Friday, July 30, 2010

The End of Five Weeks

Today marks the end of my 5-week stint here at MPhA.  Reflecting back upon my impressions coming into this rotation, I find that I have gained so much more knowledge and experience than I ever anticipated.  The breadth of opportunities during these 5 weeks has unquestionably enhanced my pharmacy school experience and has opened my eyes to career options that I previously hadn’t considered.  And the learning has continued to the very end, with several new and valuable experiences from this week.

After last week’s whirlwind traveling pharmacy tours, this week has been much more settled.  My time in the office was spent reflecting upon last week’s visits, reading and analyzing model MTM legislation, learning about federal drug disposal legislation, and reviewing a Patient-Centered Primary Care Collaborative document about the importance of comprehensive medication management in medical home models.  On Wednesday, Mark and I were able to meet with a pharmacist who is planning to open an independent pharmacy.  And today, Julie, Mark and I met with two representatives from Merck to discuss issues relating to pharmacy, such as pharmacy’s place in the medical home model, issues with e-prescribing, and how to better enable pharmacists to immunize patients.

The meeting with Merck, model MTM legislation, and PCPCC document all illustrated the valuable role that pharmacists have to play in the management of chronic conditions.  In this era of health care reform, some pharmacists are concerned that pharmacy will somehow be left out of the new medical home models.  This concern is legitimate given that pharmacists are continually striving to demonstrate how we can further enhance health care.  However, the information I came across shows that many other health care providers and legislators are beginning to realize that health care change cannot succeed without the integral contributions of pharmacists.  It seems that as long as pharmacists keep up with the issues and keep talking to legislators and other providers, there is no question that pharmacy will play a big role in bettering the health care system.

Throughout this rotation, I have been exposed to many aspects of independent pharmacy ownership.  I have seen and heard about many of the challenges that owners are being faced with.  These challenges made me question whether it is feasible to open a new pharmacy now.  Wednesday’s meeting with an entrepreneurial pharmacist was eye-opening because it demonstrated that with enough preparation and a solid business plan, opening a pharmacy today is not only feasible, but can be very profitable.  This meeting made me realize that as long as you have a niche and have a plan for making the most of that niche, it is still very possible to start an independent pharmacy, even in the metro area.  That being said, such an endeavor requires a certain personality and certain talents that not all pharmacists possess.

Overall, this rotation has been a fantastic way to start my fourth year of pharmacy school.  The experiences I have had with MPhA broadened my horizons in ways that the rest of the curriculum cannot.  This rotation has taught me to see how different aspects of pharmacy are interconnected with one another and with health care in general, and I believe this insight can only help me make the most of my remaining rotations.  Thanks to Julie and the rest of the MPhA staff for a great 5 weeks!

Reflections

Well it’s my last day here at MPhA and it is time to reflect on my time spent here.  Overall, this rotation has been a lot different than what I was expecting.  It was a learning experience for everyone, including Julie (our preceptor).  She had not had any students come during this part of the year (July) until Laura and I joined her.  Normally the students are heavily involved in the legislative work that MPhA does to keep pharmacy safe and informed, however there was not a session during our five weeks… so we had to freelance a little bit!  Like I’ve talked about in my previous blogs, Julie decided to focus our efforts on community pharmacy and specifically on independent practice/ownership.

I have learned so much about independent practice and ownership over these past five weeks.  I don’t even know where to begin.  The biggest thing for me was to clear up some misconceptions I had about owning and managing a pharmacy.  Until now I always thought independent pharmacies had no chance against the large chains simply due to the size difference.  I would always hear about the small independent pharmacist who would go out of business when the chain pharmacy showed up in town… come to find out, that is not always the case.  It just becomes a game of niches.  As long as a pharmacy has a niche, either a service or population, it can survive.  Laura and I spoke with a pharmacist who has been doing some research on opening up an independent pharmacy, and some of the information shared was astonishing!  For example, did you know a one-pharmacist store can survive by filling about 100 prescriptions per day?  I was very encouraged by this, because it put a number in front of me that made sense and seemed plausible.  Along with other things that we talked about, the conversation really gave me assurance that independent pharmacy can survive as long as the owner stays on top of their niche.

