Clinical Pharmacists Now Handle Primary Care For Veterans Affairs


clinical pharmacists

Veterans Affairs is now using clinical pharmacists to handle up to one-quarter of primary care appointments to combat wait times at some medical centers.

Last year, VA implemented changes that allowed clinical pharmacists to handle primary care for many veterans at select facilities. The push is reportedly in an effort not to increase healthcare quality but instead to decrease wait times as cheaply as possible.

The cost of a clinical pharmacist is almost half that of a medical doctor, and VA seeks to double its usage of such pharmacists over that of doctors in the near future.

But don’t veterans deserve to see doctors in a timely manner just like civilians?

Yesterday, Kaiser Health News circulated an article (more like a press release) on its own website that supports the practice – – the article is obviously written using rhetoric of apologetics meaning we need to look into this very carefully:

VA Shifts To Clinical Pharmacists To Help Ease Patients’ Long Waits

“Something astonishing has happened in the past year to outpatient treatment at the Veterans Affairs hospital here.

“Vets regularly get next-day and even same-day appointments for primary care now, no longer waiting a month or more to see a doctor as many once did.

“The reason is they don’t all see doctors. Clinical pharmacists — whose special training permits them to prescribe drugs, order lab tests, make referrals to specialists and do physical examinations — are handling more patients’ chronic care needs. That frees physicians to concentrate on new patients and others with complex needs.

“A quarter of primary care appointments at the Madison hospital are now handled by clinical pharmacists since they were integrated inpatient care teams in 2015.”

The article continues on for another half page or so discussing why this is a good thing while paying minor tribute to the legal implications.

Other publications like USA Today also copied and pasted the entire article but tweaked the headline to make veterans sound like whiners: USA Today – VA treats patients’ impatience with clinical pharmacists.

My opinion on this is much like the recently proposed regulations allowing advanced practice nurses to treat veterans without doctor supervision. Veterans should not have to choose between timely healthcare and quality healthcare, but VA is apparently putting us into this quagmire on the backs of the hysteria over the veterans killed by the wait list fraud that was originally reported out of Phoenix.

One veteran’s comments on the subject, located on USA Today, matched mine. Aside from comments like the ones posted at the bottom of this article, no one else is talking about the problem of VA maintaining the same lack of access to doctors while augmenting access with lesser qualified clinicians who are not licensed to practice medicine.

Veteran Michael Martinez commented, “So in other words…There are not enough Drs to treat our Veterans & the Govt solves this problem by allowing non-doctors to see Vets…Perfect Govt reasoning.”

What do you think? Predictable reasoning?

Is Martinez Onto Something?

Rather than create an environment to encourage the hiring of more doctors with less retaliation and hostility toward colleagues, VA decided to lower its own standards and its cost of care. This experimental treatment scheme is now being run at VA medical centers in Madison, WI, El Paso, TX, and Kansas City, MO.

These days, clinical pharmacists are not the only clinicians treating veterans under new care criteria. This year, VA is also seeking to allow advanced nurses to treat veterans without direct supervision of a medical doctor, which is presently not allowed in 30 states.

VA seems to be exploiting the wait list scandal that existed at least as far back as Bill Clinton’s presidency to now justify hiring lesser trained and lesser qualified clinicians instead of medical doctors.

Meanwhile, VA executives like Sloan Gibson IV tells the American public that everything is back to normal just in time for the election.

Why Clinical Pharmacists vs Doctors?

This is not a question of what is better for veterans at any cost. There can be no question that the advanced training of medical doctors makes their skills set, on average, far superior to that of advanced practice nurses or clinical pharmacists.

Instead, the question to answer is, “How far in the direction of cheaper healthcare resources will VA be allowed to move while risking veterans lives and safety?”

Rest assured this model is not being researched solely for veterans. Instead, once ACA collapses, the single payer model will be rolled out and the VA healthcare model will be the model for American healthcare nationwide.

It is apparent that the primary benefit here is solely focused on reducing the cost of fighting wait list backlogs at the expense of providing veterans with the highest quality healthcare possible.

Presently, clinical pharmacists are outnumbered by doctors at a ratio of 1 to 6. VA hopes to reduce that ratio to 1 to 3.

According to Glassdoor, the average base salary of a clinical pharmacist at VA is $114,000. Meanwhile, the average base salary of a medical doctor is around $198,000 at VA. So the cost reduction motive is clearly the driving force on the back of the wait list scandal.

VA will be able to hire almost two pharmacists for every medical doctor. At this rate, it will likely become even harder in the future to meet with a primary care doctor moving forward.

This means VA intends to maintain its status quo of unreasonably low access to medical doctors to save a buck without longstanding research supporting this kind of reduced training for primary care providers or the legal impact on the practice of medicine bar in every state.

Healthcare will usurp the practice of medicine where nurses and pharmacists will merely check boxes that a computer tells them to consider rather than thinking through the presentation of the patient before them in a cohesive manner while “practicing medicine” as in the past many decades.

This is uncharted territory folks, and it is being done on the backs of the dead veterans whose tragic stories gave rise to the call for immediate solutions. Instead, we are given band-aids to fix massive shortages in access to medical doctors.

