Superstars: Pharmacists who went beyond the call of duty
Whether they hang their white coat at a pharmacy chain, an independent pharmacy or in academia training the next crop of pharmacists many working pharmacists are making an enormous impact beyond their regular jobs.
Drug Store News found a sampling of pharmacists who are helping out in their local communities, becoming involved in international efforts to educate other pharmacists, or simply looking to improve the health of patients around the world. Exactly what are these people doing to contribute to their profession and help their patients? This month, DSN profiles 14 different people in the industry to learn their stories.
When Paul Doering began his education at the University of Florida in 1967, he wanted to study agriculture. It was not long before he realized how difficult it would be to grow crops on asphalt in his hometown of Miami. After speaking to his brother, who was a pharmacy major, Doering decided to pursue a Bachelor of Science degree in pharmacy. He went on to earn a Master of Science in clinical pharmacy. It was the time when the idea of clinical pharmacy was starting to gain momentum as opposed to the traditional “count, pour, lick and stick” role pharmacists were accused of, and Doering wanted to be part of it.
Fast-forward to 2019 and Doering, a distinguished service professor emeritus at the University of Florida College of Pharmacy in Gainesville, Fla., is semiretired after 40 years of teaching pharmacy students, yet he is busier than ever educating pharmacists on what he calls “the patient-oriented practice of pharmacy.”
While his whereabouts over the past two decades, and even just a couple of months ago, would suggest that he is living a life of travel and leisure, Doering is not relaxing on these jaunts. Instead, he is working to spread his knowledge about the potential that pharmacists have to engage in clinical pharmacy, both at home and abroad.
Reflecting on his recent trip to Germany, where he has traveled for more than 22 summers to provide seminars to German pharmacy students, Doering said the first slide in his deck supports the notion of pharmacists working in collaborative agreements with physicians.
“My colleagues and I fought tooth and nail to set aside our self-imposed barriers and insecurities. We ask, why is it you can’t incorporate patient-directed things? I take every opportunity where I can gather four or five pharmacists and sit down and try to motivate and incorporate all of the potential that the profession of pharmacy has,” Doering said.
Doering also has traveled four times to Brazil, and has visited Chile, Guatemala, Costa Rica, Holland and France to discuss what he calls the U.S. style of clinical pharmacy practice.
His global efforts outside of pharmacy also include digging wells to provide clean water in several countries, and providing health clinics in El Salvador, the Dominican Republic and Honduras, where many patients have not seen a doctor in a number of years. “I’m trying to export my friendship and relationships and provide health care,” he said.
Why would an independent pharmacy owner and one of his pharmacists receive medals from a fire department?
Ask Hashim Zaibak, pharmacist, owner and founder of Hayat Pharmacy in Milwaukee. Zaibak and his chief clinical officer, Dimmy Sokhal, each received a medal for helping to reduce the number of nonemergency calls to the Milwaukee Fire Department via a mobile integrated healthcare program.
Zaibak explained that many 911 calls made to the fire department in his community were from the people who frequently called 911 when they became sick from being noncompliant with their chronic medications.
Zaibak, who is the fifth vice president of the National Community Pharmacists Association, launched the program in 2014 at the Milwaukee Fire Department’s request.
“In order to save taxpayers money, these firefighters started making visits to those ‘frequent fliers’ to see what they could do to prevent these 911 calls. They bring Dimmy or one of her clinical pharmacists to go over medications and to make sure the patient understands what the medications are for, how to take them, when to take them, and how to inject themselves with insulin,” Zaibak said.
These collaborative interventions have made a huge impact on decreasing the number of unnecessary 911 calls made to the fire department’s statistics, Zaibak said. “Some of them are now not calling 911 as often because they’re more compliant with their asthma, diabetes, blood pressure and cholesterol medications. This is saving taxpayers money and also making the firefighters’ jobs easier because they don’t have to waste their time going to calls that are not super urgent, and they can take care of more urgent issues,” Zaibak said.
Zaibak, who has expanded to 15 pharmacies from just one in 2011, said that they mostly are located close to the zip code 53206 — the poorest and most underserved area of Milwaukee. “Helping the underserved. That’s what really gave us a reputation in Milwaukee. We decided to go where other people don’t want to go and to focus on those patients,” he said. “You can make the biggest clinical impact in those areas, where the patient has absolutely no access to some of the resources that the average middle-class American has.”
