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Diabetes Management Education: Addressing the Barriers

Diabetes affects nearly 10% of the American population. As pharmacists, we care for this population on a regular basis and we need to recognize where the gaps are. These gaps may provide a prime opportunity for us to increase our services to help improve outcomes for these patients.

The American Diabetes Association places a heavy emphasis on access to a diabetes self managementeducation program. These courses typically follow a traditional classroom style setting, allowing for either group learning or individualized learning with an instructor. Information is rattled off at patients according to a curriculum that is suggested by the organizations in charge of accreditation. The process looks something like this: diagnosisàreferralàdiabetes self management education. It seems fairly straight forward, and it should be. The reality, however, is that the current system presents many barriers that aren’t being addressed.

1) Insurance Red Tape: Oh insurance…we all love it. Most insurances will pay for some form of diabetes education, but the reimbursements are low leaving little desire for most providers to pursue this path unless they have a true passion for educating patients on diabetes management. Additionally, there are so many stipulations in place that make it challenging to contract for reimbursement. For example, CMS won’t reimburse an independent pharmacist for these services. The coursework takes extensive time to build, and to build it without reimbursement for Medicare and Medicaid patients is more work than its worth, especially if you live in a state where provider status has yet to be achieved. So most patients are stuck choosing from a limited number of courses, if they can even find a course to attend. This leads us to the next barrier.
2) Limited Diabetes Self Management Education Services: Generally, most primary care clinics do not house a diabetes self management education service. They typically refer out. Patients are often stuck waiting for availability or driving long distances to get this training. Not all our patients have this ability to travel, which takes us into our next barrier.
3) Limited Access: Many patients can’t take the time off work or can’t travel the distance to get to a physical location that offers these services. Telehealth diabetes self management courses have not expanded in the same way that many other healthcare services have, likely in association with the insurance red tape barrier we discussed in the beginning.
4) Traditional Courses do not recognize various learning styles: Not everyone can sit down in a classroom setting and have information verbally given to them with a few handouts to review. We are talking about life changes here. Some people need to self-study. Some people need to pause and rewind. Some people need more visual aides. Some people need to write it down and come back with questions. Depending on what insurance will cover, they may be limited in their access to these educators.
5) Lack of Individualization: because these services are formatted a certain way, and insurance reimburses a certain way, individualized services are harder to come by. Most insurances prefer group setting over individualized…because it’s cheaper.

Until we start recognizing the barriers in place for our patients when it comes to self management, this diagnosis will continue to control the lives of our patients. While there are no simple answers, we can impact these patients on a smaller level until some of these barriers are resolved. Take an extra 5 minutes to show a newly diagnosed diabetic how to use their meter. Check in with them to see what nutrition changes they have made. Review their profiles and discuss any gaps in care you assess.

On a larger scale, get involved with lobbying for provider status. These are the types of services a pharmacist could excel with if given the green light. Approach a clinic or pharmacy to build a self management course under their umbrella. It would be a lot of work, but would also highlight exactly what a pharmacist can bring to the team as we continue fight to be a part of the collaboration.

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Pharmacist. Moms. I deliberately put one word to represent…

Pharmacist. Moms. I deliberately put one word to represent a whole sentence entirely because so much goes into just one of those words alone. Some people literally have not a clue of what entails in the duties and responsibilities that come with being a pharmacist. A pharmacist helps save lives and prevent catastrophic disease states and their progression that lead to detrimental consequences on people’s lives and health. To add to that job description the immense responsibility of being a mom and you get a power house in that one human being. A pharmacist mom may be in charge of a whole retail, hospital, long-term care facility and many other settings. They may take care of hundreds to thousands of patients in just one day. That is an immense responsibility to possess. That same mom after work goes home and has a whole family with other human beings to take care of after work and truly only she can fathom what she accomplished that day at work and home. I am a mother and a pharmacist and I would not change a thing except the culture that I sometimes observed the last 16 years of my pharmacy career and I would like to challenge that thinking and propose a new way of looking at things.

I believe we have a choice to either help, encourage and uplift each other with all the things we go through and understand each other. I will never forget something I witnessed 14 years ago when I worked for a big chain pharmacy as a student intern. I witnessed my preceptor, a new mom, run around all day and in between she would go sit on the floor in a dark, small coat closet to pump to sustain a life- her newborn baby girl. She told me that she was always so nervous because it was dark in there and a few times technicians opened the door by accident not knowing she was there and the embarrassment it caused her. I was not a mother at that time but tried to support her any way I could by making a sign to let the pharmacy team know that she is busy and not to open the small, coat closed door. I thought to myself is that how it would be for me when it came to my time when I became a mother? Luckily I found a very supportive boss who was a mother herself and I had a separate room to accomplish what I needed to do.

