Public Health Matters Video: Getting Involved With State Pharmacy Associations, Advocating for Pharmacists, Promoting Professional Development

In this episode, host Dr. Christina Madison interviews Kate Gainer, PharmD, CEO of the Iowa Pharmacy Association (IPA), to discuss the significance of state pharmacy associations in advocating for pharmacists and pharmacy technicians, advancing public health initiatives, as well as shaping legislative priorities. Dr. Gainer also walks through her journey into pharmacy advocacy, emphasizes the importance of engagement in legislative advocacy.

Christina M. Madison, PharmD, FCCP, AAHIVP: Hello everyone, and welcome to another incredible episode of Public Health Matters. I'm your host, Dr. Christina Madison, also known as the public health pharmacist. I'm extremely excited to bring another fantastic guest to the podcast, Dr. Kate Gainer, all the way from the Iowa Pharmacy Association (IPA). She is doing some incredible things and I am so excited to talk about why we all need to do our part to support our states and our national pharmacy organizations because they are the heart of pharmacy, and they're the ones that are advocating for us and hoping to get us to provider status. So with that, I will go ahead and let Kate introduce herself. And we will dive into some questions.

Kate Gainer, PharmD: Yeah, thanks so much Christina for having me, [it's] always an honor to be on a podcast and have the opportunity to talk about the role of state pharmacy associations, why we exist, who we serve, what opportunities our members have, and how we really represent pharmacists and pharmacy technicians each and every day. [I've] been in my position as CEO for the IPA for 12 years—it's hard to believe—and so, I've had an opportunity to see a lot, not only what happens in Iowa through pharmacy associations and all practices of pharmacy, but also across the country and working with my counterparts and other state pharmacy associations, and like you said, the important work that our national associations do as well.

Madison: ...I apologize, I wasn't trying to interrupt you mid-sentence, but I was really excited to hear you [mention] technicians because I do think that, as pharmacists, we rely heavily on our support staff and I'm so glad to hear that you guys do so much to support technicians and to allow them to really work at the top of their license [so they can] help us so that we're able to really work at the top of our license, and be able to provide that clinical knowledge and expertise for expanded patient care and to improve health outcomes for our patients. So, as far as a couple of questions that I have for you, number 1 is how did you even get started in in state associations? I think that a lot of times when I know of people who've been in state associations, it's usually because they did a residency or a fellowship—or something in that space—or had some sort of leadership position within the board before kind of taking the leap into being the paid person at an association, because a lot of times, they think of those positions being voluntary. So, I'm just curious what brought you or led you professionally to want to work in state association?

Gainer: Yeah, good question. So while we were talking before we got started, you and I both are hitting our 20-year graduation anniversaries. So, when I was months away from graduation, now 20 years ago, if you had asked me what are your top 100 career choices, or the top 1000 places you think you'd live, working at a state association, let alone leading a state association was not in my top 100. It wasn't even on my radar. Living in Des Moines, Iowa, I don't think made the top 1000 list of places I thought I would live, so never say never.

[The] quick version of the story is I didn't match through the residency match process. So I know last week, my social media feed was flooded with all the P-4s that were excited about where they matched, and I love that and I'm so excited for them, but I also just think about those who didn't match, because I was 1 of those students at the time. But I kept searching and found a residency that was in Des Moines, Iowa, and that's what originally brought me here. And then, towards the end of my residency I had the opportunity to collaborate on a state grant actually, it was similar to some of the public health initiatives I know you want to talk about, but it was actually focused on health literacy and the role that the state association at the time was doing to educate pharmacists and pharmacy technicians on the importance of health literacy. So through my residency project—which was also focused on health literacy—I collaborated with the state association and was introduced to, not only the leadership and board members like you said, but the staff. At the time, there were several pharmacists on the staff at IPA that I consider to this day to be my mentors and those who really taught me about the work pharmacists can do at an association level. So, it was really my residency that opened the door to meet those key leaders and mentors, namely, Tom Temple—who was my predecessor—and another pharmacist, Cheryl Clarke—who worked on that health literacy grant that opened the door for me to get my foot in at working for a state association.

