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Tag: the future of pharmacy

YFP 123: Leveraging Your Expertise to Start a Side Hustle

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Leveraging Your Expertise to Start a Side Hustle

Dustin & Melody Hartzler talk about their healthcare side hustles, how these ventures have accelerated their financial goals, how they balance and prioritize their time, and how they work together as a couple when it comes to business and managing their personal finances.

About Today’s Guests

Dustin Hartzler is a Happiness Engineer at Automattic by day, where he helps business owners work all of the kinks out of their WooCommerce stores. If working with WordPress all day wasn’t enough, he spends time each week recording his WordPress podcast called Your Website Engineer (http://YourWebsiteEngineer.com). He enjoys helping people understand and use WordPress to its fullest capacity and spends time tinkering with code. When he’s not in front of the computer (which is rare), he enjoys spending time CrossFitting, reading and traveling. He lives in Dayton, OH with his wife, 5.5 year old daughter, and 2.5 year old son.

Dr. Melody L. Hartzler, PharmD, BCACP, BC-ADM, is a family medicine clinical pharmacist and Associate professor of pharmacy practice. Dr. Hartzler is a graduate from Ohio Northern Raabe College of Pharmacy. She completed her PGY-1 Pharmacy Practice Residency with emphasis in Ambulatory Care at the Chalmers P. Wylie VA Ambulatory Care Center in Columbus, OH. Following residency, she joined faculty at Cedarville University School of Pharmacy and developed a collaborative practice in a family medicine residency program. She now serves part-time for Cedarville University School of Pharmacy and part-time as a clinical pharmacist at Western Medicine Family Physicians. Her primary practice interests are diabetes, IBS/IBD, and functional medicine. In her current clinical practice, she works collaboratively with her physicians through a consult agreements. She is board certified in both ambulatory care pharmacy as well as diabetes management. She is a nationally recognized speaker, who has presented 6 times at the ASHP Midyear Clinical Meeting, as well as numerous state and local programs. She is an active member of American Society of Health System-Pharmacists as well as state and local organizations. She is also is a current board member for the Ohio Pharmacist Association. Dr. Hartzler’s passion for functional medicine lead her to start her company PharmToTable, LLC; she blogs at PharmToTable.Life. Her newest adventure is FunctionalMedicineCE.Com, she is making quality continuing education for Functional Medicine convenient and affordable.

Summary

Dustin and Melody Hartzler share their career journeys and how they are leveraging their expertise to start a side hustle. They have created multiple side hustles built on needs they are seeing while also fulfilling creative outlets they crave. Melody works 3 days a week at Western Medicine Family Physicians and teaches at Cedarville part-time. At her office job, she focuses on diabetes medication, transitions of care, medical reconciliation and does functional medicine consultations. Dustin is an electrical engineer turned Happiness Engineer at Automattic where he supports customers set up their WooCommerce stores and websites.Together they have created two side hustles: Functional Medicine Continuing Education and Pharm to Table. This episode focuses on Functional Medicine Continuing Education.

Dustin and Melody share their roles in their businesses. Dustin is able to have a creative outlet by building websites for their businesses and Melody often brings new ideas to the table based on the needs she sees in the pharmacy and functional medicine fields. They often have business conversations while driving.

Melody dives into functional medicine, a break down of what it is, her personal story leading her to learn more about functional medicine and how she incorporates it into her office practice as well as in their side hustles.

They speak more about their business model and the costs behind getting websites like they have up and running. The couple also share their advice for getting started in a side hustle and the podcasts and books they help to inspire their journey.

Mentioned on the Show

Episode Transcript

Tim Ulbrich: Hey, what’s up, everybody? Welcome to this week’s episode of the Your Financial Pharmacist podcast. I’m excited to welcome onto the show Dustin and Melody Hartzler, proud fellow alums of mine of Ohio Northern University to talk about their unique career journeys with multiple side hustles, which most recently culminated in the launch of FunctionalMedicineCE.com and a virtual symposium that they are launching on Nov. 9, 2019. This episode is an extension of the work, the excellent work, that Tim Church has been doing as a part of our YFP side hustle series where we talk about ways you can create additional streams of income to reach your financial goals faster and highlight pharmacists who are making this happen. Now, before we get started with today’s episode, I want to mention an awesome giveaway that we have going on this month in combination, in partnership with Brandon Dyson and the team over at TLDR Pharmacy. And this is the ultimate residency prep giveaway, and you can learn more and enroll in that giveaway to get yourself eligible over at YourFinancialPharmacist.com/giveaway. Again, that’s YourFinancialPharmacist.com/giveaway. In this giveaway, the ultimate residency prep giveaway for five winners, we have a variety of resources, everything from interview prep, letter of intent prep, a pharmacy residency bootcamp from the Pharmacy Advisory Group, lots and lots of resources, including the forecast application fee that, of course, costs just over $100. So again, you can learn more at YourFinancialPharmacist.com/giveaway. So Dustin and Melody, welcome to the Your Financial Pharmacist podcast.

Melody Hartzler: Thank you.

Dustin Hartzler: Hello, hello.

Tim Ulbrich: Well this has been a long time in the making, so excited to have you guys on the show. And we’re going to talk everything from business and side hustles to how do you guys effectively work together, what’s the purpose, what’s the goal, why are you doing these side hustles, so I’m excited to be able to have our community, our listeners, get exposure not only to the businesses that you’re working on but also a little bit of the behind-the-scenes of how the two of you operate and the success that you’ve had. So why don’t we start with each of you — Melody, I’ll start with you. And then Dustin, I’ll ask the same thing. Melody, can you start and tell us a little bit about your day job, what you’re doing every day as a clinical pharmacist? And then from there, we’ll jump later in the show about some of the side hustles.

Melody Hartzler: Sure. So three days a week, I work at Western Medicine Family Physicians, which is a private practice family physician office in the Dayton, Ohio, area. And then I also teach at Cedarville part-time, so I get the opportunity to still teach what I love, which is endocrinology and diabetes-focused. And also I am in charge of our residency teaching certificate program at Cedarville. So during the week at the office, I do a lot of diabetes management, also transitions of care, helping med reconciliation for post-hospital discharge patients. And then I do a lot of functional medicine consults too, which I think we’re going to get into later.

Tim Ulbrich: We are. And that was — part of wanting you to share that is I think often the value in a side hustle — most side hustles that often turn into successful businesses I think is where there is synergy between someone’s area of expertise in their day job and what they’re able to do. So split position, teaching as well as practice in functional medicine. Dustin, why don’t you give us a little bit of background on the work that you’re currently doing at Automatic as well as the previous work that you had in starting and owning your own business?

Dustin Hartzler: Yeah, absolutely. So I do work at Automatic now. I am on a support team, so I help people set up websites. And you might see where this is going here in a little bit, but I had a business when we moved to Dayton in 2010, I set up my own company because I wasn’t going to do my electrical engineering job, drive to a factory two hours away, and it just didn’t make sense. So I’m like, let’s see if I can start something here. And I started, and I had a business building websites for people. And so I have a lot of experience, 10 years almost, in just building websites and helping people get their websites set up. So that’s my primary focus, and that’s my primary day-to-day.

Tim Ulbrich: So you’re title, Dustin, if I pulled this correctly from your LinkedIn profile, is a “happiness engineer.” What is that? I mean, what does the day-to-day of that look like?

Dustin Hartzler: Yeah, so that’s just a name for our customer support team. And so our goal is to make everybody happy, I guess if you will. It’s mainly — it’s kind of a unique position in the fact that we’re not like a normal call center that says like, “Oh, you can only give them refunds if this, or you can only do this.” Like there’s so much flexibility in our jobs, like you know, if somebody has paid for a plugin or paid for something and it just doesn’t work, we can go outside their window to refund them or we give them extra time or give them free plugins. Like I’ve given customers who’ve spent thousands of dollars with us, just oh, this wasn’t working when you try to check out, it’s on me. Like it’s one of the cool things that we can do for our loyal customers and just try to make everybody, that experience when you’re building a website is so frustrating. And so our goal is to help people get what they need and to also just do it without having to ask for extra permission. Like, “Oh, can we give someone this $100 thing worth of value?” Just go ahead and do it, and everybody moves on with their lives.

Tim Ulbrich: So one of the things I don’t think I’ve ever asked you this and I don’t want to gloss over, Dustin, but you mentioned obviously you’re trained as an electrical engineer and you abandoned — for lack of a better word — abandoned that work, started your own company. You mentioned the long commute, but what other reasons, what other factors played into that decision in terms of leaving a career in a field that you had spent a lot of time obviously in training and becoming an expertise and deciding you want to go this route into web development?

Dustin Hartzler: I think the two things that stand out to me is one, I don’t like meetings. I worked at Whirlpool, and I would literally have like seven hours of meetings in an eight-hour day, plus have to do all my other work.

Melody Hartzler: He wouldn’t do well in academia either.

Tim Ulbrich: No, no, he would not.

Dustin Hartzler: And then I think the other thing was just the inspiration I was getting from listening to so many other business podcasts and people creating their own thing and doing their own thing, and the income level was — you were never capped. Whatever you could create, that’s how much money you could make. So I think those were kind of the two reasons besides the long commute. And honestly, I liked the commute more than the work because I got to listen to podcasts the whole way to and from work.

Tim Ulbrich: I love that. I mean, so the aversion of meetings and the advantage of not having a cap on your income certainly can be reasons to be able to start your own business. So I agree, though, Melody, academia would not be the environment for Dustin. You’ve got to love the meetings that are about the meetings. Those are my favorite types of meetings. So let’s jump in. And Melody, if you could start, and Dustin, feel free to chime in, you know, I’m always curious, obviously here we are on a personal finance podcast, but I think so much of people’s success in business or here in side hustles or side hustles that turn into businesses over time is really dependent on people having a solid financial base and foundation from which they can build. So tell us a little bit about your personal finance story and journey as an individual, as a couple, and how that has put you in a position to be strategic and on the offense when it comes to these business opportunities.

Melody Hartzler: Sure. So I probably didn’t have the best understanding of finances when we got married and even going into school. I had a lot of private loans that had a variable interest rate. So by the time 2008 came around, before the stock market crashed, some of those were at about 16% interest.