I will never forget the very first day I went back to work after having my first baby. It took me what seemed forever to get ready for work and I literally had 3 giant bags to carry all of my supplies to continue to pump. I can not tell you how many times everyone that saw me told me that I look like I am going on a trip or moving somewhere when I was just going to work. I know depending on your position, there are many times a shortage of staff and we have to pick up a lot of extra work and work faster and run around more and what I am about to propose may make your job even harder. We have a choice of whether or not to judge a pregnant pharmacist who is nauseous or super sick because of a possible change in performance at work. You may have to pick up an extra shift or help her with some duties. I came across a very powerful quote for me that had a huge impact on my way of thinking and it went like this, “In a world where we can choose to be anything, choose to be kind.” We have a choice to help each other and give those new pharmacist moms advice and encouragement and wisdom because we were all there and can help the next generation stick together. I will never forget a pharmacist that one day stayed at work a little longer to help me because it was such a long, stressful day and I could not get a break at all to pump. Seven years later I am grateful to her for that and her showing me compassion and being so professional about it. Years later, that same pharmacist became a mom and was having a hard time keeping up with work and pumping and I helped her and she admitted to me that only then she truly understood why I was so grateful to her for helping me in the first place. Let us be kind to each other, help and support each other because the very pharmacist you help will someday help you or pay it forward to another pharmacist mom. Until our environment changes or conditions for mothers get better in the pharmacy world let us make it as easy as possible for each other. Let us not judge each other and what path we choose to take when it comes to child care as I had tons of pharmacist moms judge me when I chose to go part-time for a little while and turned down amazing positions as only we know what is best for our families. So I challenge you today to double think the next time you have to make a choice to build up another pharmacist mom and help her in her struggles. Let the world see us not only as Pharmacist Moms but extraordinary human beings with a super power to also support and care for each other.

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Working in the Margins: Finding the Balance Between Work Life and Home Life

10 years. A decade. A lot can happen in that time. If I had envisioned in 2010 where I would be and what I would be doing in 2020, I’m not sure I could have pictured life as it is now. I was an active duty Air Force Weather Officer, proudly serving my country, but also trying to plan for a future with my husband outside of the military career I had created. I had always managed to multi-task, but it was at this point that I started to learn what it meant to work in the margins. With pharmacy school in my head, I began to take courses to fulfill the remaining prerequisites that my undergraduate degree did not require. I took night classes and online courses. I worked my schedule out to attend labs. I filled up the empty space. Or so I thought. 

With no medical background, pharmacy school had a steep learning curve. I was working in the margins more and more. I studied. I studied more. I managed a household through my husband’s deployments. I worked. I filled up the empty space. Or so I thought. 

I took on a pharmacy manager position in an “opportunity” store. I continued to work in the margins. I worked hard. I worked overtime. I filled up the empty space. Or so I thought.

I had my first child, went back to work and was REALLY learning to work in the margins. I worked hard. I worked overtime. I pumped during lunch. I pumped driving to and from work. I pumped folding laundry. I filled up the empty space. Or so I thought. 

I got pregnant again. Twins: Surprise! Gestational Diabetes: Surprise! My mom was diagnosed with a terminal illness. I worked full time during my high risk pregnancy while taking care of a toddler and coordinating care for my mom from the other side of the country, all while my husband traveled continuously for work. My mom passed. The twins were born. I went back to work with a broken body and a broken spirit. I pumped and pumped and pumped. I continued to work in the margins. I filled the empty space. Or so I thought.

Then, I reached my breaking point. I had shingles diagnosed within weeks of returning to work. My husband was on a work trip and now I couldn’t physically touch my own babies. I lost the balance and I HAD to ask for help. I had no time for myself. I didn’t eat right. I didn’t take time for self-care. I wasn’t physically active. I was stressed. I was exhausted. I re-evaluated where I was and where I wanted to be. I realized the empty space I was filling, was leaving ME empty. Does this resonate?

Now as I continue to raise 3 children, manage a pharmacy, consult on the side and build a business, I have TRULY learned what it means to work in the margins. It isn’t about working harder or longer, but smarter. 

1) Don’t let the margins spill over into your personal time: When the kids are napping, get to work. When they wake up, stop working. It’s ok to put it away and not touch it for a few days, whatever “it” is.

2) Maximize the empty space, MOST of the time: Use the 75/25 rule. Devote 75% of your empty space or free time to productive activities. Fitness, personal development, cleaning, meal prep, etc. Use the other 25% to give your mind and body a rest. Surf the internet. Watch that show. Garden. Sit in silence. Whatever floats your boat.

3) Take care of your body: ask a successful person what their normal routine entails and most will report items that include caring for their body. Fitness, nutrition and spiritual wellness are vitally important. They also give you more ENERGY to continue to work in the margins. 

4) Take time for yourself: seriously….this is non-negotiable. You think you don’t have time for yourself. I get it. But take 5 extra minutes in the shower to shave your legs. Or 10 minutes to put on some makeup. A few minutes in the car with your eyes closed? Go on a Date Night. You will reap the benefits.

