Your opinion on Psychiatric Pharmacists

[pharm B]

I don't think too many psychiatric pharmacists(BCPP) frequent these boards, so I wanted to ask this question here:

What is your opinion on the development of the certification of Psych Pharmicists?

What role have you seen them play in your experience?

Would it be feasible to have a business relationship between a psychiatrist and psych pharmacist, such as in a private clinic?

As I understand it, the BCPP plays a role similar to that of the psychiatrist and, in some cases (like the VA), is quite independent, but I don't believe they're recognized as providers in many, if any, states. I'm interested in pursuing this residency and certification, but wanted the opinion of those on the medical side of the field. Thanks!

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[Therapist4Chnge]

While I can't speak the "certification" aspect of a BCPP, I can speak to how helpful it's been to have pharmacists on the floor and available for consultation. I work at a VA and they are pretty active with on-going cases and have been a real asset to the treatment teams. They've been the most helpful with the geriatric cases where the patient is on a slew of medications and has a host of co-morbid medical conditions. If they are around during team meetings/rounds everyone typically just turns to them on med questions and go, "So...?" I can't speak to what they do day to day, though I run into them most when I'm down consulting on competency/capacity issues, and they seem pretty active in the cases. Sometimes during an assessment questions will come up about meds, and I've been able to bring in a pharmacist to speak to the patient (or bring the patient to them). The patient feels more comfortable about the meds, and as a team we hope the clarification helps raise med compliance.

 

[Manicsleep]

My only consistent exposure to the pharmacists have been on an inpatient unit. There the questions I asked them were almost never about psychiatric medications as they knew as much as I did, sometimes less/sometimes more. We would often discuss psychiatric meds on rounds however and that led to discourse that helped me stay engaged and not forget things. With other medications however, it was a huge help and especially with polypharmacy patients.

Another area where pharmacists are really helpful is on consults.
This is where I have a question but don't have time to go look things up and so I have the pharmacist there to do it for me. This doesn't really work on rounds but is very useful both inpatient and outpatient. I used the pharmacists in this capacity for both psychiatric and non psychiatric medications.

I also use residents in this capacity (I have also been used in this capacity).

 

[pharm B]

Do you think the BCPP is on the path to becoming a valid provider in the psychiatric field, or should they stay on the path of being part of a floor/clinic team?

 

[OldPsychDoc]

Do you think the BCPP is on the path to becoming a valid provider in the psychiatric field, or should they stay on the path of being part of a floor/clinic team?

"Valid provider"? What kind of validation are you looking for here?
Are you proposing adding PharmD to the list of degrees that allows one to independently interview a patient, take a history, perform a mental status exam, form a diagnostic impression, and prescribe a course of treatment that includes psychotropic meds? Or are you suggesting a more circumscribed role as a tertiary consultant (such as a neuropsychologist) receiving referrals to answer specific questions consistent with your area of expertise?

I see the most appropriate place for an "advanced practice" pharmacist being as the team member in a hospital or multi-specialty clinic team, where one would apply your specialized knowledge to difficult and complicated cases. I've had fabulous assistance from PharmDs in this--and I can't imagine any of them wanting to be the primary provider.

 

[Manicsleep]

As I understand it, the BCPP plays a role similar to that of the psychiatrist and, in some cases (like the VA), is quite independent, but I don't believe they're recognized as providers in many, if any, states. I'm interested in pursuing this residency and certification, but wanted the opinion of those on the medical side of the field. Thanks!

I don't know of anywhere a pharmacist plays the role of a psychiatrist or even a PA/NP. If you mean that they help out with medications on primary care teams, that may happen from time to time...choose a medication with less interactions etc but thats not really playing the role of the psychiatrist.

Do you think the BCPP is on the path to becoming a valid provider in the psychiatric field, or should they stay on the path of being part of a floor/clinic team?

Please elaborate. I am not sure what you mean by provider.
Are you describing where you'd be the only person making contact..then diagnose, treat and prescribe?

 

[whopper]

Where I work, we have pharmacists available to us for consultation. I have found their expertise valuable when encountering a difficult situation such as a pregnant patient who is dangerous and haldol doesn't work, or a patient treatment resistant even to Clozaril.

While all the information they provided to me, I knew, or could've obtained on my own, they dramatically shortened the time I needed to research the area. It also allowed me and the institution to state that we decided to medicate the pregnant patient after 3 M.D.s and 3 doctoral level pharmacists reviewed the case. This gave us a layer of defense should the case have been called into question.

 

[pharm B]

I spoke to a VA BCPP, and that person made it sound like they work hand-in-hand with the psychiatrist normally, but that they had no psychiatrist at their particular clinic, so they had to do intake, etc.

They also said that normally the psychiatrist sees the patient initially, but that follow-up appointments were normally done with the BCPP.

What I mean by valid provider: an independent person that essentially fulfills the role of the psychiatrist if one isn't available.

I'm not seeking to be a doctor-lite, but I am trying to find out exactly what the role of a BCPP is now, and what it might be in the near future. I know there are several different groups of people seeking to be elevated in status, but I'm not saying PharmD's should be bumped up to the status of MD/DO.

 

[Manicsleep]

I am guessing it was with a primary care doctor.

 

[pharm B]

I'm not sure what you mean. I spoke with a psych pharmacist at the VA who was doing intake interviews, etc, in the absence of a psychiatrist.

