John Gums, PharmD, FCCP - Professor and Associate Dean for Clinical and Administrative Affairs - and Eric A Dietrich, PharmD, BCACP, CPC-A, CEMC, CPB - Clinical Associate Professor from the University of Florida College of Pharmacy talk with us about billing for pharmacy services. Key Lessons: A sustainable clinical practice model is formulated by creating a business plan that considers the services to be provided as well as reasonable estimates of the number of patient encounters, the duration for each patient encounter, billable revenues, collections, and costs.  Evaluation and Management (EM) codes are used to bill services.  The complexity of the patient encounter characterizes the "level" of service, ranging from level 1 (minimal complexity, self-limiting problem) to level 5 (High, Chronic Conditions, Severe Exacerbation, Disease Progression). Comprehensive medication management services provided by pharmacists are typically billed by a recognized provider (physician / nurse practitioner) using an "incident to" billing method. Pharmacists can also bill for transitional care management (TCM), chronic care management (CCM), and annual wellness visits (AWV) - but each of these services must meet specific conditions and requirements under Medicare Part B. Learning to speak the language of billers and coders is critically important. Consider training or certification through the American Academy of Professional Coders (AAPC) There is a significant difference between what is billed and what is collected. Pharmacists should track their time, number of patient encounters, billable units of services, and collections to determine if their initial estimates are correct.  When there are discrepancies, determine the sources and address the causes. Check out these guidelines and resources on how to develop a business-practice plan and bill for pharmacists' patient care services: American College of Clinical Pharmacy (ACCP) - Developing a Business-Practice Model for Pharmacy Services in Ambulatory Care Settings American Association of College of Pharmacy (AACP) - Integration of Clinical Pharmacy Faculty in Professional Practice Care Settings National Council for Prescription Drug Programs (NCPDP) - Billing Guidance for Pharmacists' Professional and Patient Care Services

Lucinda L. Maine, Ph.D., R.Ph. - Executive Vice President and Chief Executive Officer of the American Association of Colleges of Pharmacy - talks with us about how to manage major career changes and why a degree in pharmacy is so valuable. Key Lessons: Career pivots can be welcomed and sought ... or arise from something unexpected and unwanted. Most professionals will experience several major career changes during their working years. A pharmacy degree enables a surprisingly broad range of career paths. Being prepared for new opportunities by continually updating your knowledge and skills is critical. Having the financial resources available to obtain additional education, training, or experience is an essential career insurance policy. Active engagement in professional pharmacy associations, at both the state and nation level, provides a great way to network and keep current with the latest trends. Many people, especially women, are reluctant to make a major career change without having "all the necessary" credentials and experiences.  But consider what is essential ... you can learn the rest on the job. Several resources are available to help you explore the career options that align with your strengths, skills, and interests: Check out the American Pharmacists Association Career Pathway Evaluation Program and ADVANCE for continuing professional development AACP-APhA Pharmacy Opportunities Network (PharmON) 

Cynthia Knapp Dlugosz, BSPharm, NBC-HWC - Solopreneur and Owner of Being in Balance Coaching and Artemis Health Care Communications - and Elizabeth Buckley, PharmD, CDCES - Professor, Department of Pharmacy Practice, Concordia University Wisconsin — talk to us about threats to our well-being and self-care practices. Key Lessons: We are surrounded by stressors that adversely impact our sense of well-being. The ubiquitous use of technology has increased the demands on our attention. The pillars of well-being based on research from the Center for Healthy Minds at the University of Wisconsin-Madison are: Awareness, Connection, Insight, and Purpose. Much of our dissatisfaction and psychological suffering stems from our desire to push away or change the unpleasantness in our lives. Mindfulness is a state of being where we are attentive in the present moment with receptivity, non-judgment, and compassion with what arises. Meditation and yoga are practices that cultivate our ability to be mindful - our ability to be more attentive, receptive, less judgmental, and compassionate. Gratitude increases our happiness. Those with the least material wealth are often able to recognize and express gratitude for the blessings in their lives but anyone can learn to be more grateful. Health professionals feel acutely stressed today because the environmental demands are beyond their ability to successfully cope due to unpredictability, uncontrollability, and overload. Organizations have a responsibility to implement strategies to address the environmental demands and the underlying causes of stress. Resources and Books: Center for Healthy Minds, the University of Wisconsin-Madison Brown B.  Atlas of the Heart.  Mapping Meaningful Connection and the Language of Human Experience.  New York: Random House, 2021. Moss J.  The Burnout Epidemic: The Rise of Chronic Stress and How to Fix It.  Boston: Harvard Business Press, 2021