Tim Ulbrich: Wow.

Melody Hartzler: Yes. So we left, I graduated in 2009, and I had about $120,000 in debt plus an additional $12,000 that I ended up paying back to Walgreens about three years later. Maybe a little longer. And so from that point, we knew we had to pay it back, and we wanted to pay it back quickly. We really wanted to pay it back before we had kids. Dustin had a lot less, which he can talk about. But so I — even during residency, I wanted to pursue residency and I knew that I liked talking with people and I loved the idea of community pharmacy, but I knew that the way that it was going wasn’t going to work for me and my goals. And so I did my residency in an outpatient facility at the Columbus VA. And I didn’t have weekend responsibilities there, so on the weekends, just like every other resident in town, I was working on the weekends. So I worked at Walgreens every other weekend throughout my whole residency. So pretty much had four days off a month because I was working the other weekends. And you know, that helped us a lot because we were able to significantly increase even just that first year. If you think about four days a month of a retail pharmacist’s salary plus the residency salary, it almost was about the same.

Tim Ulbrich: Absolutely.

Melody Hartzler: You know, when you got down to it. So that was a blessing to still be able to have that residency experience and then be able to get paid a separate position to help us dig out of that a little bit and then ended up having one of our cars died that year, and so we ended up having to use a lot of that to purchase a reliable car to get to those jobs. So and then Dustin, I can let him talk a little bit about his strategy when we were paying off loans. He was even paying them off when we were in Ada still at Ohio Northern, so my last two years of school, I worked as a head resident — actually three years, the last three years I was at ONU, I was the head resident. And so my room was free and we had the stipend plus we got a meal ticket. So here we got married and we’re living in an apartment on campus and going to the cafeteria as a married couple because that’s what made the most sense. I mean, we didn’t have our awakening on the whole health and nutrition thing at that point, so we were still OK with eating the food there. And so that was a big savings, we didn’t have a rent to pay for our first early years of marriage because of that. And so Dustin really was able to start driving down some of those high interest loans.

Tim Ulbrich: So Dustin, give us the strategy a little bit — and obviously chime in with your own financial position as well in terms of student loan debt. But those together when I hear 16% interest loans, were those just things you aggressively paid off? Did you guys refinance those? But in addition to that, what was the motivation for you that even while Melody was still in school that you obviously had very significant intentions of trying to aggressively pay those off. Tell us a little bit about that backstory.

Dustin Hartzler: Yeah, so when I started — so I graduated. I’m two years older than Melody school-wise. And so I graduated two years earlier. And I had a full-time job, you know, a full salary engineer position, and I drove to and from work. And this was like right at the dawn of podcasts, believe it or not. And the iPod, video iPod is the first iPod with the thick wheel, and I felt like I could invest $300 in this Apple device so that I could play it through my car deck tape player.

Tim Ulbrich: Yes.

Dustin Hartzler: To and from work. Like I was commuting an hour to and from Whirlpool. And I was like, well, I just want to learn about money. Like nobody ever teaches you about money. And so I got hooked on the Dave Ramsey Show, and all of a sudden things that he was saying was making sense. And we didn’t full out Dave Ramsey — like we took vacations while we were still in debt. Like we lived life, but we still were pretty aggressive with our student loans. But what happened was I ended up with like $20,000 in student loans. I throw that number out there like, oh, just $20,000. That’s still a lot. It’s not Monopoly money, like we paid it all back. But so I ended up — he was talking about creating a budget, and this was all before Dave Ramsey has his budgeting tools and stuff online. So I had an Excel spreadsheet, and I figured out — and I don’t know if this is true or not — but as an engineer, you’re always trying to figure out how you can save the most amount of money in interest. And so like we figured that it made more sense for Melody to take out new loans for the last couple years while we paid off her current loans. And so we had about three things we had to pay for: We paid for gas for my car to and from work. We paid for renter’s insurance. And I think we paid for like some groceries for breakfast and lunches for me. That was pretty much all of our bills. And so it was like every week, I figured out that if I wanted to spend $2,000 per month towards the loans, then I could spend $500 per week. And then that last week, whatever we had left in the month, we got that, that’s what got sent over to Sallie Mae at the time. And so that was kind of the strategy and the thought process. And was it the coolest life to live? No, not really. But looking back, our first two years of marriage, we lived on campus. And I mean, I got to do all the intramural sports and all that kind of stuff, and there were still a lot of friends that I had because I had just graduated. And so it was kind of cool, like it was a good jumpstart with such a weight around our ankles, if you will, with all of the loans that we had.

Tim Ulbrich: Yeah, I mean, there’s nothing like a good date night at the Macintosh cafeteria, right? At Ohio Northern University. I mean, what I love about that though is I love the intentionality, I love that Melody, you kind of admitted that you didn’t necessarily come in with the same appreciation for that and obviously had more debt, although that’s still well below the national average of what we’re seeing now even though it was a higher interest rate. But still were really, really aggressive. And I want to follow up on that and hear from the two of you. We talk a lot on this show about the importance of having a financial why. What is your motivator for why you even care about this topic of money to begin with? And we’ve preached over and over and over again that that’s going to be different for everyone. But if you can articulate that, especially as a couple if you can articulate that, I think it makes so many other parts of the financial plan easier to work through, such as the month-to-month budget and being on the same page and all the things that cause so much heartache and a lot of difficulty for people. So for the two of you, what’s the vision? What’s the dream? What’s the why when it comes to money in terms of why you wanted to be intentional in paying down the debt? And what’s the future hold in terms of why this topic of money matters?

Dustin Hartzler: I think the first thing that really comes to mind is like, I didn’t like paying people to use their money. I don’t know, like I had never had any credit, I had never — before, it was always like, “Oh, interest. That’s what the bank pays me.” And then when we see how much the interest is making, or how much we’re spending in interest, it just like takes your breath away almost. It’s like, wow, on our mortgage or whatever, that’s a lot of money just to spend to have used somebody else’s money. And so I think that’s kind of the driving force behind it, and then kind of looking out — and I do this a lot too with trying to figure out what happens the day comes and we don’t have our mortgage anymore, like look at all of the possibilities there. Like, oh, if we didn’t have a mortgage, we could easily cash flow college for our children. Or oh, if we didn’t have a mortgage, look how much money we would have to do these other things. So I think some of the why is just giving us the flexibility to do what we want. You think about it, and I told this to Melody, I don’t know, a few weeks ago or months ago, we were driving somewhere and I was like, “I am so glad that we do not have any student loans anymore.” With all of the things that we’re doing, the pieces of the puzzle, like you start tacking on $500, $1,000 here or there doing other things, we would rather spend instead of $1,000 to Sallie Mae to pay for education, like we would rather spend $1,000 to have our kids be more bilingual and go to a Spanish immersion preschool, which they do, and a kindergarten. So those are some of the kind of the things that I can think of right off the top of my head when it comes to financial motivators for us.

Melody Hartzler: The other thing too is that we’re Christians and we’re also passionate about giving and serving, and so we feel called to give back. It’s not really our money to begin with. And so how can we be a better steward of that? And so paying it down quicker as far as the debt that we had and even with our mortgage now is important to us so that we can be better stewards of the finances that we’re given and the opportunities that we have. We do give at least 10% of our incomes to our church and to various ministries in our community, even through the things I’m doing on the side hustles, the blogs and things like that. I also make it a priority to tithe those and things like that as well. So that’s important to us. Travel is also important to us. So I love, I’ve been to 49 out of 50 states. And so I grew up — and a lot of times, my parents didn’t have any super fancy we did, timeshare travel and different things like that where we’d cook most of our meals throughout the week, but hey, we were at the beach. And we did a lot of trips where we’d drive to the Grand Canyon or drive to Yellowstone and stopped at a lot of places along the way. And so I sort of got the travel bug and then like Dustin said, even when we were paying off debt, we were still traveling. So we went to Hawaii. My parents had gifted us two timeshare weeks out there that we were able to line up sort of back-to-back. But you know, when we were out there, we definitely used a Red Lobster gift card in Honolulu. And we totally ate peanut butter sandwiches at the feet of waterfalls. And so it was OK. We saw the beautiful creation that we were there to see. And obviously if we went back now, it would be a little bit different. But we laughed at that, and again, before our healthy food awaken, but we still have great memories of that. And even when we went to Europe before we got pregnant with our daughter, we went with another couple, we split Airbnb’s, so we weren’t out there spending — when I look at the Travel & Leisure magazine, I just sort of read it like, oh, this is beautiful. I’m never going to stay at these places. It has cool places to go, but never am I going to go on this place that costs $3,000 for the whole week just for one person. But yeah, so we really do want our kids to be exposed to travel, and that’s also important. And we like to — even each year, we like to go someplace by ourselves to sort of just disconnect from the day-to-day and I guess you could say the rat race sometimes. And then we like to take our family on a trip as well. So we just got back, actually, from St. John. But even within that, we went on Marriott points, and we got a good deal on flights. So it wasn’t like we’re just still — we’re still trying to be budget-friendly because we still are in debt with our mortgage and trying to be good stewards of our money.

Tim Ulbrich: Yeah, and I think you guys have been great examples that you can enjoy something that both of you are very passionate about in terms of traveling and exposing your kids to that but also do it in a way that fits in your financial plan and is reasonable to do in terms of how much money you have. And what you all are going to remember, obviously, is the experience. Right? I mean, not necessarily using a Red Lobster card, although that’s a great story. I mean, the meals and the food and all that are good, but obviously the experience and the time you have with one another and with your family is going to be what you’re going to remember in the long run. So let’s talk business because I wanted to lay that foundation because as I mentioned on this show and I say often, being able to aggressively pursue business opportunities, whether it’s a side hustle, whether it’s investing in another business, whether it’s buying real estate, whatever it be, doing so when you have clarity on the things that we just talked about I think allows someone to be able to pursue that opportunity with confidence and to do it in a way that’s not going to add on stress. And I think that’s so important that we all know the stress that can come from our own financial situation. And when you think about things like debt and not having emergency savings and obviously you put kids into the picture and expenses go up and home prices, all those things, and if you want to then pursue business opportunities but you already have those stressors, obviously this could be one extra layer of stress rather than hopefully something that can produce additional income and also allow you to pursue something that you’re passionate about. So what I would like to do is talk through two businesses I know that you’ve worked on, and we’ll talk about the one a little bit more in detail that you’re getting ready to launch, the virtual symposium, the functional medicine CE, but I also want to talk about your other venture in farm-to-table. But before we jump into those two, help me understand — obviously, we’re going to talk about two pharmacy-specific oriented businesses, but Dustin, obviously you’re not a pharmacist. We’ve learned you’re an electrical engineer, you’ve got a web design background, so what is the role that each of you play when it comes to the business ventures that you’re working on?