Is this the direction and consideration VA promised America when it swore it would reduce the wait list? What other maneuvers does VA have up its sleeve that have not been revealed yet?

Training Of A Clinical Pharmacist

According to the American College of Clinical Pharmacy (ACCP) a clinical pharmacist’s training is described as follows:

“The clinical pharmacist is educated and trained in direct patient care environments, including medical centers, clinics, and a variety of other health care settings. Clinical pharmacists are frequently granted patient care privileges by collaborating physicians and/or health systems that allow them to perform a full range of medication decision-making functions as part of the patient’s health care team. These privileges are granted on the basis of the clinical pharmacist’s demonstrated knowledge of medication therapy and record of clinical experience. This specialized knowledge and clinical experience is usually gained through residency training and specialist board certification.”

The organization explained how these clinicians provide care for patients. The following bullets are straight quotes from the ACCP website:

  • “Provide a consistent process of patient care that ensures the appropriateness, effectiveness, and safety of the patient’s medication use.
  • “Consult with the patient’s physician(s) and other health care provider(s) to develop and implement a medication plan that can meet the overall goals of patient care established by the health care team.
  • “Apply specialized knowledge of the scientific and clinical use of medications, including medication action, dosing, adverse effects, and drug interactions, in performing their patient care activities in collaboration with other members of the health care team.
  • “Call on their clinical experience to solve health problems through the rational use of medications.
  • “Rely on their professional relationships with patients to tailor their advice to best meet individual patient needs and desires.”

Did you see anything mentioned in there about clinical pharmacists taking over as the primary roll for primary care to help reduce any wait times? No, because this kind of scheme would never fly in a civilian facility.

But since we are only veterans, what the hell, right?

Kaiser Promoting Clinical Pharmacists?

Kaiser Health News covered this issue yesterday. Perhaps some of you may recall Kaiser partnered with VA in an initiative to share patient data on population management.

RELATED: Population Management And Genomics Act Core Of Kaiser Partnership With VA

Companies like Kaiser are always looking for ways to cut healthcare costs, and VA seems to prove itself as fertile ground for using and sometimes abusing VA’s guinea pigs – – otherwise known as impoverished veterans who cannot afford lawyers or insurance.

According to Kaiser, the use of clinical pharmacists is as follows:

“The Madison VA allowed clinical pharmacists to take over management of patients with chronic diseases such as diabetes and high blood pressure, participate in weekly meetings with doctors and other members of patients’ care teams and handle patients’ calls about medications.

“They typically see five patients in their office each day, usually for 30 minutes each, and they talk to another 10 by telephone, said Ellina Seckel, the clinical pharmacist who led the changes at the hospital.

“Many issues involve adjusting medication dosages such as insulin, which do not require a face-to-face visit. When Seckel sees patients, she often helps them lower the number of drugs they take because they may cause unnecessary complications.

“Expanding clinical pharmacists’ role in primary care has cut readmission rates and helped more patients keep their diabetes under control, Seckel said.”

The decision to usurp the scope of practice of doctors was met with heavy skepticism. Lanre’ Obisesan, assistant chief of pharmacy at El Paso VA said, “Some physicians feel like it’s a turf war and don’t want to refer their patients because they feel the clinical pharmacist is trying to practice medicine.”

Rather than address this very real ethical and legal potential breach, the Kaiser article shifts gears to highlight how the use of lesser trained clinical pharmacists reduced wait times.

But is this a legal breach? Are these clinical pharmacists “practicing medicine”? I believe they are and as such, they are likely in violation of certain laws within the states they practice within.

Perhaps that is why Kaiser never addressed the concern within the article?

Clinical Pharmacist Articles Elsewhere

Concerned, I began to look around the web for other examples and news articles discussing VA’s use of pharmacists.

The American Pharmacists Association (APA) wrote a brief summary of the Kaiser article using the derogatory title, “VA treats patients’ impatience with clinical pharmacists”. This title was also used by USA Today (I will touch on this below).

Do you see how the wait list scandal, which was allowed to fester since Bill Clinton left office, is now being used to reduce quality of care and cost of care at VA facilities? Is there ever a scandal that goes without a prefabricated solution?

According to the APA, veterans (i.e. patients) were impatient rather than fed up with other fellow veterans dying while VA administrators defrauded the system by boosting their performance numbers through fraudulent schemes to while denying access to healthcare.

You see how the conversation is being turned away from the fraud while instead focusing on veterans as the whiners? You can expect more of this kind of derogatory treatment as we move further away from the recent wars.

In light of the Phoenix VA billboard that was apparently paid for by TriWest and endorsed by all major veterans organizations, it looks like the federal government and its minions are quick at work to rewrite history in time for VA to become the model for American healthcare after a Clinton victory this November.

Aside from the Kaiser article, there was not a lot written on the subject within the news telling me this is more of a policy experiment they are floating right now.

The original Kaiser article, which appears more like a public relations article than a news article, was also published in USA Today. They also used the derogatory title blaming the use of pharmacists on impatient veterans, “VA treats patients’ impatience with clinical pharmacists”.

The full court press will be on to gain approval of this strategy nationwide.