Madison: That's so interesting...I did not realize that we had such similar backgrounds, in addition to the fact that we both graduated from pharmacy school at the same time, we also both had to do the scramble. So, I also did not match and I always tease and say I had an inflated view of self when I was graduating from pharmacy school, and I just knew in my heart of hearts that that program was going to take me—and I only ranked 1 place, because I only wanted to go to 1 place—and at the time, I was a bit naive [so] I also did the scramble and ended up at the VA in Albuquerque, New Mexico, which I absolutely adored. And that's where I got the teaching bug, because I was able to do skills labs for ostomy and colostomy care for UNM. And so, I did teaching for the skills lab, and then I also was part of the team that organized all of the student rotations at the VA. So, I totally get where you're coming from. If you had asked me when I was graduating from pharmacy school where I would end up, I would have been like, "You are crazy!" because at the time, I was like, a good patient is a sedated patient...you never know where you're gonna end up. So, I just really wanted to echo that sentiment and just let people know [that] your first jobs may not be your last job, and even if you dislike your job, that it's all for good because knowing what you don't want to do is sometimes just as good as knowing what you do want to do.

Gainer: Yeah, I like to say your first job probably isn't your dream job, and so, don't turn away opportunities, waiting for the dream job, use it as a stepping stone to get to wherever you're going.

Madison: Yeah, no, that's incredible. So, I really love that you talked about the fact that you guys collaborated with your residency project for health literacy. I would definitely agree that I feel like health literacy is part of public health because when we think about health disparities, when we think about inequities, and access to care, so much of that is related to lack of health literacy in certain populations, and unfortunately, structural racism and societal strains and implicit bias. And so, I really feel like that is absolutely public health.

And then the fact that you were exposed to the grant writing process is also something that I feel like more pharmacists and more pharmacies should have access to because it's a funding source that we don't traditionally think of when we're thinking about ways that we can support efforts to do clinical work within a community pharmacy setting. So, I'm wondering if you could talk a little bit about sort of some of the work that you guys are doing right now—in that grant space—to help support some of the initiatives that you have going on within the community pharmacy space?

Gainer: Sure. So, we're fortunate at IPA for being a small state. Our state association has a staff of 9, and that includes 3 pharmacists—I'm 1 of those—but we also have an attorney on our staff, as well as some support staff. So, not every state pharmacy association has that same bandwidth, and IPA was a strong state association long before I had the opportunity to be selected to serve in this role. So, I consider it my responsibility and duty to help maintain IPA's strength as a state pharmacy association. And for pharmacists all over the country, [I] just want to use this as an opportunity to encourage you to learn what your state association is up to. If you aren't a member, give them a look and see what they're doing to support you as a pharmacist, no matter what side of care you practice in. And not only what are they doing for you—because some people really look for that ROI—but sometimes the ROI can't be measured. Oftentimes, what state associations provide is connection, and right now, pharmacists need connection to others that understand what they're going through, what they've been through throughout the last 3 to 4 years, and the day-to-day struggles that pharmacists may face no matter what setting they're in. So, give your state association a look. I would love for everyone listening to already be a member of their state pharmacy association, but if not, maybe just check out the website or their social media and see what new is happening because I know my counterparts in every state work very hard every day to improve the lives of pharmacists so that [they] can improve the lives of their patients. Okay, that's my shameless plug...check out your state pharmacy association.

...back to the work that IPA is doing in public health. We're fortunate because of the number of pharmacists we have on our staff. We have a long-standing relationship with our state health department. Our state health department recently reorganized and is now under a Health and Human Services umbrella—not just Department of Public Health—but that creates even more opportunities for us to engage with different areas of Health and Human Services and Public Health.