5) Take help when offered and ask for help when you need it: This has probably been one of the most challenging concepts for me personally, but once I gave in, my balance was restored. Can you do it all? Yes, of course you can. Do you need to do it all? NO!

Our careers can sometimes be demanding and any mom knows the same can be said for raising children (or is it the kids themselves that are demanding?). Combing the two can be challenging, but you CAN do it. You CAN have it all, but only when you keep the balance. At the end of your life, no one will care how many hours you worked or how clean your house was. They will remember your laugh or your care-free spirit. Maybe your humor? If you’ve lost the things that made you “you” before your career or children, it’s time to restore that balance and get yourself back!

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Career and Home Infusion

There are many learning curves depending on your “branch” of pharmacy. Home infusion is an often-overlooked area that is a hybrid between a clinical-focused career and a retail career. There is collaboration with physicians, nurses, and patients. In conjunction with physicians, we safeguard antibiotic dosing and microbial coverage. Working with nurses ensures timely labs and proper supplies for site care. Patients, over time, have come to trust pharmacists as an accessible source of information and may have questions we are best equipped to answer. There will also be medication and supply deliveries to coordinate. Providing weekly check-ins with patients provides pharmacists an opportunity to assess medication tolerability and minimal side effects. You may not know what to brush up on before moving into home infusion, so here are a few suggestions.

Patient education

Pharmacists may provide patients an education upon initiation of services. Patients need to know what to expect from their line, line care, labs, and the medication itself. How should they shower with their line? If they are connected to a pump, how should they shower to keep the pump dry? Which side effects are normal from their medication and which should they watch out for? If their pump malfunctions or they cannot infuse their dose, what should they try and who should they call?

Line Types

There are specific supplies are needed for each type. Different medications are infused through specific line types.Understanding how lines are maintained and care for, the context of the line in overall care, is imperative. There are PICClines, peripherally inserted central catheter, which go in through the hand or elbow area and are threaded up to the big vein right before the heart atrium. They can be single, double, or triple lumen. A midline is inserted in the same location but only goes up to around the armpit. A Hickman catheter is similar but inserted by the clavicle with the catheter tip before the atrium. Port-a-cath is preferred for chemotherapy and can be maintained for much longer. Occasionally hospice patients will have subcutaneous lines for pain pump administration. Some may even have peripheral lines. Line type can depend on expected duration of therapy.

Medications

As pharmacists this is a given but for home infusion the key is knowing with which medications to be familiar. Antibiotics may include cefazolin, ceftriaxone, ceftaroline, daptomycin, vancomycin, ertapenem, meropenem, amikacin, gentamicin, and more. You will want to become familiar with normal dosing (dosages and frequencies), expected or concerning side effects, labs needed, and counseling points for patients. Besides antibiotics there will also be TPNs, total parenteral nutrition, hydration therapy, chemotherapy, and/or pain pumps. This may vary depending on your company, health system, and patient population.

Infusors

It may surprise you (or not) to learn there are different ways and types of infusing medications. Some are given IV push, 10-20ml in a syringe, like cefazolin and ceftriaxone. Vancomycin is given over 90 minutes to two hours typically and can be given through an elastomeric infusor ball. Pain pumps are given both continuously and via patient-administered boluses. This requires a 24-hour pump. Selecting the appropriate infusor type is a learning curve with considerations include therapy type, stability alterations, insurance coverage, patient ability to administer, and anticipated duration of therapy. Furthermore, each infusor type requires different supplies. This is part of the “context” of the line referred to previously.

Home infusion is a subcategory of pharmacy you may or may not have considered before. Generally speaking, pharmacists like to be prepared. Brushing up on these things will promote success as you begin your home infusion career.

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Pharmacist Moms interviews Medication Safety Expert Nancy Globus, PharmD

We are always interested in hearing more about women making a difference in the pharmaceutical industry. Pharmacist Moms had the pleasure of interviewing ACMA’s Vice President, Regulatory Affairs, Nancy Globus, PharmD

Where did you go to school and what was your background/training?

I have been in the pharmacy business my entire life! My father opened his independent community pharmacy the year before I was born. I grew up there, first dusting shelves and fixing greeting cards, deciding when I was 14 years old that pharmacy school was the career route for me. I went to Rutgers College of Pharmacy for undergrad and got my PharmD at Philadelphia College of Pharmacy and Science (now University of the Sciences). I also did a PGY1 residency in hospital pharmacy practice. I am a big proponent of residencies and fellowships.

How did you get into medication safety?

It was accidental, really. I answered an ad looking for an “experienced hospital pharmacist with good writing skills.” Once I learned the basics of the system-based causes of medication errors and how everything from a drug name or product label to how medication orders are communicated can be designed with error prevention in mind, I was hooked! It was a way to bridge the industry and patient care while using my clinical skills.