Hayat Pharmacy also offers transitions of care for hospital patients upon discharge, as well as adherence packaging, medication synchronization, home delivery, and vaccinations and injections of antipsychotic medications at patients’ homes.
“I told my wife and my kids that I emigrated to the United States to do something different,” Zaibak said. “I’m not going to be the average pharmacist filling prescriptions and working as a regular retail pharmacist the rest of my life. There’s no way that I imagined at the beginning, 20 years ago, that pharmacists would be able to offer all of these unique services offered by Hayat today.”
Randy McDonough took a big risk in 2006 when he decided to leave his position as a professor at the University of Iowa College of Pharmacy. That risk turned out to be the greatest accomplishment of his pharmacy career.
McDonough had been traveling around the country, helping pharmacies transform their practices so they could provide patient care services. At an American Pharmacists Association meeting in March 2005, one of the participants at his presentation challenged him, saying that he would not know how hard running a pharmacy can be until he was responsible for a pharmacy’s financials. The following year, despite being offered a promotion to full professor, McDonough left academia and opened Towncrest Pharmacy, a Health Mart pharmacy, in Iowa City, Iowa. “I wanted to prove that I could transform a community practice, and I would be fully responsible for the financials,” he said.
He came up against serious difficulties in 2013 related to reimbursement changes. “I thought we were going to lose our practice because of the reduction in reimbursement we were receiving from one of the biggest payers in our state because they went to a different PBM. We saw our rate of reimbursement going down by almost 50% across the board,” he said.
When McDonough told his family he was going to leave Towncrest Pharmacy to return to the university, his son said, “Dad, you never quit anything.” “That was the statement that changed everything. I declined the position and decided to fight. That was the right decision,” he said.
That year McDonough brought a class-action lawsuit against the PBM, which still is being battled in court. He also challenged the large Iowa payer, which ended up visiting his pharmacy and conducting a pilot project. It compared patients 100% attributed to Towncrest with patients 50% attributed to the pharmacy, as well as entirely unattributed patients. Based on clinical metrics, the payer found that at the end of 12 months, Towncrest had saved the payer roughly $300 per member per month. “We also were able to demonstrate an improved adherence rate in patients as compared to the other two cohorts of patients,” McDonough said. Two years ago, the payer developed a value-based pharmacy program with 74 community pharmacies that are being paid for their performance based on these metrics.
“My biggest success has been demonstrating the value of community pharmacy and having a payer develop a bigger program that benefits other community pharmacies, and which ultimately benefits the patient because they’re getting optimal medications at a better cost,” he said.
McDonough is on APhA’s board of trustees. He is a national luminary of the Community Pharmacy Enhanced Services Network USA, a luminary of CPESN Iowa, and the director of practice transformation for CPESN USA’s Flip the Pharmacy Program, and he has received numerous awards.
He currently is looking forward to making Towncrest Pharmacy into a family business with the impending addition of his son behind the counter. “He is working for me, and he’s in pharmacy school and finished his second year. His goal is to come on board and become a co-owner,” McDonough said.
Pharmacists hang their white coat at many different places, but not many of them hang their coat in one setting for more than three decades.
Janet Engle’s passion for teaching has anchored her at the University of Illinois at Chicago College of Pharmacy as senior associate dean for professional affairs and professor of pharmacy practice. Yet on Sept. 9, that changed as she assumed the position of executive director of the Accreditation Council for Pharmacy Education.
Although she’ll hang her white coat at a new place, her involvement in education will continue to grow.
Engle said the ability to educate the importance of helping patients understand nonprescription medicines is among her accomplishments. “The nonprescription drugs are almost more critical than prescription drugs because consumers don’t have a learned professional guiding them,” she said. “It’s important to make sure the pharmacists have a really good knowledge of those drugs and how to work with consumers to make sure they choose the best product for their situation, and use them correctly.”
Engle is an internationally recognized expert on nonprescription medicines and has represented the pharmacist’s viewpoint as a voting member of the FDA’s Nonprescription Drug Advisory Committee.
