Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk episode 60. I'm your co host, Dr. Kane, Speaker 1 00:34 and I'm Dr. Patel, and the topic we're going to discuss today is how to get your voice heard, pearls of professional advocacy Dr. Sean Kane 00:41 today we're talking about professional advocacy and how pharmacy plays a role in that arena. So Dr. Patel, why don't we get started with what exactly is professional advocacy? Speaker 1 00:51 So I guess it's good to define phrase professional advocacy. It's basically taking action to state our opinions, secure our rights as pharmacists to practice pharmacy and represent all the interests that are mutual in pharmacy arena. This matters could be regulatory in nature, or they could be even practice related. So regulatory examples would be things such as drug pricing, how the pharmacies acquire drugs and then practice related examples would be pharmacists ability to bill the insurances as a provider. Yeah. Dr. Sean Kane 01:25 And even now, there's a number of relevant topics that are going about. You mentioned drug pricing is one, but there's a ton of different topics that have come up. And even in the last 10 years, things as simple as, you know, decreasing the amount of Tylenol available in a Norco tablet, for example, or OTC Tylenol Max dosing. Or whether the state of Illinois, a pharmacist is required to counsel in all new prescriptions or keep it the way it is, where that is not a requirement, and all of this impacts us as pharmacists, right? Speaker 1 01:56 Yeah, absolutely. And you know, if talking about why it is important to stay involved with the professional advocacy when pharmacy is concerned is it's that you are still part of the practice, and if you don't get your voice heard, or if you're not keeping up with the topics, if you disagree with something, and if you didn't say anything about it, it's going to get passed, and then you'll end up practicing or taking the brunt of something that you didn't agree with necessarily. So talking about why professional advocacy is important, I used to get this all the time from my school teachers at UIC, saying, no, if you don't do it, somebody else will do it, so their voice will be heard. And it may not be what you want, as far as the practice goes. Dr. Sean Kane 02:39 And you know, as part of this, certainly part of it is advocating for yourself as a pharmacist or the profession of pharmacy. Part of it also is advocating for patient care. So maybe some policies, regulations, new laws, maybe they are or are not in the best interest of the patient or the patient care. And for that reason, you're not just advocating for yourself, but you're also advocating for future patients and how pharmacists interact with those patients, Speaker 1 03:04 absolutely, right? I mean, take a look at the Oath of the pharmacist, right? It's all about patient care and how you're going to abide by those oath make sure you're advancing so that you can advance your patient care as well. So when it comes to advocacy for profession, it's technically advocating for patient care. Dr. Sean Kane 03:22 Yeah, and you know, one other thing to think about is how the role of the pharmacist has changed a lot in the past, let's say, 50 years, and how the role of other healthcare providers has also changed at the same time. And I would assume that issues can come up if we're not advocating for our new role as pharmacists moving forward might be something that we have to think about, right? Speaker 1 03:43 Yeah, absolutely. I mean things like, you know, in a professional education is now the model, and going to be the model of most pharmacy schools with the new standards. But that education has not spread to practice world when we're talking about some of the older practitioner and so it's not only talking to our lawmakers and explaining what pharmacists can do and cannot do. It's also about advocating for profession to some of these veteran healthcare practitioners to make sure that because pharmacy has changed so much, to make sure that we educate them, we show the worth of pharmacists that is in a comprehensive healthcare Dr. Sean Kane 04:21 model, and even speaking about the worth of the pharmacist, it's not just about the physician, let's say, understanding the value that a drug expert brings to their clinical practice, but also having Medicare or Medicaid recognize the value of having a pharmacist involved in patient care as Well, to the extent of actually being reimbursed for that care. So it's anything from having a pharmacist in the ICU like myself to avoid drug errors and improve drug costs for the institution, all the way to, you know, having individualized one on one patient interactions in a clinic setting where you are making an appointment with. With a patient, and you should get reimbursed for your time to help improve that patient's care, whether it's MTM or patient education, or any number of other services that a pharmacist can provide. Speaker 1 05:11 Yeah, absolutely. And I mean, lately, what we have been hearing in news about the provider care act that is very important and that will lead or make the pathway easier for pharmacists to be able to bill as provider to some of these insurances that you mentioned. Dr. Sean Kane 05:27 And of course, knowing about what is going on is going to help keep you informed as a professional, as a pharmacist, and know how things are going to be changing in the future. With the Affordable Care Act as an example, lots of things changed in terms of insurance coverage, who got covered, how it got covered, how it got paid, things like that. And if you're kind of not familiar