What are some of the important skills that someone in your role must possess?

One of the most important traits one can possess is the never-ending desire to learn. There are always new therapeutic areas to delve into and evolving trends of how the industry is regulated and how it interacts with healthcare practitioners. Just because it wasn’t taught in pharmacy school, doesn’t mean it isn’t important or that a pharmacist can’t have an impact in a particular area. You just have to have the drive to learn. And you have to care about people—even though I have been out of clinical practice for many years, good patient care is still the motivation for why I do what I do.

What are some of the biggest initiative(s) that you are working on?

I am working to raise awareness in the industry about medication error prevention. Everyone plays a role in medication safety: Regulatory agencies like FDA, healthcare practitioners, pharmaceutical manufacturers and patients. My focus is on helping the manufacturers identify risks and build error prevention into the naming, labeling, and design of a product.

If you had one wish for the pharmaceutical industry, what would it be?

Other than a safe, effective, and easily manufactured vaccine for COVID—I would love to see a Medication Safety Officer at every pharma company. Someone, ideally a pharmacist, who understands how medication errors happen, who could work with cross-functional development teams to assess risks and implement error-prevention strategies for when the product hits the market. Someone who can look at the whole chessboard and balance safety, approval, and commercial goals.

What has been one of the bigger setbacks in your career, and what lessons did you learn from that?

A job that I had in medical communications and medical writing didn’t work out. It was what I thought was a stepwise move toward working with the industry. My confidence was shaken. Not feeling sure about what the “next right move” was, I returned to clinical practice, taking a position as a staff pharmacist. Many people around me thought it was a strange career choice; however, other than my residency, that hospital position was the best hands-on clinical experience I could have asked for. The things I learned in those several years serve me well to this day. The lesson is, be flexible! Even if a career move that looks like it doesn’t fit with your plan, there will still be something to learn from it.

Tell us about some of the biggest successes in your career and why are you most proud of them?

My biggest success in my career has been my ability to forge and maintain relationships. When I was a hospital pharmacist, I made a concerted effort to meet and interact with the nurses caring for the patients. Not only did it make for a more fun workday, but we were also able to act as a united team with the patient’s best interest at heart. Then, when I started working with industry clients, I engaged with them and made their problems my problems. Even if I could play a tiny part in their achievement of a goal—and seeing a product come to market—it’s very fulfilling!

What is some advice that you would tell your younger self or other pharmacists starting their career?

Something that resonates with me, especially with my work in medication safety is, if you make a mistake, own it. People will respect you much more for admitting that you did something incorrectly and making an effort to fix it rather than trying to hide it.

What does being a woman in pharmacy mean to you?

Caring. Not that men don’t make good pharmacists—my pharmacist role model was my dad! But as a woman, and especially as a mom, I think that ability to really care about your patients and how your practice affects other people is at the core of our profession. And if you don’t care, then you need to find something else to do.

What is your favorite quote?

From Cher’s speech when she won the Best Actress Academy Award, “…And I don’t think that this means that I am somebody, but I guess I’m on my way.”

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What To Expect When You Are Expecting During COVID-19

Erika Cook, PharmD, MBA

 

First, there were the Baby Boomers who were born after World War II, then Generation X in the 60’s and 70’s, Generation Y in 80’s and early 90’s, and then Generation Z in the late 90’s and early 2000’s. We now introduce you to ‘The Coronials’. This new generation is the babies that were born during the global pandemic of 2020 from the novel COVID-19 virus and those babies that will result from months of quarantine and isolation.

I recently gave birth to my first child in May 2020. I was pregnant and worked through the height of the pandemic as a pharmacist in home infusion. I gave birth in a mask with only my husband in the room. I am now raising a newborn and returning to work while many things about this virus still remain unknown. Most pharmacists, especially pharmacist moms, are type A people that thrive off planning. COVID-19 has limited our ability to plan ahead. For example, your Amazon Prime package with diapers is not going to arrive in two days anymore. We do not know when daycare centers will re-open and what type of new precautions there will be. However, there is still something in our control.

Being an essential healthcare worker while pregnant is difficult. Here is what to expect while you are expecting during COVID-19 pandemic.

