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DISRxUPT is a podcast from the Cedarville University Center for Pharmacy Innovation which explores novel advances in the practice of pharmacy. From nanotechnology to unique public health initiatives, DISRxUPT will highlight stories of pharmacists who are changing the paradigm of patient care.
Tune in for new content once a month detailing how the profession of pharmacy continues to change and how the Center for Pharmacy Innovation is playing a key role in this transformation.
Welcome to DISRxUPT, a podcast of the Cedarville University Center for Pharmacy Innovation. Today on the podcast, we're excited to have Dr. Michael Hogue, Chief Executive Officer of the American Pharmacists Association joining us as our guest. As the fifteenth CEO of APhA, Dr. Hogue continues to lead with passion and purpose, advocating for provider status, interprofessional collaboration, and a bold vision for the future of pharmacy.
Justin Cole:Listeners, welcome back to a very special edition of DISRxUPT.
Justin Cole:I'm your host, Justin Cole, and today marks our fiftieth episode as a podcast. And we're celebrating this milestone with a guest whose leadership and vision have truly shaped the future of pharmacy. Dr. Hogue is a nationally recognized leader, educator, and advocate with over twenty five years of experience in many areas, including community pharmacy, academia, and national health policy.
Justin Cole:He's been instrumental in expanding pharmacist administered immunizations, launching innovative workforce platforms, and serving as a key advisor during the COVID-19 pandemic, among many other things. Also, this past spring, we had the privilege of welcoming Dr. Hogue to the Cedarville University School of Pharmacy right here on our campus, where he inspired students with his insights on leadership, the evolving role of pharmacists, and the importance of unifying the profession around patient centered care. Michael, we are honored to have you join us for this landmark episode. Welcome to Disrupt.
Michael Hogue:Thanks, Justin. It's good to be with you. Appreciate this opportunity and congratulations on your fiftieth episode.
Justin Cole:Yeah, we appreciate that. Let's continue telling the story about how pharmacists are innovating and changing the paradigm of patient care. Well, you've had a long and impactful career in pharmacy leadership. What is your overarching vision for the future of the pharmacy profession under your leadership at APhA?
Michael Hogue:You know, I think that we live in a world today where medicines are so complex and they're becoming more complex. Consumer access to health care resources are becoming more difficult. And the world that we're in is just, you know, a natural progression of an aging population with fewer and fewer kids being born. So we're having a major population shift, and that's leading to shortages of providers. Pharmacists are well trained, very, very well trained, but consumers in large measure don't have access to the care services of a pharmacist.
Michael Hogue:And the reason that they don't have access to that care is because either they don't have coverage for pharmacist care services, or they're not living in a state where pharmacists have the full authority to be able to exercise their knowledge, skills, and abilities to the best of the patient. So it's a long answer to the question to say that APhA wants to ensure that consumers have access to the care services of a pharmacist whenever and wherever they interact with the health care system. And we'll keep fighting until we get to the point where consumers have that full access regardless of where they live, work, worship, or play.
Justin Cole:Well, that vision clearly sets up some of the strategies that you have for APhA, both in 2025 and beyond. So maybe could you tell us about some of those top strategic priorities and how they align with the evolving needs of pharmacists and, of course, our patients?
Michael Hogue:Well, yes, absolutely. Thanks for that question. You know, there are a number of strategies that we have to undertake in order to achieve what we're trying to achieve here. So much of what APhA does is based in regulation and law. So we do a lot of advocacy work as you might expect with the federal government, whether it's with congress or the White House or with governmental agencies.
Michael Hogue:But we also work very closely and collaboratively with our state partners to help change state laws and state regulations. A couple of very specific initiatives, though, that are not related to regulations and laws that I think are really important maybe for your listeners to understand is that APhA has a significant amount of resource currently invested in trying to help major medical insurance plans onboard, pharmacists as providers. And, you know, we've talked about for decades in the pharmacy profession having pharmacists achieve provider status. But, you know, the reality is is that we've achieved that in almost every state now. Pharmacists are designated as providers.
Michael Hogue:And there's nothing to prohibit, for example, a payer in your state from paying a pharmacist for the care services that they provide. So, you know, what we've got to do now is we've got to connect pharmacists who want to provide those care services, whether they're in outpatient settings in a hospital or whether they're in a community based pharmacy or maybe a pharmacist that's hung out their own shingle and has a private office based practice. We just need to make those connections to the insurance companies, help them onboard those pharmacists, and begin paying those pharmacists for the care services they provide. So we've major initiative right now focused on health insurers and trying to get pharmacists onboarded. That's just one example of the many, many things we're working on at APhA to try to improve these opportunities.
