All eyes are now on the Senate, which is set to debate their version of health care reform, with a new bill that combines previous bills by the Health, Education, Labor and Pensions and Finance committees. This new combined bill includes the medication therapy management program and pharmacist inclusion in the medical home model.  Debate on this bill is not likely until after the Thanksgiving holiday.  It’s also unclear whether the Senate will vote on it before the end of 2009.

The bill passed by the House on November 7 squeeked by on a vote of 220 to 215.  This bill includes pharmacists in several key provisions, including a medication therapy management grant program, the medical home model, and a loan forgiveness program.  Although the Senate bill does not have a loan forgiveness provision, we are still advocating for its inclusion in the conference committee process.

Unfortunately, neither the House nor Senate bills restore funding for second-year pharmacy residency programs. But ASHP is not throwing in the towel on this one!  We are working with South Dakota Senator Tim Johnson to seek a floor amendment to the Senate bill to obtain funding for these critical training programs.

ASHP has been advocating that the final version of the Senate bill should contain four key provisions:  MTM grant program, pharmacist inclusion in the medical home model, eligibility for loan forgiveness, and PGY2 residency funding.

At this point, it’s still unclear whether the Senate has the 60 votes it needs to pass its health care bill.  Although, it is possible that with debate going through to late December or even early January, the Senate could get the votes it needs. If so, a final version could be on the President’s desk sometime in January (after a conference committee works out the differences between the House and Senate bills).

There has actually been some talk of not using a conference committee, which would mean the Senate bill would get sent to the House for a vote – also known as the ping pong approach.  I don’t think this is very likely, given the amount of time it’s going to take the Senate to garner the votes it needs to pass its bill.

It's certainly getting down to the wire and at this point it seems anyone's guess as to whether we will see a health reform bill going to President Obama's desk.  Although ASHP has worked extremely hard on our key advocacy issues for this bill, we did not get everything we asked for.  Even if the bill is signed into law, we will need to keep working hard to achieve these important goals.

I am really proud of ASHP and our members for how hard we all worked on these issues.  We should take pride in knowing that pharmacists were not left out of this debate and our voice was heard even amongst all the other health care stakeholders, furious town hall attendees, and political jockeying ahead of the 2010 elections. Remember this is not the end, just the beginning.

‘The reason most people never reach their goals is that they don’t define them, or ever seriously consider them as believable or achievable. Winners can tell you where they are going, what they plan to do along the way, and who will be sharing the adventure with them.’ -Denis Watley

I decided quite a while back that I wanted to do a clinical residency, so question #1 was:

Where do I want to live?

Some programs on the east coast have a great reputation and may look great on my resume, but I don’t want to live and practice there (sorry East Coasters, but it ain’t my style). Where could I ride all year round, or close to it? Where do I know people who could help make the transition easier and could tell me about where to live, how the school system is, where to ride, etc? Which leads to…

Question #2: Who do I know in these places?

For starters, I know Bill Jones at the VA CMOP (mail-order pharmacy) in Tucson because he came to our university and gave a talk, and we had chatted via email. I wanted to see if Tucson was a place I could live, so I asked to set up a rotation with Bill in Tucson. It didn’t take too much footwork, and I found myself in Tucson for a month, meeting everyone I could and asking every question I could think of about the programs, the lifestyle, the weather, the riding, the schools… I can’t do that for every rotation, but others I know without children can and have.

I was dead-set on leaving the state for residency. I wanted a new experience, and I am young still, so why not? Well, I am rethinking that now, as my daughter is not handling the recent move to a new school and home very well. I don’t know if she can handle that again in a year. So, I find myself yet again trying to figure out where I want to be so that I can figure out the road there. When you go on a road trip, you first decide where you are headed, and then you look at the route. This is no different…. but now I am looking at less than a handful of options here, and I don’t want to rule out my other prospects….