Pre-partum:

  • Working while pregnant: I worked up until I was 38 weeks pregnant at which time started quarantining at home based on my hospital’s policies. I wore a mask all day at work and had a sign on my door that I was practicing social distancing. I kept interactions to a minimum and used the phone and computer for communication whenever possible. Home infusion is not directly patient-facing so this allowed me to safely follow CDC guidelines for most of my pregnancy. I recommend you utilize the company’s resources such as reasonable accommodations, leave of absences, and employee assistance programs to ensure you are safe at work.
  • COVID Policies: Both my husband and I had to get tested for COVID (we both were negative). If either of us came back positive there would have been specific protocols in place during delivery. We took this time in quarantine very seriously. There have been possible findings of vertical transmission from mother to fetus (1). In addition, if my husband tested positive he would not have been allowed entrance into the hospital and I would have had to find an alternative birth partner who was COVID negative. I was only allowed one birth partner and no visitors during our hospital stay. I originally planned to have a doula with me during delivery. Due to hospital rules my husband communicated with her through FaceTime and text throughout the day. Discuss with your OBGYN your delivery options and what the hospital policies are.
  • Doctors’ appointments: By the time the United States started having positive cases of COVID I was seven months pregnant. At that time you start to have appointments every other week and then weekly. I had to attend these appointments alone. My OBGYN allowed me to FaceTime my husband during our third-trimester ultrasound. I know of other provider offices that did not allow this. This was initially stressful and emotional to not have my husband there to experience the heartbeat sounds and learn about our baby’s development but it soon became the norm. I recommend making your appointment first thing in the morning. This was not only helpful with my work schedule but it also ensured I was getting a clean room that no one had used yet.

Delivery:

  • You can expect to be waddling out of the car having contractions while hospital staff is obtaining your information at check-in while simultaneously taking your temperature in the lobby. My husband was not allowed to come in for a few hours until I was admitted to ensure I was far enough along. We packed enough for a week in case we happened to be there longer due to a cesarean section or other complications. We had a lot of bags and could only take one trip in! Once we were both admitted our hospital door was closed and we were not allowed to leave our room; not for better food because you don’t like the cafeteria food, not for a peanut ball because the hospital took away all birthing tools, and not even for the car seat. My birth plan included no pain meds or epidural. But after an initial 10 hours of labor with no birthing tools or doula that I planned to have I ceased and got the epidural. My son was born healthy 12 hours later and we were discharged from the hospital after our two-night minimum stay. I had a lot of anxiety about COVID going into labor but I cannot say enough positive things about the nurses, midwives, and doctors who made us feel incredibly comfortable and safe during our hospital stay.

Post-partum:

  • This is the period I had the most anxiety over. I was unsure of how we would introduce our family members to our son. This was the first grandchild for both our families and an important time in their lives well. Ultimately we had our families quarantine for two weeks prior to meeting our son and ensure they were symptom-free. However, I suggest you do whatever you feel comfortable with. I was nervous about breastfeeding and what resources I would have if I had difficulty. There have been some great resources online such as Kellymoms.com. I was able to take a breastfeeding course over Zoom prior to giving birth and I joined a local Facebook group with a certified lactation consultant that allows members to post questions. While these are unprecedented times quarantine has provided us the ability to stay at home and take in this time as a new family together. The pandemic has allowed us to slow down and enjoy this alone time.

Back to work:

  • Maternity leave: Each company’s maternity leave policy is different. I did not know how I was going to utilize my time until after our baby was born because I just couldn’t plan that far ahead not knowing what the trajectory was with COVID. My husband initially took two weeks of paid time off when our son was born. He went back to work but due to COVID he is working from home. This has been a challenge and a blessing. We may be a huge distraction during his conference calls with our son screaming in the background at times, but he can also help watch him in the morning so I can get ready or take him in the afternoon so I have a chance to eat lunch. I plan to take 12 weeks of maternity leave and then my husband will take 6 weeks of paternity leave. This way it extends our time home with him to get past some major leaps during 3-4 month growth spurt and then he can start daycare in the fall.
  • Breast feeding: While I am enjoying my time home learning to be a new mom I also look forward to getting back into a routine and going back to work. I plan to continue to breastfeed. It is a federal law that employers have to provide space and time dedicated to breastfeeding moms. I discussed this with my employer beforehand and I know going back to work these accommodations will be ready.

While we do not know what this virus will look like come the fall and if there will be a second wave I am now taking things day by day. Before I used to have my whole year planned out but having a baby during a pandemic has resulted in short term planning and adjusting to our new life day by day. The babies that entered the world in 2020 first saw the face of a doctor hidden behind a mask. Their first year of life may only involve car rides to the pediatrician. But it also may include daily walks around the neighborhood and nights in with their mom and dad. These babies will be known as Coronials and who knows what this generation will be known for. Will they be known as the greatest generation of the 2000’s? I do know that their parents who had to work during a pandemic because they are essential health care providers, and who had to deliver a baby in a mask and raise a newborn in quarantine are strong, caring, dedicated, and can face any obstacle.

Works Cited: 1. Egloff C, Vauloup-Fellous C, Picone O, Mandelbrot L, Roques P. Evidence and possible mechanisms of rare maternal-fetal transmission of SARS-CoV-2. J Clin Virol. 2020;128:104447.

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Why This Pharmacist Enjoys Her Side Hustle in Short-Term Rental Properties

By Dr. Rachel Gainsbrugh

Within my first few years working as a pharmacist, I knew that I wanted to find ways to generate passive income.  I wanted to dictate my schedule and my life.  Real Estate has been an interest of mine for years.  When I first started investing and managing short-term rental (STR) properties, I was hooked!