In addition to what has been a very hectic schedule in the United States, Engle is very active in international pharmacy. She is proud of her work with the Pharmacy Council of Thailand. “One of the things that I’ve been involved with in Thailand is helping them expand their clinical pharmacy services by enhancing their training programs for faculty,” she said. In 2003, Engle received an honorary Ph.D. in pharmaceutical sciences from Khon Kaen University in Thailand for her work with the clinical practitioners in that country.
In July, Engle visited South Korea, where she gave a presentation to the Asian Association of Schools of Pharmacy about board certification and the role it plays in pharmacy practice.
In addition to serving as president of the American Pharmacists Association from 2002 to 2003, Engle has been elected as a distinguished practitioner in the National Academies of Practice in Pharmacy, which only includes 150 pharmacists worldwide. She also has been named a fellow of the APhA Academy of Pharmacy Practice and Management and a fellow of the American College of Clinical Pharmacy. She is the recipient of the APhA Distinguished Achievement Award for clinical/pharmacotherapeutic practice.
There was a time when Sandra Leal, CEO of Tucson, Ariz.-based SinfoníaRx, wondered what it would take to become president of APhA and lead the pharmacy profession.
These days Leal, who is the incoming president-elect of APhA, is humble when she says that sometimes she wakes up and asks, “How did I get here?”
Yet once Leal begins to explain her accomplishments as a pharmacist over the past 21 years, ensuring that patients have the best possible health outcomes, it’s very clear that she deserves this honor.
Leal now leads SinfoníaRx, which she joined in 2015 as vice president of innovation, and which provides MTM services nationally, working with numerous health plans and provider groups. “We try to make sure we are delivering the best care for the patients through that service model,” said Leal, who also earned a public health degree to enable her to work with underserved populations that struggle with health literacy and equity in health care.
Leal, who is Hispanic, grew up in Nogales, Ariz. Her family didn’t speak English, and they went to Mexico to obtain health care from a pharmacist.
“To me health care was the pharmacist. That was our primary care clinician, so immediately, growing up in 11th grade, I knew I wanted to be a pharmacist,” she said.
Leal earned her pharmacy degree from the University of Colorado. When she returned to Tucson, she worked at the El Rio Health Center, a federally qualified health center, where in 2001 she designed a program in which pharmacists practiced in a collaborative practice model with physicians.
“They would refer patients to the pharmacist and we would work closely with the patient to help manage their diabetes,” Leal said. “We developed a collaborative practice model, where pharmacists could order labs, we could do referrals, we could work in collaboration with the providers, and we could start new prescriptions. Diabetes and chronic conditions associated with diabetes, like high blood pressure and cholesterol, are very medication heavy chronic conditions.”
Leal recalled that in the 14 years at El Rio Health Center, she spent 75% of her time working with Spanish-speaking patients. “Spanish patients trusted me as a provider to help them with their concerns, and to ask questions in Spanish and work with them directly,” she said.
Leal, who also partnered with a local Indian tribe to support patients where they lived, received the Tucson area Indian Health Service Director’s Award in 2004 for her work.
She also serves on the board of the National Center for Farmworker Health — a cause that is close to her. “My father was a farmworker,” she said. “It’s a population that is very challenged to receive care. We have fragmented care, so I’m very passionate about anything to do with reaching out to people and connecting them to care, and to be a resource.”
Bruce Roberts has been the pharmacy manager of Rite Aid in Newark, Del. , for two and a half years, and he already has become 1-of-6 pharmacists across the entire pharmacy chain to be recognized by Rite Aid’s annual Pharmacy Champions program.
Roberts, who has been a pharmacist for more than five years, was nominated for the award by the parents of an infant who had been hospitalized. The child was discharged with about a half dozen prescriptions.
“We contacted the doctor because some of the medications needed insurance approval, and we took the time to order the medications in advance. One of our employees went to another store to pick up one of the medications, so the family didn’t have to wait,” Roberts said. “When the parents came to pick up the medications, I made sure I discussed the medications in detail because some of them needed refrigeration, and one of the medications was injectable. I showed them how to put the injectable drug into the syringe and how to administer it, and what to expect.”
In her nomination letter, the mother wrote that on the way to the pharmacy, she was crying because she was stressed and anxious. “We took time to go over the medications and administration, and she was very intimidated, but she left very confident,” Roberts said.