Dustin Hartzler: Yeah, so the thing about working at Automatic, it’s an awesome company. It’s the — WordPress.com is the company behind that, and there’s a specific little thing in my contract with them that I have a — it’s a conflict of interest for me to build websites for other people and charge money for it. I can out of the goodness of my heart for as many people as I’d like, but the time doesn’t really — I don’t really have the time to build websites for the goodness of my heart for many people. And so I think one of the really interesting things with that conflict of interest, you know, I was always trying to think like, OK, what can I do as my side hustle? Or what can I do that I’m really passionate about? But everything I’m passionate about is WordPress and websites, developing code and stuff like that. And so that’s one of the things that really, it was kind of once I started at Automatic back in 2013, it was like for a few months and a few years, it was like, well, I don’t have to do anything else. I’ve got this good-paying job, let’s not worry about it. But then that itch continues to be there. And then Melody comes up with these ideas, it’s like hmm. So I can build something for free, and I get revenue from it, essentially. So like I was talking to some people at we have an all-company meetup. It’s once per year; it was back in September. And I was telling people like, oh yeah, I built this. I was using WooCommerce and my wife is making all this money with this website. And they’re like, well don’t you mean you? And I was like, no. My wife is making all this money. So I think that’s a really good blend of what we can do as a couple because I can’t create that kind of thing on my own, mainly just because of the conflict of interest. Like had I — if I leave Automatic, I can go and do whatever I want. But I really like my job, and so this just gives me the opportunity, it scratches the itch of I get to build things but then I’m also getting the benefit of building this by as much as Melody can fill.

Tim Ulbrich: Hey Melody, I know how big of an asset that is, you know. For us, we have the magic bullet of Tim Church. You have the magic bullet of Dustin Hartzler that can do all of that. But the web design piece, the opt-ins, the lead magnets, the format, that can often consume people when they’re trying to just get their idea off the ground. So what an incredible resource. So building on that, it sounds like based on what Dustin said, you’re often coming with the vision, the idea, and then are you batting that back-and-forth with Dustin? Is he helping on the execution? Help me understand how you’re fleshing out a business idea that you come up with.

Melody Hartzler: Yeah, so normally, honestly, it’s a lot of conversations in the car when we’re driving places because if the kids are watching something on the iPad and you can’t do anything else when you’re driving, that’s when we have a lot of our business discussions. But I think a lot of times, it’s like, hey, this is what the need is that I’m seeing. And then like we’re just sort of going back-and-forth about how we can meet that need but also turn it into that side hustle and generate revenue from it.

Tim Ulbrich: Yes.

Melody Hartzler: And so for example, with the functional medicine CE, I all the time was seeing people saying, “Hey, I want to learn more about functional medicine. Where can I go?” And there’s a lot of great organizations teaching about functional medicine. The challenge is not a lot of them are providing pharmacist CEs. So if people are looking to meet their Continuing Education requirements with this education, that wasn’t happening in a lot of those situations. And also, the conferences are sort of expensive. And so when you’re looking at Institute of Functional Medicine, which is a great organization, and I’m hopefully going to be — I want to go to their conference next year at some point. It’s a great organization, but there’s no pharmacist CE currently, and there’s also — it’s a couple thousand dollars, if not more because you’re talking plane travel and really nice hotel stay for five days. And that all adds up really quickly. And so you know, a lot of people are too like I’m not sure if I’m ready for that. What can I learn to before I get to the point where I want to spend a couple grand on this. And so a lot of the other functional medicine programs out there, there’s Functional Medicine University, which is a great site that’s a couple grand to do their certificate program, which is actually one of the lower cost ones for getting a whole certificate. But anyways, so if you’re talking like IFM, you’re talking maybe $20,000 by the time you’re done with all the things you need to do to get that certificate. So I thought, you know, there’s got to be a better way to do this. So with my background in education, I’ve developed a lot of Continuing Education as well over the years as a faculty member. And I thought, you know, we can teach people, and we don’t have to have them go anywhere. You know? We’ve got webinar, you can Zoom software, and the ability to work with — I work with CEI, which is a great CE company. And so the ladies there that I’ve worked with have been fabulous. And so I’d already been working with them a little bit, writing for them. And so I thought, you know what? I can do this but host it on my own site and then I can still pay them to certify the CE and get this sort of going. And so I started talking about this with Orthomolecular, there’s a pharmacist that works for Orthomolecular, which was like, hey, that’s a great idea. We could sponsor it. And I was like, awesome. And so you know, the more I talked about it, the more people started to say, OK, yeah, we can do this. And so I had a lot of support. The speakers that are speaking this time around are all awesome and have been sharing a lot about the conference, and so Lauren Castle (?) is the founder of FMPhA. It’s funny because I was on maternity leave with my son, I think, and I saw the flyer for OPA that year. And it was this Introduction to Functional Medicine. And I was like, who in the world is giving that talk? Here I am holding this baby. So I looked at it, and I looked her up and I called her and we started connecting, and so that’s been awhile now. It actually might have been when I was on maternity leave with Kinley now that I think about it, about five years ago. But then now she lives like 10 minutes down the street from me. So —

Tim Ulbrich: Small world.

Melody Hartzler: It is a small world. But it’s been fun to help encourage her and what she’s doing in the functional medicine world and also have her support for what I’m doing as well.

Tim Ulbrich: So we’ll link to this in the show notes as well, FunctionalMedicineCE.com. The first virtual symposium is starting on Nov. 9. So for those of you that are interested in the topic, obviously check it out. Also I would encourage for those of you have an educational idea that you’re batting around and wanting to get a feel for what a virtual symposium is, I would check that out as well. You guys did a great job with the website setup, Dustin. Nice work. And I think it looks really clean, you’ve got great speakers on there, and I think it’s a great model that others can look at and build off from as well. So let me — couple more questions. I want to dig into this business model a little bit further, but for those of our listeners that maybe aren’t as familiar with functional medicine, give us the down-low on what is functional medicine? And why is it a topic that you care so much about? And why as a pharmacist do you think you have a lot to offer in that space?

Melody Hartzler: Sure, that could be a whole hour conversation, so I’ll try to not do that. But so essentially, functional medicine is really looking at the root cause of disease. And so we do that really well when we talk about infectious disease, you know, we have a treatment, it gets rid of it, we’re gone. But as far as the chronic disease model in this country, when we think about chronic disease, we really don’t have a lot of cures for most of our chronic diseases. It’s just something we manage with symptom management, and I do that every day in my practice too. I manage diabetes with medications, but I also try to incorporate some of these functional medicine principles as well. But essentially, it’s acknowledging that patients are individuals too I think is a big component of it. So just because something works in the population health, it doesn’t mean it’s necessarily going to work for this person sitting in front of you. And so trusting that what the patient is saying about their symptoms and using information that’s evidence-based is part of it, so it’s not like we’re just throwing these supplements that don’t have any science. It’s so much biochemistry, I wish I would have really paid a lot more attention in biochemistry. I give these reports, I do this one report from Genova Diagnostics called The NutriEval, and you literally get the kreb cycle printed out with all the different components of it of the patient’s actual body, and then it tells you what nutrients you need to make that cycle more efficient. And I was like, man I should have — and it seems like such a long time ago too. So it’s good — that’s why education, Continuing Education, is so important to try to keep brushing up on those skills. But I think the best example that I like to give is functional medicine approaches IBS. Irritable Bowel Syndrome is not just constipation or diarrhea. Like there’s something causing it. But the drugs that we have both of those conditions, whether it’s IBSD or IBSC, are just symptom-managing drugs.

Tim Ulbrich: Right.

Melody Hartzler: They’re not actually correcting any of the issue. And so typically, IBSD is often caused by a dysbiosis or an imbalance in the microbiome, which is why we do now have a prescription agent that is an antibiotic. But there’s also challenges with that because it’s only 60-70% effective after one course. And so there’s other things that we have to think about. And then as far as constipation, we don’t really have anything that addresses a lot of the root cause. And so when we are looking at someone with IBS, we’re thinking about is there a potential pathogen that’s causing this? Is it a parasite? Is it a microbiome imbalance? Or is it inflammation? So even some of our IBS patients, their fecal count protectants (?) is really high, so there’s a lot of inflammation going on there even though you wouldn’t classify it necessarily diagnostically as IBD. And so looking at some of those things, is food intolerance related? And so we organize sort of our thoughts based on the patient. There’s this whole timeline piece of functional medicine. So they look back questions that we’re asking patients on our intake survey: Were they breast fed? Were they born prematurely? What kind of stressors did they have early in life? Was it parents went through a divorce and then all of a sudden these abdominal symptoms started to appear? And so there’s different points in your life that this cycle piece and the stressors also sort of turn over the epigenetics. So epigenetics is, you know, you have this genetic code at the beginning, but then the influences in your life turn on and turn off different things. And so everyone is unique in that aspect because we’ve all had different influences in our lives, whether that’s chemical or external stressors from family circumstances and things like that. So my stressor that led us to functional medicine was actually the birth of our daughter. So it was quite the experience, and we sort of planned for this natural birthing experience, and our doula was in jail, so that’s a podcast for another day.

Tim Ulbrich: Oh gees.