with that, you're going to be left in the dust in terms of knowing what is moving forward in terms of health care and the role of the pharmacist and things like that. It's important to stay informed about those things, because the patient is going to look to you to be an expert on some of these topics. Speaker 1 06:03 Absolutely, my patients nowadays, you know, do ask questions about some of the Affordable Care Act being changed too. So you not only need to know what's changing within your profession, but you need to also know about what's changing in the global health care arena in itself. So we're going to talk about how you can get involved in the process of advocating for the profession what tools are available. But we're going to do a little law making, 101, and go over how a bill is then converted into a law in itself. Dr. Sean Kane 06:31 So why don't we start with the very beginning, the idea of a bill. So where do bills actually come from before they even are considered to become Speaker 1 06:38 a law? So a bill is basically an idea that is presented by a representative that could be your lawmaker. You know, local lawmaker, lawmaker. That idea, like I said, the lawmakers don't necessarily know what's going on in the pharmacy world, let alone be in the healthcare world. So you have to be as a constituent. You have to be the one generating the idea. So again, that's why it's important for you to get involved in this process. Dr. Sean Kane 07:05 Of course, you know, with anything that deals with medications, for example, it's not just pharmacists that are going to be involved in promoting ideas to representatives. It could be any other healthcare profession that may or may not have the best interest of pharmacists as a profession in mind Speaker 1 07:21 absolutely and may not know more about the whole process of how the drug, whether it's made, how it's handled, what's the intended use, what are the future consequences of use? You know, risk versus benefits. And so you have the knowledge, and that's why you need to be involved. So once that idea is introduced as a bill, the representative is going to look for sponsors within the house in itself. So those sponsors will be other colleagues of the representatives in the House. Dr. Sean Kane 07:50 So then once they have kind of a contingent of a person representing the bill and sponsors for that bill, I assume that at some point they have to introduce it to the entire house for discussion, right? Speaker 1 08:02 Yeah, and this only can be done by the representative that you're working with, and so the term H.R. is placed in front of the bill by the House clerk, and the Speaker of the House then will announce this bill and send it, send it to the standing committees. So then Dr. Sean Kane 08:19 these committees aren't the entire house or the entire voting block, right? This must be a small contingent of that. Then, yeah, Speaker 1 08:25 these committees are affiliated with the topic of the bill in itself. They have a little bit more knowledge, and so the representatives who are affiliated or impacting committees will weigh in and provide the feedback to the entire house. Dr. Sean Kane 08:39 Then, okay, and then I assume at some point it goes to everyone to debate it and then vote on it. And then at that point, Are we all done? Speaker 1 08:45 Yeah, that's the most interesting part. I mean, if you do get to visit your local capital, you know, state capital, it's an interesting process to watch the debate. They all have viewing galleries. So we encourage you, if you're living closer, to go take a listen and a view on how these bills are debated. Dr. Sean Kane 09:04 And of course, you know, once the house is done, let's say they pass it. It's not a law yet, right? Speaker 1 09:09 No, it's not a law. So after the debate, they go by section by section, you know, point out any issues and stuff, and the bill goes up for voting. So if it passes through the house, then it will go to the Senate, and the same process starts again, so they can also sign the bill to special committees within the Senate who can weigh in and provide feedback, and it gets debated, and then the Senate will go ahead and vote. So once the bill is passed through the House and the Senate, it will be sent to if it's a state bill, it's going to go to the governor. If it's the national bill, it's going to go to the President, and the Presidents have three different options over here. They can just simply pick up the pen and sign the bill, and they'll become a law. They can veto, basically. They can refuse to sign it. They can provide reasons for the veto, and Bill is then sent back to the house, and then the whole process. Process of modifying it, debating through the House and Senate ensues again. Another option is do nothing. So President will just sit on the file of the bill, and if Congress is in session, the bill will automatically become law in 10 days. But if the Congress is not in session, then the bill does not become law, and then renegotiation and debate starts again. Dr. Sean Kane 10:24 And of course, if the president vetoes it again with the balance of power, the House and the Senate could feel very strongly about still approving it. Instead of a majority, they would need two thirds of the vote to override the governor's or the President's veto. Speaker 1 10:39 Right? Absolutely so. Again, the President or the governor may not agree with it, but the Congress feels really strong about it. A two thirds voting is all that's needed to override that veto. Dr. Sean Kane 10:50 What's really interesting, and something I think many people don't understand, is that oftentimes