“I never went out to seek recognition. I just try to treat people the way that I want my family to be treated when they need help. It was a very nice surprise,” he said.
Becoming a certified immunizer and vaccinating the community members against preventable illnesses is another role that Roberts is excited about. He also enjoys the personal interaction that he and his staff have with patients on a daily basis, whether it’s delivering a prescription to someone who is homebound or taking time to listen to an elderly woman speak about the loss of a loved one.
One hundred fifty miles.
That’s how far Laura Thomas, a Walgreens staff pharmacist in Chantilly, Va., drove the evening before Easter. Yet, rather than traveling to spend Easter with her family, her trip was to get a medication for a six-year-old patient with a chronic lung disease.
The day before, Thomas had been filling one of her prescriptions that she found was in the pharmacy’s out-of-stock queue. “I realized there was an industry shortage,” she said. “I called around and couldn’t find it. I even called other chain pharmacies, her mail order, trying to find and locate the medicine. Without finding it, she would have to go to the hospital, which is 40 minutes away,” Thomas said, referring to the patient.
Although Walgreens could ship the medication overnight, Thomas was worried there might be a delay because of the holiday weekend. “I didn’t know if it would get there in time. I knew the alternative was that she would have to go to the hospital, which was not around the corner. That’s traumatic for a young child and she has a younger sister, which is a big pull on the family,” she said. “I looked at it as if she was one of my family members. I had to go find it for her. It just wasn’t an option for me not to find it. I was going outside of Walgreens at this point. She needs it to stay alive. I have to find it for her. I drove down Saturday night and came back Sunday with it.”
The family was shocked and appreciative that Thomas went the extra mile to obtain the medicine, especially since she was scheduled to have the week off for vacation.
As for the patient, a visit to the pharmacy with her little sister was perhaps the greatest reward for Thomas after returning from her vacation. “She drew a picture, which is priceless,” said Thomas, who has kept the drawing.
In 1968, when Kam Tam left China to come to the United States by way of Hong Kong, he only had a small suitcase with necessities and he was very sick. Some six months later, after the 96-pound 16-year-old was treated at a clinic in San Francisco’s Chinatown, he was strong enough to go to school.
Fast-forward to 2019 and Tam, who has been a pharmacist for 40 years, is owner and operator of seven pharmacies — three pharmacies in Oakland’s Chinatown, two pharmacies contracted with UCSF Benioff Children’s Hospital, and two pharmacies that serve the FQHC Tiburcio Vasquez Health Center.
Tam, who recently received Health Mart’s Community Excellence Award, started out with three employees and now has 50 full-time and 20 part-time staffers. The health care that he and his parents received from the community clinic instilled in him the desire to serve the community.
Reflecting on 1989, when Albert Wong, a classmate who asked him to join him in Oakland to run a pharmacy, Tam said, “I found my role and the real purpose of pharmacists. I quit working at a chain and joined forces with Wong in Chinatown. We served the community of immigrants, mostly seniors, who are low income and who have language issues. They don’t speak English, so when we gave them a prescription with instructions, they had no idea what it meant.”
In order to improve their compliance and understanding of the medications, Tam put Chinese-language labels on medication bottles. As technology has developed, Tam installed a software program that provides prescription information in Chinese, Vietnamese and Spanish. He also provides patient information leaflets that can be printed in multiple languages via Meducation subscription.
Tam looks beyond his pharmacies’ patients to serve the homeless population in Oakland. In addition to providing medications for patients via two clinics that operate from a van, Tam was an advocate in helping the program evolve into a brick-and-mortar clinic.
If you think that pharmacies in rural areas lag behind pharmacies in large cities when it comes to fostering innovation to serve patients, think again.
Rhonda Yarzab owns Medicine Shoppes in the rural areas of Greenville, Pa., and Hermitage Pa., and she co-owns a Medicine Shoppe in Canandaigua, N.Y., an upstate community in the Finger Lakes region.
Two years ago, Yarzab, who has been a pharmacist since 1983 and a pharmacy owner since 1991, received an innovation award from Medicine Shoppe after remodeling and expanding her Hermitage location.
“It’s a very modern pharmacy,” she said. “We embraced automation. All of our stores have either ScriptPro or Innovation’s cabinets to assist us with counting. It’s a very efficient way to count pills, and allows our staff to have more time with patients.” She said the Hermitage location has a machine to assist with compliance packaging, which has been its focus in recent years.