We spent some time this week talking about some of the financial business of the association.  Although it may not sound like the most intriguing conversation, it was definitely necessary to hear.  It gave me a good lesson in budgeting.  I learned a little bit more about some of the things Julie (as Executive Vice President) has to be cognizant of while leading the association.  Every business has to keep in mind that if they can’t pay the bills, they can’t help the people they serve.  But possibly just as important are the relationships Julie and MPhA have to keep strong in order to keep the wheels of the association spinning.  The Executive Vice President has an obligation to keep strong bonds with all of MPhA’s partners and sponsors.  It may sound like a lot of work but it can also be very rewarding.  I was so impressed with the network of people around Julie, and I was so impressed with how well we were received around the state.  To put it in perspective… We called ahead to maybe half of the 10 or 11 pharmacies that we visited during this rotation, and each owner/pharmacist gave us almost an hour of their time to explain independent pharmacy.  Many of us know how busy a pharmacy can get, and here were the owners giving a significant chunk of their day to two students they did not even know!  I think that is a testament to the hard work Julie and MPhA do to keep their relationships strong throughout the state.

All in all, this rotation was not what I expected but it was a welcome difference.  I learned a lot and it gave me a wonderful opportunity to explore areas of pharmacies that I didn’t learn about at the college.  One piece of advice for future students… Keep an open mind.  This rotation will probably not be as structured as you are used to or expect, but you will also see things that you never expected… and it’s fun! 

This was my first shot at blogging and I hope it was at least OK to read… Thank you to those who did!

Monday, July 26, 2010

Rural Pharmacy

This week at MPhA was interesting to say the least!  We decided to expand our focus of independent community pharmacy out of the Twin Cities Metro area and into the rural setting.  This was a welcome change for me because I have not experienced rural pharmacy in any capacity in the past.  So I had a lot to learn…

We started off the week on a 2 day road trip to southwest Minnesota.  The group was myself, Julie, Laura, and the director of pharmacy for Astrup Drug Tim Gallagher.  Astrup is what you could consider an “independent chain” of pharmacies.  They consist of 10 pharmacies spread across the state, with the majority south of the metro area.  Our trip entailed visiting 4 different pharmacies in Fairmont, Worthington, and Adrian, the latter being a “telepharmacy.”  Our first stop was in the little town of Adrian, population 1234.  Adrian had recently lost their community pharmacy, but due to a variance by the Board of Pharmacy and a big leap by the leaders of Astrup, the town now has their pharmacy back… a telepharmacy.  This telepharmacy was really cool.  It was staffed with just one technician, Karen.  The way it worked is that Karen would do everything to prepare the prescription and then have a pharmacist in Worthington (about 20 miles away) verify the prescription via a computer connection.  The pharmacist would also be available to patients for counseling.  It was a lot like a web-cam where the patient and pharmacist could see each other and talk in realtime!  It was a great set up and the town seemed to LOVE having their pharmacy back.

That night we went out to dinner in the tiny town of Fulda, population 1196.  One of the pharmacists from Worthington joined us, his name was Bryan.  It was interesting to get his perspective about the telepharmacy, and by all accounts it has been running smoothly.  Laura and I also noticed something that we have only heard about in school.  Bryan was an integral part of the community.  He must have had 5 different people/patients come up to him to talk during dinner, just because they knew him as their pharmacist.  The kicker was that Fulda in a good 18 miles away from Worthington, and people STILL recognized Bryan!  To put it in perspective, that distance is about the same as leaving the college of pharmacy in Minneapolis and heading due west until you reach Long Lake (past Wayzata)!  That is the kind of impact a community pharmacy can have in a small town. 

The next day we visited Worthington and Fairmont, and visited 3 more independent community pharmacies and learned about all the services they provide, along with some of their struggles.  Overall, the road trip gave me great prospective about a subject that is lacking in the college of pharmacy curriculum.

Thursday was another day of travel, this time to Comfrey, population 344.  You want to talk about small town livin’… This was small town livin’.  We met up with Jim Schneider who had owned Schneider Drug in town for many years until he had to retire.  The next owner worked many years after Jim, but decided to close down.  This left yet another small community without a pharmacy.  Jim is on a mission to get the pharmacy back up and running again.  He is reaching out to anyone and everyone who would be willing to move to Comfrey and restart a once prosperous business.  I must say, Comfrey was unlike anything I had seen in my life.  A small community all within relatively close quarters, but you could tell everyone who lived there was invested in their town.  There was a definite pride that radiated from the residents.  The town was clean, well kept, friendly, and welcoming!  Talking with Jim was interesting and yet a little heartbreaking.  Here is a guy who put his life’s work into this town in the pharmacy, only to see it close down with little hope of reopening and carrying on the legacy.  Anyone who is interested in small-town community pharmacy should contact Julie Johnson (julie@mpha.org) at MPhA, and she can connect you with Jim about this wonderful opportunity!