So, I know Christina, you are actually a presenter, we did a recent forum. We have a 5-year grant with our public health department to increase health screenings specifically for HIV and hepatitis C in the community pharmacy setting. And this has been an exciting grant because really, public health sees screening for HIV and hepatitis C like finding a needle in the haystack. So, anytime you can get someone to come and take a test or be tested for HIV or hepatitis C, public health is thankful and happy that pharmacists are serving as that access point, and as that trusted health care professional to talk to patients, or talk to community members about the availability of a test. And testing, not just for hepatitis C or HIV, but also in the test and treat space. So, pharmacists in Iowa have the authority to do a point of care test, and under a statewide protocol prescribe treatment for strep or influenza. There's also a statewide protocol for COVID, but really strep and influenza are what we see pharmacists taking up and doing the test and treat service that they have authority for. A few other options—or areas—where IPA has collaborated with public health in our state, we've been invited to serve on a number of commissions and task forces and even though we have a capacity of 9 on our staff [including] 3 pharmacists, we can't be everywhere, so, this is really where state associations reach out and rely on our members or pharmacists across the state. So, we have an IPA member, for example, that serves on our state's tobacco commission. We have a pharmacist that's an IPA member that serves on our state's preparedness advisory council, so planning for emergencies, emergency planning and preparedness. We also have pharmacists that are involved in our state's opioid response and putting together plans for naloxone distribution, as well as...women's health is another area that was involved in our state's public health efforts and [we're] working to increase expedited partner therapy, [that] is another public health initiative that we have pharmacists working on currently.

Madison: I really love the fact that you are having your membership engage in some of these initiatives, and what a fantastic opportunity! If I was a member of your organization and I saw that opportunity come across my email, I would have been so excited to put my hat in the ring and to potentially be considered. I know from a professional advancement standpoint, I would feel so honored to sit on such a prestigious board and some of these task forces. The other thing, too, is that I really feel like representation matters, and a lot of times when I was one working in public health when I was the clinical pharmacist for our public health department—you probably have realized this throughout your partnership with your health department—I felt like I was the only pharmacist in the room, and then they would be like, "Oh, pharmacists can do that?" or "Oh, we didn't know pharmacy could help with that." And just being in the room really does make a difference, because oftentimes, there are clinical things that we can do, there are capacity building things that we can do, we can help with technical assistance, we have such a breadth and expertise in so many specialty areas, that it really is impactful just to have a seat at the table. So, I'm so glad that you're providing that opportunity to your membership, and that you have that—for lack of a better way of saying it, secret sauce or street cred—[which] allows you to get that seat at the table and that they are wanting you to be at the forefront of the decisions that really impact the care and the quality of care that you have for your residents in the state.

Gainer: Yeah. And COVID really put a spotlight on pharmacy [being] public health [and] the role pharmacists have in the community.

Madison: Yeah, I couldn't have said it better...Not only are we public health, but we are providers, right? We are clinicians, we are providers, we are experts, absolutely.

So, as far as where you see sort of the future of your guys' impact...you have so many different initiatives going on right now, what would be your measure of success? So, obviously, right now, you've got things that are kind of like mid-projects, new projects, existing projects, but what would what would be like your measure of success and ways that maybe the people who are listening to this episode could potentially think about ways that they can get involved, and how they can see a successful program?

Gainer: One measure of success that I'd love to see every state achieve—and I know a number of states are there—nearly every week or every couple of weeks, I see across the [board] of all state associations, a new partnership that has come to fruition between public health and a state pharmacy association where the state pharmacy association can help pay pharmacists for services help engage pharmacists in providing care in a different way. And the measure is that public health is coming to us. Once that relationship is established and there's a way to close that gap between having an idea, having capacity, and having a role that can be fulfilled, to those that need that service and in the role of public health where there may be funding to provide that service...helping to connect those dots is a vital role that IPA plays in the state of Iowa, and I'm seeing it in more and more states where the state association is serving as that bridge between a state health department and the pharmacy providers throughout the state. So, that's 1 measure of success that these opportunities build upon each other, and once the capacity is there, more opportunities keep coming.