Yarzab does not charge for the compliance medication packaging, and she believes that it is a huge benefit to patients and their families. “It’s checked by a pharmacist, and we also follow up every three weeks before we fill the packs,” she said, adding that they proactively call patients to see if there have been any changes to their medication regimens. “We just try to provide the best possible service and keep our patients healthy and happy. We try to have excellent customer service, and we’ve adapted through the years as the industry has changed. We ‘ve expanded our offering and diversity in what we do and the services we offer.”
Gone are the days of just filling prescriptions. Yarzab has expanded into diabetes care, offering diabetic shoes, and the pharmacy has become accredited with Medicare to provide such services and products as durable medical equipment.
One of the pharmacists she employs is a functional medicine practitioner. “We’ve taken a more holistic approach. We try to improve people’s lives by putting them on vitamins and supplements, discussing better nutrition and lifestyle changes to make them healthier so they don’t need as much medicine,” she said.
In July 2019, the pharmacy received Medicine Shoppe’s Licensee of the Year Award in recognition of how the pharmacy has adapted to the times and the needs of the community.
“We see pharmacy as a whole has changed drastically. It used to be mom-and-pop drug stores. People came in and filled prescriptions, and went away,” she said. “Now we have more people who are more interested in their health. We have more time to talk with patients and they are requesting information from us. Millennials want to be an active participant in their health.”
When Vaishali Deshmukh, pharmacy manager at CVS Pharmacy in Farmingdale, N.Y., heard that one of her patients was in the hospital having gallbladder surgery, she didn’t think twice about heading to the hospital to visit her.
A few weeks prior to the patient’s surgery, Deshmukh had urged the patient to go to her doctor when she said she was experiencing symptoms. “We definitely can catch things at the community level when people talk to us because we take the time to listen,” she said. “I was really concerned and felt that visiting her in the hospital was the right thing to do. I wanted to let her and her family know that we were there for her. She was scared and never had a surgery.”
Deshmukh, who is receiving CVS Health’s National Paragon Award for the pharmacy’s patient care programs in September, credited her dad, who is a physician, for showing her the importance of empathy at a young age.
“I was exposed to my dad’s care and empathy and sympathy, and good bedside manner from a young age. I remember my dad being so humble and holding patients’ hands, and giving them a hug if they were crying,” she said.
Deshmukh’s sister had leukemia at a young age and she said that experience taught her about how medications can affect the body, and that they also can be lifesaving.
“CVS is community-focused, where we can give our patients the care and empathy needed to achieve better health outcomes,” she said. “I want to make sure our customers, pediatrics and the elderly, are taken care of. If they are going through something rough and traumatic, we send cards and are there for them. It’s important for me to hold that care and empathy at a high level. The care and empathy and those connections with my customers hold me grounded.”
Deshmukh said that patient care ultimately is a team effort. “We’ve excelled in patient care programs at our location, and getting patients adherent on their medication. I use the word ‘we’ a lot. I received the award, but I have a quote, ‘Teamwork makes the dream work.’ I wouldn’t be anything without them,” she said.
When CVS Pharmacy manager Saurabh Mistry was filling a prescription for an elderly patient who looked unsteady and lacking in energy, he initiated a conversation with her that turned out to be a pivotal moment in his pharmacy career.
Realizing that the patient was on multiple medications, which were redundant, Mistry contacted each of her providers and faxed her medication list. After removing several redundant medications, he developed an optimized drug regimen for her.
“Over several weeks, she felt much better. This opened a personal relationship. She brought us homemade bread and cookies, and would stop in to say hello and have a quick chat. She came in with her family and talked about them, and asked about our families. It was gratifying to see that we helped somebody to that extent,” he said.
After the patient moved back to her home country and Mistry moved to Austin, Texas, he received a call from a colleague in Ohio, saying the patient’s son wanted to reach out to him. “She had passed away. I spoke to him, and she said she wanted me to know that she always regarded me as a son,” he said. “That was a career-changing experience for me that made me more passionate towards patient care and patient relationships, and building those bonds with the patient,” Mistry said. “As community pharmacists, we take in stride and think we’re just doing our job by helping patients with their health and medication management. It was helpful to know you have a deep impact on a patient’s life. It goes above and beyond your regular call of duty in some cases.”
