It's Never Been Done Before

   The physician that owns the clinic I work in wants a pharmacy in the clinic. We had talked about this many times as he was making his plans and discussing what he wants to do. He envisioned a pharmacy where his patients could leave with the medication they need so they can start treatment right away. That sounded like a good plan. I began to do research on what was needed for a pharmacy.
   Almost immediately I ran into a problem. It was floor space. The rules specified a certain amount of floor space. That was not going to work in the tiny clinic. The pharmacy would be located in a spot with less than half the amount of floor space than required in the rules.
   This meant I was going to have to ask for a variance. A variance is permission to operate outside the rules. You have to explain why compliance with the rules would not be possible. You also have to explain why your solution would work and not cause public harm. I put together my license application and variance request, sent them off and waited nervously. I hoped that the variance would be approved and that we could go ahead with the pharmacy. In the meantime I started working on documents and thinking about how I wanted things arranged and looking for required reference books.
   A few weeks ago I contacted someone I knew at the Board of Pharmacy office to see about the status of my request. A day later I got my answer. It was denied. I would get the official letter soon.
  I'd be lying if I said I wasn't a bit deflated. Then I started to think. What could I do to get this pharmacy licensed? It was clear to me that I wasn't going to be able to do a traditional dispensing pharmacy in that space. How could I do this?
   A thought slowly formed in my head. I remembered when I was looking at types of pharmacy licenses, I saw one called limited service. Thinking that this might apply  to a pharmacy in a specialty clinic I asked about it. A limited service pharmacy is a pharmacy that does only one thing like immunizations or patient counseling. It didn't fit what I was looking for so I filed the information away in my head.
   Patient counseling, that might be my ticket. That's what I really wanted to do anyway. My thought was that anyone who got a prescription would also get counseling on the medication they would be receiving. That way they would leave with all the information they would need to take care of themselves. All they would have to do is pick up the medication at their pharmacy of choice.
   I called my contact at the Board to see if it was workable. He thought it might be. He also said, "This has never been done before." Literally no one in this state had ever proposed a pharmacy practice like what I was proposing. He told me what I needed to do and what steps I would have to take. I had to work fast. If I wanted to be considered for the next month's committee meeting,I would have to have the paperwork in by noon that day.
   There was no time to consult the physician. He was on vacation with his family. There was no time to do anything but act. I worked quickly to fill out the forms and wrote a new cover letter. Then C and I had to go to our remote office space to scan my documents and send them to the Board. We got them sent with half an hour to spare.
   I'm back to nervously waiting again. A good part of my nervousness has to do with the fact that I'm trying to put together a novel practice. I'm breaking new ground in my profession. This has never been done before. I have no guide to follow, no precedents no anything. If this gets approved I'll be the first and I might be closely watched. I have never done anything like this before.
  Or have I? Way back when I was a new pharmacist, I took a job in a small town.  No pharmacy in this town had ever hired a woman to work full time as a pharmacist. It was hard to get doctors to work with me as they just couldn't believe that women could be pharmacists. Patients didn't want to talk to me as they had always spoken to an older man. How could a young woman possibly be any good? Pharmacist were men with lots of experience. I was yelled at, had my judgment questioned more times than I could count, was spit at once and had a bottle thrown at me. There were numerous times when a customer argued with me about something. When a male colleague told them the same thing in almost the same words, there was no argument.  I was breaking new ground then as well. Perhaps I have been the first before....
   One thing I know, there is a need for what I want to do. Working as a patient care specialist I have already seen two situations where a pharmacy consult would be helpful. I've even thought of reaching out to the University of Minnesota for some help in attempting to document my outcomes with an eye toward proving to insurers that paying pharmacists for their time is a good investment. This could lead to new job opportunities for pharmacists in the future.
   These are daydreams I have as I once again nervously wait. I'll keep you posted.