Justin Cole:That's great. Now you had mentioned that advocacy policy changes are also central to what APhA is doing. So are there any particular structural or policy changes that you believe are most urgently needed to advance the role of the pharmacist in The US health care system?
Michael Hogue:Yeah. Well, one thing I think that's really critical that needs to happen is that it's not just enough at the state level for the states who have recognized pharmacists as providers in their state laws. We also need to have mandates at the state level in the insurance regulations and laws or in other laws or regulations maybe that are relevant that requires health insurance companies to cover the care services as a pharmacist at the same rate and level that they would cover those services if they were provided by any other health care providers. So it's really critical that we have what I call payment parity. And there are not a lot of states that have payment parity.
Michael Hogue:So that's one big thing that we're advocating for at the state level. The other thing that I think is critical right now, and and, you know, your listeners may have heard a little bit about this, Idaho passed a law just a few years ago called standard of care for their pharmacy practice regulation. Right now, if you look at state pharmacy practice acts, it's chock full of all kinds of laws that say, well, the pharmacist can do this, but they can't do this. And they can do this and this and this, but they can't do this. And and if they do this or this, they've gotta have six hours of additional continuing education.
Michael Hogue:And if they wanna do this or this, You know what? Pharmacy is the only profession that has that in state regulation and state farm in state practice acts, and it's ridiculous. We've put those throttles on ourselves. We put we know, it it holds us back from being able to do the things that we're trained to do. So what we are advocating at APhA is that the states adopt a standard of care model of legislation, which basically says in its simplest form, that pharmacists will provide to the patients that they care for the standard of care, and that pharmacists will be held accountable for providing the standard of care.
Michael Hogue:And if a pharmacist is providing care, they will be allowed to provide care at the standard and within the scope of their practice at the state practice level. Very simple. Idaho did this. Since then, Alaska and Iowa have also adopted legislation that allow for standard of care. There's legislation pending in California and other states that would expand practice to allow for the standard of care.
Michael Hogue:That's exactly how medicine's practiced. That's exactly how nursing's practiced. It's exactly how dentistry is practiced. When you look at every other healthcare professional and the governance of their practice at the state level, it follows a standard of care model of practice. So we are really gonna turn up the heat, 2025 and 2026, particularly on getting state regulations changed in all 50 states to move to this standard of care model.
Michael Hogue:It's time for us to stop nickel and diming what pharmacists can and can't do and give them the ability to do whatever it is that they're trained to do and whatever they need to do to provide the very best care to their patients.
Justin Cole:Well, agree that standard of care model is where we need to go in the profession. I also see, though, in schools of colleges and pharmacies like ourselves here at Cedarville, we have a responsibility for training future pharmacists to be ready for that type of practice. So I'm curious if you had any suggestions for us in the Pharmacy Academy on how we can evolve to better prepare future pharmacists for expanded clinical roles and interprofessional collaboration. What are some of those things you think we should be focusing on?
Michael Hogue:Well, I would say remember that, pharmacists are the medication experts on the health care team, And inappropriate medication use in The United States is costing us at least a dollar 55 for every dollar that we're spending on medicine. So, you know, we're spending just listen to that statistic a little more closely. For every $1 we're spending on medicine, and this study is now about three years old, we're spending a dollar and 55¢ on resolving medication related problems. That's well almost $600,000,000 a year in The United States getting spent on medication related problems. Somebody has to solve those problems.
Michael Hogue:And solving those problems requires not just simply correcting a dosing error or a drug drug interaction, and those are really, really important, but it's ensuring that patients have appropriate medication therapy outcomes. We have got to become accountable for the outcomes of our patients, the medication outcomes of our patients. I think schools and colleges of pharmacy need to be teaching students how to take personal responsibility for the patients that are under their care. Not just simply putting pills in a bottle, but saying this is my patient, and the outcomes of this patient are my responsibility, and I will do whatever is necessary to ensure that my patient has a positive outcome. And when you put it in that perspective, you take that personal responsibility for a patient, then you think about all of the things that you need to teach and that you need to train to in order for a pharmacist to be able to do that.