To give you an idea of the conversation, I am providing the following comments from the USA Today article below. Typos were corrected for readability. I would like to see where you all fall on this issue, either for or against

I would like to see where you all fall on this issue, either for or against.

Comments From USA Today On Clinical Pharmacist Story

Scott Gardner “So this is supposed to be good news, but it is not. This is just another way to give veterans sub standard health care. Things will get missed far more often now, and there will be more anti-depressants handed out like candy than ever before…. So sad….I will never step foot in the VA again after the way I have been treated in KC. Total incompetence at ALL levels.”

Michael J Martinez “Thank you for your service. I am sorry and disgusted to see our vets being mistreated like this.”

Ben Francis Tarsitano “Why not just hire chiropractors? Veterans are not entitled to actually be seen by a licensed physician.”

Peggy Stewart “In addition to clinical pharmacists, there are also physician assistants and nurse practitioners. Are they also being utilized? Probably not – as the El Paso doctors demonstrated – this is a turf war, and even though I the doctor do not have the ability to hold the turf, I will be damned if I ever let someone have a little of it.”

Wainaina Wainaina “Good idea, pharmacist can as well help the patient and manage as well as doctors.”

Michael J Martinez “NO they cannot…If this was true then they WOULD BE Dr’s!”

Jeremy Moretz “Actually- we are “doctors”. We hold a doctor of pharmacy, in the same regards a physician holds a doctor of medicine. Although I never go by “doctor” unless I’m teaching in a classroom. To practice as this kind of pharmacist- you have to have at least two years of training after pharmacy school specializing in medication therapy management and adjustment. If you are cared for at any academic medical center, including the VA- there is a high probability you have a pharmacist on your rounding team helping the team direct medication decision making. To devalue our profession as a “bean counter” is quite offensive- but I won’t be rude, as I’m sure it’s a matter of not understanding the advancement of our profession. We would never claim to diagnose- that is certainly beyond the scope of our training and licensure. Our objective is to aid in medication therapy management and adjustment. To clarify- I don’t actually work at a VA. I work at an academic medical center and round with an advanced cardiology team. I can find a multitude of my physician colleagues who appreciate and value having a pharmacist on their service helping care for their patients. I would kindly ask to fact check understanding of the pharmacy profession before devaluing our collaborative work with physicians.”

Michael J Martinez “Jeremy Moretz You are not a Medical Dr. And you know full well that is what was meant by my statement. If you were qualified to be a medical Dr then you would be. I am not devaluing your contribution to the system. And I didn’t call your profession Bean Counters…it was a reference to the cost of it all. You also round with a team and that is not the way the situation at the VA is being described here. I am pointing out the crap that we are being fed about this being a better situation than actually having more – Medical – Dr’s available to treat our Vets.”

Michael J Martinez “So in other words…There are not enough Drs to treat our Veterans & the Govt solves this problem by allowing non-doctors to see Vets…Perfect Govt reasoning.”

Michael J Martinez “Kaylee Caniff Babble on all you want about it, doesn’t change the fact that there arent enough Drs to treat our Veterans. Instead of hiring more, the govt decides Clinical Pharmacists are a better choice instead. Tell me Kaylee, what VA hospital do you go to for your medical care?”

Anna Showalter “For a chronic illness 30 minutes with a knowledgeable pharmacist, nurse practitioner who may discuss diet, exercise, etc sure beats the 5 minutes we get with a doctor who always checks our BP and heart beat (even with no heart disease present). Oops he/she gives us a refill on our Rx. also.”

Michael J Martinez “Anna Showalter Your comment only clarifies my point…. this is about a shortage of Dr’s and the only solution from the Govts viewpoint is to allow non-Dr’s to handle the cases. Spin it as much as you want, but I guarantee the congressmen who send us to war would never accept being told this crap about compromising on the level of their healthcare just so some bean counter can make the numbers work. Heres a suggestion…how about we MAKE GOOD on our promise to take care of our vets and hire enough Dr’s!”

Jeremy Moretz had some good points about the profession, and I think it is probably wise to have clinical pharmacists working closely with doctors. But unlike where Moretz works, VA is allowing its pharmacists to take on the primary care role, which is dangerous and possibly illegal in some states.

Thoughts On Clinical Pharmacy?

What do you think on this issue? Should VA maintain the status quo of unreasonably lacking access to medical doctors by augmenting care with cheaper, less trained alternatives? Or, should VA hire more doctors?

I know some veterans are comfortable with the lower quality so long as they see someone with medical-type training. I find this low standard unacceptable.

Veterans should not need to choose low standard health care in exchange for at least speaking with someone with medical training for longer than five minutes.


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hhhmmm….. Pharmacists doing the “Doctor” stuff– who was picked for surgery? VETerinarians?

Albert Dodd
Albert Dodd

I try my best to not knock anybody’s profession. As that is what they choose to specialize in and have invested lots of time and money into it. I am sorry but a Clinical Pharmacist is not a Doctor of Diagnosis or Conditions. Yes they may be needed for their knowledge of Medicine’s but not for knowledge of Human Anatomy and Diagnosing Medical Illness’s. If this is going to be the case why not go out and hire a bunch of Veterinarians at least they some Knowledge of Anatomy and Diagnosis.