But maybe going upstream, I'd say a measure of success—and this isn't something everyone likes to talk about, but I think you have to call out the elephant in the room—is that so many pharmacists feel burned out right now. And for pharmacy practice to have the resources and the payment model to fully support pharmacists so that they can provide these additional services that they can provide the services they have the training to do and perform. So...getting to complete payment reform where pharmacists are fully supported is a big win. It's something that's going to take a long time and a lot of steps to get there, but then you'd have pharmacists who have the capacity to provide the care and services that they were trained to provide. And I think that's so important.

Madison: Yeah, success begets more success, right? We need to honor and we need to...talk about these successes so that it can foster future growth in other states, because now you've got proof of concept and you can say, "Look, this state did it, they collaborated with public health, they were successful, we should be able to recreate that here." And we don't have to recreate the wheel because we already have a template that we can use, and we have a potential partner that we can reach out to and we can talk with them so that we don't potentially fall into some of the pitfalls or some of the challenges that you had because you have the benefit of already [doing] the service. So, I really do think that, in general, pharmacists and pharmacies don't like to toot their own horn, and so, I love the fact that now you can think, well, if you don't want it to your own horn, we'll let your state association do it for you, let your state association be your cheerleader and help you to get that additional funding and get you continued contracts, because now we've proven your overall need, and then also, we've proven that you can have a successful program and that that collaboration can bear fruit, and that could be something that could be very sustainable, and potentially lead to other partnerships.

Gainer: Yes, and that sustainability piece is 1 more measure of success. So, grants are fantastic at getting things off the ground and helping to get things started to conduct research, but it's not a sustainable business model. So building it, and then, another role that state associations provide is the advocacy for payment for services. And that might be legislative advocacy—or it may just be advocacy with regional payers or state Medicaid payers—to help ensure that a pharmacist is a credentialed and recognized provider for the list of services that they can provide. So, definitely building on the framework and groundwork of grants leads to sustainability in the future. And that's another role that state associations play with advocating for sustainable payment models.

Madison: Kind of in that same vein, I'm curious what legislative initiatives and advocacy work are you guys working towards right now? I mean, we're in the middle of a presidential election, and we have lots of representatives and senators that are coming up for re-election or new campaigns. I'm just curious how you guys approach potential champions or people that can help you with bringing legislation to the table. I know here, where I live in the state of Nevada, we only have our legislature meet every 2 years, so it's really challenging. But for the majority of the country, the legislature meets every year, and so there's always sort of this...having your legislative agenda sort of ready and at the top of mind, so that when you do find a potential ally, or partner, or champion for some of that legislation, you can bring that to the table and you have the data and the resources to really back up the need.

Gainer: Yeah, in Iowa—and every state association works a little differently—we have a very robust process of engaging our membership. We have policy debate at our annual meeting—similar to APHA or ASHP—in a house of delegates. Our policies tend to inform our legislative committee which sets priorities that then go to our elected Board of Trustees, even though our legislative session is typically January through April, it truly is a year-round process to be working on legislative and regulatory advocacy priorities for the association. And we're fortunate to have lobbyists in Iowa for pharmacy for IPA at the Capitol every day, so they represent pharmacists and serve as the voice when someone has a question about pharmacy. [They are] also the eyes and ears to pick up on what other people might do to our profession instead of what we are proactively doing for our profession. Oftentimes, advocacy work is playing a lot of defense, as much as it is having priorities that would be, you know, the offensive strategy on what we wish to achieve and what we plan to achieve, so it is a lot of work to be at a state capitol representing the profession and it's what every state pharmacy association does on behalf of the profession.