Traveling is truly a great way to de-stress, unwind, and escape the hustle and bustle of daily life.  However, travel accommodations can take up a huge chunk of a travel budget.  Thanks to short-term rentals, travelers can cut down on their expenses significantly, while enjoying some benefits that hotels could never offer.

My husband and I have had the pleasure of hosting various folks looking for comfortable, well-designed, accessible homes in our local town.  We have created a private, homey environment for travel guests.  Hosting has given us the opportunity to house diverse, interesting groups of individuals, such as travelers for business, work groups, those visiting families and relatives, resident doctors, engineering interns, golf teams, professionals looking for a comfy bed after a long day of training, airline pilots, government officials, cast and crew members working at Pinewood Studios, and those in need of relocation. We truly enjoy being hosts!!

Currently, we have both short-term and medium-term rental properties in our portfolio.

These are my top 5 reasons why I love Short-term rentals as my side hustle:

1)    Revenue Generation!!

Short term rentals generate about 3X the average revenue of a traditional long-term lease.  That’s right.  Read that again.  3X the average rent revenue!  This has helped pay down our mortgage on the rental property faster and accelerate our path to financial freedom.  Whether the rental is a cabin in the Smokies, a villa on the beach, or just a spare bedroom in your own home, short term rentals can provide a great opportunity for higher cash flow and financial freedom.

2)    Personal Use of Vacation home

If your rental is located in a resort or touristy area, you can use your own properties while on vacation.

3)    Upfront Payment

Short term tenants pay upfront through a platform (AirBNB, VRBO, etc).  Your guests pay PRIOR to showing up.  Long-term tenants that do not pay for a couple of months will need to be evicted and this can be a lengthy, stressful, and expensive process.

4)    Minimal Wear and Tear to your property (Surprised?!)

Because STRs are constantly in a state of readiness for guests, they are maintained at all times.  After each guest, our homes are cleaned and sanitized by our professional cleaning team.  In order to serve our guests and keep our 5-star rating, ALL maintenance issues are taken care of immediately and are not deferred.  Additionally, our guests tend to eat out or order take out quite a bit.  Therefore, there’s minimal use of our kitchen appliances.

5)    It can be A LOT of fun!

Once you buy a rental home, you can put your own personality into it!  For one of the homes, I went with a French Country Bohemian theme.  I really enjoyed the design process.  I’ve encountered some really neat treehouses, Harry Potter theme, Beachy theme, etc.  The customization and options to personalize these homes are endless.  We’ve enjoyed the process and have had the opportunity to serve a lot of great guests along the way.

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What Your Pharmacy Coworkers Need Right Now

What Your Pharmacy Coworkers Need Right Now
Compassion.
Patience.
Grace.
Palm Trees.
Not surprising, right? This Harvard Business Review article nails it for me. [I added the part about the palm trees.]
I was on a virtual call today and it was during the only 45 minutes I had to make dinner. That was our plan – I was going to make dinner and my husband was going to set it up, fix the plates, poor the milk, wash the hands, and clean the pans. I had my video off so everyone wouldn’t see me bouncing between the stove and fridge while stealing sips of wine from my favorite stemless glass. I’m not ready to launch my cooking show – yet. Then I heard my name, “Brooke – won’t you introduce yourself?” I jumped to
the laptop, switched on my video, smiled, and started talking. “Brooke – you’re muted.” [Of course.] I explained why my video was off and then remembered that virtual backgrounds allow you to pop in and out of the camera area. I chose a beautiful tropical scene. Wouldn’t that be nice in person, I thought? To
pop in and out of meetings by ducking behind some fake palm trees? We’re all experiencing new human behaviors right now. According to the HBR article, if someone is short with you, it’s probably not because they intended to be disrespectful or rude. If you now receive a strangely short email or text, it’s probably because they are responding to an exponential amount of
correspondence compared to before. With virtual meetings galore, we’re all invited into everyone’s home, and with that comes knowledge of all of their routines, childcare, and support systems. If someone has a babysitter or a grandparent watching their children, it’s probably because it’s available to them and they need it, not that they aren’t aware of curve flattening.
During my cooking-behind-the-palm-trees virtual meeting, someone suggested a group photo. I heard my name again – someone graciously remembered to call me back in from behind the trees so I would be a part of the photo. Wouldn’t that be nice in person, I thought? To include those who are kind of
here but who are momentarily distracted by life’s demands.
Compassion.
Patience.
Grace.
Today taught me that I could give a little more, too.
If we’re ever on a call together and you see palm trees, then yes – the wine is available and needed.