It is bad enough we have to be subjected to Nurse Practitioners thinking they are above Doctors since they implemented them. And now the VA thinks Clinical Pharmacist can treat Veterans better than Doctors. Here is the Point I do not knock or down anyone of you for what you choose to do, but that is why Doctors go to school longer have residency training before they can even be called a Doctor. What makes anyone think that we only need a Band-Aid and were good.

My last thought on this is if you (Non-Military, Doctor, Nurse, Pharmacist, Politician, VA Employee) will not give up your Health Care Benefits of seeing when your sick. Then why the Hell should we. And to furthermore understand what we are saying go buy yourself a AR-15 and Fight Your Own Dam Battle and see if we care about what kind of healthcare Hillary and Bill are going to give you.

How long do you think this Nation would last if you so called Stuck-up High Polluting Snobbish better than everyone else people had to defend for yourself. It would be a Sad Day as some of you would not have clue of which end the bullet comes out of. Much less how to put bullet into the magazine. I would like to see General Hillary and all the Politicians put on combat gear and defend this Nation that us Veterans call Home.

jeff kleven
jeff kleven



Actually a pharmacist with a PharmD is a Doctor of Pharmacy, in fact your pharmacist will have more knowledge about medications than then the average PCP. Also, PharmDs catch physician errors more than you realize and they are trained in Patient Assessment skills.

Seymore Klearlly
Seymore Klearlly

Lame, Pharmacy, Very Lame.

If you want a pharmacist handling your health care go for it. We all would prefer having a qualified doctor.

Don Karg
Don Karg


Dear Benjamin Krause,

You had asked the question: “How far in the direction of cheaper healthcare resources will (the) VA be allowed to move while risking veterans’ lives and safety?”
The answer is all the way! Who is going to stop them? It is not going to be Award winning [Feb. 2015 George Polk Award] journalist Dennis Wagner from USA Today/Arizona Republic Newspaper or any Congressmen in Arizona, and it appears “…IAVA, DAV, VVA, VFW, American Legion, Purple Heart..”[ “and one other” you could not make out on the new billboard in Phoenix] will not be of much help, either.
The People, think this VA is going fix itself, like Dennis Wagner, it is not going to go that way, after decades of major events, and now the “Three Years” of Scandal after Scandal; this VA “mess” is going to turn a page.
Billions lay waste in the hands of treasonous bastards who refuse to help the Veterans. Anyone who had asked questions got reprimanded and those who had helped cover-up this mess kept their jobs, and were promoted, and or allowed to retire [sounds like Aerospace in 1988—190th Allied Signal in Torrance, CA—or the Banking Industry/Wells Fargo].
Put the brakes on now—it will be a long skid.
Don Karg


“[Is this the direction and consideration VA promised America when it swore it would reduce the wait list? What other maneuvers does VA have up its sleeve that have not been revealed yet?]”

1) VA Gastroenterologists to be replaced by VA Grounds and Gutters Crews. Why? Because the Rand Corp. has found that since VA Grounds and Gutter Cleaners indeed flush-out drainage systems, there is very little difference between the Human Bowel and VA Gutters. Done.
2) VA Infectious Disease Specialists to be replaced by same Grounds and Gutters Crews since they have some knowledge of Dutch Elm Disease. Rand Concurs Dutch Elm Disease is SO close to HIV, Hep B & C & Ebola.
3) VA Oncology & Cancer Specialists replaced by same Grounds & Gutters Crews since they also have the inside knowledge on why the grass is always greener on top of septic tanks and happen to be able to fix a microwave oven in a pinch.
4) VA Psychiatrists replaced by same Grounds & Gutters Crews, as they are known to be great at conflict resolving through their extensive experience in negotiating wildlife down from trees, namely those escaped from VA experimental labs.
5) VA Pharmacists replaced by same Grounds & Gutters Crews since they have extensive knowledge of how to rid the grounds and golf courses of pesky vermin. (think Caddyshack)
6) All VA Witch Dr.’s will continue being Witch Dr.’s but will also be required to serve in the VA Chapel for chicken sacrifices to the Caribbean Gods, which then will be recycled in the VA Cafeteria.

Peter Greene
Peter Greene



Let’s face it, a pharmacist knows what antibiotic is needed for different infections, what the dose should be according to the patient’s body weight and which is the cheapest option, but they don’t know how to listen to lung and heart sounds, what tests to order to find out why someone’s anemic, or how to insert an arterial line, a chest tube, diagnose vasculitis or glomerulonephritis or how to treat post interferon side effects.

So they can cross dress all they want but that still won’t make them doctors.


You are right about all of those, but if you read the Kaiser propaganda carefully, you see this treatment mode being described as only for routine, minor care in order to sell it. How many in the public would read that and say, gee, why would you not want a fast appointment just to have your blood pressure checked?

Once it’s sold and in practice, you can bet your life pharmacists will be involved in much more than routine care.

This does make me wonder though….

Does the VA have the same protection policies in place for pharmacists as they do for doctors? They brag on their recruiting site that VA doctors don’t need malpractice insurance as well as other ways the VA protects their quacks. Will they extend the same protections to pharmacists? Or let them take full responsibility and swing in the wind? Along with the poor bastard veteran suffering from their mistake?