Michael Hogue:So, you know, if it's a patient that's sitting in front of you, for example, with congestive heart failure, you better know how to order laboratories, you better know how to interpret those laboratory tests. You better know how to do basic physical assessment to see if a patient's heart failure is improving or worsening. You better know how to follow-up on that patient's medications to make sure that they're all working. You better know how to communicate with the rest of the health care team to ensure that appropriate outcomes are happening. There's so many things that you've got to know just with heart failure to be able to make sure that that patient has an appropriate outcome.
Michael Hogue:And I think every pharmacist that graduates from school or college of pharmacy should be able to take care, you know, of the patients that have primary top 10 chronic diseases in The US. I mean, we ought to be able to handle a patient with diabetes coming into our practice or a patient with hypertension or heart failure or hyperlipidemia or asthma. I mean, these these are things that you see every day multiple times. And and and I think we just need to move beyond this mindset about, that it's just about teaching students how to put pills in a bottle. It's about how to be responsible in a practice and to ensure that those outcomes happen.
Justin Cole:Well, love that. And I think the Oath of the Pharmacist really captures that commitment to patients and their outcomes. And we talk about this idea of a fiduciary duty, right? This responsibility, almost covenantal in nature, that we as pharmacists need to have toward our patients. And I think you've summed that up really, really well.
Justin Cole:Yeah. Also, another thing that's been big in the news, and even the state that I'm in here in Ohio is tracking this specifically, is the increase in pharmacy deserts, right? We're seeing this all over the nation. It's not an Ohio problem, clearly. But it means that health equity and access to care was already an issue, right?
Justin Cole:We know that that's something going on in health care community here. But we see it getting worse. So what do you think pharmacists can do to address health equity and improve access to care in all communities, but maybe in particularly underserved communities?
Michael Hogue:Well, let me just say that the number of communities out there that don't have a pharmacist available to them, the number is growing at an alarming rate. Rite Aid's recent decision to file bankruptcy and close its pharmacies is the latest example. Your neighbor, Pennsylvania, is actually experiencing that to the greatest extent in The US with over 350 pharmacies closing in one single state. Many of those pharmacies are in communities where there is no other pharmacy. And so the commute loss of a community pharmacist there is is really a major issue.
Michael Hogue:But you know what? This is not just about community pharmacy. We need hospital and health system pharmacists to to to realize that this pharmacy desert issue is going to create negative pressures on health systems in ways that have not existed before because patients are going to seek their care from emergency departments. Costs of medications are gonna go up. And if we don't put systems in place to be able to provide access to care from a pharmacist, even in communities where pharmacies close, then we're gonna have a big problem.
Michael Hogue:And this medication use problem is gonna get out of control. I wanna share with you something, Justin, that that I got in the mail this week. It's a letter. This this letter came from the village of Yorkville, Ohio. Sandy Reasbeck is the mayor, and the council city council sent to me here at APhA headquarters this letter that says, to whom it may concern.
Michael Hogue:I'm writing this letter in hopes of receiving your assistance in locating a pharmacy service willing to serve the village of Yorkville residents and those in our surrounding areas. The Walgreens in our village has closed leaving our residents scrambling to find a pharmacy. There's a CVS in a neighboring town, but this does not help our elderly who no longer drive any distance. The village of Yorkville is located in the Appalachian Ohio River Valley, and then the mayor and city council tell me all the wonderful qualities of of Yorkville so that hopefully we could find someone that would come in. But they have a community of 968 with two other communities within two to three miles that have a similar population, and they're just asking for help.
Michael Hogue:And, you know, this this letter is fresh on my mind, and I knew I was coming on the air with you. So I thought I'd hold on to it to to to discuss it with you. The reality is is that there are a lot of inner city areas, the big cities that have this problem. This is happening in a lot of small communities. And I think it's going to require us all to get creative in our thinking about how we provide care.
Michael Hogue:Now this is juxtaposed over a situation, Justin, where the volume of just dispensing the medications is now overwhelming our traditional pharmacy system in the outpatient setting. And we're hearing stories of pharmacies that have had their volumes double or more overnight because of the closing of a pharmacy. So the pressure that's created is not just the pressure of the loss of access to care that happens in a local community, but it's the intense pressure to just get the right drug to the right patient, the right dose efficiently and effectively, for those who remain. And I'll be honest, a lot of pharmacies are at their breaking point. We can't seem to hire pharmacists fast enough.