Bruce Berger, Ph.D. - Berger Consulting LLC and Professor Emeritus, Auburn University - and Col. John D. Grabenstein, R.Ph., Ph.D. - Vaccine Dynamics SP - talk with us about treatment hesitancy, its root causes, and how health professionals can engage patients in treatment decisions more effectively. Key Lessons: Treatment and vaccine hesitancy is often grounded in inadequate information, changing information (leading to doubt), personal beliefs,  misinformation, distrust (of the health care professional's motivations), and (sometimes) apathy.  Actively soliciting and listening to a patient's concerns is the key to understanding the sources of doubt and hesitancy. Confrontation and dismissing a patient's understanding will cause "face loss" and lead to more resistance, not less. Monologues about "the facts" are not helpful. It is important to ask permission and then gently offer new information for the patient to consider. The patient is always driving the bus and all treatment decisions rest with them. The goal should be to become a trusted advisor who's always on the patient's side. It may take some patients several months (or even years) to arrive at a decision to start a new treatment or receive a vaccine. Our words can alienate a patient and sever a relationship. This is perhaps the worst possible outcome because it prevents us from having a positive influence in the future. Want to learn more about motivational interviewing and vaccinations?  Be sure to check out these resources:  Immunization Action Coalition (www.immunize.org)  ComMIt - Comprehensive Motivational Interviewing (MI) Training  eLearning MI Training for Health Professionals - Purdue University  Berger B.  Using Care and Compassion to Respond to Vaccine Hesitancy.

Andrew Traynor, Pharm.D., BCPS - Professor and Assistant Dean for Experiential Education at the University of Minnesota - and Brent Reed, Pharm.D., BCPS - Associate Professor at the University of Maryland and Doctoral Student in Organizational Sciences at UNC Charlotte - talk to us about job satisfaction. Key Lessons: Autonomy, mastery, and purpose contribute to our motivation and energy level ... and increase our sense of satisfaction from our work. Finding your "why" and being passionate about your work is helpful but doesn't account for the small, everyday things (tasks) that make the work fulfilling.  The job demands-resources model helps to explain why some jobs are more satisfying (or conversely dissatisfying) than others.  Do you have the right resources to meet the challenges and hindrances in your work? The pebbles in your shoes can really make a big difference in terms of your satisfaction with your job. Job satisfaction is not just about individuals learning to be more resilient and productive but it's also about the organization addressing the hindrances and providing sufficient resources to meet the demands of the work. High employee turnover and customer dissatisfaction can be "red flags" that the work environment may be problematic. Being self-aware - understanding your strengths and values - is important to finding employment that's a good fit. Try to get/set realistic expectations when entering a new job by getting an honest "preview" of the work. Job crafting can help an employee shape the work to make it more satisfying — finding new challenges, removing hindrances, and seeking resources.

Special Host Timothy Bloom, Ph.D. - Associate Dean of Academic Affairs and Associate Professor, Bernard J Dunn School of Pharmacy, Shenandoah University  - and Guests Heather Petrelli, MA, Ph.D. - Associate Dean of Students Affairs, Taneja College of Pharmacy, University of South Florida - and Teresa O'Sullivan, Pharm.D. - Director of Experiential Education Scholarship and Metrics, School of Pharmacy, University of Washington - talk with us about how faculty can facilitate professional identity formation. Key Lessons Faculty and preceptors play a critical role in students' formation of their professional identity. Colleges/schools are now beginning to introduce the concept of professional identity to their students and faculty. Experiential education and practice-based experiences are critical to professional identity formation. Preceptors and faculty can promote reflection by asking questions about authentic practice-based experiences. Explore the why - what is the motivation?  Help students to identify their values, their future goals, and how their (current) behavior reflects (or fail to reflect) those values and goals.  Use motivational interviewing strategies to create cognitive dissonance when appropriate. Early and authentic practice experiences are important. Conversations with students about their journey toward "feeling like a pharmacist" can prompt reflection. Assessing professional identity formation is a major challenge. How will we know if the curriculum is building professional identity and preparing students well?  This is an area ripe for new evaluation models and scholarship. For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation

Special Host Eric G. Boyce, PharmD - Professor of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy - and Guests Alex N. Isaacs, PharmD, MS, BCPS - Clinical Associate Professor, Purdue University College of Pharmacy - and Sally A. Arif, PharmD, BCPS, BCCP - Associate Professor, Midwestern University College of Pharmacy, Downers Grove - talk with us about professional identity formation, people and events that influenced their professional identity, and the importance of reflection. Key Lessons Our identities are who we are and aren't easily changed (but can and do evolved over time) Our lived experiences have a significant influence on our professional identity Role models and mentors play a critical role in our professional identity formation Emotional experiences have a powerful effect in shaping our beliefs and motivations Reflection and introspection can help us solidify and clarify our values and beliefs Developing a regular and ongoing reflective practice can help us think through challenges and plan for the future so that we are clear about our purpose and what aspire to be For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation

Special Host Kristin Janke, PhD - Senior Associate to the Dean and Professor, University of Minnesota College of Pharmacy - and Special Guests Jessica L. Johnson, PharmD, BCPS - Associate Professor, William Carey School of Pharmacy - and Karen Kopacek, BPharm, MS - Associate Dean and Associate Professor, University of Wisconsin School of Pharmacy - talk with us about professional identity formation, how our identities are formed, and why they are important. Key Lessons Our identities shape our sense of self ... which influence our values, beliefs, and actions All of us have multiple identities ... including a professional identity Professionalism and professional identity are related but distinct concepts Students and residents may feel uncomfortable or experience identity conflicts as they form their professional identity — assimilating the values and norms of the profession Our professional identities are developed through interactions with colleagues and mentors A strong professional identity can help counterbalance work stressors and negative emotions that lead to burnout For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation

Charmaine Rochester-Eyeguokan, PharmD, BCACP, CDCES - University of Maryland School of Pharmacy - and Jeffrey Tingen, PharmD, MBA, BCPS, BCACP, CDCES - VCU Health, Department of Family Medicine & Population Health - talk to use about the ins and outs of collaborative practice agreements. Key Lessons Collaborative practice is governed by state law and regulations; it is important to be familiar with the specific rules for constructing collaborative practice agreements (CPA) in your state. Many states require pharmacists to have specific training and experience in order to enter into a CPA - but some states have relatively few requirements or none at all. CPAs are useful tools to enable greater efficiency by granting the pharmacist greater autonomy to carry out certain patient care functions; however, a CPA is not required to perform many functions that are ordinarily a part of a pharmacist's scope of practice. It's important to have a significant level of rapport and trust with your providers crafting a CPA together. While CPAs are fairly common in ambulatory clinics, they are a potentially useful tool in community pharmacy practice, long-term care facilities, and specialty pharmacy practice. To learn more about collaborative practice and CPA, check out the Collaborative Practice Resource Page on the iForumRx.org website.

Alan J. Zillich, PharmD — William S. Bucke Professor and Head of the Department of Pharmacy Practice, Purdue University College of Pharmacy — talks with us about getting your work published; from identifying great ideas, collaborating, writing, and revising your manuscript. Key Lessons: From review articles to meta-analyses, from case reports to observational studies and controlled trials, getting your work published is immensely gratifying.  But it requires many months (and sometimes years) of effort. Working with a mentor who has experience producing scholarly work and getting published is a great first step. Good research questions arise from practice.  When there are gaps in our knowledge, that's where a scholarly project that's potentially publishable often emerges. Working with an authoring team - bringing together people with different skills - can really improve the quality and rigor of your scholarly work. Use explicit criteria to determine who qualifies as an author on a paper.  Be sure to acknowledge those who contributed but not meet the definition of author. Finding the "right" journal for your work is important.  Each journal has a different audience and mission. Getting rejected is part of the process. The feedback from peer reviewers can be extremely helpful and you are one step closer to getting published.   Beware of predatory journals (who don't provide a rigorous peer review but still charge high publication fees). Blocking time in your schedule to regularly engaging (at least weekly) in scholarly activities - researching and writing - is critical to success.  Make an appointment with yourself. Unfortunately, this might require early mornings, evenings, or weekends if you can't negotiate the time into your workday.