the law, the bill that becomes a law, isn't incredibly descriptive, meaning that it kind of outlines how things are kind of supposed to happen, but it's not the nitty gritty detail of things. So really, it's an outline, if you will, for future things to happen, Speaker 1 11:10 right, correct? It's, it's a very general statement, and it then is turned to the governing body. So for example, we were talking about Illinois over here, right? Governor approves the bill becomes an act or law. That law then is given to, for example, ipha or ichp. Those are pharmacy board in itself in the state of Illinois, and they are going to be the one that's going to write the rules and the regulation how they're going to if there's any training required for these professionals, how they're going to ensure the proper training and and then monitor that these professions are following the law in its entirety and not breaking the law, setting up the consequences, etc. It's all done by the governing of the regulatory Dr. Sean Kane 11:59 body, and that kind of makes sense, right? So if you had a congress person who isn't familiar with the practice of pharmacy, you probably don't want them having an incredibly specific bill or law that goes into every single detail on how long the pharmacy can stay open for, how many technicians a pharmacy should have with respect to the ratio to the pharmacist. You know that really should be someone who's an expert in that topic. So it makes sense that a law kind of sets a scaffolding and then an expert, so a pharmacy organization or someone who's an expert in that field, they're going to step in and actually create the nuts and bolts exactly how it's supposed to work. And as you said, all of the detailed explanations on how that law is then implemented? Speaker 1 12:43 Yeah, absolutely. Those are ruled out by the state organizations or the pharmacy board organizations of the state. Dr. Sean Kane 12:49 So everywhere from the bill all the way to these rules and regulations as pharmacists or even pharmacy students. How can we impact that process from A to Z in terms of either the initial concept all the way to how it's actually implemented by the rules and regulations. Speaker 1 13:04 So you can actually do a very little to integrate yourself in the process, or you can do a whole lot. A whole lot would be you introducing the idea to your representative, and think about how amazing it would be that you did something that turned into a law, and now it's benefiting the patient care in itself. So that would be a bigger version, but as little as calling, writing or visiting your representative's office, whether it be in support of the bill that's being debated, or whether it be against the bill that's being debated, and verbalizing your opinion and views about that bill. It's important. Dr. Sean Kane 13:44 And if you just think about the term that we're using, representative, they're representing you right? So these representatives are hopefully taking your opinions and your viewpoints and implementing them with everyone else's viewpoints and opinions to come up with an informed decision, and they're kind of relying on you to represent you to have that informed decision. Speaker 1 14:05 Yeah, they're relying on you to provide the right information. Again, they don't practice health care right they may have some background, but they might not necessarily know everything about what pharmacy does and how the drugs work, and so they rely on you to get the right information. How would you look up that lawmakers? You know information like who is your representative. You know where you can contact them. You can go on either the House or the Senate website, so both State House and Senate or the National House and Senate website, and if they are, you know, in Washington, DC, they do have local offices that you can make appointments and Dr. Sean Kane 14:40 go to cool. So what else can someone do who wants to advocate for or against a certain policy or bill or anything like that? Speaker 1 14:48 So our wonderful state pharmacy organizations have something called legislative days, right? These are designated days for all the practicing pharmacists, pharmacy students, pharmacy. Technicians to congregate, talk about some of the legislative issues, and then go up to the Capitol, talk to their representatives that they're constituents of, and then really advocate for the profession. The idea over here is that we have a collective voice that's being heard rather than individual. One of the example was one of our students, you know, and the recent legislative day in February, visited the Illinois State Capitol, and the representative was so interested and wanted to demonstrate the power of constituency and a power of, you know, making your voice heard, and also power of social media that the person went on Facebook Live, and so our student got to interview the representatives on Facebook Live and ask questions and kind of you know, view our opinions about the existing bills in the house that they're being debated similar kind of legislative days are also being organized at Washington, DC. They call it march up to the hill, where various different pharmacies. Students and leaders across the nation congregate, and then they go and talk to their legislator at the hill. Dr. Sean Kane 16:07 Yeah, in addition to that, you know, there are letter writing campaigns that are generated at student chapter events. So this could either be urging lawmakers to do something like voting or voting, voting for or against a particular bill as an example, or even just thanking them, saying we really like your opinion and