‘The ’80s are calling Dr Zappala.’


Pharmacists are unimpressed with the latest pot shot from GPs, in which they were called “usurpers”

Earlier this week, AMA vice-president Dr Chris Zappala wrote in Australian Medicine that he felt that “collaboration” was a euphemism for role substitution and that pharmacists are “straying dangerously” into medical territory.

He wrote that this push was “conceivably a strategy of self-defined job redefinition in order to improve market share and profit, given how aggressive the pharmacy retail market has become”.

Pharmacists have a conflict of interest when offering medical advice, he said, claiming that they have a “perverse profit incentive”.

The pharmacy profession took to social media to express its displeasure.

“This article does very little beyond demonstrating the author’s clear lack of understanding of the nature of conflict of interest, the scope of practice of non-medical health care practitioners, and the capacity to respectfully discuss an issue without relying on hearsay, claims without evidence, or even wild accusations,” wrote Jarrod McMaugh, on the original piece in AusMed.

“The 80s are calling Dr Zappala—they want their tired, unproven, hysterical arguments back.”

Mr McMaugh also discussed the opinion piece here at the AJP.

“Pharmacists aren’t expanding scope; pharmacists are meeting scope as demonstrated by international evidence,” he wrote.

“The motivation for doing so is professional satisfaction, workforce utilisation, and improved outcomes for the health of the people we serve.”

Dr Zappala’s article comes from a place of “insecurity” and “fear,” he wrote.

Other high-profile pharmacists posted their thoughts on Facebook and Twitter.

Pharmacists expressed agreement – “the amount of ‘gap payments’ I’ve had to make recently, they’ve got a hide!” wrote one – as well as concern about Dr Zappala’s call to integrate pharmacists into GP practices.

“So we can march to the beat of their drum,” wrote one.

“When are those pharmacists pushing for pharmacists in GP practices going to realise it is just a con for the AMA to control pharmacists?” wrote another. “Naivety at its best!”

On AJP, PharmOwner wrote that there was value in having a “clear demarcation” between prescribers and dispensers; and that “doctors make more profits when they refuse to authorise repeats so patients have to present to their GP more often than necessary just so the doctor can claim another medicare consultation for prescribing a repeat script”.

And Karalyn Huxhagen wrote that “this is not a war about profit, this is a battle to maximise patient health outcomes using available and appropriate workforce”.

“GPs who do work collaboratively with pharmacists in the true sense of the word gain as much value from our expertise as they possibly can,” she said.

“In my role the GP practice and the GP has me on speed dial and I answer the questions while the patient is in front of GP. The GP folllows up with whatever recommendation is then needed.”

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21 Comments

  1. Karl Landers
    13/10/2018

    Dr Zappala writes that if doctors dispensed medications, only covering the cost of the dispensing, “there would be less cost to the patient and system, and no perverse profit incentive as exists for the pharmacist”. Well there it is in a nut shel!! Dr Zappala wants to be a pharmacist via his medical degree!!

  2. Dr Phil 42
    13/10/2018

    Karl – I think you are making Dr Zs argument for him. If I need pharmacy qualifications to dispense medicine then surely a pharmacist needs medical qualifications (degrees, internships as a minimum) to prescribe them.

    • Jarrod McMaugh
      13/10/2018

      Dr Zapalla doesn’t make an argument.

      What he has done is grab a bunch of tough sounding sound bites that have been around for decades & produced a political opinion that defeats it’s own purpose.

      You say that Karl makes Dr Zappala’s argument without realising that Dr Zappala’s defeats his own “argument” by hypocritically calling for change on two fronts that oppose each other.

      There is clearly no substance to this – it is political grandstanding similar to “make America great again”

      • Dr Phil 42
        13/10/2018

        Okay then answer me this – given the assumption that a doctor is not qualified to dispense medications – then why is a pharmacist qualified to prescribe a medication?
        And when you talk about OTC medications then remember there are times a doctor prescribes and dispenses (eg doctors bag, heck even the government subsidies it, and when I worked rural/remote I was dispensing meds on the pbs with the governments blessing)

        • Jarrod McMaugh
          13/10/2018

          Medication in a dr bag is dispensed by a pharmacist. It is administered by a doctor

          When you were dispensing in a remote area, what did you have to do to be approved?

          • Dr Phil 42
            13/10/2018

            Medicines in a doctors bag does not have to be dispensed by a pharmacist – including government subsidised meds. Indeed I can buy them direct from the wholesalers.

            As for prescribing I will do a Jarrod and refer you to the S100 legislation (and the HSD state and federal legislation but you should come across this when you look up S100)

          • Dr Phil 42
            13/10/2018

            Anyway getting back to my main issue – if a pharmacist can prescribe without a medical degree and internship, why can’t a doctor dispense without a pharmacy degree?
            Or don’t you want to answer this question?

        • Free pharmacist
          14/10/2018

          Who said doctors are trained to prescribe? Doctors are trained to diagnose and surgically intervene with human species, pharmacist are the only healthcare professionals who is fully trained and educated about medications from the early beginning as a small molecule till formed in a formula and then taken and metabolised by the human body along with their roles, interactions, bioavailability and a lot more, we don’t want to diagnose and do a doctor role but on the same level, doctors shouldn’t prescribe drugs they are not fully educated or trained about.

