spacecowgirl]

Handing patients free samples is pretty convenient and effective in getting them to follow your treatment recommendations.

Until you run out and they have to get it filled and their tier 3 non-preferred copay is $75. Then the retail pharmacist has to fix that mess. Awesome, thanks.

If prescribers want to dispense, they will have to follow the rules imposed on pharmacies. We'll see how long that lasts I just just picture the reams of paper for med guides and reporting controls to the Rx monitoring programs. And then there's the insurance adjudication and software for maintaining records. Not gonna happen.

 

[meister]

Believe it or not but it is possible to hand out generic samples, and it is possible to have an understanding of a patient's insurance plan when a third of your patients are unionized factory workers with the same excellent insurance.

 

[All4MyDaughter]

I'm with spacecowgirl on the sample thing. I spent WAY too much time on my advanced community rotation switching Medicaid patients from Micardis --> lisinopril because this one doctor (married to a drug rep) had samples and started EVERY newly diagnosed patient with hypertension on the fancy expensive ARB. Then after the freebie month was over they'd try to fill their scripts and the Medicaid PBM would laugh. It was a huge PITA. I hate prescription samples.

In terms of in-office dispensing (by MD/DO/NP/PAs) - I am just not that excited. It will never be more than a few samples here and there, or perhaps some speciality products at the dermatology office (my derm does this) or *maybe* a limited stock of regular RX drugs. No physician is going to want to carry thousands of dollars of specialized inventory just so they can dispense in the office. Do they really want their money tied up in Enbrel, Byetta, Tarceva or ______________ and other high ticket items? Doubt it. Not to mention storage space, logistics, etc.

 

[All4MyDaughter]

Believe it or not but it is possible to hand out generic samples, and it is possible to have an understanding of a patient's insurance plan when a third of your patients are unionized factory workers with the same excellent insurance.

That is highly unusual amongst physicians. Most don't have a clue about insurance formulary. Heck, I couldn't tell you what's on specific formularies because it changes and the lists (if they are even published) don't get updated.

I've not seen a lot of samples of generic drugs. I still maintain that prescription samples, in the majority of cases, interfere with evidence based prescribing. And that's from me.

 

[spacecowgirl]

Believe it or not but it is possible to hand out generic samples, and it is possible to have an understanding of a patient's insurance plan when a third of your patients are unionized factory workers with the same excellent insurance.

Actually, I don't believe it. Explain more, please.

 

[PharmDstudent]

There are pharmacists who just want a job.

Then there are ones who want a very specific position and a career and receive training to prepare themselves.

They both can fall into a repetitive day to day work mode.

But innovation comes with inspiration. Some of us are inspired and some are not.

In the end, not everyone is capable of leading.

I completely agree with that and that's fine with me if you just want to punch in and out and bide your time. But you forfeit your right to complain about the direction of the profession and to be disparaging to those who are trying to be innovative then.

Agree. I don't care if you want to go to work, put in your time, and leave. That is fine. I have plenty of friends who are brilliant pharmacists who want to do just that. I can respect that.

Just don't try to put down those that want to do other things...we are all pharmacists.

So now it's ok to simply work as a pharmacist, be it retail, hospital, "clinical", or whatever. Then it must be ok, now, to know where the toilet paper or bathroom is at a retail pharmacy, because it hasn't been that way on this forum for a looooong time.

If the "clinical" people say it's ok, then it must be ok.

Historically, this forum was full of snide remarks and "put down" about retail and the mentality that "you're wasting your education" by going into retail. Well... what goes around comes around, I guess (since a lot of members aren't disillusioned by residencies and "clinical" pharmacy anymore - thinking it's some utopia or an easy escape from hard work).

 

[naus]

If doctors can't dispense, then pharmacists shouldn't consult or recommend either.

It is what it is.

 

[owlegrad]

If doctors can't dispense, then pharmacists shouldn't consult or recommend either.

It is what it is.

Oh Snap.

 

[cashmonyz]

I intern'ed at the Iowa City VA which is probably the best VA in the region. The Pharmacy does all the dosing for antibiotics, warfarin, you name it and nurses and doctors rely on the pharmacists all the time for a myriad of questions. I highly doubt pharmacists will be replaceable. The amount of knowledge that a seasoned pharmacist has in a pharmacy is invaluable. In the VA the pharmacist is king of drug protocol!

 

[cashmonyz]

I report to the appropriate board if I think doctors over prescribe for themselves and think they are giving it to their patients as 'samples' or themselves....what doctor writes himself cipro 90 day supplies at a time for the past year? Docs in my town know not to mess around at my pharmacy now that i cleaned it up and made a couple reports.

 

[bananaface]

If doctors can't dispense, then pharmacists shouldn't consult or recommend either.

It is what it is.

OBRA 90. Read it.

 

[rxlea]

Lulz. You know, as I learn more and more about pharmacy, I don't understand why people say retail isn't "clinical". You can do a lot of "clinical" work in a retail/community setting simply by asking the patient lots of questions- what are your home BP readings, when was your last pap, why are you asking about Azo, tell me more about your rash, how many times a day are you checking your glucose and what do you mean your machine is complicated, what color is your mucus at 3pm, what do you mean you wake up in the night and have to stand for a while before you feel better, how many pillows are you using, how many times are you going to the bathroom, how long have you had this cough, would you like to talk more about quitting smoking, what is the pain in your legs like, etcetcetc. Just by talking to your patients, you could probably do a lot. I think the companies are what is ruining retail/community pharmacy. You can't blame a person for needing a job and picking a retail spot close to home. But, you don't have to become a mindless pill slinging drone either.