Mistry, who is receiving CVS Health’s Paragon Award in September, recently was promoted to the pharmacy’s emerging district leader program. He said that the most fulfilling aspect of his career has been leading his teams in Cleveland and Austin to deliver results in patient care outcomes, including MTM, optimum medication utilization and therapeutic management.
“This has a tangible impact on patients’ health and satisfaction,“ he said. “I place a very high emphasis on quality patient counseling and building that relationship with the patient, and creating and enhancing adherence and cost effectiveness.”
An epidemiologist by training, Mistry has a school in India for blind children, and provides about 5,000 free meals on a monthly basis to cancer patients in hospitals and supports scholarships to help students obtain higher education and degrees in the country. In the United States, Mistry participates in his temple’s annual health fairs, hosting a pharmacy booth to provide medication counseling and immunizations. He also educates the community on safe medication use and how to prevent medication abuse.
Chris and Mindy Munden
The signage above pharmacists and co-owners Chris and Mindy Munden’s Good Neighbor Pharmacy reads “Prescriptions,” but the signage tacked onto the 100-year-old building does not begin to encompass the focus of Hemmingsen Drug Store in Marshall, Mich.
In fact, the quality of patient care that the Munden’s and their staff provide to the community has led to Hemmingsen Drug Store being named 1-of-3 finalists among over 5,000 independent pharmacies for the Good Neighbor Pharmacy of the Year award.
The Mundens bought the pharmacy in January 2016 with the aim of fostering improved patient outcomes. So intent are they on this mission that they offer a multitude of free services, including delivery of prescriptions and free diabetes supplies that include testing strips, meters, lancets and lancet devices. The hope was that regular testing would lead to better outcomes and better control of their condition for patients.
“We concluded that because of the difficulty justifying the billing of testing four times a day, we would provide these testing supplies for free and without a copay,” Mindy Munden said.
In addition to making workflow changes and remodeling their store with new paint to new floors, the Munden’s added a consultation room. “We knew that was going to be important for immunizations and medication therapy management, and other consultations we wanted to do. The transformation process improved our workflow,” Chris Munden said. “We added a larger dispensing area, including an area for our medication synchronization program. We’re really focused on medication adherence.”
The Munden’s launched a medication synchronization program at the end of 2017 after attending a boot camp. About 60% of their volume is on their medication synchronization program.
“This is the first step to helping patients be adherent. We want people to take their medications correctly and will identify barriers to achieving those goals, whether it is side effects, forgetting to take medications, or complex medication regimens requiring multiple dosing times per day. Any way we can creatively solve problems to help a patient is what we are going to focus on,” Chris Munden said.
Joel Zive, director of education at Medly Pharmacy in Brooklyn, N.Y. for three years, recently launched a program to improve the health and lives of asthma patients in the Bronx. The program is helping these patients to understand the difference between rescue and control medications.
“Asthma is complex. One of the simplest ways to help an asthmatic is make sure they understand which medication to use. They have to use both medications, but they have to know when to use them. I came up with the idea to have the delivery drivers reinforce what the pharmacists tell patients. They are not allowed to counsel, but they give out information in English and Spanish language leaflets,” Zive said.
Besides reaching out to improve the health outcomes of patients in the Bronx, Zive also is having a positive effect on a young man in Rwanda in Africa.
Since 2006, Zive has been paying for this young man’s education. In 2005, when Zive was working at a clinic, he took a photo of the boy and his mother at a food bank in Kigali, the capitol of Rwanda. “I said to a doctor, ‘I want to use their picture for my nonprofit.’ The doctor informed me that I would have to get the woman’s permission,” Zive said.
Upon returning to the United States, Zive’s friend translated a photo consent form into her language. “I gave the picture and consent to the doctor, who dropped it off at the clinic. A month later, the woman came into the clinic and the clerk recognized her. She signed the consent. A few months later, I returned to Rwanda. I asked her, ‘How can I repay you? She said, educate my son.’”
Zive was humble when he said, “I paid for his nursery and primary school and high school, and I’m just going from there. I’m just trying to contribute to making him better, and if I can help him be better and get an education, then he can help his mom.”