So our priorities in Iowa are really exciting. We're working to update our Practice Act to a standard of care regulatory framework, the last time our Pharmacy Practice Act was updated in full was in the 1980s. It's been updated piecemeal, since then, by adding something here or adding something there, but creating a new framework to a standard of care regulatory model—similar to the path Idaho has taken and some other states, on a smaller scale—but this would be a full rewrite of our Practice Act, and it's been many years in the works. We had a task force, actually, in 2018, and we hosted meetings across the state for stakeholder and member input. And then COVID happened, so [it] really got set aside, all of that work that was done. And then the bill we introduced actually was introduced in 2023. And it passed one chamber, our House of Representatives 90 to 10, but then it stalled in the Senate. So thankfully, we have a 2-year legislature, so that bill was still alive when we came back in 2024, and it has now been voted out of the Senate and we're working to get it across the finish line. So that'll be an exciting passage of 1 of our priorities, but I give that timeline to also say [that] it takes time to advance those priorities that an association or a profession is looking to achieve. And that's where it's really important as a pharmacist to understand how your state association operates, and where you can have a point of influence, or impact, or input, because it's likely year-round, as well as showing up on a hill day or legislative day to be a grassroots advocate at your state capitol. But there's so many more opportunities for impact, and input year-round when it comes to advocacy.

Madison: So if someone was listening, and they're like, "Man, this sounds so exciting, and I'd love to get more involved," what would be your advice, if they're in a state and they may not be a member of their state organization. Maybe they went to APHA or an ASHP meeting when they were a student, but then now they're kind of in the thick of things, and they just haven't even thought about getting involved. What advice would you give them, what sort of benefits [are there] to membership, and why it's so important to be involved?

Gainer: I'd say it's never too late. When I was a student, I wasn't a leader in any organizations [and] I wasn't even a member of any pharmacy organizations. When I was first hired at IPA, I remember sitting in a staff meeting, and I didn't know the difference between legislation and regulation, or administrative code versus Iowa code, I honestly remember mixing up the words legislature with legislator and legislation, I had no clue. So, it's never too late. This isn't something you're taught in pharmacy school. And, if you're like me, I grew up in a very apolitical family, these weren't dinnertime conversations either. So, it's never too late. And to get started, if you're even a little bit interested—and kind of [a] pro tip—every pharmacists should be a little bit interested, if not, even more interested because this impacts all of us. Talk to someone who's already involved in your state, maybe it's someone who serves as the CEO or executive director of your association, but maybe your state is volunteer-led and the faces and names that are out there might be the board members, or the president, or president elect. Just reach out, you could connect on social media, or you could connect in real life at a state, national, or local event, and ask how they got started. That often will give you ideas for how you can get started. At IPA, we really try to break it down for our members to make it as simple as possible. Sometimes it's just sending an email and telling your own story, offering to be a resource as a health care professional in that legislator's district. Maybe it's inviting a legislator to your practice site, and the state association might show up to support you and add information that's relevant to state happenings. It might just [involve] attending a state event and learning more about what those who are involved are already doing. [As an example,] if you're in Nevada, and you go to a meeting, and Christina Madison is there, say "How'd you get involved, and how did you start your path towards advocacy and public health?"

So, I'd say just start...it's kind of that "don't be afraid to dip your toe in the water" and it might feel uncomfortable at first, but just remember, I was hired at the association, and I didn't know the difference of any of those words. So, you're better off already than I was when I first got started.

Madison: Well, I so appreciate that, authenticity and candor. Because oftentimes, I think that we see people who are successful and are in leadership positions, and we feel like they may be an overnight success, but you know, that overnight success to 15 or 20 years, and all you're seeing is the highlight reel and not the work that it took to get there. So, I'm so grateful that you that [you're talking] about sort of the things that led you to where you are and that it was a steep learning curve, and that you did have to get acclimated and really steeped in[to] the language, the nomenclature, and it's like alphabet soup of all the different things...[even in pharmacy,] I remember when I first started working in public health, and I was like, "What are all these acronyms?" And I learned all the FEMA terms, and disaster preparedness, and ICS codes...you can be an incident commander, and all these things that I was like, "What, that's crazy!" So, yeah, I affirm that and I really want you to know that I feel you, when you when you first started out, but look at how far you've come.

Also, the fact that it's wonderful to see more female leadership. As another fellow female pharmacist, it's always wonderful to see other female pharmacists [who are] in positions of power, of influence, and so, thank you for that. I'm sure that you are an inspiration to many other female pharmacists because if you can't see it, it's much more difficult to have those aspirations [and] to want to potentially get [to] those positions later on in your career, so thank you for that.