Well, one more week to go here at MPhA.  On tap for next week is some talk about starting an independent pharmacy from scratch, as well as some financial information about the association.

Friday, July 23, 2010

A Glimpse of Rural Pharmacy Practice

Wow, what a week it’s been!  Our days have been filled with travel and meetings all over southern Minnesota.  Monday and Tuesday were spent in Worthington, Adrian, and Fairmont touring Sterling Drug stores and the towns.  Thursday brought us to Comfrey to speak with Jim Schneider about the recent closure of Schneider Drug.  This week provided an informative glimpse into rural pharmacy, which I had never seen before.

Perhaps one of my more surprising revelations was that these towns in rural Minnesota are not as small as people from the Cities might think.  Worthington and Fairmont both have populations of 10,000-12,000 and boast large towns with a variety of services and opportunities.  Even Adrian, with a population of 1200, had a beautiful golf course and new assisted living facilities.  These towns do not seem as “rural” as I had expected.  Comfrey fit my expectations a bit more, but I was shocked to see how beautiful the buildings and homes are, since everything was rebuilt after the 1998 tornado.

Along the lines of pharmacy, I again had a few surprising revelations.  After visiting several independent pharmacies in the metro area and hearing about the challenges they face, I had assumed that most rural pharmacies had the same problems.  And I also assumed that rural pharmacies would have problems finding enough patients to sustain the business.  But after visiting southern Minnesota, it seems that rural independent pharmacies are generally thriving.  One of the largest factors causing their closure is not slow business, but finding a new pharmacist to replace the retiring owner.  Rural pharmacies are able to thrive for a few reasons.  There are fewer chain pharmacies as competition, and while there is certainly competition between the several independent pharmacies in the community, pharmacies are able to find their niche and somehow everyone can survive. These rural pharmacies offer countless services that enhance their business, from large DME sections to diabetic shoe fittings to MTM visits.  For some pharmacies, their niche includes a large gift section.  I was surprised at how important these gift sections are to the communities, because many times they don’t have other local options when searching for items like home decorations, for instance. 

Another interesting find regarding rural pharmacy is that pharmacists in these communities are really recognized as health professionals.  Pharmacists are trusted and respected, and communities seem to truly understand and appreciate the services that pharmacists offer.  Pharmacists also generally are very involved in other aspects of the town, whether it is the economic development association or running for the school board.  Rural communities view their pharmacies and pharmacists in a much different light than anything I’ve ever experienced here in the metro area.

Lastly, I should mention the unique and exciting setup that Sterling Drug has started in the cities of Adrian and Worthington.  Adrian lost its pharmacy a couple years ago and they were not able to recruit a new pharmacist to take over the store.  Sterling Drug recognized this opportunity and put a telepharmacy in place about a year ago.  Karen, the lone tech at the Adrian location, fills prescriptions and takes pictures of the process.  These pictures are electronically sent to the pharmacists at the Worthington store, who then perform quality assurance checks and verify the accuracy of the prescription.  When a patient arrives in Adrian to pick up medications, Karen again calls the Worthington pharmacist and a patient-pharmacist consultation takes place over video and telephone.  Only a small handful of telepharmacies exist in Minnesota, but I’d guess that their number will rise over the next few years as aging rural pharmacists close up shop.  Telepharmacy is a fantastic way to serve communities that otherwise would have to travel to meet their pharmacy needs.

I went into this week with an open mind and some excitement, and I can safely say that I am now strongly considering rural pharmacy as a career path.  I am so very thankful to have had this opportunity.  I really wish that somehow all Minnesota pharmacy students had the chance to see firsthand the great opportunities that rural pharmacy practice can offer!

Monday, July 19, 2010

The Many Directions of MPhA

The end of week 3 is here and it’s time to reflect and keep everyone updated on our progress.  Laura and I have had an interesting week.  One of the things I have noticed about being in a position like Julie’s is that her job can take her in countless directions everyday.  I remember feeling the same way on my community IPPE rotation due to the wide variety of patients I would see.  However, this is different… much different.  On Monday alone we had a staff meeting at the MPhA offices, a nationwide conference call with NCPA, and finished the day with a fundraising event for Rep. Paul Thissen of district 63A.  And that was all in one day! 