that you acted in our best interest, and we think that you did a great job. You know, sometimes a pat on the back can go a long way too Absolutely. Speaker 1 16:31 And then the third way of kind of involving yourself into this process is actually invite these lawmakers to your practice site, right? We said they don't know enough about the practice the pharmacy world. By having them at your site and then seeing what you do, either as a student or a practitioner, they will understand the process a little bit better. So this example doesn't really necessarily include that the lawmakers came to a practice site, but it's an example how lawmakers came to one of our students community events. So Representative Bob Dold and Illinois State Attorney Mike Nerheim were actually present at one of our drug take back events who supported the community initiative on making sure that the drugs are disposed properly. And the underlying motive over here was to reduce some of the narcotic abuse that's prevalent. Dr. Sean Kane 17:21 You know, I think both of your examples are great, just showing how these aren't representatives that you can't ever contact and you'll never see, and that they're in some office that isn't attainable. To actually communicate with them like they want to be part of the community. They want to see what's going on. They want to hear from their constituents, right? Absolutely. Speaker 1 17:39 You know, these are public figures like you said, they are public servants. So by the virtue of being in that public office, they are there to listen to your ideas and opinions, and you should do so respectfully, and they should do so respectfully equally. Dr. Sean Kane 17:55 And I know that you know one thing to think about, or one common concern that I hear is, as a pharmacist or a pharmacy student. I'm not going to read every single bill that goes through a house. Are there any ways that you can kind of filter out the noise in terms of, what are the bills that really matter for a pharmacist or the the profession of pharmacy, that could be relevant that would potentially prompt you to take action? Speaker 1 18:16 I absolutely understand, right? We are really busy, and so we're not like glued to the TV or listening to a radio hearings of what's being debated on the House or Senate floor, but make being aware of the changes is very important. You can do so by going to your state pharmacy organization's website being a member, and you get those emails that are regulatory legislative related like I mentioned, going to this legislative events, legislative days that are organized by your state organizations, maybe some affiliated journals, magazines and newsletters, can be able to tell you the progress of the current pharmacy affiliated bills. And then everybody knows C-SPAN. Nobody wants to watch it. But some of the important healthcare bills, including pharmacy bills, are debated. And if you don't want to see the entire debate, because it could be very lengthy, some of the snippets are sometimes posted on pharmacy organization websites, if it really pertains to the profession of pharmacy. Dr. Sean Kane 19:13 And I think you know, one of the most powerful ways to influence anyone is the power of an anecdote. So if a particular bill is being argued on and you have personal experience in that particular topic. One of the best ways to have your voice heard is to talk about your personal experience, to have something to say and have a history to explain why a particular bill could be good or bad based on what you've seen in your own practice. Again, the people who are debating this aren't typically pharmacists, and they don't know that, and if you don't provide that anecdote, the history or the background, they're not going to know any better. And that's kind of your role as a constituent and a pharmacist to be to be honest. Speaker 1 19:50 Yeah, and flipping the roles. I mean, if representatives are arguing for or against the bill, and they find a voice that is an expert. Voice, and they would love to have you come and provide a testimony in front of the house or sign a floor. Excellent. Dr. Sean Kane 20:07 So, you know, we've covered a little bit of background for where you can see bills that would be relevant to pharmacy, things like that. What are some of the best resources that you could recommend to the HelixTalk audience, or to the pharmacist or pharmacy students that are listening specifically that would kind of give them the tools to be an effective advocate for the profession of pharmacy. Speaker 1 20:25 You know, some of the resources we already mentioned that being a part of a local, national or even student organization is very important because it's like the power of money comes along with it. You know, maybe one voice won't be get won't be heard, but if you have a collective voice, it's a roar, and it will sure be heard. So be part of a local, national or student organization if you are student on campus. And this will also help you receive updates, attend legislative days, and then the leaders of your local organization, the state organization, they serve as excellent resource. So if you're not sure about you know what exactly is being discussed or where exactly this bill is, it's as simple as picking up a phone and calling your ichp office, or ipha office, for example, in Illinois, and say, Hey, I wanted to know a little bit more about what's going on and how I can be helpful. And they're always putting out calls to, hey, can you call your local lawmakers and make sure they support this bill? Make sure they oppose this bill. Dr. Sean Kane 21:26 So Dr. Patel, in terms of some