          • Dr Phil 42
            14/10/2018

            /Facepalm

          • Free pharmacist
            14/10/2018

            Convincing, I think all doctors should be examined for drugs ingredients, their interaction and metabolism because recently I had many gps who are not fully aware of such things. Just a fair question, did you actually study those topics in details in your medicine college? And if not, do you think fairly that makes you the decision maker in what medications should patients have
            Believe me drug interactions and metabolism is a serious matter and not a joke as serious as diagnosis

          • Dr Phil 42
            14/10/2018

            And if you can have many gps not aware of such things then I can offer you as many pharmacists who blindly follow doctors or who offer such delights as homeopathy and have little or no idea what something like ZSC is or or or …

            In medicine there are specialists called clinical pharmacologists (also sometimes called toxicologists) and they actually have a significant input into undergraduate medicine. (If I sound patronising because you have heard of them I apologise otherwise go check out a medical syllabus sometime)

            I think that pharmacists make just as many serious mistakes as doctors. I remember receiving 100x100mg trimethoprim instead of allopurinol – wtf would I need 100 trimethoprim (it’s not even a multiple of pack size).

            (Jarrod, yes I know we all make silly mistakes and should have each other’s backs but I do feel like I’m being attacked – plus you haven’t answered my question)

            Oh and finally – how did you go on that quiz?

          • Jarrod McMaugh
            15/10/2018

            If you feel you are being attacked, I can’t help that. Perhaps some self reflection on why general comments about prescribers make you feel personally uncomfortable is warranted.

            Contrast that with actual comments about me specifically, which wouldn’t even be acknowledged if it didn’t serve an illustrative purpose.

            I spend much of my day discussing this topic & answering questions on a broad range of pharmacist practice, yet I’m not in the slightest way interested in answering yours, because your aim in asking them isn’t to learn something or changey your perspective… It is an attempt to cast doubt on the validity of pharmacists performing any role that you see as “competing” with yours.

            Again, some self reflection on why this is the case is in order. Many doctors claim pharmacists “ain’t shit” yet are very threatened by pharmacists. Its very telling that prescribers feel so threatened by a profession that they have no respect for.

            I’ve spent the time responding, so I’ll address 2 of your points:
            1) why can’t doctors dispense?
            A: The can, but they are very inefficient at it. I also doubt (but stand to be corrected) that any doctor is interested in doing a dispensing role that is separate from a prescribing role.

            2) why don’t pharmacists have to undergo further training/internship to prescribe?
            A: who said they didn’t?

            Most of your questions come from not being familiar with the background to pharmacist prescribing including frameworks, accreditation, place in practice, etc (or not caring).

            The answers are out there Scully, if you’re willing to look for them. Try starting in the UK where pharmacist prescribers have been going for over a decade, and their GPs are still struggling to meet demand (they haven’t gone bankrupt or become obsolete)

          • Dr Phil 42
            15/10/2018

            In psychology theory when there are two opposing points of you one tries the get the conflicting sides to see each other’s point of view.
            Luckily you seem expert at this as well. (Sarchasm)

          • Dr Phil 42
            16/10/2018

            And doctor dispensers – your lack of belief that I actually might know something is… well is disappointing

          • Dr Phil 42
            16/10/2018

            And doctor dispensers – your lack of belief that I actually might know something is… well is disappointing

          • Gavin Mingay
            15/10/2018

            100mg trimethoprim??

          • Dr Phil 42
            15/10/2018

            You win the prize! Yes of course 300mg (which you will note Triprim and Aloprim both come in).

          • Free pharmacist
            14/10/2018

            I’m not questioning your knowledge personally, I’m really clear about my question, did you study intensely at uni that type of drug knowledge or not?
            I’m aware too of many diagnostic knowledge but that doesn’t make me a doctor for just answering some questions about diagnosis

          • Jarrod McMaugh
            15/10/2018

            Valsartan + trimethoprim right?

  3. Free pharmacist
    14/10/2018

    My reply to an article that was written by a physician on AMA website which is related to the topic:

    5 big known reasons why doctors shouldn’t play pharmacists
    1- medicines and drug are not a physician’s area of expertise (only diagnosis and surgeries)
    2- Pharmacist is the only healthcare professional who is a specialist in drugs and their roles, effectiveness, interactions, clearance, metabolism and much more.
    3- till now we still have a high number of GPs who prescribe high risk contraindications.
    4- how would you allow a doctor to do a job that he is not a specialist at (authority of prescribing drugs which he is not totally educated and not fully trained about).
    5- If we really care for patients and healthcare system, no scripts should be allowed to leave gp surgery without pharmacists approval (gp pharmacist) and/or gp should send their diagnosis and blood tests results to a pharmacist who should be the only healthcare professionals who choose the right formula and the right drug to patients.

    Until then, it’s a big joke to ask a pharmacist not to play a doctor, because as a pharmacist myself, I never wanna play a doctor because I’m proud of who I’m and I know exactly what kind of knowledge I have.
    N.B1 a quick note about the dilemma of “conflict of interest “ it’s easy to get rid of such an issue once we have a system that makes pharmacist an independent healthcare professionals that is getting paid directly for their service from Medicare (by having their own provider number). And if your main core of discussion is a bout business profits, you’re talking about a small percentage of registered pharmacists who have their own pharmacies, but the majority of pharmacists doesn’t benefit directly from any drug’s profits.
    N.B 2 on the same level of the issue of conflicts of interest, doctors who owns medical centre are allowed to have a lab/X-ray or other diagnosis facility can still benefit from getting paid for sending patients to do tests they might not really require all the time.

    Things are getting tougher on us as non pharmacy owners pharmacists who represents the majority of pharmacists in the nation and I’m calling all non owner pharmacist to join our voulantry, free and not for profit group/lobby to stand up for our profession.
    We are united pharmacists of Australia group
    https://m.facebook.com/groups/113834048670621

    Pharmacist and proud

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