Michael Hogue:We can't seem to bring pharmacy technicians fast enough into the community pharmacy setting to be able to fulfill this need. And I know that a lot of pharmacists have got negative images right now about what it's like to practice in community pharmacy. And in fact, a lot of pharmacists have left community pharmacy practice. And I just wanna challenge our profession to say that, look. It's wonderful that we have the versatility of this degree, but we need to figure out how we can all pitch in regardless of where we practice and how we can help address this acute situation because it's desperate.
Michael Hogue:It's created desperation for our colleagues. We have colleagues that are becoming, so stressed out and depressed that they're becoming hopeless. And hopelessness leads to, you know, very, very bad thinking. And, you know, recently, we've heard of a spat of of, suicides among pharmacists because they become depressed. And, you know, I don't know if their work environment had anything to do with that or not, but it couldn't have helped.
Michael Hogue:And so I would just say to all of us, everyone, no matter where you practice, no matter what your practice setting is in, have a heart for the entire profession and what's going on with the entire profession. Because when one part of our profession is hurting, the rest of our profession is also hurting. And we all need to understand this crisis and do what we can to advance patient care and to ensure that patients' needs are being met wherever we're interacting with them in the health care system. We just may not have access to all the same points that we had before. And that means the rest of us have got to step up and step in and do what we can to take good care of our patients.
Justin Cole:Well, strikes me too that even though pharmacy is facing some difficult headwinds, behind every crisis is an infinite amount of possibilities and opportunities, right? There's a lot of places where pharmacists have the opportunity to step in with new care models, different approaches that can really meet some of these needs that we're seeing. So I'd love to turn that way and talk about some of those opportunities that you see. So one of the big things, of course, with AI coming front and center really to the public in the last two years is we're now thinking more about the intersections of technology all across our lives, but including in the professional pharmacy. So I'm just curious, generally, are there any innovations you're most excited about that you feel like really could transform pharmacy practice in the next five to ten years or so?
Michael Hogue:Well, I mean, I think there are lots of technologies that have been out for a long time. I mean, I will speak specifically to AI here in just a moment. But let me first say that, sometimes the the limitations that we have for adopting technology are unnecessary limitations that are put on us by board of pharmacy regulations. And, you know, we have APhA has a lot of great conversations with the National Association, the boards of pharmacy, NABP, and with the state boards of pharmacy. And we have got to embrace technology.
Michael Hogue:And I know that there are a lot of pharmacists out there that say, yeah, but if we embrace this technology, it's gonna take pharmacist jobs away, and we're not gonna have the ability to have gainful employment. And I would just say to you, I don't think that's true. I I think that the problems we have right now in terms of just getting the right drugs in the hands of the patient are so severe. And the shortage of pharmacists that we have across the system to fill the positions that are open right now is so big that, you know, if we don't adopt this technology, we're going to just continue to have this, stretch to the breaking point situation in in the outpatient dispensing of drugs. We need to embrace automated dispensing technologies.
Michael Hogue:We need to embrace tech, tech, tech. I'll get I know that I'm gonna get emails now that I've said that out loud from pharmacists. They're gonna be really mad that I've that I've talked about this. But I'm sorry, ladies and gentlemen. The data are just as clear as a whistle.
Michael Hogue:Study after study after study has been done in the VA. It's been done. Iowa has done tremendous work in this area, demonstrating that technicians, checking technicians, utilizing technology that's available to them are actually more accurate and more safe in their dispensing than pharmacists are. And, you know, pharmacists, we need you to engage your brains in helping patients get the best use of their medicines, and let's let our technicians help get the right pills in the bottle. I think that that's important.
Michael Hogue:And, again, I know saying that is gonna probably make some of your listeners angry, and that's not my intent. I'm not trying to get anybody riled up. But I'm trying to say that, you know, the system is going to demand changes whether we come along with them or not. It's better that we embrace the technological changes and set up the right regulation and the regulatory system and the right oversight systems to ensure safety. That's better that we do that because if we don't do that, then the system's gonna run beyond our profession, and they're gonna do it the way they wanna do it.
Michael Hogue:And we may not like what the outcome of that is. So so that's what I have to say about the technology. Now let me get back to AI, Justin, for just a minute. AI is a wonderful tool that could in fact help us, but it is not yet at a stage where we can depend entirely upon AI to make patient care decisions for us. For example, where AI might be helpful.