Melody Hartzler: So from that, it turned into a pretty stressful induction, long labor and the first five weeks of her life, she was super colicky and tongue-tied, and it took us awhile to realize that. And so all of that stress I think just sort of set my bad diet, probably poor microbiome balance, sort of over the top. And then, you know, about a year later, I started to have this abdominal pain that wasn’t going away. And everybody was like, oh, you’re fine. Yeah, basic interventions type things. Even then GI specialist was like, no, there’s no reason to scope you, you’re completely fine. I was like, well I literally have this pain every single day in the same exact spot. And so I finally found some functional medicine practitioners and turned out it was probably dysbiosis, probably CBO — I never actually did the breath test, which I don’t always do for our patients either — but did some of the comprehensive stool testing and took some antimicrobials. I even tried the laxin (?). It was a long journey, so it was about at that year point from her life for about a year and a half that we were still sort of going through the journey. I even went to the Cleveland Clinic Functional Medicine Institute. And I felt a lot better at that point, but I had finally made it on the waitlist, and so I was like, you know what? I’m going to go and learn from them. So let’s see what they have to tell me because at this point, I knew functional medicine was something that I wanted to incorporate, but I wasn’t sure exactly how to do that because I was working at the time in a federally qualified healthcare center, which was a little bit challenging because, you know, the cost of a lot of these interventions right now is really only available to people in the middle class and above. So I think some of the things other people are doing in this community to try to make these resources more available to the masses is awesome. So but at this point, it was challenging for us to do a lot of that testing. But there’s still a lot of basic things we can do, not only in community pharmacy but also in settings like that, you know, as far as testing vitamins and using probiotics and doing nutrient supplementations to help to heal the gut. And so even in that practice, looking back, there’s probably a lot more that I could be doing at the time, but I didn’t have enough experience to know what that was. And so — but anyways, so at about that time, it was right before, actually, we got pregnant with our son that we decided that I needed to go part-time with my faculty position. And that was coming from a lot of the stress with not only not knowing what was going on in my body and trying to — I was like, if I’m going to have another child, like I really need some extra time during the week. And I also in my head also had a lot of these ideas sort of out there, that I would like to do the blogs and stuff like that. And so made that decision and then started my part-time position with Cedarville and also at that time then, transferred offices to work in a different family medicine office, which that was really I think one of the pivotal points for my career because the family medicine physician that I work for is wonderful. And he is very open to a lot of these things, and so when myself and actually my best friend is one of my colleagues there who’s a nurse practitioner, and we sort of went to him together because he needed a new nurse practitioner. But we had also heard that he needed someone to manage his diabetes. And so I was like, well she may not want to manage diabetes, but I can do that. And she didn’t want to do something else, so we sat with together and sort of said, this is what we can do, that we both have this interest in functional medicine. And then fast forward to today, we have a functional medicine service that patients see her, sometimes they see me as part of that. And so we’re starting to be known in the Dayton area for our functional medicine service, so it’s pretty exciting. And so I really feel like had we not made that decision to go part-time, like that really wouldn’t have been where we would be landing right now. And so yeah. So it’s exciting and I really think the passion for sharing about functional medicine is because of that experience that I had as a patient, and I think that’s a lot of pharmacists that are involved in functional medicine had some kind of personal experience, whether it was them or it was their spouse going through something or their child. And even with our daughter, I’ve learned a lot about pediatric approaches to functional medicine through some of her journeys with allergies and asthma and things like that. And so a lot of my initial blog post that I have on farm-to-table are based on a lot of those topics that I was sort of walking through and researching anyways for our own personal health.

Tim Ulbrich: And what I love about this is one, just great example of — I think great businesses are made out of identifying a problem that needs to be solved that people actually care about, and you’ve checked that. Obviously, there’s lots of concerns people have out there about their own personal health and diet and exercise or not getting successful treatment plans with traditional medicine. It also has a combination of certainly your expertise, so an area of practice and an area that you’ve experienced firsthand, an area that brings your educational background as you’re looking at building CE and online courses and things like that. And then obviously, it has a personal component as well. So I think as people are out there hearing this, I think it’s just a great example of as you’re thinking about a business, you’re thinking about a side hustle, is there something out there — you mentioned you and Dustin talking in the car where you often say, OK, well, there’s a need here or there’s a problem that’s here, something that needs to be solved. That’s where it starts, and then it’s trying to figure out what is the solution? And is it a solution that you can bring value to based on your previous experience and personally? Or based on your experiences and expertise in what you do every day. So before I ask you a question about the business model of this, Dustin, as I look at the website, which again, is incredible, as I look at the website if I’m somebody listening to this podcast and thinking, oh, I have this idea and I need to build this site whether it’s a site for a CE program or whether it’s just a site for what they’re trying to do, I look at this and say No. 1, I could never do this. I don’t have time or this is way too expensive. So give us a ballpark. Like what would be involved here if somebody were building a site in terms of time and roughly expense to get something like this off the ground?

Dustin Hartzler: Sure. And this was one thing that — I mean, you mentioned it earlier. Like Melody’s able to do these things because she doesn’t have a lot of upfront tech costs because like that’s my thing. But honestly, I bought a — I didn’t do all the design, I didn’t have time for that either. But I bought a $20 theme online and I did some customizations and I did some things with it, and you need a website and you can get hosting for $5-10 per month or $50 a year or so. You can even go to WordPress.com. We’ll do a little promo there. But they have the ability for $100 a year or $300 per year, you can get live chat support and do all kinds of things online. And you can have somebody physically help you if you run into things like that. So I would say all in all, with my development time if you were to pay somebody to do it, I probably have 20 hours in the site and just because it was a lot of tinkering, and there’s probably 20 more hours of things that I want to do because I know — I want to be able to do this multiple times. Like that’s kind of our goal. We want to have this virtual symposium and then another one and another one. And a lot of the stuff that’s in there is kind of hard-coated. It’s like built right into the theme. And so if Melody needs to make a change, I have to do it. And I don’t want that, I want her to be able to do all the changes because I want to make it easier for me in the future. And so I don’t know, I would say you — if you would invest like $500, you could get a pretty decent website up and running to test a business idea or test a model out or something like that. You could go a lot less than that if you are a little bit techy and you’d rather do a little sweat equity if that’s something interesting to you. You know, a minimum if you bought a theme and you have some hosting, you could get by with about $100 investment. And so I think anywhere between the $100-500 could get you a pretty decent website up and running to start testing that idea out.

Tim Ulbrich: Yeah, and I think that’s great. That’s what I want our audience to hear is that we’re not in an age where you have to be paying $10,000 or $20,000 to get your site off the ground, right? When you look at themes and you look at some of the things that are out there in terms of plug-and-play and what you can do with e-commerce, whether it’s them digging a little bit deep to read and learn on their own or ultimately hiring that out, it shouldn’t be an expense that is unbearable, even if they don’t have a Dustin Hartzler on their team. It should still be an opportunity they could pursue. So Melody, let me ask you a question or two in terms of the business model of this. And I want our audience to hear kind of your thought and vision of where this is starting and where this could go in the future. So I’m on the website right now, FunctionalMedicineCE.com. I see you have a symposium on Nov. 9, and I see you have a silver package, which essentially is the live option that people can tune in for seven hours of CE, it’s live only, $129 all the way up to a platinum pass, which gives them both the live as well as the video recording and then a post-conference networking. So what, as you were putting this together, what is the business model? What’s the goal in terms of running this? And I know there’s other virtual symposiums that have been out there that offer a free option and then they offer a buy-up option and then they’re promoting additional products and services. So as you started this way, why did you start this way? And where do you see this going in the future?

Melody Hartzler: So we started this way because looking at what other people were paying for functional medicine education, this is still much less than that. Even the weekend, I went on a Saturday-only symposium, that was Pharmacy CE in Indianapolis in September, which was great. But it was like the conference fee was $499 for the day. And then there was a discount code that got it to $299, but then we stayed at the Marriott downtown and the gas to drive there and a lot of people flew there, and so it added up to probably $1,000 pretty quickly for a lot of people. So we knew that — and there was I think 115 pharmacists that were there that day, and so I knew that if people are willing to fly across the country for this one day event, I feel like there’s enough people out there that would pay a fraction of that to be able to learn this information from people that are experts in the field. And so that was sort of the thought process by not having a free option upfront, and also I think the cost of the CE was part of that too and having to pay for accrediting the CE, AACP-accredited. And so we didn’t want to lose money on our first adventure in this, and so that’s part of the reason. We do offer discount codes, and we actually did make a YFP code as well. So if anyone’s listening to this and wants to sign up, YFP will get you 10% off. And so our future plan is to move forward with more of these virtual symposiums. And so our goal is to have three or four a year but then also eventually have a membership to the site where you would get all of those included in your membership throughout the year. So we’re looking at doing our second one probably late February, maybe early March, focusing on pain and inflammation. And we’re also going to try to have a session on CBD since that’s something that’s very popular right now and a lot of pharmacists have questions about because their patients are asking questions. And I think that’s the other thing about functional medicine that’s so important is whether or not you’re interested for yourself, a lot of your patients are interested and they’re asking you questions about way more herbal supplements and different products than they probably ever have. And so really being able to have the tools to answer some of those questions I think for a lot of people is important. I just kept hearing over and over, like hey, where do I get good information about this? And so I really just felt like we needed to try to provide that.

Tim Ulbrich: So when you think of threats to this, I think of the concept of how do you bulletproof your business, right? So you mentioned membership, which I’m guessing is maybe one answer to this, but what thoughts do you have in terms of the next person who comes on and says, “Well, I’m going to offer a free symposium, and I’m going to offer it for $79.” Like what’s the differential advantage that you see here? Because I think that’s an important aspect people need to think about when they’re working on a business idea is of course there will be competition, but what differential advantage do you have to this business model that you think will allow you to be successful in the long run?

Melody Hartzler: Well, that’s a good question. I think overall, the having a team of people of that have expertise in this subject, I mean, there’s a lot of people growing and learning more about functional medicine, so I anticipate that there’s going to be other opportunities. And I think the membership piece, we might morph into having a certificate program as well because I know a lot of pharmacists are looking for a lower cost certificate training program compared to some of the other options that are out there. I think developing a community is also important in trying to keep people engaged in your business versus looking at other places, and so I’m hoping that after this conference, we’re going to develop even just a Facebook group to start out with for people that all attended and just sort of stay connected and offering discounts for the next conferences for those that attended. And so I think trying to get the community built around it, I mean, you guys are a great example of that with the community that you’ve built around YFP. And so I think that’s really important to being able to continue to drive what you’re trying to do.

