Pharmacies, Vaccinations and Health Benchmarking

The state legislature in Florida decided it is legal and appropriate for pharmacists and pharmacies to begin administering vaccines against multiple diseases.  Their list of adult vaccines includes seasonal flu shots, pneumovax (pneumonia vaccine) and zostavax (vaccine to prevent shingles).  The rationale of the legislature is that access to doctors to receive these preventive vaccines is limited and difficult.

By refusing to administer vaccines in their office because it is time consuming and not profitable enough, my colleagues in primary care have not made my argument against permitting this any stronger. I thought prevention and administering vaccines was part of the job description in primary care.  I am not asking my colleagues to lose money, but I do believe there is a distinct difference between not making a large profit and losing money.  Isn’t it our professional and ethical responsibility to provide preventive services?

Over the years, the fall season and start of the school year have always provided an opportunity to remind patients that they were due for an annual checkup and to make positive suggestions on what other opportunities were available for them to try and prevent infectious or chronic disease. School-age children have been required to receive immunizations before entering school for obvious public health reasons.  This provides an opportunity to benchmark their growth and age goals and discuss healthy living as well. The visits came towards the end of the calendar year when most individuals had met their annual medical deductible so the out of pocket costs were not great.

As I walk into my local CVS I am confronted by ads for vaccines and same-day clinics. They remind me that physicians have lost this encounter to enhance the doctor/patient relationship and provide sound health advice for the future because administering vaccines isn’t very profitable.  Pharmacies often use vaccinations as a loss-leader to draw you in and get you to purchase other, more profitable, items.

I will continue to provide vaccines in my internal medicine office as I believe it is the professional and responsible thing to do.

2 Responses

  1. I too as a practicing internist bemoan the fact that vaccines in Florida are being given through pharmacies. Pharmacies are pushing shingles vaccines that are not neccesary and perhaps dangerous to certain populations and administeringing the high dose flu vaccine inappropriately. Dr Reznick, however, I am concerned that you criticize your fellow primary care physicians who don’t give vaccines because they are losing money.(The numbers are actually very tiny who don’t) Also I note you have also blogged about the Physician Shortage in primary Care. I do not begrudge any of my colleaugues who have gone concierge. The people served by concierge physicians get very good health care. However lets reckognize that Concierge medicine is part of the problem with the primary care shortage not a solution. You shouldn’t criticize those of us who are still taking the inadequate government insurance as our full payment and trying to keep the fight going and treat all americans. Please join us in advocacy with your medical society and the ACP

    • Last week when I re-applied for staff privileges at the institution I have been a staff member at for 33 years and I filled out the list of clinical privileges I was requesting I noticed that most of the procedures and activities I was trained to perform are no longer being performed by general internists or family practitioners due to changes in bylaws and liability issues. We have surrendered our skills in many cases without a fight even if we have demonstrated in training and subsequent to training that we are competent in those procedures. Certainly I no longer wish to insert central venous lines because I no longer perform enough of them daily to remain adept and expert at them. Reading EKG’s , working ventilators on critically ill patients are bread and butter procedures taken away from us.
      Vaccinations are an integral part of prevention. It is our job and duty to offer them. I did not distinguish between concierge PCP’s and non concierge PCP’s when I criticized them and our specialty colleagues for no longer ordering and administering vaccines in their office. Yes it is far easier to administer a vaccine program in a 350 patient practice than in my former 3500 internal medicine practice. We did it then and we do it now. Giving vaccines is the tip of the iceberg of practices formerly done in medical offices but no longer done due to efficiency and the need to see more patients in volume. Our colleagues are giving up longitudinal patient care by not following their patients during hospitalizations in an inpatient setting. I am told it is not cost effective to leave the office to see an acutely ill patient in the emergency department. That is an excuse and a cop out. It is planned obsolescnce and one more reason why our surgical and procedure oriented medical colleagues devalue primary care. You make yourself less valuable and they are only too willing to make you pay for that decision in the pocket book.
      I respect my primary care colleagues whether they are in a capitated practice, a practice targeting insured patients with PPO’s, an employee of a multispecialty group, or small mom and pop general medical practices whether they are direct pay , concierge or old fashioned fee for service. When you surrender privileges and activities to non medical businesses or other specialties you lessen your value.
      The physician shortage is simply due the failure of Congress and the medical schools to expand classes to the size needed to meet the population growth and replace older retiring physicians. This is coupled with a failure to develop residency programs for post graduate training. Yes limiting your practice size does create pockets of PCP decreased availability. At the end of the day I like to be able to look in the mirror and feel that I did the best job possible. Seeing an increasing number of aging and chronically ill patients in five minute to ten minute appointments did not allow for comprehensive and detailed care . I chose concierge medicine to be able to give the patients I did retain the best overall comprehensive care possible in an increasingly dysfunctional health care system. My medical society ( I am a member of the state and county society) and the ACP ( I am a fellow) are worthless. They are over run with specialty and procedure oriented docs who like the Medicare Payment Commission Advisory Board put primary care as its lowest priority

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