The American College of Physicians recently voiced its position on the role of nonphysician health care providers [1]. The College recognizes the need for an expanded role of nonphysicians to meet future demands for primary health care. The debate on midlevel practitioners has previously focused on physician assistants and nurse practitioners. I suggest that a third group of practitioners—clinical pharmacists—also be considered.

Equipped with extensive didactic and clinical pharmacology training, PharmDs and other clinical pharmacists are often called on by physicians, physician assistants, and nurse practitioners for therapeutic consultations. (At our institution, 9 hours of pharmacology and 10 hours of applied therapeutics and pharmacology are required, in addition to other pharmacy-related courses such as biopharmaceutics and pharmacokinetics.) A logical extension of a clinical pharmacist's professional expertise would be to acknowledge and formalize this relationship by extending prescriptive authority under physician protocol. Seven states currently authorize prescriptive authority for pharmacists, and other states are considering similar legislation [2]. In these models, only clinical pharmacists interested in this role apply to a state authority for credentialing for prescriptive authority under protocol or under the auspices of an attending physician or health care facility. For those physicians who have worked with PharmDs or other clinical pharmacists, the model would offer a welcome relief. Working with physician assistants and nurse practitioners who have diagnostic prowess, the pharmacy practitioners, if allowed to handle the treatment issues (for example, drug therapy selection, monitoring, and modifying and surveillance of adverse effects, drug therapy, and patient counseling), could allow more patients to be seen within a given period.

Any professional with prescribing authority should participate in a checks-and-balances system whereby the prescription is checked by another professional before it is dispensed. To date, this role has been filled by dispensing pharmacists. The College's sixth policy position statement advocates a system in which physician assistants and nurse practitioners dispense their own prescription drugs [1]. It is interesting that an association representing physicians has ignored the daily telephone calls physicians receive from pharmacists correcting inaccurate and sometimes dangerous prescriptions that the physician assistants and nurse practitioners have written. To deny these professionals the value of this check system would be a disservice not only to these midlevel practitioners but, more importantly, to the patients they serve. I strongly urge the College to reconsider their position on this matter.

Health care reform is upon us, whether legislated or not. An increased role for nonphysician health care providers is one of the few possible solutions to meet the need for primary care, especially in rural areas. Clinical pharmacists with prescriptive authority should be considered a part of the solution.