That, dear reader, is the comic book image that springs to mind* while observing the recent collision of two of the most powerful lobby groups in the health and medical industry.
The AMA took on the Pharmacy Guild with this swift upper cut, calling for doctors to be allowed to own and operate pharmacies, but the Guild was quick to strike back, labelling the proposal “backward and dangerous”.
Meanwhile, a regular Croakey contributor, Ron Batagol, a pharmacy and drug information consultant from Victoria, has also been watching the spectacle with some incredulity. He writes:
“I thought I’d heard it all!
But the AMA’s latest suggestion of doctors co-locating and taking over the ownership of community pharmacies is the kookiest one I’ve heard in ages. After I quickly checked the date to make sure it wasn’t April 1st, I started to think about this very odd suggestion from the country’s peak Medical Group.
What I’m really fascinated by is the purported rationale for their suggestion.
Three main points seemed to come out the AMA Press Release to justify the proposal:
1. “Patient care would be integrated and patients would be seen by the right health professional, at the right time, for the right treatment and health care advice.”
2. “Incorporating pharmacy services into general practice would improve patient care by allowing GPs to lead a team of co-located health professionals, including pharmacists and general practice nurses, in providing multidisciplinary health care to patients at the local community level.”
3.“It is an arrangement that fits within the GP Primary Care Centres proposal that is outlined in the AMA’s Priority Investment Plan for Australia’s Health System.”
Now, of course, all of these are laudable aims, and leaving aside the 3rd self-justification point, the first two have been canvassed many times before in discussions of Primary Health Care initiatives at various levels.
But, why, for heaven’s sake, would you need to transfer ownership to the doctor to achieve these patient benefits? Indeed, it implies two things:
Firstly, that the only way to have doctors, pharmacists (and nurses) working collaboratively under the “same roof,” is for the doctor to hold the purse strings.
Secondly, that doctors possess some financial “medical magic’ which can provide special financial expertise, obviously hitherto unknown to experienced pharmacy proprietors who have been successfully and efficiently purchasing and dispensing medications under the PBS system for years, in a way that will result in a net saving on drug costs to the community purse.
Yet, no evidence is presented to support either of these preposterous assertions.
However all of this pales into insignificance in comparison to the ethical and professional dilemmas, to say nothing of the lack of transparency, which would flow from doctors having financial control over the prescribing as well as the dispensing aspects of the prescription supply chain.
Indeed, The Pharmacy Guild in their Press Release on this proposal stated: “To any objective observer, the idea that doctors should be able to write prescriptions and direct patients to their own pharmacy in the same premises should ring alarm bells.”
But, let’s leave aside, for a moment, the inter-professional politics about the legalities and ethics of the pharmacy ownership provisions.
As I have written previously at Croakey, if we really want to have doctors, nurses and pharmacists working collaboratively in the same health care location, this can best be achieved, by having individual pharmacists, who are accredited Medicare accredited providers, working in clinical and advisory roles within a dedicated community care location such as the “super-clinic” type of concept which is beginning to roll-out, albeit slowly, at various levels.
This concept has gained support from some, but, unfortunately, not all, peak pharmacy organisations.”
• NB In case this needs spelling out, Croakey is not meaning to imply that either the AMA or the Guild are superheroes fighting to save the helpless patients…
Holy professional turf wars, Batman!
Talk about giving the drunk the keys to the brewery. The AMA is already in bed so far with the drug companies, why not give them control of dispensing them too and eventually they can kill us all with their poisons. The “Sickness Industry” takes another step fwd in controlling all our lives.. not me.
Of course there is no ethical and professional dilemmas in pharmacists recommending and selling lots of unneeded vitamins, OTC medications etc. Perhaps we should separate out the pharmacy professional services from the retail services. I also note that there are pharmacists that own medical practices – no issues here???.
Steve
I think the comment by the AMA was a little tongue in cheek and designed to highlight the inherent flaws in the Pharmacy Guild’s recent statement (only a few weeks ago) that pharmacists are the “experts in medications” and should be allowed to prescibe. In reality, any concerns about conflicts of interest raised by the concept of doctors dispensing could equivalently be applied to pharmacists prescribing; there are some very good reasons for a professional separation of these tasks. By pressuring the Pharmacy Guild to make strong statements against conflict of interest for prescribers to also dispense, it weakens the pharmacists’ claim that it is appropriate for them to also prescribe medication.
“To any objective observer, the idea that doctors should be able to write prescriptions and direct patients to their own pharmacy in the same premises should ring alarm bells.”
Oh come now . . . . spare me the hypocrisy.
If they truly believe this, why is the Pharmacy Guild pushing for pharmacists to be allowed to prescribe?
Doctors are allowed to dispense any medication. Some States forbid doctors charging for medications, but the real issue is the PBS won’t rebate a doctor’s dispensing, except in some very isolated towns too small to support a pharmacist.