I have been feeling lost, until this last month, when I found some focus…at a retail pharmacy, nonetheless! I was at Pharmaca, where they practice integrative medicine. Alongside the traditional pharmacy are homeopathic, herbal and chinese medicines. Out on the floor, they have licensed herbalists and Doctors of Oriental Medicine. Everyone did a great job of working with each other and learning from each other, and I learned so much in that 4 weeks. I affirmed that integrative medicine resonates with me, and that I had neglected that side of me. Timing is everything. Starting up my yoga while working at this pharmacy opened up so many possibilities, and now I have an idea, a destination. The path to take I may have to just figure out using my mental compass, but it’s so good to have purpose and direction back in my everyday activities.

I am letting my curiosity lead me yet again. The neurons are firing, the ideas are flowing, and the future holds much promise. 

This is especially important as we head to Las Vegas for the Midyear Clinical Meeting.  I spent some time over the past few days updating my CV, ordering business cards, registering for PPS, and contacting individuals whom I would like to meet with at Midyear.  Because I dedicated some time to reflection of the past year and organization of my thoughts, I will now be able to focus and prioritize what is left to be done before my flight leaves the first Friday in December.   This coming week will be spent finalizing my appointments and putting the finishing touches on my research project poster, tasks that now feel much more manageable.  This process of reflection followed by refocusing and prioritizing allows me to go from stressed and overwhelmed to refreshed and energized.  I am ready to face the next challenges with new insight and perspective. 

I encourage you to spend some time doing the same.  Take a few steps back to see the forest, and you will have a wonderful new appreciation for the trees!

The interventional radiology department oversees the chemoembolization process at my institution.   I worked closely with the physicians, physician assistants, and nurses in the interventional radiology department to gain a better understanding of the topic, and I couldn't have asked for a better group of collaborators.  They arranged for me to observe a chemoembolization procedure, provided me with radiology images for my Power Point, and consistently went out of their way to answer all of my questions.  What did I do to garner this special treatment?  I simply asked.

The typical pharmacotherapy rounds audience consists of approximately 60 individuals from the pharmacy department.  This week, we had a few extra guests - my colleagues from interventional radiology.  If you took a survey of those in attendance, I think you would find that most were surprised to see individuals outside of pharmacy in the audience. Their attendance stimulated good discussion, and I was extremely grateful for their support.

The purpose of this story is not to acknowledge my networking skills, but rather to serve as a reminder to others to continue to breakdown disciplinary silos.  Often, it begins by asking.  As a resident, I have seen the power of strong interdisciplinary collaboration from rounding in the SICU to attending the P&T Committee meetings.  My challenge to you is to seek out new opportunities to break down the silos and collaborate with others.  The successful outcomes will be well worth the effort.

I remember my first research project and publication opportunity I lacked confidence and had very little experience. I was very intimidated and needed guidance. My mentor did a great job on helping me overcome the intimidation factor by sitting down with me and showing support, sharing ideas, and brainstorming along with me. The collaboration soon gave me the confidence and enthusiasm to be independent and feel comfortable to proceed and challenge myself to meet the high expectations of the department. The processes of developing that mentor-mentee relationship helped mold my success with the research project as well as grow professionally and personally.  Our relationship was successful because he recognized my weaknesses, provided constructive criticism was a positive role model, gave me access to learning resources, and most importantly, believed in my success. This was just one of my past experiences that establishing a mentor-mentee relationship with effective communication, trust, and respect for one another assisted me in accomplishing something that I thought at the time was not within my capacity. The concept of growth is important both on a personal level and as students soon to be pharmacists.

Who do we confide in to push us to be great future pharmacists, create those challenges, and inform us about opportunities? So, my challenge to you is to seek out mentorship and establish that mentor-mentee relationship to build a sturdy foundation as you embark on your future pharmacy career.

You can seek out a mentor easily within ASHP through the mentor exchange program at www.ashp.org/mentorexchange

 It is not to late to find a mentor before Midyear!