My favorite part of Monday day was the fundraiser event for Rep. Thissen.  He has been a very important legislator for MPhA to work with over the years, and it was very important for us to be there to show our support.  I also dispelled a misconception that I have had for a long time while at this fundraiser.  I have always thought of lobbyists as a rather dishonest, immoral group of people.  Part of the reason for this is probably all the bad press lobbyists seem to get because of a few bad apples.  Basically what I learned is that lobbyists are simply advocates for a cause.  They are paid by organizations to present the message of that organization in a way that legislators can understand.  And from my experience I found that they are NOT affiliated across party lines.  They are simply trying to convey a message to anyone who will listen.  Lobbyists generally know that members of the House and Senate very well, and in turn, most senators and representatives know many lobbyists.  Therefore, their credibility is essential!  If a lobbyist is not trusted, there is a slim chance that any legislator will listen to them.

The rest of the week Laura and I teamed up to visit a few more independent pharmacies and we also had a meeting with the marketing firm that AWARxE uses.  We visited three independent pharmacies in the west metro called Center Drug.  These three are owned by two partners named Josh Lemm and Chris Beckman.  It was awesome meeting them and talking about their operations.  They serve vastly different communities at each of their stores, and provide a wide range of services.  They have full time delivery persons that make over 90 deliveries per day, they service nursing homes, and they run two separate software systems out of their Hopkins location.  Above all this, Josh and Chris were extremely personable and more than willing to take time to talk with Laura and me about independent pharmacy.  They had a great atmosphere of ‘helping people at any cost,’ and I can see why their patients feel at home each time they enter the store.  Check out Center Drug at www.centerdrug.com

Finally, our meeting with the AWARxE marketing firm (called Mark it!) went great!  We discussed continuing education ideas surrounding the AWARxE campaign, and got the ball rolling on both sides.
Now I’m looking forward to next week when we will be taking road trip to Worthington, MN to see some rural independent pharmacies and to see telepharmacy in action.

Thursday, July 15, 2010

Week Three

The conclusion of week 3 is fast approaching, and this week’s schedule was again filled with varied experiences.  Monday started off with an MPhA staff meeting where the main topic of discussion was reflection regarding the recent Annual Meeting.  Staff discussed the venue, logistical concerns, and some feedback from attendees in an effort to identify opportunities for improvement.  I know that when I attend meetings, I don’t always take the time to write comments or fill out surveys.  But I can tell you from firsthand experience that your input is appreciated, valued, and taken into consideration!

Mark and I listened in on a conference call with the National Community Pharmacists Association.  NCPA leadership discussed important national bills that would affect community pharmacy practice, and urged pharmacists from various states to contact their legislators about these issues.  Prior to this experience, I was not aware that pharmacy organizations from all 50 states came together regularly to discuss important issues.  I was pleasantly surprised to hear that these organizations share information and have a genuine interest in helping one another to improve pharmacy nationally.

We ended Monday by attending a fundraiser for Rep. Paul Thissen of district 63A.  Thissen has been a longtime friend of pharmacy and really seems to understand pharmacy issues and how legislation around pharmacy can have very broad impacts on businesses, individuals, and health care.  Meeting with Thissen also impressed upon me how it really isn’t intimidating to meet with elected officials.  I think many students, pharmacists, and individuals can feel intimidated by the office, but it’s important to realize that without constituents like us, these “regular people” would never be elected.

The rest of the week, Mark and I visited 3 more independent pharmacies, met with marketing executives to discuss using CEs as a method to get the AWARxE word out, sat in on a technician academy meeting, and researched some of the issues surrounding the use of antibiotics in livestock.  As you can see, our plates have been full with many different issues and opportunities.  I continue to be grateful for all these different experiences, and I’m really looking forward to learning more about rural pharmacy next week. 

Friday, July 9, 2010

Welcome Resident Nickell!

Hello everyone!  My name is Mark Nickell and I am a fourth year pharmacy student from the University of Minnesota.  Much like the other students who have done a rotation with MPhA, I will give you all a brief introduction about me and share some of my excitement about being here with MPhA for this rotation.  I was born and raised in Eagan, MN from a family of seven children!  After graduating high school I attended undergraduate school at the University of MN-Duluth.  I majored in biology with a minor in chemistry, and this led me to pharmacy school at the U of M Twin Cities.  While on campus I was heavily involved in multiple organizations, including MPhA.  This past year I served as the student representative on the MPhA board of directors, where I got a glimpse into the inter-workings of a state association.  It was a great experience!