Michael Hogue:If I'm a ambulatory care pharmacist working embedded in a family medicine clinic, for example, which is what I did at an earlier part of my career, I didn't have time to see all the patients. And normally the ones that got prioritized for me to be able to see were ones that the physician referred to me. And I stayed pretty darn busy based upon the physician referrals, which was great. But if you consider the number of patients that are out there that need to be seen, what might be good is if we could set up AI to help us use predictive analytics and other things to identify which patients most likely are gonna benefit the most from our services and then proactively reach out to those patients and get them scheduled in to see us, we might be able to prevent more adverse health consequences from inappropriate medication use. And we might be able to de stress our day because we might be able to take patients who are not perhaps as critical or as, you know, gonna get as much benefit and make sure that we have others that aren't gonna get that benefit being seen.
Michael Hogue:Now, all of that said, there still needs to be human decision making, and physicians and pharmacists still need to be able to work together to make those decisions. But that's one way I see AI becoming really helpful.
Justin Cole:Well, that's great. And I fully agree with you. I think those that learn to leverage technology and even simple changes in a model like Tech, Tech, Tech are the ones that now have an opportunity to do some of the things you've already talked about earlier, and that is be responsible for outcomes. That human element, that touch of patient care, and showing that really ownership of not just drug to patient, but how the patient actually ends up being treated. That's what it can free us up to do if we embrace it.
Justin Cole:So fully agree with you on those points.
Michael Hogue:Justin, could I just interject one other thing there that I think is really important? I recognize as your listeners are hearing you say that and hearing what I'm saying, they're gonna say, yeah, but I don't have that kind of practice autonomy when I go to work for the local chain drugstore. They don't give me that kind of autonomy to do that. Well, let me just say to you, pharmacists, you are professionals. It's your license and it's your practice, and you have to take ownership of it.
Michael Hogue:And I will tell you that APhA is having conversations with the chain pharmacy partners, and we're saying you have to give your pharmacist autonomy of practice to take care of the patients. Yes. You have a business to run, and, yes, you have to do certain things in order to run that business. And I get that. There's nothing wrong with, you know, meeting the business demands.
Michael Hogue:You've gotta do that. But ultimately, that pharmacist at the front line has to be held accountable for the care that they're going to be providing. And I will tell you that if a health plan is going to enroll pharmacists in chain drugstore settings as providers into their network of health care providers, they will demand that the individual care that's being provided to that patient be tracked to the individual NPI. It will not be enough to just simply report that store five thousand three twenty one has got this care and this care and this care. No, it's gonna be you.
Michael Hogue:It's gonna be your license and your NPI number. You say, well, that's a pipe dream. That'll never happen. Oh, no. You're wrong because it is happening.
Michael Hogue:In fact, I can give you specific examples in specific states where health plans are enrolling pharmacists that work in chain drugstores. They're tracking the outcomes of the individual pharmacists in those chain drugstores related to the services they provide, and the chain is cooperating and helping with that. So, you know, just because you don't necessarily see it happening in your community or your backyard doesn't mean that it's not happening, and it doesn't mean that it won't begin to happen more rapidly across the country because change in health care is accelerating, and we're gonna see this happen much more rapidly as we move forward.
Justin Cole:Well, Michael, to your point, just a couple episodes back, we had Doctor. Lydia Bailey on the podcast who's in the charitable pharmacy space. And she talked extensively about how that model has been created all around outcomes, right? And I think she's a shining example and her team, of course, of how that can happen in any unique space, of course. So I'm curious, do you have other examples that you could share about pharmacy models, maybe some pilot programs that you believe could be scaled nationally to improve patient outcomes and maybe even pharmacist satisfaction?
Michael Hogue:Well, I'll tell you one that I'm very familiar with in Southern California. The National Association of Chain Drug Stores Foundation gave a grant to Loma Linda University to implement across San Bernardino and Riverside Counties an HIV pre and post exposure prophylaxis program based in community pharmacies. And, every national chain pharmacy organization that does business in Riverside and San Bernardino County has at least one participating pharmacy, in this in this particular project as well as the independents. And and, basically, what they're doing is, working with, social workers and community health workers. The pharmacists are, doing HIV testing testing in their pharmacy for which they're getting paid, and they're doing, or they're doing evaluation and prescribing of HIV pre exposure prophylaxis therapy in their community pharmacies.
Michael Hogue:And guess what? The local Medicaid program plan in in California, they have Medicaid managed care, and the Medi Cal program for San Bernardino and Riverside County is paying pharmacists for their care services in addition to reimbursing them for the medication, which is just absolutely remarkable. The success of that program is is really, really great. That is just one microcosm of an example of where individual pharmacists providing care, billing through, getting paid, and they're in every setting, Walgreens, CVS, Albertsons, Vons, Walmart, Rite Aid until recently, and independent community pharmacies all participating in that project. It's just remarkable.