If you get a Doctorate of Pharmacy you are trained in physical assessment and I can assure you we know what tests to order. Pharmacist in civilian hospitals order labs and dose patient medications every day.

Seymore Klearlly
Seymore Klearlly

Nice to have your assurance but still prefer having a qualified doctor for my healthcare. You are free to do what ever gets your kicks with yours.

Thank you Very Much.


Let me ask this: If you had a legal case and needed representation, would you hire someone like a paralegal in training to do all the work a State Bar Certified Attorney can perform? Most cases, no! Same goes for medical care. A pharmacist usually has intimate knowledge on medications and interactions of those medications from a purely academic, what’s written by Drug Companies…NOT actual patient in the trenches, bedside manners, as a good Dr. should have (unless at the VA).
This move by the VA would be akin to asking the airport baggage handlers to fill-in as mechanics on the jet engines. The baggage handlers have experience being around and ducking from hitting those large engines, so through osmosis, naturally know how to work on them as well….R-R-R-ight. Cheap Rat Bastards!


A VA Pharmacist is specifically, more like an assembly line worker, not so much your friendly Walgreens Pharmacy. It would actually make more sense for a VA Pharmacist to sit-in for a Ford or GM Assembly Plant Worker on the Line rather than playing Dr. or better yet, as a fast food drive thru window teller. “Want ketchup with those fries?” 🙂


Ain’t it obvious DVA and VHA are there to kill us. That is their purpose, looks better than a DD214 and a pair of cement shoes. Least at Tomah VA they prescribed enough opiate that you would be so far out of it you wouldn’t really care. As far as this veterinarian goes wouldn’t be so bad if they didn’t stick the thermometer up your ass. At VA if they did that you wouldn’t be terribly sure if it was in fact a thermometer. Veterinarians would have better bedside manner.

Crazy elf
Crazy elf

I like what Albert Dodd wrote. Let all those in government, who never served, pick up a weapon and fight their own damn wars! (paraphrasing)! When their injured, and return, let them use “clinical pharmacists” as their primary care physician. Bet they’d have a different opinion.
Of course, all our politicians “opted out of Obamacare”.
Plus, the shit’s going to hit the fan in 2017, due to it’s failure. Many will be without healthcare.

How many times have y’all heard a VHA employee say, quote: “We work as a team!” That’s nothing more, in my opinion, than a way for these asswipes to get away with lots of “medical malpractice”.
Until there’s a complete overhaul of VA’s nationwide, the corruption will continue.

There’s so much “wrong” going on in our government, it’s hard to distinguish between the “BULL” and the “SHIT”!

Just Another Veteran
Just Another Veteran

Veterans are regularly getting same day and next day appointments?

That’s a bunch of horse manure.


Oh and don’t forget, turn your head and bark.


What is the difference between this and a gaggle of foriegn dr’s from the middle east that dont speak english and could care less about veterans.

At least with with nurses and pharmicists you can have someone to hold a conversation with while you are being killed at the evil empire…er I mean VA

Seymore Klearly
Seymore Klearly


Sorry but many of the nurses and pharmacists at the VA are just like the doctors who are a “gaggle of foreign dr’s from the middle east”. So it will still be hard to Hold a conversation while you are being killed.

Crazy elf
Crazy elf

I wonder how many of those “foreign” VA employees are here on a “work visa”? Wouldn’t that be an interesting to find out?
When I, occasionally, use VHA, there’s more foreign healthcare positions than in the lower rank and file.
Plus, I always knew, to become a citizen, one had to be able to speak “ENGLISH”!

steven g larson
steven g larson

So what”s new,,, over 47 years of this crap I have seen,,, They have and will not ever be able to solve as told all of you laying in my room and a light bulb went out took it up front to the nurses station,,, they brought it back inserted it back in,, and said had to call maintaince to replace it ,,, many hours later in the dark,,, Maintaince replaced it ,,, just one of 1000s of professional ways they practice,,, But don’t worry there hiring overseas replacements to take care of us,,,, YEP,,, I don’t go to the VA any longer I will die at home,,, If that must be,,,


Just spoke to the head pharmacist at the retail pharmacy I have gone to for 6 years now and had him read this article and before he even got 1/4 into it he looked-up and said to me, “We pharmacists indeed have PhD’s and similar educations as M.D.’s, and we CAN administer basic flu shots, wellness sessions, blood pressure…BUT we are not to be used in lieu of or employed as M.D.’s as we DO NOT take the specific medical residency requirements as M.D.’s, with our expertise concentrated in Chemistry and Bio…are you serious, the VA wants to use pharmacists to fill a short-fall…without direct supervision of an Attending M.D.???!!”

He then read more and asked me after taking a phone call, “What, did the VA run out of money already or is the real deal the VA cannot get enough competent M.D.’s to work in a scandal blighted environment ?”

YES…great guy and he can totally relate to our plight with the VA. He also said that State’s Laws can differ slightly from each other and he wondered if they are only able to get away with this because it’s Federal Property. I had no answer but he also made another good point in jest as I was leaving, “Maybe this way anything documented will later be found erroneously awarded because they were not M.D.’s after all?”

Is the VA that low or simply spent too much money on “art” and needs to cut some throats, err, corners?


