Career Manager By Bethany Murphy, PharmD, BCACP
Six months after finishing my residency, my co-worker and I were given the task of establishing clinical pharmacy services within an outpatient, private physician practice—a charge that is given to many New Practitioners following a residency experience. At that time, we struggled with where to begin the process and how to encourage the physicians to be on board with our new services. The following ideas served us well during our first year of building and establishing our presence within the practice.
Keep your options open
When we initially met with the group of physicians to discuss possible pharmacy services we could provide, we kept our options as open as possible. It would have been very easy to tell the physicians that we would start by offering one service, such as a diabetes clinic or anticoagulation clinic, and grow from there. However, we decided to approach the physicians in a different manner and provide as many examples as possible of ways that we could be of assistance to them. This allowed each individual physician to use us in the way that would be most beneficial to him or her.
One physician who is very comfortable with diabetes management may have never used us if that service was all we offered; instead he regularly uses our services for medication reviews and smoking cessation appointments. By keeping our options open, we received referrals from a greater number of the physicians and are helping each of them in a way that benefits them the most.
Remind the physicians of how you can help them
When we initially began offering our services, we had several physicians make comments along the lines of, “I really want to take advantage of what you’re offering, but I just have a hard time remembering to send patients your way.” In order to remind physicians about our newly established presence in our early days at the clinic, we implemented a process of identifying patients who might benefit from meeting with the pharmacy team.
We spent time each Monday looking over the charts of patients who had appointments during the upcoming week. For each physician, we selected 10 to 15 patients that they would be seeing during the week who we thought might benefit from our services, whether it be for management of diabetes or another chronic disease, for smoking cessation, or for a medication review. We then typed a letter to each physician, listed the patients we identified, and noted what concern we thought we might be able to assist with. This served to not only remind them of the variety of services that we can provide as pharmacists, but it also highlighted specific patients during the course of the week that they might want to refer to us.
Although this task was laborious at first, it served to greatly increase the number of patient referrals and quickly became unnecessary as physicians became familiar with using our services.
Always let the physicians know you want to work with them
One of the difficult parts of beginning pharmacy services is ensuring that the physicians understand that pharmacists are trying to assist and augment what the physicians are already doing, versus trying to encroach on physician territory or take away patients from the physician. The best way to build this level of trust with the providers is through communication with them.
Be careful about how things are said and always make sure they know that you are on their side and trying to help them out. With each referred patient, it goes a long way to thank the physician for allowing the pharmacist to assist with the patient’s care and to encourage the physician to not hesitate to ask about any other ways that the pharmacist can help the physician and make his or her job easier.
Build trust in your services by showing what you have done
The best way to build trust in the services you have established is to show the value of those services. Always, always, always keep track of what you are doing with your services! We tracked every single appointment and all clinical results for the patients that were referred to us; this has allowed us to show the physicians not only how many patients we have seen and for what types of concerns, but also the impact that we have had on patient care.
We recently met with the physicians to discuss results from the first year of our diabetes services alone. By placing actual values on improvements in A1c, lipid parameters, weight, and blood pressure, the physicians were clearly able to see evidence of the ways in which our team has been able to assist the physicians in improving patient care. Following this presentation of results, we have seen an additional increase in physician referrals because physicians now know what we are capable of and better understand the value of our services.
These are many ways to engage physicians to ensure that pharmacists are used to their greatest potential in the outpatient clinic setting and create a growing, effective clinical pharmacy practice.