|Member Profile - Linda Smith|
Linda M. Smith, RPh, CGP
Independent Consultant Pharmacist
This is one in an occasional series of member profiles. All pharmacists were asked to provide answers to several questions. This was originally published in the January, 2015 issue of The Consultant Pharmacist.
Tell us about yourself and your business/ practice.
I graduated in 1969 from Bucknell University, Lewisburg, Pennsylvania, with a BS in chemistry, and I worked for Pfizer Pharmaceuticals as a research chemist for four years. In 1977, I graduated from the University of Connecticut School of Pharmacy, in Storrs, with a BS degree in pharmacy. I have been a registered pharmacist for 37 years and have worked in hospital, retail, institutional, home infusion, and health maintenance organization pharmacies before starting my own business in 2003.
How difficult was it to start your own consulting practice?
The first job I ever got as a consultant was completely unexpected. In December 2002, I was invited to a Christmas party at the Center for Business and Training in Hagerstown, Maryland, where I was opening an office. There I met a group of people who were working for a marketing group that had been retained by Allegany County, Maryland, to look into setting up an insurance program for the working uninsured in that county. They had a nurse and a government executive who had worked in health care, but they realized they needed a pharmacist to research the feasibility of including prescription drug coverage in the plan. They held focus groups and, of course, everyone involved, including physicians, hospitals, citizens, and local businesses, said that they may as well not have the program unless there was prescription coverage. They approached me about doing this, and I studied national drug cost data as well as information from the local free clinic, and concluded that it was feasible. The plan was eventually adopted and is operational today.
After that I did consulting for a hospital’s extendedcare unit as well as in nursing facilities, assisted living facilities, and facilities for the developmentally disabled. I also developed a medication management services program that I offered to companies and individuals. I worked with the P3 program (Patients, Pharmacists, Partnerships) in Maryland, in an employer-funded, health education and management program. I met with diabetic and cardiovascular employees of the Western Maryland Health System in Cumberland, and a local company on a month to every-three-month basis for consulting services, depending on need. We talked about medications, but also stressed diet, exercise, immunizations, eye examinations, foot exams, and other health and wellness activities.
I also worked with one of the original national medication therapy management (MTM) companies, PharmMD, and I provided MTM to about 250 mostly elderly individuals by telephone across the country. I have individual, one-time clients and some who have been with me for years. I also have taught in the pharmacy technician program as well as allied health sciences at local community colleges, and have recently started doing inspections of surgical facilities. I have provided in-services for nurses and other health care practitioners on home infusion, psychotropic medications, and fall prevention, as well as giving talks at pharmacy conferences and community meetings on medication reconciliation and error reduction.
I believe my practice is unique only in that I have done so many different things as a pharmacy consultant. I started when I had more than 25 years experience as a pharmacist, and I was hoping to develop a practice that I could continue to do as long as I am able. I do not want to retire.
The highlights of my independent consulting business have been the times I have felt that I really made a difference in the lives of my clients, which happens most of the time. I have established relationships with other health care practitioners and have been successful in getting clients off medications that were causing drug interactions or that were inappropriate or unnecessary because of their age or comorbid conditions. I have also become more familiar with over-the-counter products and supplements and the increasing role that they play in medical care in individuals who try to take control of their own health. Individuals feel that these products are natural or not that strong, so they don’t consider how they interact with other medications they are taking. Teaching and advising individuals about this has been very rewarding. I use the Pharmacists Letter Natural Medicine Comprehensive Database, which has a wide breadth of information available to practitioners.
What have the highlights and challenges been over the years?
The most significant challenge I have faced is getting proper reimbursement for my services. First of all, people think of pharmacists as people who dispense medicines in community pharmacies. Some people don’t even realize that there are pharmacists in hospitals. Pharmacists have been giving away their knowledge and advice for so long that people hesitate to pay someone for those services. We have only been paid for the medications we dispense and whatever ancillary business costs we incur. There is a very steep learning curve that we have to overcome for people to recognize pharmacists as medical providers. Even companies that I have worked for who hire pharmacists for MTM services or as consultants don’t want to pay what it really costs to do the job properly and have wanted me to cut corners, which I have refused to do. Contracts come and contracts go. It is hard to know what my monthly income will be. That is why one of my priorities as president of the Maryland ASCP chapter was to work on state and federal initiatives on provider status, which would recognize pharmacists as health care providers and allow federal reimbursement under Medicare.
The other challenge that I have faced as a one-person operation is that in 2007 and again in 2012 I had to stop working altogether for about six months as I recovered from hip replacement surgeries. Fortunately both have been successful and I am very active again.
What advice can you offer other consultant and senior care pharmacists?
My advice is to always think of yourself as providing a service to individuals, to be completely ethical in what you do, for example, when asked to do more reviews than is possible without sacrificing quality. It is not an easy road that I have taken, but it is extremely rewarding. You must be willing to think outside of the box, be flexible, and enjoy new challenges. For those who want to work in geriatrics, I would recommend becoming a certified geriatric pharmacist. I also recommend becoming certified in as many different areas of health care as you can. I have certifications in pharmaceutical care for patients with diabetes, lipid management, and MTM services. I can never stress enough the importance of involvement in pharmacy and pharmacy organizations. Stay informed about what is happening clinically as well as politically in your profession.
My hopes for the future of my business and for pharmacy in general is a paradigm shift where pharmacists are recognized for the vital role they play as part of the health care team.
Consult Pharm 2015;30:10-11. c 2015 American Society of Consultant Pharmacists, Inc. All rights reserved. Doi:10.4140/TCP.n.2015.10.