I wanted to clarify that my pharmacist, when talking of differences in education and “Medical Residency Req.’s”, he pointed to the couple of Grad Students doing just that; working for extended periods of time, experiencing first-hand different facets of…running and keeping track of a Pharmacy…not diagnosing. For example, a Grad Student doing Medical Residency to work in their Specialty or Gen Practice, get that experience there, whereas those same M.D.’s in training do not go and spend a couple years working with pharmacists…because pharmacists do the heavy lifting and often know much more than the M.D.’s prescribing, as far as the interactions and side effects…but not diagnosing unless it was some sort of National Disaster Triage….but this is the VA, supposedly “World Class Care”….if you’re a VA Employee.


This is akin to the ending of the Vietnam war. They didn’t treat us with good medicine, they managed us with good drugs…….

Don Avant
Don Avant

I’m all FOR increased access but NOT AT THE COST OF REDUCED QUALITY OF CARE…No Pharmacist has the training of an MD. That’s why they have a PHD on their name instead of an MD…I love nurses…They’re great people and those that go into the field usually do so from the standpoint of caring for their patients. My niece is a Neonatal Nurse Practitioner at Princeton Baptist Medical Center and Neonatal Nurse Practitioner at UAB Critical Care Transport. She transports critical care infants (usually in a helicopter ) and is eminently qualified for her job (getting critical infants to a place where they can be better treated than where they are..)…As a matter of fact, I would bet that most of the MDs that she is transporting kids too would flounder in the high pressure atmosphere she operates in…(no pun intended ) She’s GREAT at keeping kids alive till they get where they need to be…HOWEVER, She’s still not an MD…When she gets the kids to UAB Hospital, their care is turned over to an MD who specializes in Pediatric care ( probably assisted by other Pediatric Nurses that specialize in in-house care…) I sent her a link to this discussion and here was our interaction..

ME Hi Sweety…I need your perspective as a Nurse…Are you up for a discussion on whether or not NPs and Pharmicists should be providing primary care at VA hospitals and clinics without an MD’s oversight??? Here’s the article I’m commenting on… I (and I’m sure other commenters ) would like to get your perspective as a respected practitioner of the art and science of Nursing…You can just reple here and I’ll forward your comments (un-edited of course )

Her: Just read the article. My concern would be with a clinical pharmacist being the primary healthcare provider. After diagnosing the present issue they probably would be a great resource for managing medications and educating the patient and their families. NNP’s and pharmacists sometimes have more time to spend with our patients which would allow for proper education and answering questions regarding diagnoses, prognoses, care management, medications, and follow up. NNP’s are highly regulated; we practice only under the supervision of a collaborating physician. I call them for questions, concerns, or advise on difficult cases. They are and must be available to us 24/7. There is also a strict standard of supervision after the fact in which our H&P’s, diagnosing, treatment plans, etc…are strictly reviewed and critiqued by our collaborating physicians. Our masters level training is specialized to a particular patient population (neonatal, pediatric, adult health, geriatrics) and we must pass boards in our specialty before applying for a license in our state. If the VA wants to use NP’s I feel it should be at the patient’s choice, for more routine cases/follow up’s, and always under the investigation of a collaborating physician. I’m not familiar with the qualifications and educational background of a clinical pharmacist. Do they have training in Anatomy & Physiology, Pathophysiology, Cellular Biology, Genetics, Psychology, etc…? These are basic level nursing requirements. Are these clinical pharmacists practicing under the supervision of a collaborating physician? I would welcome their input in medication questions and management, but I would be asking about their qualifications and supervision. If they are to be used as providers it should be at the choice of the patient.
ME:One of my chief concerns at the VA has always been that even the MDs they employ are often not held to the same standards as MDs outside the VA… They are often from third world schools and the VA almost never requires them to be up to the standards of the state they are practicing in…
If they don’t hold the MDs up those standards how can we expect them to hold Pharmacists and NPs up to those standards…
Her:Agree; if those administrators and congressmen wouldn’t send their own families to these providers then they shouldn’t be sending vets to them.
You don’t know HOW MANY TIMES I’ve seen Vets express the same idea in this and other forums…Sorry for the HUGE post But I needed to get all my thoughts in…

Mike Moore
Mike Moore

Pharmacists have been helping Vets for quite a while. If you use the anti coagulation clinic to have your INR checked monthly, it’s done totally by a pharmacist. Doctors don’t even work this clinic, they just refer. Plus if there is a prescription problem, I would like to have a Pharmacist working the problem.


