Spotlight in Practice: Genetic Consultation and Entrepreneurship in Pharmacy

Today, we interview Dan Fieker, RPh owner of an independent pharmacy in Highland, IL, Family Care Pharmacy, and a pharmacist with a new and interesting niche: interpreting genetic testing for drug efficacy for a laboratory.

What led you to your current day role as a pharmacist?DF: I became interested in pharmacy in high school, although I thought I initially wanted to study electrical engineering. I started working for a pharmacist who owned his own pharmacy in a small town in Illinois during high school and really liked it. So, the second semester of my senior year in high school, I decided I wanted to go to pharmacy school instead of studying engineering.

My intention after pharmacy school was to graduate and start my own pharmacy business. However, when I graduated from pharmacy school in the late 1970s, the thinking at the time was that more patients were going to have insurance pay for their prescriptions instead of cash, so we were told that independent pharmacies would not survive because of insurance payments. The best option was to work for a corporation.

I took a hospital job and enjoyed it, but frankly missed the community pharmacy experience. I decided to head back to retail and worked for several corporations as a pharmacist, and even as a district pharmacy manager. Ultimately, however, I decided to fulfill my original intent and bought into Family Care Pharmacy twelve years ago, and this past year bought the pharmacy out completely.

Now, I really enjoy getting up in the morning and deciding what direction the business needs to take. What challenges are we facing today? How can we overcome those challenges in order to continue to do business and serve our patients? What can we do to help our patients be healthier? That’s what drives our business. Every decision I make and what we do boils down to this: is this the best decision for the customer? If it is, we’ll probably be OK.

You also consult for a genetic testing company. How did you get interested in this aspect of practice?DF: I attended a seminar at the National Community Pharmacists Association convention in San Diego in October 2012. It was early in the morning, and I think about 5 other people were there. The seminar happened to be on pharmacogenomics—a topic that piqued my interest. When I was in school, we didn’t talk about pharmacogenomics at all, and the Human Genome Project didn’t yet exist.

At the seminar I sat at a table with a few pharmacy students and had a frank discussion about how they felt about pharmacogenomics. They were very interested, but they didn’t know of any opportunities to put pharmacogenomics into practice. After the seminar, I stayed in touch with the molecular testing lab that provided the presentation, and we decided to work together and figure out how pharmacists could help patients by integrating pharmacogenomics into a community practice pharmacy setting.

Why?DF: Well, there are 2 really good reasons why we should integrate pharmacogenomics into community pharmacy practice. First, it adds a revenue stream for the pharmacy beyond filling prescriptions. But second, and most important, it helps physicians better manage their patients, because it helps determine whether or not, or how well a patient will respond to a medication.

Can you give an example of what you do in pharmacogenomics?DF: For example, let’s say a patient has back pain, but they are taking more pain medication than normal, and they aren’t achieving any pain relief, and the drug is hepatically metabolized. The doctor can requisition an order (through a cheek or buccal swab test), to have a lab assess the patient’s genetic variations, mutations or polymorphisms in their cytochrome P450 enzymes. The lab results along with a list of medications the patient is taking are posted on a web portal, and that’s where I go in, check the lab report and determine whether or not the medications are being properly metabolized. If not, I recommend to the doctor perhaps a better dose of the same drug or a different drug that the patient may respond to better for pain, based upon their genetic liver enzyme profile.

You precept pharmacy students. Why?DF: Honestly--I do it for selfish reasons—to keep me young. I find out what they are learning about in school. It’s interesting because most students come in searching for answers, and by the 5th week of the 5-week rotation, it is golden, because they are comfortable enough to ask questions, but also share with me what they are learning. It helps me become a better pharmacist. I have to understand what I’m talking about too when they ask me questions, so it keeps me sharp.

What’s your general advice as an entrepreneur?DF: The first thing I tell students is that they need some practical experience as a pharmacist working for someone else first. There are always exceptions to this rule, but generally, that’s where I recommend most start. Second, I share with them that no one will ever have all the answers. Students think they have to have all the answers before they start, but I don’t even have all the answers now, and never will! Get a team of professionals to work with you and not with just other pharmacists, use accountants, other entrepreneurs, marketing experts, small business owners etc., as it is a team effort. You’ll never know everything, but as long as you keep on continuously being a student of pharmacy, even after pharmacy school, you’ll be meeting the responsibility of providing the best care possible for your patients, and ultimately, that’s what being a pharmacist is all about.

Erin Albert is a pharmacist, author, entrepreneur, lawyer, and associate professor at Butler University College of Pharmacy and Health Sciences. For more on her writing, go to www.erinalbert.com.