Now that my stint on the board is finished I am lucky enough to begin my rotations in a familiar place with MPhA.  Plus, I’m here with a fellow classmate, Laura Grube.  So we are learning together!  I look forward to learning more about the legislative process and how MPhA works to serve Minnesota pharmacists.  Although the state legislature is not currently in session, there is very important election coming up on August 10th which will most likely bring large changes around the capitol.  This will be an opportunity for us to put our best foot forward with the candidates who endorse the wonderful work our Minnesota pharmacists do on a daily basis.

With the legislature not currently in session, it gives us an opportunity to put a different focus on the rotation than previous students have experienced.  Over the past week, and in the weeks to come, we will be putting an emphasis on independent community pharmacies.  This is a very important area of practice, which is experiencing some difficult times.  Independent owners often look to the association for help and support, and we got an opportunity to meet three different independent pharmacists earlier this week.

I’d like to share a couple thoughts about our meetings.  First of all, I have never been to an independent pharmacy or seen how they are different from other pharmacies, so this was a unique experience for me.  I was surprised to see the location of some of the stores.  One, in particular, was literally right next to a big chain store.  And the independent STILL did well.  My perception before seeing and talking with this owner was that when new pharmacies open up near independents, the independents suffer greatly.  This is not always the case, and I wondered why?  We soon found out that it was because of the wonderful services an independent can offer that a chain store does not always have the capability to offer.  It was very encouraging!

My other thought I’d like to share is in regards to a question posed by my preceptor, Julie Johnson.  She wanted to know what I would tell someone outside of the pharmacy world about my experience with independent pharmacies.  In the limited experience I have, I would tell people to take a good look at the pharmacy they use and ask themselves if that pharmacy is truly meeting their needs.  If it is not, DON’T settle!  There are many different pharmacies with many different business models.  Take a look around, and don’t be afraid to check out an independently owned pharmacy on your way!  Independent pharmacists take a lot of pride in the relationships they build with their patients.  If you’ve never checked one out… give it a shot!

If you’re interested in, or looking for a pharmacy in your area, try this link from the MPhA website.

https://m360.mpha.org/frontend/search.aspx?cs=213

Welcome Resident Grube!

Hello readers – My name is Laura Grube and I am a fourth-year pharmacy student at the University of Minnesota.  I’m here with the Minnesota Pharmacists Association for my first five-week rotation.  I grew up in Plymouth, MN and am the first in my family to enter a health care field.  I completed my undergraduate studies at the College of Saint Benedict in St. Joseph, MN with a four-month stint at Bunkyo Gakuin University in Tokyo, Japan.  I earned a BA in Biology with a minor in Asian Studies.  After completing my Pharm.D., I am interested in community management or pharmacy benefits management.  I plan to complete a part-time MBA program locally within the next few years.

I have completed two weeks with MPhA so far, and it has been a unique experience.  Because the legislature is not in session, I have been spending a lot of time getting to know the inner workings of MPhA.  This knowledge is invaluable, because prior to this I did not have a firm grasp on what MPhA really does or what they have to offer.

I have already experienced a variety of things and learned that many pharmacists value MPhA.  Julie Johnson, Mark Nickell (a fellow rotation student) and I visited Blomberg Pharmacy, Setzer Pharmacy, and the Medicine Chest over the course of an afternoon.  Seeing these independent pharmacies was eye-opening, as we discussed the benefits and challenges of owning your own pharmacy.  Owners feel a sense of pride in their work and their relationships with customers, but also have to deal with difficult business issues like decreasing reimbursement rates.

I have also participated in a few meetings regarding the Minnesota Pharmacists Foundation’s AWARxE.  I learned about the background of the program, the current initiatives within the program, and plans to expand the program and gain much more visibility.  AWARxE brings to light the important and somewhat shocking fact that misuse and abuse of prescription drugs is now a much greater problem than use of illicit drugs.  I think many people, pharmacist or otherwise, aren’t fully aware of this growing problem.  Hopefully, AWARxE will succeed in its mission to inform and educate both health professionals and the public.

Also this week, I was able to sit in on a meeting between some members of MPhA and the Iowa Pharmacists Association.  The sharing of information and ideas between the groups was inspiring.  It’s exciting to see first-hand what these professionals are working on in an effort to change pharmacy and health care for the better.  I’m really looking forward to reflecting on that meeting more and contributing my viewpoint as a student nearing graduation.

Overall these first two weeks have offered a variety of experiences.  I’m thankful that I was assigned this rotation, because it gives me some opportunities that I wouldn’t have throughout the rest of the pharmacy curriculum.  Thanks for reading and I’ll update you with more next week!