Jessica Louie, PharmD, BCCCP — president of Clarify Simplify Align, the host of the Burnout Doctor podcast, and Associate Professor of Pharmacy Practice at West Coast University — talks to us about developing a meaningful side gig to reinvigorate your passions. Key Lessons: Every career has ups and downs ... and health care professionals are prone to burnout.  Burnout is a syndrome of emotional & physical exhaustion, cynicism about work, and a lack of a sense of personal accomplishment. Overcoming burnout takes time to address -  examining your emotional, physical, and spiritual needs. Learning how to "own" your time and being intentional with your energy is critically important. Starting a small business can be very gratifying so long as the activity aligns with your core values and passions. The ten pillars of life can enhance one's sense of wellbeing.  A meaningful side gig can enhance the sense of wellbeing by address several of the life pillars. Surround yourself with like-minded people who are interested in or who have successfully developed a side gig. Be mindful of the big transitions in life - to minimize stress, whenever possible, limit your attention to one major life event at a time. Starting a side gig will require a significant time commitment but you can manage it by using time blocking and simplifying. You can download the Burnout Starter Kit to learn how to clarify, simplify, and align your life.

Christie Nemoto, PharmD, BCACP - Clinical Pharmacy Specialist in The Queen's Health Systems - Queen's Clinically Integrated Physician Network (QCIPN) - talks to us about providing care to patients at a distance and creating an effective work environment at home. Key Lessons: Health professionals had to learn new skills in order to deliver care to patients and interact with colleagues at a distance over the past year.  Remote work became the new norm during the COVID-19 pandemic. Clinical care models in Hawaii have evolved over the years to support patients at a distance.  Hawaii is an archipelago of islands and access to health care services is enabled by a variety of technologies. Pharmacists play a critical role on the healthcare team, even more so in the digital age. Remote communications with patients are challenging - particularly written patient education sheets and post-visit summaries. Clinicians need to rely on verbal clues (rather than visual clues) to ensure patient understanding. When working from home, it's important to create habits and routines that mimic your work at the office such as dressing professionally, starting and stopping the workday in normal work hours, creating a designated workspace, and setting ground rules with family. Be creative using remote activities to increase bonding and consistent communication between team members.

Donald Klepser, Ph.D., MBA - Professor and Associate Dean for Academic Affairs at the University of Nebraska Medical Center College of Pharmacy - and Michael Klepser, Pharm.D. - Professor of Pharmacy Practice at Ferris State University College of Pharmacy - talk to us about the role of point-of-care testing in disease state management and to achieve public health goals. Key Lessons: Point-of-care tests (POCT) can be performed in non-laboratory settings, such as the patient's home or in a community pharmacy, and provide clinical data to make treatment decisions. The sooner test results can be made available, the sooner treatment can be initiated.  This is particularly important for many infectious diseases because the outcome is closely tied to how rapidly the treatment is started. When deployed in community-based pharmacies and clinics, POCTs help increase access to care, particularly in rural and underserved areas. POCT can be used to test for influenza, SARS-CoV-2 (aka COVID-19), Streptococcal pharyngitis (aka strep throat), human immunodeficiency virus (HIV), and other sexually transmitted infections as well as monitor serum lipids, serum electrolytes, and renal function. Under a collaborative practice agreement (CPA), community pharmacists can use the results of POCT to quickly initiate treatment or adjust the doses of medications. POCT empower pharmacists to provide a range of health-related services. Student pharmacists can play a critical role in building our capacity to deploy POCT and provide disease management services in new locations. Key opportunities for the future: PrEP (pre-exposure prophylaxis) to prevent HIV Hepatitis C infection Sexually transmitted infections panel Lead exposure