Tim Ulbrich: Yeah, I really like that aspect. And I think the book that comes to mind if people want to learn more on that, one of the books that will never leave me that I always think back to is called “Tribes” by Seth Godin. He talks about exactly that concept of how do you build a community? Another article out there is around the concept of superfans and 1,000 superfans. But building a community that are passionate about this topic, which I’m guessing people are that are engaged here, either because of personal experience or because of the outcomes they see with patients that they’ve worked with and how do you create that platform and community that they can engage with each other all the time, throughout the entire year as well as these events that may happen throughout the year. So let’s jump into some fun questions to wrap up here. And we didn’t get to talk to as much but I want to reference our listeners to you also have another site you’ve worked on, which is Farm to Table, FarmtoTable.life, where they can learn more about the blog and the work that you’re doing over there. But I want to talk about some more of the fun, lighthearted questions on the business. And Dustin, I want to start with you because obviously, you’ve gone through this process of owning your own business. You started your own media company, and I’m sure there’s many people that are listening to this podcast that have some type of business aspiration, whether it’s big, small, medium, anywhere in between, they’ve identified maybe a problem that they see as unsolved, the process that could be done better or differently, or maybe there’s others that are just out there feeling stuck and they don’t even have an idea formulated but know they want to do something different. So from your experience of both starting a business and now working with Melody on this, what advice would you have to them in terms of next step that they may be able to take?

Dustin Hartzler: Yeah, I think it all really depends in your life is like, it depends on how much time you have. Like if you’re young, you’re right out of school, like you have so much time available to you that it’s kind of silly that you say you don’t have enough time. But I think really, the big thing is just spending some time thinking about it and just starting. Ask some people. Like when Melody figured out this thing was — she’s seen all these people commenting on Facebook and relationships and connections she has, like she saw the need there. If you find a need — you know, I found a need. I wanted it to help people have less horrible websites online, and that was a passion of mine to do that. But then also, I wanted to learn more about tech. And so the two things really came together for me, which was super nice. And so the advice is just start. I mean, it’s so hard to just start anything. But if you have a passion, you have an idea, like come up with a little thing that you can do. And I think the other thing that’s a big that was always a big thing for me was like, let’s just work on it for five minutes. Like five minutes goes by really, really fast when you’re working on something. And then all of a sudden it’s 10 minutes, and then it’s an hour. And then it’s like, wow, I spent a lot of time on this today, and I’ve made progress. I’m moving forward in the right direction.

Tim Ulbrich: And Melody, let me follow up with a different question. But you know, often people are interested in side hustles, of course, in part because they’re passionate about the idea and helping others but also the idea that there’s additional income that can be used for other financial goals and things that they’re working on. So for the two of you and your family, what are you hoping to do with the additional income that you’re earning through the business side hustle?

Melody Hartzler: Well, should I say the truth? Dustin wants a new pair of running shoes.

Tim Ulbrich: Yes.

Melody Hartzler: We definitely want to invest back into the business as part of that. So anything from this first conference, honestly, we probably won’t do much with personally but invest into this concept and continue to grow it. We may set aside some for our emergency fund or car funds because our one car has got 245,000 miles on it and something is loud in the back that needs fixing bad. So there’s that. But you know, that’s part of the financial goals. And we’ve always driven used cars and we would still buy a used car with the next step, but that’s part of how we are able to afford travel and things like that. But I think also, we want to give. We’re going to be giving back to the people that are sharing about this conference too. And so all of our speakers that are promoting the conference have a specific code and even your code and whoever’s, we’re going to be giving a percentage back to those people because again, we want to create that community and everybody is a part of that for promoting this. And it’s not just our work that’s helping to spread the word.

Tim Ulbrich: And I want our community to hear from the two of you. I sense — and Dustin, you alluded to certain podcasts that you turned your car drives and your commute essentially into an additional education or two that you received along the way — I think it’s so important for our audience to hear, what are you reading? What have you read? What are you pulling inspiration from? So Dustin, let me start with you. Is there a book or a podcast or a resource that you would reference people to that was really helpful in your own journey?

Dustin Hartzler: I have so many of these. Like I could go on for hours. I’m looking at my podcast archive here, and I’ve got hundreds that I’m subscribed to and just listen to ones that are encouraging to me. The ones that — I’m still a Dave Ramsey subscriber. Like he just gives me inspiration like hey, look what you can do when you have your financial life in order. It’s all about you don’t make money to — how does he say it? He says something along the lines of like, you really want to — look how generous you can be when you have more money and you have your life in order. So that’s one of the things that I like. So the Dave Ramsey Show is one. I listen to a bunch of podcasts that are tech-related to give me inspiration of how I can become a better developer and how I can — some of the tech tools that I can do.

Tim Ulbrich: Sure.

Dustin Hartzler: And then I’m also reading a book that was a recommendation from a podcast. But it’s called “PsychoCybernetics,” and it’s a book written by a guy, his name is Maxwell Maltz. And he’s an MD, and it was written a long time ago, before digital technology. And so it’s kind of a cool thing, it’s talking about your brain and how you can — some experiments of like thinking through the visual success. Like they did experiments with people shooting free throws. The first group — you shoot 20 free throws every day for a week and see the results at the end of the week. And you have one group that shoots 20 in the first day, and then shoots 20 on the last day and see how they have improved. And then the third group was like, they shot 20 on the first day and then they did nothing but imagine shooting 20 free throws every day. And then their percentage improved by 50-some percent, even though they never actually made a shot. So it’s kind of an interesting book. I’m still at the very beginning of it, but it gives me some inspiration of like, hey, here’s some things that it’s not all about your life and your circumstances, like how you think about things. And I think that’s really interesting.

Tim Ulbrich: Yeah, mindset and visualization. Those are great takeaways from that resource. Melody, how about you?
Melody Hartzler: So most of the podcasts that I listen to are functional medicine content podcasts. And so I really love Kara Fitzgerald’s New Frontiers in Functional Medicine. It is a good one that — she’s an MD, but she interviews people all over the country that are researchers, that are MDs, that are PhDs, that are clinicians, like doing the work of functional medicine, and goes through great protocols and just getting people’s opinions about different things and how they would treat things. Some of the people she interviews are even, you know, the lady I was listening to yesterday on my drive to Columbus for the OPA meeting was a nurse practitioner in New York that was treating a lot of weird patients and just gleaning insights from that. So I like those. I also love from a faith standpoint, “Dayton Women in the Word.” It is a local organization here. The podcast obviously airs wherever there is Internet, but it’s been a good, you know, like hey, I need to listen to something that’s about — get me away from all the business ideas because I’d drive to work and just think about all this stuff and what I need to do. But it helps keep me grounded in what my true purpose is. So obviously our church and things like that have podcasts. But sometimes I even forget to turn on the podcast when I get in the car because I — sometimes, I’ll use that time to pray and sort of reset my thought processes for the day and just pray over the people that I’m going to interact with.

Tim Ulbrich: Which is always important before you get home, especially with young children and kind of entering that space. So thank you so much, both of you, for taking the time to share your journey. And I think it’s going to be an inspiration to many. And again, I would reference our listeners to FunctionalMedicineCE.com, virtual symposium beginning Nov. 9, as well as the work they’ve done over at FarmtoTable.life. So appreciate the time that you’ve taken. And as always, I would ask our listeners if you like what you heard on this week’s episode of the Your Financial Pharmacist podcast, please do us a favor and leave a rating and review in iTunes, Apple podcasts, or wherever you listen to your shows each and every week. And as a last reminder, make sure to head on over to YourFinancialPharmacist.com/giveaway. For those that are pursuing residency training and are going through that application process, we have the ultimate residency prep giveaway going on for the next couple weeks where we’re giving away over $349 value in resources to five different winners: information on residency interviews, how to effectively write letters of intent, we have a boot camp course, and a great resource from TLDR Pharmacy as well. So again, YourFinancialPharmacist.com/giveaway. And until next week, we appreciate you joining us.

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YFP 122: What Will Be the Future of Pharmacy Practice?

Posted on by yfpadmin


What Will Be the Future of Pharmacy Practice?

Dr. Todd Sorensen, President of the American Association of Colleges of Pharmacy (AACP) and Associate Dean for Strategic Initiatives & Innovation at the University of Minnesota joins Tim Ulbrich on this episode. They talk through the workforce challenges facing the profession of pharmacy, rising indebtedness, the change.org petition, and Todd’s vision for the future of pharmacy practice including dramatically expanding the number of pharmacists working alongside primary care providers.

About Today’s Guest

Dr. Sorensen is Professor and Associate Dean for Strategic Initiatives and Innovation at the College of Pharmacy, University of Minnesota. He also serves as the Executive Director of the Alliance for Integrated Medication Management, a non-profit organization that engages health care institutions in practice transformation activities that support improved medication use. He is currently serving as President of the American Association of Colleges of Pharmacy.

Dr. Sorensen’s work concentrates on identifying strategies that facilitate clinical practice development and developing change management and leadership skills in student pharmacists, pharmacy residents and practitioners. His research and service activities have focused on working with health care organizations to implement strategies that improve health outcomes associated with chronic illness, specifically identifying leadership strategies that allow organizations to integrate and sustain medication management services delivered by pharmacists within interprofessional teams. This work has been greatly influenced by ten years of experience participating in and leading national quality improvement collaboratives for health systems seeking to optimize medication use in outpatient settings.

Summary

Dr. Todd Sorensen joins Tim Ulbrich for a conversation covering many topics such as workforce challenges facing the profession of pharmacy, rising indebtedness, the change.org petition, and Todd’s vision for the future of the practice of pharmacy including dramatically expanding the number of pharmacists working alongside primary care providers.

Todd is the President-elect of AACP and also Associate Dean for Strategic Initiatives & Innovation at the University of Minnesota. Todd explains that he believes there are two broad reasons why the pharmacy job market is changing and why the Bureau of Labor Statistics projects 0% job growth in the profession over the next ten years. One of those reasons is that there is a lack of perceived value in the medication distribution process. The other is that the professions has seen this coming for 20+ years according to a workforce projection report from 1999. In that report were new roles for pharmacists, however those roles haven’t grown as projected.

Todd discusses his Presidential address at the 2019 AACP Annual Meeting which was titled Leading in Dickensian Times.” He began the speech with the notable quote, “it was the worst of times, it was the best of times” referencing different viewpoints of pharmacists today. There is a group that sees the current state of pharmacy as the worst of times and are legitimate in feeling that way as they are experiencing job loss, wage cuts, and a saturated job market. However, others see it as the best of times because there is a lot of opportunity available.