I am going to flat out say it, I don’t care what anyone says…Hiring these pharmacists to do a doctors job is being done on purpose. First, they are out of money because “again” it went into the pockets for bonuses. Second: what a better way to knock off the veterans in a quickly and timing matter…sure! over medicate, push those pills even more than they already have! mix up some mad cocktails to knock these veterans off even faster. Effing pill pushers!! Not to cure the problem..only to mask it!
I am sure many veterans have been so highly over medicated it’s sicking. I know, because over the years the VA has had my husband so over medicated he couldn’t even function or get out of bed, which I call “Soft Kill” slowly dying from being over medicated to the point it starts to shut down major organs and rip your insides apart. Thanks to the VA the Metformin they had my husband on for so many years in high doses has finally taken it’s toll on my husbands kidneys, and now he is in stage 3 renal failure. All the Nurse practitioner NP could say was “OOPS” My husband was taking over 12 or more medications on a daily basis, doses of two or more pills a day. He has finally weened himself off all these drugs that were slowly killing him. Now he can function, get out of bed, take a shower and get dressed. But the damage has already been done, and now he is dying…not much longer to go. Is this what we need to replace our doctors? Pill pushers? really? Haven’t we learned our lesson from the damage that has already been caused and the many veterans who have already died as a result? This is their main knock off as many veterans as possible, get rid of you guys because you have become such a burden to the VA system.
These doctors have quit the VA, walked off the job because they are mistreated by VA management. They are not allowed to practice medicine unless it’s done the “VA Way” not their way. These doctors are fed up with the rules and regulations of the VA way and are not allowed to treat patients the way they want to. So they have quit and now these VA’s are short handed on medical staff. Such a sad situation for everyone involved.
So with that being said…if you want my opinion…this is a extremely bad idea to put pharmacists in place of doctors!! Shut the VA down and give all the Veterans a medical card to seek outside medical care.


Your comment makes me think of a question.
First the setup. Many vets will recall patriotic commercials on TV or radio or other media, trying to get young people to join the military.
The patriotic theme is really ramped up to appeal to most Americans love of and willingness to serve their country to get them to join, particularly after attacks like on 9/11.

Why doesn’t the VA attempt to recruit doctors in the same manner?

Instead, they promise protection from malpractice suits, perks, low hours worked, low patient load and no requirement for malpractice insurance.

The VA uses a cheap method to appeal to certain people to recruit, and then wonder why they have problems recruiting competent people, or cannot get better doctors.

It would be the same result if the military recruited using the same tactics. They would recruit a bunch of thugs running from the law with no conscience or care for their country.

yes i complain loudly
yes i complain loudly

I remember Bobby going on a speaking circuit to many medical schools two years ago shortly after he first got hired as Sec. He was explaining to students in med school about the “virtues” of joining the VA, like taking part in medical research projects to help mankind and other stuff that may be appealing to perspective newbe’s that were about to graduate Med school to come join the VA instead of going to private practice elsewhere. He thought many would see that as doing some sort of good for mankind, and far more important than making a higher annual salary if one joined a private group practice. He also told them the gov. would pay a lot of student debt off if they committed to the VA for 5 years or something like that. I guess he didn’t do such a great sales job since relatively few bought in on that. The whole ‘push’ fizzled out – not a word about how well (or how bad) his circuit speech plan worked (it was a waste of time). This guy Bob acts like some sort of a do-do bird that lacks reality, and I think he is a total waste of time. I don’t think he could sell himself out of a wet paper bag. His plans always suck.
I have friends from high school who have become pharmacists, and they are not allowed to diagnose patients. They fill a Rx the dr. writes and advises on effects. That’s all.


I had forgotten about Bob doing that. Being he couldn’t sell a life jacket to a drowning man, I’m not surprised it flopped.

Rather than a huge horde of ass covering PR flacks or interior designers, they should have a specific office to do recruiting, and do it in a way other than trying to tell smart young doctors how to start work avoiding responsibility and accountability for their actions.

I also can’t see why they couldn’t have a program recruiting kids in High School to join the National Guard or Reserves for training in anything having to do with medical care, nursing, pharmacy, xray tech, etc., requiring they work at a VA during the term of their service, and guaranteeing them conversion to a full time VA employee in the hospital of their choice once their service term is up. Or released to work anywhere they choose.

Crazy elf
Crazy elf

You brought up a great point. A few years back, the military WAS caught enlisting criminal “gang bangers”. Don’t you remember that little bit of “scandal” the Army had to downplay?


I recall reading about that, and thinking that it seemed more hype than reality from the little I read.

Yes there may have been gang bangers going in to the military, but I wondered how many thought they were escaping that life, and went back to it once they got out. Or how many may have been a cook or supply person when they went in, ended up in a gang when they got out, and when busted for whatever…someone claimed they went in to the military at the direction of their gang to learn tactics, with the claim made by someone just to increase their chance at a federal grant or to get federal equipment.

I’m not defending gangs, but I do wonder how widespread the problem really was. The military always lowers their standards to get recruits when they ramp up for war. I just can’t understand the thinking and dedication of going into the military as a gang member simply to learn tactics and be a better gang banger when they get out. One would think a gang banger would get as much from playing Xbox every day.

Perhaps it was more widespread than what I recall.

jeff kleven
jeff kleven



This is so damned absurd. I don’t know what to think!


I don’t think anyone is putting down Pharmacist. The issue is not having them diagnosing medical problems. I for one don’t want an x-ray technician managing my perscriptions????????


Well my pharmacist at the VA isn’t allowed to write a prescription in the state . I really haven’t seen a pharmacist, that I know of. But now they’re trying to give me nurses instead of doctors . I am doing my best to get out of the VA. and I agree, what good can a nurse or pharmacist do you at a hearing?


I see no problem with this. At any facility outside the VA where a patient has the rights to address any problem with legal and licensing authorities.

