The Oncology Pharmacist (TOP) spoke with Steve Stricker, PharmD, MS, BCOP, Senior Medical Science Liaison, Takeda Oncology, Florence, KY, and Associate Editor-in-Chief of TOP, at the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference about the importance of provider status, why clinical oncologists may be overlooked by their peers, and the most fulfilling part of his work.
TOP: What are some of the biggest issues facing oncology pharmacists today?
Steve Stricker: Provider status is a huge issue. The statistics continue to tell us that there is a shortage of physicians, and many clinical pharmacists are poised to take that next step in doing direct patient care.
It may be a lack of understanding about what a collaborative practice agreement is, or a reluctance by physicians to relinquish some of their clinical responsibilities to a pharmacist. But no matter how you paint the position, many physicians see pharmacists as working in a dispensing capacity. I do not think many physicians realize the clinical backgrounds and skill sets that pharmacists, especially those who have been residency trained and board certified, have developed, and where they are in the professional landscape. That ultimately results in pharmacists being pigeonholed into a niche of chemotherapy education and drug dispensing, when they are capable of so much more.
Reimbursement for drugs is also an issue. Especially in the current landscape of expensive new drugs, it is critical that the right drug is given to the right patient at the right time and the right dose. But pharmacists also need to make sure that patients have access to those drugs. We need to help minimize the financial impact on patients so that they can actually receive the drug that has been prescribed to them as the best fit.
The third area is a more knowledge-based domain. With the movement toward personalized therapies driven by pharmacogenomics, there is a knowledge gap that pharmacists need to fill so that they are equipped to best utilize these new therapies, such as understanding the need for next-generation sequencing of tumor samples, identifying actionable genetic abnormalities, and finding the correct drug partner.
TOP: How can pharmacists bridge that knowledge gap?
Dr Stricker: Professional organizations can play a huge role. Because it is run by oncology clinicians who are pharmacists, HOPA is especially poised to help identify the knowledge deficits and training needs of pharmacists.
Our board certification system in oncology is also helping to bridge that gap. I heard that approximately 20% of the new board exam in oncology is related to pharmacogenomics and pathophysiology. From a credentialing and training perspective, and a continuing medical education perspective, I think we will start to fill those gaps.
TOP: How has the shifting site of care changed the oncology pharmacist’s role?
Dr Stricker: One of HOPA’s goals has been to make sure that an oncology pharmacist is involved in the care of every patient diagnosed with cancer. As roles and responsibilities shift, however, and oncology pharmacists move out of practice settings—from the community settings to academia or to academic medical centers or even to industry—it is taking some of the brightest minds away from providing direct patient care.
That being said, I believe that achieving provider status will encourage more pharmacists to stay in practice. They may recognize that they are finally fully and legally able to do all the things that they were promised they would be able to do during residency training. That has been a discouraging factor for many people who have made the decision to change roles in the oncology world.
TOP: How will changes to the Affordable Care Act affect oncology pharmacists?
Dr Stricker: This issue has become so politicized that I am not sure we know what the landscape will look like. Our goal is that clinical pharmacists in particular be recognized as providers so that they can bill and be reimbursed for clinical services. This will help to fill the unmet medical need that is left by a dwindling number of physicians, and it will fill that gap with clinicians who are ready to take on those responsibilities.
The data suggest that the rates of new medical school graduates are dropping every year—someone has to fill that need. Many pharmacists are just as bright as physicians, but they made the decision to go to pharmacy school instead of medical school.
TOP: What’s the most fulfilling part of your work?
Dr Stricker: Without question, seeing patients do well. Most of the people at HOPA would tell you that we are in it for the patients. Even though my role has changed, and I am now on the industry side, I am involved in clinical trials that have the potential to deliver new drugs to patients who otherwise might not have access to those compounds. At the end of the day, seeing patients do well is what drives us.