CHOOSE YOUR OWN PRACTICE: PHARMACY IN THE PUBLIC HEALTH SERVICE

WHEN RADM ROBERT PITTMAN received a scholarship to attend the University of Arizona College of Pharmacy from the Indian Health Service (IHS), his journey of serving the public through a unique model of pharmacy practice had just begun. This 3-year commitment began with his first assignment in 1984 in <?xml:namespace prefix = st1 />

Whiteriver

,

Ariz

, as a staff pharmacist working with the White Mountain Apache tribe. During that time, Pittman became certified as an emergency medical technician, worked in inpatient and outpatient pharmacy, and became the hospital librarian, as well as a nursing home pharmacist.

RADM Pittman later moved to Sells,

Ariz

, and became the deputy chief of pharmacy services for the

Sells

Indian

Hospital

located on a reservation, which was where he got his first experience managing a pharmacy staff. He went on to become acting chief of pharmacy and later earned his Master of Public Health at

Johns

Hopkins

University

. Later, Pittman was accepted at the Health Resources and Services Administration in

Rockville

,

Md

, with the National Health Service Corps (NHSC), where he was the acting deputy chief for the recruitment branch. He stayed with NHSC for 7 years before joining the Bureau of Health Professions where he was deputy branch chief, reviewing grant proposals for health-related programs and working to increase the number of health professionals in rural areas as well as the number of minority faculty in pharmacy schools.

In 2000, RADM Pittman was appointed the principal pharmacy consultant for the IHS, where he was responsible for providing performance improvement, risk management, cost containment, and professional pharmacy coordination, analysis, consultation, and collaboration with and for IHS. In this capacity, he managed 237 pharmacies and 600 pharmacists in 23 states west of the

Mississippi

. It was a big job, considering the IHS provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states.

Today, RADM Pittman is the chief pharmacist for the Public Health Service (PHS), where he advises the Surgeon General on pharmacy matters and is chief pharmacist for the Department of Health and Human Services, which includes 940 commissioned officers and 350 civil servants.

THE WORLD OF PHS

Right now, the biggest issues facing the PHS are pharmacy services during disasters?providing continuity of care, safety and efficacy of drugs, drug importation, and transformation of the US Commissioned Corps so they can better respond to patient needs.

?It is very competitive for pharmacists right now,? remarks Pittman. ?We are actively recruiting pharmacists for about 90 openings, 60 with the IHS.?

MODEL OF CARE

Pittman says, ?They stay with us for the clinical practice we provide. Some go to the Bureau of Prisons; some want to start practicing the clinical model they learned in pharmacy school. We train them on the model for IHS or Bureau of Prisons, where we have the patient?s medical history from birth. Pharmacists go through the record to see if the patient is receiving the best possible care. For example, if we have a diabetes patient, we will check for hypertension. All patients receive counseling on medication. We make sure they understand the medications and their side effects. We provide a higher level of care, interpret labs, and counsel patients.?

The PHS also has specialty clinics?cardiovascular, anticoagulation, lipid, smoking cessation, hypertension, among others. Pharmacists practice at clinics and often act as a primary care provider, mainly because patients see their pharmacists regularly, whereas they see their physicians intermittently. He credits new electronic health records with helping the PHS provide better care.

PATIENT CARE: PRIORITY ONE

?We give our [recent graduates] the resources to learn to be pharmacists in those first couple of years, while helping an underserved community. Our pharmacists have a 97% retention rate,? says Pittman.?...Our goal is to provide the best care ever, and if that means you spend 30 minutes explaining to someone how to use an inhaler, then that?s okay.? That is not to say that PHS pharmacies are not efficient. They are run on moderate budgets and, therefore, need to be financially efficient. It is a different pharmacy model than other venues. PHS pharmacies have a reversed ratio of pharmacists to technicians?it is more like 4 pharmacists for every 1 technician. Pharmacists have more direct interaction with patients. In the larger facilities, automation allows pharmacists to fill prescriptions at a higher volume, which in turn allows pharmacists to take more time with patients.

Pharmacists also have opportunities to operate special clinics or screenings focusing on a particular disease state. Additionally, if a pharmacist develops a certain protocol for delivering care that results in positive patient outcomes while working in an IHS or Bureau of Prisons pharmacy, they can submit that protocol to the National Center for Patient Safety (NCPS), have it reviewed, and it may possibly become an NCPS nationally certified protocol.

ATTRACTING PHARMACISTS

Students interested in working for the PHS will find different benefits when compared with those of a large retail chain, for example. Federal pay scales are lower than some of those job opportunities; however, other benefits offset that. The PHS cannot recruit anyone who has not graduated, so one of their challenges is getting to students early enough in their decision process. Right now, they offer a couple of programs that allow students to get a taste of practice in the PHS. The Junior Commissioned Officer Student Training and Extern Program (COSTEP) is where students can work in the summer for 1 to 4 months, much like a senior-year rotation. In addition to pharmacy work, they also will work on a summer project on an area of interest. According to Pittman, the IHS takes most of those students. The Senior COSTEP program is where the PHS hires students for their last year of school in a ?2-for-1 payback? on graduation. For example, the PHS pays for 12 months of schooling, and pharmacists work for the PHS for 24 months. They also offer senior-year externship programs with the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and Bureau of Prisons, and end up hiring about 70 pharmacists a year, most of whom go to the IHS, one of the premier clinical programs of the PHS.

One of the major draws for working within the IHS is their loan repayment policy. If a pharmacy student is in debt for $60,000 or more, the IHS can reimburse up to $20,000 a year to pay off loans. They do not want their pharmacists to be focused on loan debt.

Being a federal entity, pharmacists have opportunities in either the Commissioned Corps or Civil Service. In the Commissioned Corps, pharmacists enjoy the same benefits as military personnel in terms of free medical and dental, 20- to 30-year retirement, 30 days of vacation, and a $30,000 sign-on bonus.

One important benefit of the PHS system is location. Unlike the military, where service personnel are given orders on when and where they will be relocating, PHS officers decide when and where they want to go. Once in the PHS system, a pharmacist can move to the FDA, NIH, Coast Guard, Bureau of Prisons, or CDC. With so many different opportunities, the choice of what to do and where to do it is up to the individual.

One aspect the PHS is working on improving is the application process. ?Right now it is long,? says Pittman. ?We have to wait until we have an assignment to call you to duty. We hope to have this online by the end of the year and streamline the process down to 1 to 2 months.?

The PHS also is changing the recruitment and placement process to help applicants find sites to meet their interests and personal needs. ?You have to think about what might be important to you,? advises Pittman. ?Do you need to be near an airport or a university, what are your spouse?s needs, etc??

?We think that PHS has the best combination of benefits of the uniformed services. We do not have a minimum commitment. But for the most part, PHS pharmacists [enjoy the work and develop a career]. We want to help you meet your professional and personal needs. We want you to have a say in what you want to do for your future, first and foremost.?

BENEFITS AVAILABLE TO PHARMACISTS IN THE PHS:

? Only 1 license is required for assignments in any state

? Opportunities to transfer throughout much of the country

? Nontaxable earnings in addition to basic pay

? Moving expenses covered for call-to-duty and change-of-station relocation

? Opportunity to compete for longterm training

? Noncontributory insurance program for dependents

? Survivor benefits

? Retirement (noncontributory) after 20 years of service

? Military Post Exchange and commissary privileges

? Space-available transport on military aircraft, on-base lodging, and recreational facilities