I read this Kaiser propaganda last night, and thought those pharmacists at Madison and other VAs are likely given unlimited resources just so the VA could claim this works. We all know the reality of the VA expanding this where those same resources will not be available, and a veteran will be stuck with a single pharmacist, with no ability to change to a doctor or get a medical mistake addressed.
I notice in the ACCP description the terms “collaborate” and “part of a team”, which clearly means a pharmacist in that setting is a part of a team supervised by a physician. The reality at the VA would not be so rosy.
When I went to the VA in OKC, there was no mention of treatment by a team. When I got to Madison, I was assigned to a team, and I truly believe it was a team based on the providers comments about discussing it with the team, and the appointments I had with other team members depending on the condition.
When I got to Grand Junction, I am again assigned to a “team”, but it is a team of 1…which is what treatment by a VA pharmacist would be.
I think this would work if it worked as advertised where pharmacists stuck to the routine things like blood pressure, diabetes management and prescriptions and a veteran had a right to immediately see a doctor for anything more serious, but again, that would not be reality at the VA.
A veteran would be seen by a pharmacist, and if they needed to see someone like Ortho, they would still wait weeks to see that specialist, if at all. Given its the VA, they would likely require an appointment with a physician to review and approve the appointment before seeing Ortho.
As for legalities in any of the states, that will not matter. The VA ignores licensing requirements or any other legality a state requires by simply claiming they are exempt. I’ve proven that here in Colorado, but nobody cares.
…just like nobody will care about pharmacists being the sole provider for a veteran because the poor treatment will not affect them.

jeff kleven
jeff kleven

my experience with p.a. doing [email protected] exams for 14 years at saint cloud v.a.,in Minnesota ,I noted that she had a license to practice in Georgia,and was a contract employee, with little regards for the true welfare of the veteran being examined using her rubber hammer and a stethoscope,lol,failing to record veterans medical complaints ,and failing to record her entire session ,with one goal in mind to deny the veteran any compensation benefits! my american legion case worker ,quit her job and found another job ,shortly after she looked at the medical reports filed by the [email protected] examiner in saint cloud!


I don’t know about primary care, but I have been followed by a clinical pharmacist that specializes within the pain clinic for over a year now. It has been some of the best care that I have ever received. Maybe I’ve been lucky.


This comes as no surprise to me. As a licensed optician, I was informed that VA contractors providing prescription eyewear are not required to comply with a state’s laws requiring eyewear be fitted & dispensed by licensed practitioners. The simple reason for this? The VAMC is FEDERAL property and is not part of the state, therefore state regulations do not apply. In other words, when you cross the border from your state to the VAMC, the rules no longer apply and your rights have been forfeited.


From personal experience, you can bet your ass the VA will bill private insurance for those glasses for whatever the prevailing rate is, regardless of VA policies or what the VA might pay.
I am not service connected for any eye condition, but I was referred to the eye clinic by the VA. Once done, I was told by the VA eye clinic contractor that I could only choose frames under a specific dollar amount because that is all the VA would reimburse them for.
It was interesting to see a statement from my insurance company how much the VA billed them for, which was much more than the rate they paid the outside clinic.

I’m sure the extra amount went into whatever VA slush fund they have hidden away.

Peter Greene
Peter Greene

I’ve spent YEARS searching for a full-fledged medical doctor that is knowledgeable about Gulf War Illness (GWI) including diagnosing and treating the disease based on current published scientific medical literature. My search has only uncovered a plethora of VA medical doctors who not only do not know how to diagnose or treat GWI, they have been indoctrinated by the VA to believe that the disease doesn’t even exist despite the overwhelming evidence that it does, including literature published by the VA itself.

Now I have to deal with a pharmacist that understands even less?


In any civilized country, the entire VA system would be flushed and rebuilt from the ground up. I think we call it “reform.”

I hate the VA. I hate the bastards that deny that I am desperately ill and in nearly constant debilitiating pain and refuse to acknowledge and treat my disease. I hope they all hang from their balls over a pit of burning oil and suffer a long, painful death because that is exactly what they have sentenced me to.

Thank you to the pharmacists that are there when I have questions about my medications and the ones who toil daily to fill countless prescriptions. I appreciate your job but please stay in your corner of my care team and let the truly ignorant doctors fuck up my care and let me live in unforgiving pain.

Seymore Klearly
Seymore Klearly


If you are still looking for a doctor that is a full-fledged medical doctor that is knowledgeable about Gulf War Illness (GWI) including diagnosing and treating the disease based on current published scientific medical literature. You may want to try contacting Dr. Meryl Nass, M.D. she list her phone and email address on her blog at “”.


Dr. Nass is good, but is she still involved? I met her some years ago, and she was doing research then. I don’t know how much she was involved in the treatment side.
Dr. Beatrice Golomb is good. I believe she is in San Diego and has been very involved in both research and treatment of Gulf War veterans for years. In fact, she is involved in a research project right now.
Drs. Baraniuk and Haley are very good for Neuro research. I don’t know how much Haley is doing any more, or how much either might be involved in treatment.

Do a search using CDMRP or GWIRP and you should find a good deal about independent research that has been conducted for GWI.