I know that your time is valuable, and I know we've been chatting for a while, so I'm going to end our conversation with a question that I like to ask all of my guests. If there was something that you could tell your younger self, what would it be and why?

Gainer: [I would want] to tell my younger self throw your plan out the window, because when I was graduating, I had that checklist, I had a plan. And if my life had gone according to that plan, I wouldn't be in Iowa, I wouldn't be in this position, I wouldn't have had 4 kids under the age of 4 and everything that came along with that, and meet my husband. So, leaning into the uncertainty has really helped me and lowering those expectations [I have] about what things should be or look like. I, somehow along the way, have found the opportunity to be vulnerable and authentic, and it's really helped me like accept all the uncertainty that comes with life, and I've been very fortunate and very privileged and have had not a super hard road by any means. But still, there's uncertainty along the way, and I think as women and as pharmacists too, being type A [and] analytical very often, we can make life harder for ourselves if we have these expectations that are either unachievable or we're too inflexible to bend when uncertainty or when a fork in the road presents. So, my life didn't go as planned, but I couldn't be more grateful.

Madison: Yeah, that's awesome. I love that. Everything that you just said...yes, I would agree with that. I always say, don't let the perfect be the enemy of the good and embrace the messy. Because you never know where it might take you, you never know where it might lead you.

And I will push back on 1 of the statements that you said, you said [that] you've been incredibly fortunate. I agree that you have been fortunate, but you also put in the work, so, that cannot be understated. You put in the work and you put in the time, and so, I always like to make sure that I acknowledge that, especially because I think as women we tend to undervalue ourselves. But you did everything, you did at all, and continuing [to address] your abilities, not only are you doing this, you [are also] doing this as a mom of 4 and a spouse...when you think about the balance—which I think there's no such thing as balance—between your professional life, your work life, and your home life, it's hard. It's hard to get that harmony, but it seems like you've figured out what the sweet spot is, and in spite of all of that, you are making sustained and lasting change for your state, and [you] are really an inspiration to other pharmacists but also to your kids, which is just incredible.

Gainer: I hope so. We'll see, time will tell. But Christina, right back atcha, keep inspiring. I've been inspired by your posts and following you on LinkedIn, and other social media, so I hope to connect with more of your community. If there are people listening to this podcast, you can find me on LinkedIn. I like to post about the work state pharmacy associations do, things that are happening in the profession, but I also post a lot about being a working parent and it's not a highlight reel, it really is like how you just make it work and it's not always perfect or pretty. So, I've really found a lot of value from sharing posts like that, and not only pharmacists, but other professionals out there...and working parents who are maybe in the same stage of life, but also, I might learn from [them] because they're further along the parenting journey than I am, or others who I'm farther along than are learning from me.

So, I hope to connect with some of your listeners and your community, and I look forward to listening to more of your public health pharmacy podcasts.

Madison: Yeah, thank you so much. And again, I just want to say, please, if you have not been following Kate on LinkedIn, you should be following her, you should be connecting with her today—if you haven't already—because there's lots of just incredible little pearls of wisdom. And like you said, being a working parent is challenging sometimes and it's nice to know that you're not alone. And even if you're not a parent, just navigating being in the pharmacy space and seeing that there are people like you that are advocating for our profession, advocating for us to be valued, and to be working at the top of our license. And so, again, I truly appreciate the work that you're doing and I know that my audience does as well. I hope that they take this opportunity to connect with you and to expand your network so that we can have more people going out in their communities feeling like they can make a difference.

Gainer: To all the pharmacists listening. Thank you for the work you do each day.

Madison: I couldn't have said it better.

And with that, I will say to everyone out there thank you so much for listening. This has been another episode of Public Health Matters. And again, I am your host, Dr. Christina Madison, and remember, public health matters.

Connect with Dr. Kate Gainer on LinkedIn.