Even though Todd falls in the second category, he says it’s imperative to acknowledge the pressures and difficulties pharmacists are facing today. Todd shares AACP’s plan to address those issues. He also sees a large opportunity for collaboration between physicians and pharmacists and envisions every physician office having a pharmacist working in it. To attain this goal, first we have to have the mindset that it is possible and shift to a model of value based healthcare. He points out that no one is as highly trained and skilled as pharmacists are in managing complex medication problems.

Lastly, Todd addresses the #ChangePharmacy petition on change.org that requests organizations such as AACP halt accepting new accreditation applications until standards are installed, among a number of other requests. Todd explains that the reality is that they are unable to do this. As we’re in a free market society, restricting or halting such openings could be viewed as restriction of free trade. Instead, Todd says that we should shift our focus to create new opportunities for pharmacists that were predicted 20 years ago. This alone, according to Todd, should shift dynamics and balance the supply and demand of pharmacists.

Mentioned on the Show

Episode Transcript

Tim Ulbrich: Hey, what’s up, everybody? Welcome to this week’s episode of the Your Financial Pharmacist podcast. I have joining me today Dr. Todd Sorensen, president of the American Association of Colleges of Pharmacy, also known as AACP, and Associate Dean for Strategic Initiatives and Innovation at the University of Minnesota. In addition to hearing about Todd’s background and career story, we’re going to focus our time together on the current workforce challenges facing our profession, including a flat job market over the next 10 years as projected by the Bureau of Labor Statistics, the student loan debt that continues to be on the rise, and his vision for the future of the profession of pharmacy. Dr. Sorensen, welcome to the show.

Todd Sorensen: Great, thanks. Glad to be here.

Tim Ulbrich: Well first of all, thank you for taking time out of your busy schedule. I know you have essentially two full-time jobs this year, both as president of AACP and associate dean at the University of Minnesota. And before we dive into the discussion around the workforce challenges that we’re facing as a profession and your vision for the future of pharmacy practice, if you could give our listeners just a brief background on your career journey and how you got to this point in time leading as the president of AACP.

Todd Sorensen: Sure. So I was a graduate of the University of Minnesota as a pharmacist in 1994. I entered practice, actually moved to Canada and was on faculty at Dalhousie University and practiced at the Queen Elizabeth II Health Sciences Center, where I was a critical care pharmacy specialist for three years while my wife and I were in Canada. It was a great experience, learned a lot there, got to experience a lot of Canadian pharmacy, which was a great experience to then bring back home, understanding similarities and differences between the two countries. Came back to Minnesota, worked for a period of time in managed care, really brief stint there, about 15 months. And then joined the faculty here at the University of Minnesota in 1998. My time here I have had kind of two distinct teaching experiences. I taught skills in our curriculum for a long period of time, physical assessment skills, was one of the instructors in our skills lab for almost 10 years. And then shifted my teaching activities almost entirely over to teaching leadership development. And my research work has really focused over the entire span of time at the University of Minnesota of how we advance the role of pharmacists in clinical areas, primarily in ambulatory care, both in community pharmacy as well as in primary care clinic settings. I would say the one thing that has really carried through my entire career starting as a student is I’ve really always been fascinated with about how leaders facilitate change in organizations and in their environments. I really got that bug in me when I was a student and saw some of the things that were happening back in the early ‘90s. And that’s what ultimately led me to focus on teaching leadership in our curriculum. I have done that in one way or another now almost, well, over 20 years I’ve been teaching leadership in one way or another. And that’s gotten me very involved in national organizations as well, which in the case of AACP, I’ve been very involved in a lot of different ways, worked my way through the different ranks and ultimately had the opportunity to run for president and get to serve in that role.

Tim Ulbrich: Yeah, and I’ve had the pleasure of attending several of your leadership sessions you presented on a national level. I’ve attended with some of my mentees, we’ve done some workshops and other things, and so I appreciate the work that you’ve done on that and the influence you’ve had on hundreds, probably thousands, of pharmacy leaders out there, students, residents, and other practitioners. And we’re going to come back, I appreciate your comment about your interest in change management and that aspect of leadership as well as your background and interest in primary care as I think that’s going to come together nicely as we talk about your vision for the future. So I don’t want to assume that everybody listening knows and understands AACP. So can you give us just a high-level overview of what is AACP?

Todd Sorensen: Sure. AACP is a national organization that represents faculty and schools of pharmacy. So we have two groups of members: We have institutional members, so all of the 144 schools of pharmacy across the country are members as institutions of AACP, and then the faculty at those schools, anyone who holds faculty appointment can choose to join AACP. We have approximately 5,000 members, faculty across the country, and again, those 144 schools.

Tim Ulbrich: So as our listeners know, and many pharmacists are unfortunately experiencing firsthand, the profession is pharmacy is changing. Many brick-and-mortar pharmacies are closing, we’ve seen a lot of news in the last year of full-time hours that are being reduced, in some places, jobs that are being cut, and I think for many, the job market is becoming more saturated than they probably have seen throughout their working career with the Bureau of Labor Statistics recently projecting a 0% job growth for pharmacists in the next 10 years between 2018-2028. Obviously, a topic that’s near and dear to my heart. To top it all off, we now see pharmacy graduates that are carrying student loan debt in excess of $170,000 on average. So from your perspective, Todd, both as the president of AACP as well as somebody who’s just had a lot of experience in the profession of pharmacy, why are we seeing such dramatic changes over the last few years? And what’s happened across I guess the last five to 10 to 15 years that’s led to these changes?

Todd Sorensen: Well, it’s a question that’s probably on the mind of just about everybody in pharmacy right now. It’s an important question, and from AACP’s standpoint and from our school’s standpoint, of course, this is a very important topic to us in terms of our alumni, all the practice sites that we work with in providing education and really just being part of the overall profession of pharmacy. And what happens out in practice, of course, does have influence and affects what happens in education as well and vice versa. What has happened? What has led to this? Well, it really is a complicated, multifaceted issue. And I don’t know that we can pinpoint any one thing. I do think there’s two broad issues that come into play. First, there is a lack of perceived value in the medication distribution process by people outside of pharmacy. Most payers and consumers, they do see medications and the process of acquiring them really as a transactional process.

Tim Ulbrich: Yes.

Todd Sorensen: And therefore, there’s little belief that any payment beyond cost of a medication should be required. And until we are able to demonstrate the value beyond that and a perception among payers and consumers, that is the reality that we live in. And that is been getting to be a tighter and tighter and tighter margin as that perception continues to drive those traditional payment systems over the last several years. And second, I’d say that we’ve really, we’ve seen this coming for over 20 years. If you go back to 1999, there was a workforce projection report authored by David Knapp (?), and eerily, some of his projections have born out to be quite accurate, particularly around some of the reductions in the number of pharmacists in the drug distribution process. What didn’t happen that were part of his projections was there was projections around new roles for pharmacists and how do we create those opportunities? And we have not seen the growth in some of the areas that were projected at that time. So I would say that there’s a number of things that happened over the last 20 years that maybe were a bit of a distraction from causing the profession to really look at what we need to do to create those new opportunities and bring value into the healthcare system in a new way. And now, we’re at that point in time where we really have to focus on that because we can’t ignore it any longer. There’s a lot of other factors that come into play that we probably don’t have time to get into. I would like to highlight for the listeners, if they are interested in really kind of getting into this in a deeper way, Dr. Lucinda Maine, the executive director/CEO of AACP, authored and published this summer a commentary titled, “It Really Isn’t That Simple” in the American Journal of Pharmaceutical Education. That is an open access journal, so anybody can access it. And she really gets into a lot more of the statistics and the numbers and the trends and the factors along the way from 1999 to 2019. And I think it’s really a good read that explains how complicated this issue really is.

Tim Ulbrich: Yeah, you beat me to it, Todd. I just had that pulled up; I was going to reference that piece to our listeners. We’ll link to that in our show notes as well. But I think the multifactorial, the reasons and discussion is really important, and I would encourage our listeners, I think this is a topic that often carries a lot of emotional aspects to it. It can feel charged based on how this is impacting your personal situation, whether that be somebody who’s impacted by job loss or just feeling the pressure of student loan debt or other things and really looking at all of the different variables and looking all the way back to some of the projections that were made in terms of the shortage and why we saw some of the expansion and, as you mentioned, some of the lack of evolution of where we thought the roles of the pharmacist was going to go beyond the dispensing aspects. And we’re going to come back to that as we talk about your vision in the future. So in your title of the piece that you facilitated in your presidential address at the American Association of Colleges of Pharmacy annual meeting this past summer in July, the title of that, which is published in AGAPE, which we will link to in the show notes, is “Leading In Dickensian Times.” And so what do you mean by that? What did you mean by this as you were choosing the topic and using that as the keynote for your presidential address?

Todd Sorensen: Yes, the reference is, of course, to Charles Dickens and “The Tale of Two Cities,” and I started out that speech with the familiar phrase that many people are familiar with: “It was the worst of times, it was the best of times. And I really feel like that is the mindset that we many have in pharmacy today. There is a group who sees this as the worst of times and probably in their personal experiences, that is a very legitimate perception to have. There is also a group who sees this as potentially the best of times, that the opportunity for pharmacists is as great as it’s ever been. I fall into that category. And so I started out the speech kind of using that traditional — paraphrasing the first paragraph of “A Tale of Two Cities” to kind of highlight this dynamic between things are as bad as they can be versus there are opportunities, and we can choose to look at where our opportunities are in a new way. I mean, I can honestly say that in the 25+ years I have been a pharmacist, the recognition of the good that can come from medication use and the harm and the cost associated with medication use is as great as it’s ever been. They may not — the people who are recognizing that now at an acute level outside of pharmacy may or may not see pharmacists as part of the solution. But that awareness is there like it’s never been before. And they’re looking for solutions, and so that creates an opportunity for pharmacy to be part of that solution in a way that I don’t think in the past 20 years have really existed in the same way that that acute understanding of where medication use is in our society and the good and bad that it can produce is a great opportunity for us to shift what we bring to the healthcare system.