Amanda Schartel, PharmD, BCACP - Clinical Pharmacy Specialist with ChristianaCare CareVio - talks with us about the roles and responsibilities of a population health pharmacist. Key Lessons: Population health involves holistically evaluating the health needs of a population and bringing together the resources and expertise needed to address those needs. Population health teams often include practitioners that many patients in primary care settings don't ordinarily have access including social workers, respiratory therapists, and clinical pharmacists. Sophisticated data analytics and remote monitoring tools help population health practitioners proactively identify patients who may need additional services or whose health status may be changing. Patient encounters are often conducting using videoconferencing technology and text-messaging can quickly capture patient experience data.  The role and responsibilities of the population health pharmacist often extend beyond what an ambulatory care pharmacist might address. Population health pharmacists often have the authority to adjust medication regimens and order laboratory tests. Residency training and board certification are not required but preferred for those seeking employment as a population health pharmacist.  The key skill sets needed by a population health pharmacist include patient management experience addressing complex medication-related issues as well as a deep knowledge of quality metrics and value-based payment structures.

Rear Admiral (RADM) Pamela Schweitzer - retired Chief Professional Officer of Pharmacy for the United States Public Health Service (USPHS) - talks to us about the roles and responsibilities of pharmacists during a public health crisis.  Dr. Schweitzer was responsible for providing leadership and coordination of USPHS pharmacy programs for the Office of the Surgeon General and the Department of Health & Human Services from 2014-2018. Key Lessons: Pharmacists play a critical role in the USPHS because they have a unique skill set. A pandemic, like COVID-19, requires a coordinated effort between the public and private sectors to address mass vaccination efforts as well as shortages of medications, testing, and personal protective equipment using an incident command structure. USPHS pharmacists are deployed to the hardest-hit zones to provide medical and scientific assistance.  With the COVID-19 pandemic, USPHS officers have been helping set-up community testing and mass-vaccination sites as well as providing input on federal guidance impacting pharmacists and pharmacies. Pharmacists in the USPHS must wear many hats. While formal training is helpful, getting a wide breadth of on-the-job experiences is critical. Be curious. Learn new skills in every position/job. Be flexible and positive. Be comfortable with shifting conditions. Step up, speak up, and volunteer.  Act when you can.  Be a role model. If you'd like to get more involved, consider volunteering with your local Medical Reserve Corps , applying to become a Commissioned Officer in the USPHS or the newly formed USPHS Ready Reserve Corps.

Ashley Barlow, PharmD (MD Anderson Cancer Center) & Brooke Barlow, PharmD (University of Kentucky Chandler Medical Center) - @theABofPharmaC and PGY2 Pharmacy Practice Residents - talk to us about developing their professional brand using Twitter and why creating an online presence can help you achieve your career goals. Key Lessons: Social media, especially Twitter, has become an increasingly important forum for connecting with professional colleagues and engaging in dialog about cutting edge issues that impact patient care and pharmacy practice. To get started, read this brief article by Robert Pugliese entitled How Twitter Has Made Me a Better Pharmacist. Consider maintaining separate professional and personal social media accounts. Instagram, Facebook, LinkedIn, and Twitter are the most commonly used social media platforms for professional networking purposes. Everyone should purposefully develop their professional brand online.  Your digital footprint ultimately reflects your reputation. Your online persona is perhaps the first and most important impression that others with have of you. Think about the ABCDEs of your social media presence. A - align your social media with your professional goals.  B - build your profile with a professional bio and photo.  C - curate the content you find interesting and important.  D - define your audience.  E - engage in conversations ... be sure to like, comment, and retweet! Your online network through social media can lead to many new opportunities. Get the Social Media Infographic by Ashley and Brooke Barlow (@theABofPharmaC)