websites, you know, it's great to attend these legislative days. It's great to have a resource at some of these professional state based pharmacy organizations. What about web based resources? You know, those are probably the most convenient in terms of staying updated. What are some of the web resources that you recommend? Speaker 1 21:45 Yeah, so both American Pharmacists Association as well as the American Society of Health System Pharmacists have their own initiative going on at the end of the day. Nationally, it's one voice heard to the Capitol. So we don't come up as you know, we don't know what we're doing because we are divided. But a really good website for our APhA is the pharmacist.com/advocate, you can also receive updates from www.pharmacistsprovidecare.com. Tons of resources available on this pharmacist.com/advocate. Website page talks about things such as, you know, make sure you make your voice heard. There are tons of different helpful hints to contact the legislators. Great resources to start a face to face meeting. Tips on you know what to do when you're meeting with your lawmakers, what not to do when you're meeting with them. Even great resources for the students, when they're, you know, ready to attend the Legislative Day. They even provide information about, you know, how to set up a meeting for a legislator to come to your pharmacy practice site. You know, pharmacy or practice site. They even have tips for writing and placing the op eds and then things such as 10 steps to make your congressional visit successful. So all these tools are kind of like the tip sheets of making your voice heard properly. Dr. Sean Kane 23:06 That's excellent, you know, just to have something kind of in one spot, to be able to briefly look through and get some tips from the professionals who, you know, their job is to advocate for pharmacy. That's the nature of many of these professional organizations. At least one of their goals, these guys know what they're talking about, right? So to be able to rely on them and use them as a resource is Speaker 1 23:25 excellent, absolutely. And then I mentioned ASHP, American Society of Health-System Pharmacists, their website is www.ashp.org/advocacy-and-issues. They have a grassroots network, as well as the ASHP-PAC, which is a political action committee, and they address key issues such as drug pricing, medication safety, hospital reimbursement, etc. And where all these topics are currently, you know what? Bills are introduced, where they stand, etc. All that information is available on the ASHP-PAC website. And of Dr. Sean Kane 24:00 course, if you're driving in your car, for example, we're going to have links to all of these websites and these excellent resources on our website. So again, this is episode 60 HelixTalk.com and you'll be able to find links to these websites as well. Speaker 1 24:14 And so you know, here we are sitting and talking about how you can get involved today, and maybe you want a proof of why do I need to get involved? Well, think about where our profession was. You know, think about practice of pharmacy back in 1970 I wasn't even born, but I assumed that it was more apprentice style, more apothecary style, where now look at us today, we're almost at the brink of being recognized as providers. And so if it wasn't for the pharmacy leaders advocating for our profession like we are asking you to do today, we wouldn't be where Dr. Sean Kane 24:48 we are today. And just to you know, point out a couple really dramatic things that over the past 100 years have impacted us that hopefully, you know, similar decisions in the future will be relevant. You know, the. FDA didn't exist before 1938 that was, you know, a bill that became a law that produced the organization that we called the FDA, right? We didn't have refills up until, like, the 1950s we didn't recognize that we wanted to approve drugs based on efficacy, not just safety, through 1960 and then drug pricing, how drugs are approved, things like that. These are all national bills that have come about in the past 50 to 100 years that dramatically impacted how we practice right and similar things are going to happen in the future, and if we aren't part of that discussion, then we're going to be left behind in terms of advocating for ourselves and for the profession of pharmacy Speaker 1 25:36 and, most importantly, for our patients, education care. So that being said, you know, this is your profession, and your formal oath is about practice of pharmacy and protecting the patient and caring for patient, but it is also to shape and protect the profession of pharmacy in itself. And so I'm going to close out by saying, my favorite saying from Gandhi is that Be the change you wish to see in the world. So don't just sit in and complain about you know, this law is not right if you if you want to see it changed, you'll have to be the change agent. Dr. Sean Kane 26:10 So with that, again, we have a number of resources that we talked about that will be available on our website. If you go to HelixTalk.com and then click on the link regarding episode 60, you'll be able to see all of those resources with that, if you wouldn't mind going into iTunes and giving us a five star review, it really helps us climb up the charts, so that pharmacists and other healthcare providers are more likely to find us. So with that, I'm Dr. Kane Speaker 1 26:34 and Dr. Patel, and that being said, advocate hard. Narrator - Dr. Abel 26:38 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store. Search for HelixTalk and place your review there Narrator - ? 26:49 to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.