Tim Ulbrich: Yeah, and I think what you just said there is so profound that the awareness piece is there. It’s finally there to the level that I think we had hoped it would be. And now the question is, are pharmacists going to be the center of that solution? And how do we as a profession begin to think about our role in that and making sure we’re advocating for our role. And that may mean shifting the role that we know or have been comfortable in for some time. So I think as there is a need for a problem to be solved, now the question is, are we willing to really pivot to make sure we’re a part of that solution? So Todd, in your address, you acknowledged that there’s some tough challenges pharmacists are facing in the current reality of our profession. So you said, “Pipeline of candidates seeking to enroll in professional programs continues to be far below optimal numbers. The employment prospects for our newest graduates are not consistent with the story we want to tell prospective students. Our alumni frequently express frustration about the nature of the work they’re expected to perform and the difficult environment in which the deliver it. The traditional model of compensation through distribution of medications is as difficult as it ever has been. So my question is, what is your vision? What is AACP’s strategic plan to remedy the challenges current and future pharmacists are facing here?

Todd Sorensen: To address that, I’d first say in presenting that information and saying that I fall into the category of people that see this could be the best of times instead of the worst of times, it is important to acknowledge that there are pressures. And so the last thing I wanted to do through this speech and through conversations like this is to send the message that I don’t recognize these issues but that they are real. They are. Now, in terms of AACP’s strategic plan, we really have three priorities related to this that we’re very focused on. First is increasing the pipeline of candidates. So regardless of where we are with number of schools, and we have been seeing a decline in the number of applicants interested in pharmacy.

Tim Ulbrich: That’s right.

Todd Sorensen: And that’s an unfortunate situation for the profession as a whole. There’s a lot of factors, again, this is also multifactorial, but for a number of reasons, individuals who are thinking about what their career choice is going to be might be looking at other options, not even in healthcare. We’re competing with lots of things in technology and other areas that are where high school seniors and into the undergraduate years of college are really wanting to focus their attention. So we have to demonstrate that pharmacy is a vibrant profession and a great career choice. And it is. So that has included a number of things that AACP has done with schools to really get the word out to candidates about pharmacy as a career.

Tim Ulbrich: Right.

Todd Sorensen: The second priority is then the consumer understanding of the role of pharmacists. And there’s a lot of misperceptions about the role of a pharmacist. And that affects, then, the pipeline as well because parents are often guiding their children in their career choices. And so a year ago this month, actually, we launched the Pharmacists for Healthier Lives campaign, which is largely a social media-based campaign targeting consumers to understand the diversity of the roles that pharmacists play in healthcare, the impact that pharmacists play in healthcare and really trying to help consumers understand how to work with a pharmacist and to proactively understand the role that they have that really, their healthcare team is not complete if they don’t have a pharmacist actively as a part of it. And then the third strategic priority for AACP is really focusing on innovation and education and in practice. That’s really where our work is focusing on this year is what is going to be the role, what should be the role of schools of pharmacy to help transform the way that we prepare practitioners for practice in the future and help stimulate the innovative practices that are going to bring value into healthcare in the future.

Tim Ulbrich: Yeah, and I’m hopeful going forward what obviously the focus of our podcast is personal finance, and so of course I have a bias here, but I’m hoping that we can see beyond just the somewhat of a grassroots movement, which is great, where we’re seeing many colleges more vested in this topic than ever before. I’m hopeful we can see some more movement on the national level, whether that be with AACP, other national pharmacy organizations. I think there’s some good models out there in medicine and vetment to really make this a priority. And I firmly believe — and we can talk about lots of reasons of why students are coming out with over $170,000 of debt, much of that is related to rises we’ve seen in tuition, much of that is self-inflicted with cost of living expenses, a whole host of reasons. However, we know that the financial literacy and education piece is so important, and we also know that if we can help decrease the burden of this financial indebtedness, I think we’re going to see more pharmacy graduates that are willing to take the risk that we need them to be taking when we need to have complex problems that need to be solved and we need solutions to solve those. So I’m hopeful that we can continue to further this conversation on a national level, and I think we’re seeing traction on that. And I’m excited to see where that goes in the future. Now, in your speech, you reference one of my favorite books, which is Gary Keller’s “The One Thing,” which I would highly recommend to all of our listeners and we’ll link to in the show notes. And that book, “The One Thing: The surprisingly simple truth behind extraordinary results,” he links success to narrowing your focus on really a single question. That single question is, what’s the one thing I can do or we can do such that by doing it, everything else will be easier or unnecessary? So how have you used this book, this concept, this method, to think of solutions to the current state of pharmacy?

Todd Sorensen: Well, you know, I’d mentioned before that the issues that we’re facing right now and the reasons why we’re facing them are multifaceted. So if you look at all those different issues and facets, it can become overwhelming. And so the premise is the book, as you described, is to really — and I know that it can sound simpler than it is, but in a very complicated world, you have to be able to distill things down to their essence, to some degree so that you can know where to go to create change. And it’s really — I think the book talks about this — it’s really ingraining in yourself a way of thinking and asking that question over and over again. What’s something that you can focus on today? What’s the one thing I need to do today to make everything easier or unnecessary? Or at the level we’re talking about, what’s the one thing that we can do to make everything else easier or necessary. So spent a lot of time with that question and really trying to not take the easy way out and just say, well, there is no one thing in this case. It’s too complicated. And from my experience, from my observations, what I landed on was the one thing that we can do to make everything else easier or unnecessary is forging collaborative, authentic relationships with physicians, that that could have more impact and more power than just about anything else that we would do that might focus on directly attacking some of these different factors that we’re focusing on, whether that be debt in itself, the job market in itself, so forth. Partnerships with physicians help us solve healthcare-related problems and create advocates for pharmacists in a way that would be stronger than we could ever be on our own. So I think it would make everything else easier or unnecessary.

Tim Ulbrich: And as I mentioned to you before we hit record, Todd, when I read this article and I listened to your speech just a few days after the annual meeting in July, you know, I think a lot of people are going to hear this and quickly start listing the objections. Well, we can’t do this because of this, this, or this. Or we can’t do this. Or what about this? Or what about this? And I think certainly of course there’s room for all that discussion, we should have that discussion, we should bat up these ideas back and forth. But the one thing I really, really appreciate is I feel like we have been lacking bold vision in terms of what are some potential solutions going forward? And so I commend you for putting a bold vision out there that leans on your experiences, and I think leans on a lot of opportunities and successes you’ve seen pharmacy have over the last five years. And so some more questions I have about this because I did my residency training 11 years ago in a physician office when at the time, you know, patient-centered medical homes were really just coming to be. So I certainly can appreciate the value of this living it firsthand and seeing many other primary care, ambulatory care pharmacists, when you see them in that practice and you see the impact they have on the patients, on the relationships you’re able to build with those other providers and the impact they can have on quality metrics, it pretty much becomes very obvious of wow, this is incredible if we could replicate this vision all across the country. But obviously, the questions are coming in terms of well, how do we scale it and how do we fund it and how do we replicate this with different state practice acts and all these other things? So couple questions for you on this vision physicians and pharmacists collaboration. What are the one or two areas that you think we need to start as you think about the potential objections or barriers that are in the way? How do we begin to forge forward when it comes to this idea of really replicating this model of pharmacists in a physician path? What are the one or two things of where we begin to do this?

Todd Sorensen: Well, I think we start with a mindset that it’s possible. And it is possible, I’ve seen it in my own state play out over and over and over again. And one of the reasons why it’s possible is the shift to value-based healthcare. If we continue to be focused on fee for service payment structures, it becomes very difficult to see how this maybe will play out in the way that we hoped it might. But when you focus on the fact that healthcare is moving more and more into paying for value, and I believe fully that pharmacists can bring value into healthcare, then there is a place for that. And so much of that value is being measured and determined upstream in that primary care area so that we can prevent the costs that occur downstream in terms of hospitalization, complications secondary to chronic illnesses, and so forth. So moving upstream to that place is where we need to be. And the healthcare system is becoming more focused on primary care than it has been in many, many, many years. So how do we align with that? The other reason I believe that it can happen, I referenced this story in the speech. I was at a conference where I saw a physician colleague who I knew by name, they were somebody that I work with that have a couple of pharmacists actually working in their clinic, and I didn’t know her personally, and I went up to introduce myself. And so I said, “Hi, my name is Todd Sorensen, I’m at the University of Minnesota.” Her immediate response without a beat of pause was, “So nice to meet you. I will never work in another clinic again that doesn’t have a pharmacist.”

Tim Ulbrich: Yep.

Todd Sorensen: And you know, that’s the vision that we need to have, that we can say the physicians don’t want to collaborate with pharmacists because there’s history, there’s been experiences that have suggested that. But the physicians that are coming through in the early parts of their career now and the pressures that they’re facing create a whole dynamic that didn’t exist 10 or 20 years ago in creating those teams. So it can happen. And so that’s where I would start, and then we could get into technicalities, different things that need to happen. But we don’t need to start with worrying about practice acts, we don’t need to start with worrying about — we have to build the relationships first. And the relationships will then create the advocacy that will make all the other things fall into place, which is, again, “The One Thing” principle. One other thing I’ll add is that we’ve done this before. The ‘70s and ‘80s schools of pharmacy were often the catalyst for creating change in acute care practice. I’m not sure if we have, as schools, maintained that same mindset that the leaders of those schools in the ‘70s and ‘80s had. And so part of this is calling for our schools, again, to see their role as catalysts in building these partnerships and creating these opportunities. We’ve done it before, we can do it again.

Tim Ulbrich: Yeah, and I think we’re in somewhat of a perfect storm environment, you know, building off of what you said. When you think of the challenges physicians are being faced with, the multiple pressures they’re being faced with, in combination with the value-based healthcare model that we’re shifting towards, I think pharmacists fit very nicely into that. And in my opinion, I think we often get caught up in the weeds of the conversations of what about practice acts? What about this? What about this? And I think starting with the relationships, starting with the vision. And I think in any time where there’s a complex problem like this where you start hearing a lot of objections that are being presented, I think that is so ripe for entrepreneurship and innovation. And so I personally think we’re going to look back and this 10-year period, whatever number of years you want to call on pharmacy and say, “Wow, a lot of cool things came out of this because these people decided to take risks towards this bigger vision and what could be achieved.” So one of the objections, Todd — and we could talk about many of these. I just want to talk about a couple here. But one of them I commonly hear and think about myself is, well, what about nurse practitioners? What about PAs? And how do pharmacists differentiate? What’s our differential advantage in terms of competing with those providers, especially when you think about factors like ability to prescribe, ability to get paid and reimbursed for those services that they’re providing inside of the clinic. So as you’ve thought about this on a bigger vision type of level, I’m sure that issue has come to mind for you and obviously from your experiences as well. So what are your thoughts on that?

