U.S. Surgeon General Report

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Anusha McNamara
U.S. Surgeon General Report

The Office of the Surgeon General, under the direction of the Surgeon General, oversees the operations of 6,500 members of the Commissioned Corps of the U.S. Public Health Service, including Veterans Affairs and Indian Health Services. Our current Surgeon General is Dr. Regina M. Benjamin, MD, MBA, and she serves a four year term appointment by the President of the United States. She also appoints several members, one of whom is RADM Scott Giberson, the Chief Professional Officer of Pharmacy. He led the revision of the report to the Surgeon General on improving patient and health system outcomes through advanced pharmacy practice at the end of 2011.

The report provides rationale and compelling discussion to support health reform through pharmacists delivering expanded patient care services, and focuses on four points: pharmacists integrated as health care providers, recognition as health care providers, compensation mechanisms, and evidence-based alignment with health reform. The education and accessibility of pharmacists allows a unique and under-utilized position to play a larger role in primary care in the U.S. health care system. They can meet the needs of medication expertise, growing shortage of primary care providers, and overall health and healthcare delivery of the nation.  

Currently, pharmacists deliver patient care services in various practice settings through collaborative practice agreements allowing them to perform patient assessment, have prescriptive authority, manage laboratory tests, formulate clinical assessments and plans, provide care coordination, manage and prevent disease, and develop patient relationships for ongoing care. The benefit of pharmacists included in interprofessional teams has been abundantly clear from as early as the 1960s in federal infrastructure such as the Indian Health Services (IHS), Veterans Affairs (VA), and Department of Defense. All but six states allow for collaborative practice agreements between physicians and pharmacists.

The recognition of pharmacists as healthcare providers through legislation and policy will promote and support and fully-sustain these value-added services that are proven to improve patient outcomes and healthcare delivery. Pharmacists in the IHS and VA, as well as a growing number of states (New Mexico, North Carolina, and Massachusetts), already allow for prescriptive authority to pharmacists through collaborative practice. There are also a number of references to pharmacists as part of the healthcare team in the Affordable Care Act.

The lack of compensation mechanisms is a current barrier for the expansion and sustainability of pharmacist involvement in clinical roles. Currently, pharmacists are eligible to receive some compensation through Medicare Part D, but multiple attempts have been made to compensate pharmacists federally through Medicare Part B. No further action was taken since December 2010. On a state level, Medicaid programs pay clinical pharmacy services in New Mexico and Minnesota.

The last focus point addressed in the report cites a plethora of evidence proving how pharmacists can address the need of improving quality of care and patient outcomes, disease prevention and management, cost-effectiveness and cost-containment, diminishing primary care workforce, and access to care. The need and evidence is apparent, and it seems pharmacists constantly need to present it to prove the value they bring to a healthcare team. It will take a paradigm shift of healthcare professionals and society to accomplish the four focuses of the Surgeon General report, but this is a start to supporting healthcare delivery improvement and the advancement of the health of the nation.

Questions to consider:

-Are dispensing pharmacists able to contribute to the healthcare system and work at the top of their license within our current system?

-How were nurses and physician assisstants able to get prescribing rights and compensated for patient-care - yet it's remained so difficult for pharmacists?

-When will the government and other payers see our value? What will it take?

-Why aren't pharmacists being fully utilized, and what needs to change for this to happen?


Giberson S, et al. Improving patient and health system outcomes through advanced pharmacy practice: A report to the U.S. Surgeon General 2011. Office of the Chief Pharmacist. Dec 2011.