 

[CaMD]

I'm not sure what you mean. I spoke with a psych pharmacist at the VA who was doing intake interviews, etc, in the absence of a psychiatrist.

This is not something I've seen at any of the 3 VA hospitals I've worked at.

What type of training would you have in terms of conducting interviews and making assessments? None of the pharmacists I know would feel comfortable doing that.

On an unrelated note, I LOVE pharmacists. I owe them majorly for averting lots of little and big mistakes throughout intern year.

 

[snarfer]

I'm not sure what you mean. I spoke with a psych pharmacist at the VA who was doing intake interviews, etc, in the absence of a psychiatrist.

If this is indeed true, big IF here, then your friend may lose his/her pharmacy license in the event of a bad outcome.

To be aware of pharmacokinetic/dynamic is one thing but if she/he does not know how assess EPS/TD, interview and dx pts, recognize early serotonin syndrome or NMS, interpret labs/ecgs,and/or perform AIMS; and the pts die or what not there will be lots of questions.

 

[pharm B]

I suppose that's one of the reasons I'm asking questions. I thought perhaps BCPP residencies covered some of the skills utilized by psychiatrists and that the BCPP had a significant amount of patient interaction.

I assumed that the assessments you mentioned would be part of the residency, since the pharmacist is specializing in this particular area of clinical care (psychiatry). I understand none of you went through this residency, but since so few BCPP's frequent SDN, I figured I would try to gather information from the community that works with them.

 

[pharm B]

This is not something I've seen at any of the 3 VA hospitals I've worked at.

What type of training would you have in terms of conducting interviews and making assessments? None of the pharmacists I know would feel comfortable doing that.

On an unrelated note, I LOVE pharmacists. I owe them majorly for averting lots of little and big mistakes throughout intern year.

It's entirely possible I misunderstood what this person was doing. Again, I'm trying to do research on the role of the BCPP, but there isn't much information available online that gets into the nitty gritty of what a BCPP does and can do in a clinical environment.

 

[Therapist4Chnge]

I do not believe physical assessment is a common course for a pharmacy program, though I have seen pharmacy students take a physical assessment course for additional training. I wouldn't feel comfortable giving a physical based on the course + lab, though that is one reason why I didn't choose medicine. I like my patients a comfortable distance away, thankyouverymuch!

The VA can be a bit of an odd duck because psychiatrists can often be housed in a couple of different places, depending on the facility. Our sister VA has an in-patient unit, so the psychiatrists are primarily there, and I believe they cover the ER as needed. At my VA, the psychiatrists are all out-patient, so the ER is covered by a psychologist and the attendings.

The PC staff consults with a psychologist for any behavioral health issues that come up during the appointment. The clinical pharmacist often contributes to the med management discussions in a few different departments, typically being the go-to resource for interaction issues and some of the more nitty-gritty issues. They consult with both the patient and also the staff about a range of pharma-related issues. Some cases still get referred to out-patient psychiatry if the PCP isn't comfortable with the medication management side of things, though this is pretty infrequent. Our psychiatrists are great, though they are always swamped so they tend to handle more zebras than horses.

 

[Manicsleep]

I'm not sure what you mean. I spoke with a psych pharmacist at the VA who was doing intake interviews, etc, in the absence of a psychiatrist.

What I meant was they weren't doing intakes on their own. They weren't admitting, making diagnoses, ordering labs, doing physicals etc.
They were assisting a physician of some kind.

I do not believe physical assessment is a common course for a pharmacy program, though I have seen pharmacy students take a physical assessment course for additional training. I wouldn't feel comfortable giving a physical based on the course + lab, though that is one reason why I didn't choose medicine. I like my patients a comfortable distance away, thankyouverymuch!

The VA can be a bit of an odd duck because psychiatrists can often be housed in a couple of different places, depending on the facility. Our sister VA has an in-patient unit, so the psychiatrists are primarily there, and I believe they cover the ER as needed. At my VA, the psychiatrists are all out-patient, so the ER is covered by a psychologist and the attendings.

The PC staff consults with a psychologist for any behavioral health issues that come up during the appointment. The clinical pharmacist often contributes to the med management discussions in a few different departments, typically being the go-to resource for interaction issues and some of the more nitty-gritty issues. They consult with both the patient and also the staff about a range of pharma-related issues. Some cases still get referred to out-patient psychiatry if the PCP isn't comfortable with the medication management side of things, though this is pretty infrequent. Our psychiatrists are great, though they are always swamped so they tend to handle more zebras than horses.

Having worked in a few VA systems, 2 after medical school, VAs tend not to have too much in the way of surprises. CPRS is excellent and so if there is a patient who has a psychiatric history, they have been seen by a psychiatrist. This info is readily available to any urgent care. Also, I have seen a VA have an "ER" in the true sense of the word but rather an urgent care center. People who really need to go to an ER usually go somewhere else. This predictability makes it easier for triage to be done without a psychiatrist in smaller VAs.

In that setting an internist can handle a situation if needed, sometimes with and sometimes without additional resources such as a psychologist, social worker or pharmacist. Larger "hub" VAs have inpatient units for just about everything so will have psychiatrists available.

 

[jettavr6]

Related to this topic, in the absence of a psychiatrist at a VA or Military facility, I would feel comfortable with a flight surgeon, family practitioner or EM Physician doing a provisional intake.

BTW: I love pharmacists. They have helped me on numerous occasions; I could never do my job without them.