Todd Sorensen: I have thought about it, and it’s a really important question. It gets back to the issue of bringing value into healthcare. We are in an environment where the practitioner or the individual that can produce an outcome at the lowest price is the one that’s going to get the business. And in many cases, pharmacists are the second most expensive person on a healthcare team. So we really have to think about what is it that we do uniquely, that nobody else can do as well as us, to be able to justify that price point and be able to demonstrate value. And there’s a couple of things that I think of. First of all, no one is trained. And nobody is as skilled as pharmacists in managing really complex medication-related problems. So that’s where we have to focus our team. For us to spend time on the majority of our time on things that are not very complicated, that our single disease-focused, others can do that. You mentioned nurse practitioners and physicians assistants. Honestly, RNs, at even a lower price point can manage essential hypertension on protocol. So we really have to be looking at where our unique knowledge and skills are different and can be leveraged in a way that exceeds that of others. The other thing that I would highlight is this was a small study, but it has gotten a lot of attention because it’s kind of put a new lens on, again pharmacist and physician teams. And one of the things that physicians are really dealing with — and of course, pharmacists are as well, which is issues of burnout and lack of joy in practice.

Tim Ulbrich: Yeah.

Todd Sorensen: We interviewed a series of primary care providers who had formal relationships with pharmacists and asked them whether or not that relationship affected their sense of burnout or joy in practice. And basically unanimously — of course that group, this was through interviews that we did this with — they said absolutely. And then we asked them why. And one of the things that came out of that that I in hindsight maybe could understand, but I hadn’t thought about it at the time, was that they said that the way I work with a pharmacist and this type of relationship is different than I work with any other practitioner. It’s different than how I work with a nurse practitioner. All these clinics had nurse practitioners in them. And the reason why was that the nurse practitioner has their own panel, and the physician has their own panel. They don’t really collaborate on individual patients. They collaborate at a population level, not necessarily an individual patient. Whereas they said with pharmacists, these really complicated, complex medication-heavy burden patients, they wear me out. They create mental burden, and often I just don’t know where to go with them. And it’s really part of what’s contributing to my lack of joy in my practice. But when I work with a pharmacist collaborative on that, it lifts much of that burden. So the way I work with a pharmacist on this select group of patients is different than the way I work with any other practitioner. And that’s starting to get to that uniqueness and to that value because we’re finding something that nobody else is doing or can do as well as a pharmacist can, and it’s bringing value. In that case, the value is in the sense of joy in practice with physicians, which will play out as an influential element in decision-making.

Tim Ulbrich: Absolutely.

Todd Sorensen: It also leads to then costs, better care, it really can lead to the quadrupling.

Tim Ulbrich: That’s an interesting angle. I’ve never heard that talked about. I’ve heard obviously the impact on value-based contracts and being able to improve quality metrics. I’ve heard about and seen studies related to freeing up physician time so they can see more patients, which certainly works in a fee-for-service model, but I think run flat longer term. That’s a really interesting angle in terms of the provider satisfaction. And it makes sense. I mean, I think back to my time in a primary care office, very much the 80-20 rule where you’d have 20% of the patients, maybe 10% of the patients, that took up 80-90% of the time in terms of the questions they have, the complexity of their care and the frequency of their visits, and so I think the pharmacist certainly could play an important role in that process. Todd, one of the things I also think a lot about is just from the academic perspective obviously living in this realm, and I think back to one of my favorite books called, “The End of Jobs” by Taylor Pearson is that I think as I hear you talking, as I listen to your vision, I read more about your vision, I think we have to find a way to better facilitate students and pharmacy graduates and practitioners being comfortable in the uncomfortable. So when I hear your vision, you know, I think pharmacists often want the A-Z checklist of OK, what do I need to do to execute this to be successful to earn a paycheck? And I think the answer is, it’s not there yet. And I think that those that are going to be successful, both practitioners now and students that will be out there in the future, in my opinion, is you have this broad framework, you have this broad vision, but now the creativity lies in the multiple pathways of solutions that can be had. So I would encourage our listeners for those that are out there, whether they’re working full-time, part-time, thinking ahead to the future, begin to think about what are the business solutions that may exist in this framework that you’re hearing Todd talk about? So Todd, I want to address — and you acknowledged this, and I appreciated it — that many pharmacists are frustrated right now with the state of the profession. And many of them are being deeply affected by the current reality. And so those that are out there listening or working today, maybe some of them got laid off, hours got cut, and they’re hearing about this longer term vision to expand pharmacists role in a primary care, they may feel like this message doesn’t do much to address the current challenges. And I’m not necessarily suggesting AACP has this responsibility alone, I think there’s a shared responsibility across all organizations and also shared responsibility by the individual as well as the associations, but any thoughts on short-term solutions or short-term strategies in addition to this longer term vision?

Todd Sorensen: Yes. You know, I would start off by saying that I think that part of the reason that we are — if you go back again and think about the 1999 and some of the projections that were in that NAP report and the factors that maybe did not allow those things to come to fruition on the growth side of the projections, I think it’s in part because it is much easier to focus on short-term initiatives in the short-term. It is much harder, even with the best of intentions, it is harder to get organizations let alone a whole profession, to really look at the long term.

Tim Ulbrich: Yes.

Todd Sorensen: The phrase, “the tyranny of the urgent” comes to mind. And many of the things that we have done over the last 20 years I think are with a short-term focus in terms of trying to pursue this payment opportunity here or even though they might not be the right thing or solving the problem in the long term. Let me give you one quick example.

Tim Ulbrich: Sure.

Todd Sorensen: I’m a particular fan of pharmacists trying to achieve revenue through annual wellness visits in primary care settings. We can’t demonstrate a clear value in net value proposition in that role because again, a nurse practitioner or even a nurse can do that. So by adjusting your service line to try to take advantage of that payment opportunity is very much a short-term focus that is not building the capacity and the direction for the future where you can actually demonstrate value. So I understand the dynamics. It’s easier, we have these short-term pressures that we have to address, so it is a balancing game that we have to consider. And it takes more discipline, and it takes more risk to be able to focus on the long term. And as you’re speaking to the audience and encouraging the idea of these opportunities in entrepreneurship, that’s the same thing. There’s the short-term of the job that’s in front of me right now. There’s a long-term of how I can be a solution and be creative and entrepreneurial to create an opportunity for the long term.

Tim Ulbrich: I think that’s such a great example, the annual wellness visits. I mean, I think it’s no different than how I treat my business and how other business owners look at things in terms of if you’re going to develop a product or a service, you want to think about, again, what’s your differential advantage? And even if this has short-term revenue gain, could this be replaced quickly by something else? I think that’s a good example where can we show a value proposition that is different than what others are doing? And I think based on the criteria for what’s involved in an annual wellness visit, I would agree with you, no. The other example that comes to mind, which isn’t going to be popular, is that even though we have a short-term urgency to focus fixing reimbursement rates on dispensing of products through fair reimbursement through some of the PBM things that are going on, all of that important efforts that we need to continue and we should be doing. It still, again, is a shorter term horizon as we think about 10, 15, 20 years, is the value of the pharmacist still tied to that product? And I think personally, the answer is no. And so I think that, again, we need to be thinking about the longer term and certainly addressing some of those issues. Todd, I want to end by talking about the change.org petition. I think we have to talk about it. For those that are not familiar, the change.org petition #ChangePharmacy, it’s been signed by almost 23,000 people now as of October 1. It probably is beyond that. And it urges the leaders of ACPE, AACP and APhA — not sure why only those three, but nonetheless, to halt and/or postpone accreditation of new pharmacy schools until 2030. So again, I have been a big advocate that we need to be having a constructive, informed conversation that addresses the challenges we’re facing today but also talks about the future and the vision that we need to aspire towards. So what insights can you provide, Todd, either from your personal perspective or AACP’s perspective, to those that signed the petition in terms of the authority for these organizations to “halt and/or postpone accreditation?” And really, what do you think the type of impact that that would have in terms of a solution and the impact on the profession?

Todd Sorensen: Yeah, it’s probably — it’s not really appropriate to hypothesize what that could look like because the reality is that it can’t. And ACPE has commented on this a number of times that we do operate in a free market society, and to do anything on their part to overtly restrict accreditation of schools could be viewed as restriction of free trade. And so that’s just a reality that we have to address that the market is part of what we believe drives supply and demand in our economy. Now, in terms of the number of schools, I mean, right now, that, again, is the short-term focus is that the reason why we are in the situation we are is because we have too many schools. Well, what if we would have created the new opportunities that were projected 20 years ago? Let’s say that even just 50% of primary care practices had some sort of formal relationship with pharmacists right now. That doesn’t even mean embedding them as an employed member of the team, but relationships between the community pharmacist and the primary care setting. That alone probably would shift our dynamics to the point where we would say we might be in balance with our supply or maybe even undersupplied at that time. So we don’t want to run the risk of taking, again, the very acute issue and blaming one thing as the reason for why we are in that situation. And instead, we need to look to the future and say, what does society need? What is the value that pharmacists can bring? And we don’t really know the number of pharmacists that are necessary. I would project that if we could accomplish the aim that I would like to see us pursue that we would not then say we have too many schools. We potentially are not fulfilling the needs of society with the number of pharmacists that we need. So it all is in your perception of how you look at things. Is it the worst of times? Or is the best of times?

Tim Ulbrich: Todd, I thank you so much, again, for taking the time that you did to come onto the show. Thank you for your leadership in AACP and all the work that you’ve done for the profession.

Todd Sorensen: Thanks, Tim. I enjoyed it. Great to have the opportunity to share some of these thoughts with your listeners.

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