Michael Hogue:And I think that those kinds of things are gonna expand more rapidly across the country, and they're already happening now. I could give you a dozen more examples. That's just one that comes to mind immediately.
Justin Cole:Well, that's great. And I love that a lot of that centers around collaboration. And from your visit here with us, Michael, I know that collaboration is something that you are passionate about. In pharmacy, we have a lot of pharmacy organizations. I think no one would argue that.
Justin Cole:And often that can mean that there can be disparate voices. But one of the things I know you're passionate about is bringing those voices together in pharmacy to help support one another, as you've already talked about. So could you tell us about some of those efforts that you've been doing personally to invest in and connect with some of the other pharmacy organizations here in The US?
Michael Hogue:Yep. I sure will. I'm happy to do it. You know, I came in as the CEO of APhA two years ago, and I made a commitment to the other national pharmacy associations that APhA would always be a collaborator with them, at least as long as I'm the CEO of the association. I've made it a point in the last two years to attend the national meeting of just about all of the national pharmacy associations.
Michael Hogue:I may still have one or two that I haven't gotten to yet, but I've made it a point to attend their annual meetings. Our social media folks have been intent on posting about their annual meetings and promoting their association. We have good dialogue where, you know, the the Joint Commission of Pharmacy Practice Organizations, JCPP, has become a place where the CEOs and the presidents of the associations can get together at least three times a year and have good dialogue about the current issues. And we talk about how do we work together to help advance pharmacies' purpose and cause. We we regularly get together with these associations that we just had a summit last week on workplace conditions and the pharmacy workforce, and it was cosponsored by APhA, NABP, and ASHP.
Michael Hogue:And, you know, all three of us, the CEOs of the association, sat at a round table at the front of the room. We were present and engaged for the entire conference listening and carefully considering everything that was being said. But, you know, also present at that conference, even though they were not sponsors, but they were present were nearly all of the other JCPP organizations. They all had representatives there. This is important that pharmacists know that we do work together.
Michael Hogue:And I think that that's, that's just so critical. So, you know, yes, we have a lot of voices in the pharmacy profession, and my mission is to try to bring us together as one voice and to speak with one voice and to act with one voice in the profession. Long gone should be the days of, you know, one organization going in one direction and another one going in another direction. We're working very hard to unify our profession and ensure that we're all together moving in the same direction.
Justin Cole:Well, personally, I love that vision. And I think that's what it takes to be a larger voice of advocacy for the profession. I think other professions probably do it better than we do. But I think you are a shining example of how there's some really positive headwinds on working together to advance pharmacy. So, I also want to return back and maybe let you give some advice to our listeners, whether they're pharmacists, student pharmacists or others, on how can they get involved with APhA or other organizations to help pharmacists be recognized and reimbursed as health care providers, whether at the federal or state level?
Justin Cole:What can the individual pharmacist or school of pharmacy or organization do?
Michael Hogue:Yep. Well, that's a great question. And, you know, first of all, I wanna just emphasize to everyone, this is a profession. People in professions belong to something that's bigger than themselves. And we live in a world that's very individualistic and focused on the individual's needs and the individual's desires, and I understand that.
Michael Hogue:That's that's human tendency that we all want to do things that better us as individuals. I can tell you when you join APhA, our purpose here is to ensure that you have opportunities to advance your career, no matter what direction you decide to take your career in. And sometimes our careers take left turns when we wanted to go right. And sometimes they take turns when we thought we were on the path that we wanted to be on. And that's why APhA is here, is to help you as an individual accomplish what it is you wanna accomplish in your career.
Michael Hogue:There are specialty associations out there that may help you be better at your specialty, which is wonderful. But I think that it's important that you're a part of APhA for that anchor in your career as an individual. But being a part of APHA also demonstrates that you've got a commitment to the bigger picture that you understand that there's something bigger because APhA is leading these changes that happen at the federal, and state level. We're working closely with our partners, our state association partners, boards of pharmacy, other national associations to ensure that there's a unified voice. So the very first thing that we need pharmacists to do is to join.
Michael Hogue:And you'll say, well, you know, I used to be a member. I've never been a member, and I'm not sure what the value is. Well, you know what? Give it a try. But put you know, join and connect and be engaged.