Brooke Griffin, PharmD, BCACP
Be.superheroic@gmail.com

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Pharma Leader, Pharmacist Mom talks about her PharmD career path in medical affairs

Monica Arora Sukhatme, PharmD
Pharmacist Moms Interview
April 1, 2020

1. What is your current role?  Executive Director & Head, MSL Team at Coherus Biosciences

2. Where did you go to school and what was your background/training? After completing my pre-
pharmacy training at Purdue University with a minor in Organizational Leadership, I attended a 3-
year accelerated PharmD program at Massachusetts College of Pharmacy & Health Sciences in Worcester, MA. After practicing as a clinical pharmacist in Chicago for 4 years, I obtained my post-doctorate through the Rutgers Pharmaceutical Fellowship Program where I worked in New Product Market Analytics at Daiichi Sankyo, and taught as an adjunct professor at the pharmacy school at Rutgers University

3. What are some of the important skills that someone in your role must possess? For a role in management & leadership within Medical Affairs, the most important skills include 1) An
understanding of the business, 2) A love for the science, and 3) A desire to communicate both of the above in a dynamic, concise and impactful manner

4. What are some of the biggest initiative(s) that you are working on? One initiative that seems to be a continuous journey is how to evaluate MSLs in a quantitative and measurable way. This is of course easy to do in the sales side of the business, where metrics include sales – but is more of a gray area on the MSL side. Other initiatives include maximizing impactful MSL insight gathering to support cross-functional teams and enhancing effective “soft skills” to effectively communicate the science
to healthcare practitioners

5. What are 3 predictions you have for the pharmaceutical industry in the next 10 years?
1. The MSL role will continue to grow. As information begins to come from a variety of sources,
the need for a scientific, fair-balanced exchange from a credible source within the pharmaceutical industry will accelerate
2. There will be greater scrutiny from assorted stakeholders (i.e. regulators, consumer advocacy groups, and payors) of pharmaceutical brand pricing, which will increase competitive pressure. As a result, this will increase market opportunity for high quality, cost-effective biosimilars
3. Currently, the U.S. subsidizes the vast majority of new drug development in the world. Drug development will eventually be increasingly global in nature with both costs and clinical trials
spread internationally

6. What has been one of the bigger setbacks in your career, and what lessons did you learn from that?
One of the bigger setbacks of my career was inaccurately assessing the corporate culture of a company I joined. In my early years, I didn’t give much thought to corporate culture – but it’s
important to know that the leader of the company sets the undertones of the corporate culture. And I dismissed my inner instincts which were telling me that the leader of that company and I were not on the same page. Thankfully, I am no longer at that company, but have learned that there are many types of personalities, which end up determining corporate culture. Make sure you find one that fits you!

7.Tell us about some of the biggest successes in your career and why are you most proud of them? I’ve
been fortunate to have many inspirational mentors throughout my career. During those times when I wasn’t sure which way to go, I have been grateful for my mentors’ advice and more importantly,
building my confidence by trusting that I’d eventually arrive to the answer myself My most memorable successes involve situations where I was able to bring teams together by taking
into consideration viewpoints from all members of the team. Success is much sweeter when applying the perspectives of a multidisciplinary team. Lastly – no matter the company, people are the most valuable resource. And I’ve also found success
through hiring individuals not based on experience (i.e. prior number of years in the role), but rather
based on potential (i.e. the motivation and perseverance to do the job). This, too, has yielded positive results for me so far.

8. What is some advice that you would tell your younger self or other pharmacists starting their careers? If you aren’t where you want to be in your career, I would say never stop exploring. Continue reading about the healthcare changes affecting patients and caregivers across your community, your country, your world. This will undoubtedly help you to find your passion and where you want to make a difference. Spend time talking to people in careers that interest you…but don’t take their word as the gospel. Follow your instincts and if you fail, try to fail fast. Move onto the next area that interests you. Sometimes finding what you really love is a just a process of elimination!

9. What does being a woman in pharmacy mean to you?  What I’ve found is that careers in pharmacy
offer many options, which is what most women want. Whether it’s retail, hospital staff, clinical-focused, nuclear, academia, or pharmaceutical industry, the options are abundant. To add to that,
most pharmacy careers offer geographical flexibility to move almost anywhere in the world (even when I was a hospital pharmacist, I remember getting an offer to move across the world to practice in Saipan, a U.S. commonwealth where a pharmacist degree from any state is recognized!).
But for me, I’m very happy with a career as a leader in field medical affairs – in addition to working with wonderful colleagues on a mission to bring cost-effective biosimilars to patients in a world
where costs continue to rise exponentially, I have the pleasure of working from home and having a flexible work schedule – with three kids under the age of 5, this is a gift!

10. What is your favorite quote? “Fortune favors the bold” (Apparently, there’s also an Italian version of
this which my friend uses frequently: “Luck kisses the brave”!)
11.  How do you believe becoming a BCMAS can impact one’s career? BCMAS raises the bar of a Medical
Affairs employee’s skillsets, which include heightened scientific acumen, ability to communicate the
science, and last but not least, understanding the greater impact medical affairs has on the overall business.
In the recent climate of concerns about off-label promotion, BCMAS certification remains focused on
training on the importance of a fair & balanced approach, which will further strengthen the
credibility and ethical leadership of medical affairs across the industry.