Dave L. Dixon, PharmD, BCACP, BCPS, CDE, CLS  - Virginia Commonwealth University School of Pharmacy and - Brent N. Reed, PharmD, BCPS, BCCP  - University of Maryland School of Pharmacy - talk with us about using social media for professional development and staying current with the latest evidence to support your practice. Key Lessons: Social media includes a wide range of online applications intended to interact with other users in a public setting. Social media, especially Twitter, has become an increasingly important forum for connecting with professional colleagues and engaging in dialog about cutting edge issues that impact patient care and pharmacy practice. Social media use should be done in a systematic, thoughtful way - you need to decide what your goals are, who to follow, and how frequently to check your social media feeds. Being a passive recipient of social media posts (aka being a "lurker") is a great way to get started but eventually, you may wish to share and comment on content you find valuable ... as well as create your own original content. Learning how to curate your social media feed can help prevent information overload. Following a professional conference (and the people attending) on Twitter can enhance the conference experience and enable those who are not able to attend the conference to learn about what's happening. Engaging in social media can be personally and professionally rewarding.  Share your personality!  It should be fun. Get the Social Media Infographic by Ashley and Brooke Barlow (@theABofPharmaC)

Casey Tak, PhD, MPH - University of North Carolina Eschelman School of Pharmacy and - Karen Gunning, PharmD, BCPS, BCACP - University of Utah College of Pharmacy - talk with us about hormonal contraception and how pharmacists in community and ambulatory care settings can increase women's access to care. Key Lessons: A variety of contraceptive methods have been available through pharmacies for decades but many states now permit pharmacists to directly "provide" hormonal contraception without a prescription. A state-wide standing order is the most common mechanism for authorizing pharmacists to provide hormonal contraception directly to patients, but state laws and regulations vary. The CDC Guidance for Healthcare Providers - US Medical Eligibility Criteria do not require a woman to have a pelvic exam prior to receiving hormonal contraception. The pharmacist needs to ask about and document the patient's medical and medication history, take the patient's blood pressure, and inquire about contraceptive preferences before providing hormonal contraception. Some states require pharmacists to refer patients to a primary care provider to receive recommended preventive care, such as pelvic exams, breast exams, and Pap smears.  Even when this is not required by state law, it's a best practice to ensure all women are receiving appropriate health maintenance services. Insurance coverage for pharmacist-provided hormonal contraception is not universal - many private insurance plans do not cover the cost of hormonal contraception or compensate for the pharmacist's time.  However, Medicaid programs often do (varies by state). Increasing access to hormonal contraception is good public policy because it can positively impact Medicaid costs by reducing unintended pregnancies, high-risk pregnancies, and infant mortality. Student pharmacists can (and have) played an important role in advocating for pharmacist-provided hormonal contraction.

Kristin Wiisanen, PharmD - Clinical Professor and Director of the Graduate Program in Precision Medicine at the University of Florida College of Pharmacy - talks with us about using genomics to guide therapeutic decisions. Key Lessons: Precision medicine and personalized medicine are synonymous terms. Pharmacogenomics is a tool to personalize treatment decisions.  However, it is not the only tool.  Other readily available and routinely collected clinical information has been used to personalize therapy for decades (e.g. blood type, serum creatinine, CV risk score). While creating a separate pharmacogenomic service can help ease practitioners into using pharmacogenomic tests, learning how to integrate genetic information as a routine part of clinical decision-making is the ultimate goal. Pharmacists have a unique role (and responsibility) to know when and how to use the results of pharmacogenomic tests. Teaching students, residents, and fellows to use pharmacogenomic information should be done in an integrated manner - considered alongside other clinical data, not in isolation. Several excellent resources now exist that can assist pharmacists and other providers use the results of pharmacogenomic tests including the Pharmacogenomics Knowledge Base (PharmGKB) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines.

Lucas Berenbrok, PharmD, BCACP, TTS - Assistant Professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy - talks with us about hearing loss and the important role pharmacists can play as OTC hearing aids become available in 2020. Key Lessons: Most older adults have some degree of hearing loss and it can significantly impact the quality of life There are many causes of hearing loss including medications, infections, cerumen, and aging A screening exam for hearing impairment is part of the Welcome to Medicare Exam, but hearing aids are not covered by Medicare. OTC hearing aids are predicted to be a far more affordable option for patients with mild-to-moderate hearing loss. Pharmacists have an important role in assessing patients and referring them to an audiologist for hearing exams. Pharmacists can assist patients select an appropriate OTC hearing aid To find an audiologist: American Academy of Audiology