US Pharm. 2006; 4:3.

Remember a few years back when pharmacists and their associations were in an uproar about physician dispensing? It seemed like every trade journal you picked up had an article or two about physicians who were taking money out of retail pharmacists' pockets by installing prescription-dispensing units within their practices. Thankfully, the number of physician dispensaries was fairly small, and the trend never really caught on. Primarily, in my belief, there were two major reasons why physicians did not want to be in the pharmacy business: economics and stringent regulations. Most physicians learned pretty quickly that any return on their investment would take some time, considering the expense of maintaining a costly drug inventory (even if it represented only the top 100 most prescribed drugs) against the time it took to sell the drugs. This reason, combined with many states insisting that physicians dispensing prescription products from their offices had to be licensed by the state's Board of Pharmacy and follow the same regulations as retail pharmacies, was enough for many physicians to think twice about opening up a pharmacy business in their office.

Pharmacy associations argued that physicians should do what they do best, diagnose and treat sick patients, and pharmacists should continue to do what they do best, dispense prescriptions and consult patients on their use. At the time, I personally thought this was logical thinking. That's why I was surprised to learn that several large chains have now entered into the business of running medical care clinics within their stores, and others are seriously considering it. But the more I think about it, the more it makes sense to me.

Running medical clinics within the walls of a drugstore is not the same as physicians dispensing prescription medications in their practices. For one thing, pharmacists are not administering medical care in the drugstore. Depending on the location, medical treatment is being provided by a physician, nurse practitioner, or physician assistant. In many cities and small towns, the number of drugstore locations certainly makes them more accessible than freestanding walk-in clinics or doctors' offices, with their restrictive patient hours. Pharmacists can interact readily with patients to provide pharmaceutical care by counseling them on medications being prescribed by the health care practitioners running the clinics. From a patient's perspective, it eliminates a trip to the doctor, then another trip to the pharmacy to get a prescription filled. People get their medications quicker, which means they are on the road to recovery sooner.

Most importantly, I believe housing medical clinics within drugstores offers retail pharmacists the opportunity to practice pharmacy to its fullest by being an integral member of a health care team, similar to what is done in most health system settings, instead of being relegated to behind the prescription counter. While there is no question that checking prescriptions before they are given to the patient is an important part of the pharmacist's responsibilities, so are compliance issues and making sure patients are educated about their prescriptions.

Of course, none of this can happen without the support and commitment of drugstore management. I hope that a portion of what they are charging patients for in-store medical treatment would go to the pharmacist and that more pharmacy personnel would be hired to allow the pharmacist to have a vital role in a patient's medical and drug therapy. I like this new twist in health care and hope it becomes a mainstay.

Harold E. Cohen, R. Ph.
Editor-in-Chief

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