Michael Hogue:And, you know, engagement has never been easier in the professional organizations. Most organizations like APHA have communities you can connect with, that you can, find other people who are doing what you're doing that you can connect with. But you can also find people that are doing innovative things. APHA is the place where innovators connect, and it's the place where the innovators come together. So if you really want to be as your podcast focuses on innovation and entrepreneurial focus, APHA is a great place for you to be able to explore that because this is where the entrepreneurs and the innovators tend to go, and they tend to be belong.
Michael Hogue:And so a good way to connect. But, yeah, it's just, first of all, join. Second, pay attention to what's going on, and then realize and give yourself permission. Look. Not everybody can serve on a committee.
Michael Hogue:Not everybody can run for an office, and not everybody needs to do all of that. But, you know, there are gonna be seasons in your life where you can fully engage, and there's gonna be seasons in your life where you're gonna just have to be a spectator because that's the way life is going at that moment. But through the whole thing, stay connected through your membership at least so that you can show the profession you're supporting and you can have that connectivity. And then when that phase changes that you no longer need to be a spectator and you're ready to reengage, you'll have that clear pathway for doing it.
Justin Cole:Yeah, great advice. And I'll just echo some of the richest collaborations that I have seen in my own career have come from being involved with associations within the pharmacy profession. So I second all of that. Michael, I'd love to give you an opportunity also that you've just given our listeners great advice on how to be part of shaping the future of the profession. One is connect, right?
Justin Cole:But do you have any other pieces of advice that you would give to either student pharmacists who are the future of the profession, or maybe even early career pharmacists that do want to be some of those changers that we need in the pharmacy profession?
Michael Hogue:Yeah. Well, first of all, be proud of who you are and realize that you are a doctor of pharmacy. I mean, you're a pharmacist. And I really don't care what your practice setting is. I think, unfortunately, too many people in our profession try to segment us by where we practice.
Michael Hogue:And that is not the important part. The important part is that we're a patient care provider. We're pharmacists first, and and we're defined by our, our degree and our profession. And I'm proud to be a pharmacist. And, you know, I may provide care in a local community through a community pharmacy, or I may provide care telephonically, through a managed care plan, or I might provide care at a hospital or a health system.
Michael Hogue:But every pharmacist is a pharmacist first. And you can you know, if if we could get in our profession to the point where we'd stop labeling each other and stop labeling ourselves with all kinds of, fancy, terms, I think that would be a good start for all of us, in in positive engagement. But, that's a soapbox issue, Justin. I didn't answer your question. The the the answer to your question is that I think that we need to you know, you need to think about what your level of desired engagement really is.
Michael Hogue:Now I'm gonna give you a couple of that. You know, there's probably if, you know, if a 100 people were listening to your podcast today, I'm there may be one or two people who will take this kernel, but I'm gonna give this kernel because it needs to be heard. We need more pharmacists in Washington on Capitol Hill, and we need them there desperately because people are not getting pharmacy's message as clearly as they need to in setting health policy. There are opportunities to be on Capitol Hill outside of running for congress. And I would just challenge students particularly, if you think you have an interest in health policy and you wanna catapult your career, then one way to do that is to actually take a job as a staffer on Capitol Hill working for one of our members of congress in their office.
Michael Hogue:Now your salary is not going to be a pharmacist's salary when you get out. Your salary is gonna be more like what a pharmacy resident salary would be, but you're going to gain the intense opportunity to be learning about how policy is made and shaped, and it gives you the opportunity to then catapult your career, into something bigger. So you may say, well, I don't wanna do this the rest of my career after you get done. That's fine. But look at the the skill that you've developed.
Michael Hogue:Look at the opportunities you've created for yourself, the value you've created for your profession. Dig in and learn. We currently have five pharmacists on Capitol Hill working in capacities like that. We need 25, pharmacists working on Capitol Hill. And I you know, if you're interested in that, you know, send an email to CEO@aphanet.org.
Michael Hogue:I'll connect you with our government affairs staff, and they'll help you find, positions that might be available on Capitol Hill that a pharmacist could fill. There's really, really great opportunity right now, and, Congress needs you. So that's that's one little nugget of something that you could take away. Maybe I still didn't fully answer your question, but hopefully that's a little something.
Justin Cole:Absolutely. I think that's great advice. And I'd love to see people step up into those types of roles and really be, again, the people that are prepared to shape the future of the pharmacy profession. And ultimately, it is about the profession, but we exist for patients. And so that impact that you have in the profession then impacts infinitely more those patients who are cared for through it.