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Loving The Hustle (Danielle Plummer)

Hi Ladies!

Here’s my story. Thank you so much for sharing.

Danielle Plummer, PharmD 🙂

When I was growing up, I both listened to stories about my grandfather’s pharmacy in the mid twentieth century and also worked at my father’s independent pharmacy. With my family history, my interest in medicine and my love of making others feel well, I knew that someday I would become a third-generation pharmacist.

My journey to my current career followed a long and winding path which involved various roles including being a professional figure skater, a hotel manager, and a military spouse while I raised my three daughters. In 2016, I finally fulfilled my dream of becoming a pharmacist.

Retail pharmacy was extremely different when I was a teenager. Then, many pharmacies were owned by pharmacists, while Medicare Part D and PBMs did not exist. Today, large corporations, PBMs and insurance companies have too much power, but I still saw myself working in a retail environment. As an intern, my preceptors questioned my decision due to pharmacists having little control, but I assured them I knew what I was doing because I still would be able to counsel patients; however, after just a few years, it was time to move my career to another direction. My goal was to open a company which combined my experience as a pharmacist with my background as a hotel manager to resolve all the non-emergency medical needs for visitors in Las Vegas. I was fortunate to have a per diem hospital job while I built my company.

In 2019, I took a chance and left my job as a Walgreens RXM to form TeleMDcare, www.teleMDcare.com, a concierge service for tourists, which offers telemedicine, prescription services and delivery of DME. My dream of taking care of tourists from outside the retail box was realized when our first customer who was in town for CES left his medications in Germany. He was able to see a doctor via our app during a break from his meeting, and then had his prescriptions waiting for him at his hotel when the meeting was over. The days of having to get an Uber or taxi and go to an urgent care or hospital only to wait in line at a pharmacy were over!

When the Covid-19 pandemic took over this year, and telehealth became a household word, my company added a subscription service. This came about because we had as much demand for  our services from our local community as we had from tourists. I was surprised how many of my friends did not have health insurance! Our subscription service includes unlimited telemedicine visits with some prescriptions for a low, monthly price. We also have companies offering the plan as a benefit to their employees and give a percentage of each subscription to non-profits. Once travel resumes, we’re going to be relaunching our concierge service for travelers in Las Vegas and then expanding to other high tourism areas. I’m elated to be supporting the health of our community, even if it is not what I had envisioned when I was in school.

Around the same time that I left my job at Walgreens, I received an email from the HER Foundation asking followers what they are doing to support International Hyperemesis Gravidarum (HG) Awareness Day 2019. I had HG with each of my three pregnancies, but moved on with my life knowing that I’m lucky and forever grateful to have three healthy, happy daughters. I came across www.hyperemesis.org during my third pregnancy and was relieved to know I wasn’t alone. I was even a test subject in the HER Foundation’s first clinical study, which resulted in finding the gene which codes for HG, so receiving this email brought back a flood of memories.

When I was pregnant, there was no possibility I would have let anyone take a photo of me. I literally looked and felt like death. With a quick glance of #hyperemesis gravidarum on Instagram, I saw that women today are not afraid to post pictures of themselves with HG, and I admire how brave they are. To my dismay, however, I discovered that treatment has barely improved since my first pregnancy almost 22 years ago. Almost every time I work a shift at the hospital, there are women in our ER for excessive vomiting and dehydration, and I’ve had several ER doctors call me for advice.

I also remember when TPNs were first mentioned in pharmacy school, and was dumbfounded to learn that I went through my three pregnancies completely malnourished when options for nutrition existed. If it’s possible to get nutrition through a tube, then why didn’t I get any during my pregnancies?

The combination of seeing pictures on IG, knowing the absence of nutrition I received when I had HG, and recognizing the lack of development in research and treatments for HG over the last two decades all prompted me to take action. I honestly believe that if this were a man’s disease we would’ve made progress, so in May 2019, I launched a blog to support women with HG, www.hgpharmacist.com. I also became a board member of the HER Foundation in December 2019, and today I’m excited to officially announce the launch of my HG Consulting business, offering support and medication management to women with nausea and vomiting in pregnancy. My mission is ensuring that every one of these women are treated with dignity and receive the best medical care possible throughout their pregnancy. My dream is to find the causes and treatments for HG, so that in the future, we will look back and see HG as a disease of the past. Please follow me on social media and contact me to be a guest on my blog or YouTube channel, or to share your experience or advice with NVP, info@hgpharmacist.com. For more information on either of my companies, go to www.teleMDcare.com and www.HGPharmacist.com.

Thank you for all the support from our amazing group of Pharmacist Moms!

Danielle