Justin Cole:As we wind down, Michael, I wanted to let you maybe pull out your crystal ball a little bit and or maybe it's more dreaming than it is crystal ball and prognosticating what really will happen. So if you could fast forward ten years, what would you hope to see as the most significant transformation in pharmacy practice?
Michael Hogue:Well, I think the biggest thing I would like to see is I would like to see every well, this is gonna be a little bit lengthy because I'm trying to expand on a on a concept. But in short, what I think will be the case in ten years is I do think that pharmacists will be, paid, routinely for their care services. And I know we've been talking about it for years, but I there are a lot of signposts out there and guideposts out there that tell me that it's happening, and it's happening in real time right now. And I believe that, you know, whether you're a pharmacist embedded in outpatient clinics or you're working in a capitated care model or you're, working in a community based pharmacy, I think the system, will finally recognize pharmacists for the care that we provide. And I suspect that the major driver of revenue for community based practices will be care services and not prescription drugs.
Michael Hogue:I do think that, what's coming is that, patients see drugs as a commodity. Pharmaceuticals are commodity as is natural with all commodities is that consumers will end up getting those commodities delivered to them at the cheapest way that they possibly can in the most effective and efficient way that they possibly can. And frankly, there are cheaper ways to get drugs to patients than some of the models that we use in today's world. So that's evolving. And I'm not saying that, you know, pharmacists give up dispensing.
Michael Hogue:We need to pay attention and control and oversee the dispensing process because of its role in patient safety. But we've we've got to recognize that that's not probably where our bread and butter is gonna come from in the future. We've gotta use those medicines as a tool and recognize that it's our intellect that's actually the the value. So I think that's changing in our system, very rapidly. And I think, you know, in the future, pharmacy technicians are probably going to have to complete some sort of education and training, more extensively in order to take on advanced health care roles.
Michael Hogue:Our system is beginning to make that happen. But, you know, we we've got a lot of we do have a lot of headwinds in front of us, but, you know, a lot of positive signs that things are happening. And, I I feel good about the future. I I really do. I feel that there's there's a rewarding practice of pharmacy in front of us.
Michael Hogue:I think that pharmacists and health systems have seen this evolve over time with specialties and other things that transpired. I think that, with physician practices being paid based upon quality and physicians understanding that pharmacists improve the quality of care within their clinics, I think increasingly physicians want pharmacists embedded in the health care team and ambulatory care clinics. That's not the standard across the country, but I think it will be the standard in ten years because I think there will be payment mechanisms for the pharmacist time to be covered and paid for under that model. And I think that, you know, the system will, in fact, pay pharmacists even in local communities to ensure that patients get good outcomes. And so this is all coming.
Michael Hogue:It's it's coming. There are a lot of bright spots. We're getting patient advocacy organizations now that are demanding it. The American Diabetes Association meeting was just a week ago, and ADA spoke strongly, positively about pharmacists being members of the care team and being compensated appropriately for the care that they provide. You know, I think when you've got these these organizations, these these non pharmacist organizations coming along and and really advocating that pharmacists, we need pharmacists on the team, you know, something is significantly changed, obviously, and, and that's gonna accelerate our pace of change.
Michael Hogue:So all good stuff I hear in front of us. But, you know, right now it's painful because there's a lot of change. When change is happening, when you're in the midst of change, it's the toughest time because the friction that's created from shifting models and changing paradigms and and so forth, it's it's extremely painful when you live in it. But you gotta realize that there will be a moment when the crust is gonna fall off of that diamond and it's gonna shine, and you're gonna see something that's much brighter than what you've, than you've had to live with. And it'll all have been worth it when you get to that point, and it's coming.
Michael Hogue:I can tell you it is coming. So hang in there and stay focused through the challenges, and let's keep ourselves working together in a collaborative way through our associations in order to to get this change to happen as fast as we can so that we can enjoy the fruits of our labor for the rest of our careers.
Justin Cole:Well, I certainly hope that vision becomes our reality, and I'm fully behind it. Dr. Michael Hogue, been an absolute pleasure to have you here on the podcast. Thank you so much for joining us, and we also thank you for leading our profession well and into the future.
Michael Hogue:Thanks, Justin.
Justin Cole:You have been listening to DISRxUPT, a podcast from the Cedarville University Center for Pharmacy Innovation. If you enjoyed listening today, please subscribe and share this podcast with others. Thanks for listening.