editorial Getting above the storm hen nomadic herders encounter snowstorms in the Himalayas, they go down the mountain. They go up. They and their are then literally above the clouds. There might be a lesson here for pharmacists. We have an opportunity to lift our profession higher in these challenging times. I sense a consensus building around this approach, but that mean that the journey to a new place in the health care system will be an easy one. Frontline pharmacists in community, institutional, and other settings are being asked to do more with less. talked recently with older pharmacists who tell me never seen it this bad. Dispensing workloads are hitting 500 prescriptions per day, technician support is being cut back, and pharmacists are having to juggle telephone calls to nonadherent patients while administering immunizations, even as the physical environments for these services are still being created. The frustrations younger pharmacists are feeling are illustrated only too well in the anonymous letter from my blog that is reprinted on page 16 of this issue. Managers and owners are in just as tough a bind. Two or three decades ago, margins were to cover the cost of dispensing and counseling. But now, just covering the cost of the medications is The pharmacist shortage may have dissipated, but never been harder to manage a pharmacy. It is truly a painful and frustrating time out there. There is a path above the storm, though. We realize that pharmacists and employers need Thomas E. increased service-oriented opportunities to reach a critical mass. This critical mass Menighan, of compensated services will ultimately support the needed to provide the services, but BPharm, MBA, in a transition right now and nobody is comfortable. ScD, FAPhA, In the October 11 issue of the Archives of Internal Medicine, B. Joseph Guglielmo, PharmD, Executive Vice of the University of Francisco, called for community pharmacists to at President and CEO the top of their I like that phrase?at the top of their training?because where we all should be practicing. Pointing to the success of the Asheville Project and other initiatives in which pharmacists excelled in management of chronic diseases, Guglielmo wrote: is clear that an economic model that gives community pharmacists incentives to participate in risk reduction and chronic disease management must evolve. One potential solution is for Medicare to give pharmacists provider status as they do physician assistants, nurse practitioners, clinical social workers, and others. Provider status is associated with a fee schedule for practitioner service. Other models, such as partnerships between physician provider organizations or self-insured entities and community pharmacies with the goal of achieving Healthcare Effectiveness Data and Information Set and other core measures, are options as The clinical and economic of involving pharmacists in direct patient care were also discussed in review articles by Marie A. Chisholm-Burns, PharmD, MPH, and colleagues in the October issue of Medical Care and the October issue of the American Journal of Health-System Pharmacy. Of particular note were the effects on glycosylated hemoglobin, LDL cholesterol, blood pressure, and adverse drug events when pharmacists were included in team-based care. never easy to move an entire profession from one place to another, especially under stormy conditions. I hope we can keep in mind the circumstances in which we all ourselves right now, even as we consider the promise of a better day?one in which we will bask in bright sunlight while we look down on the storms we left behind. 10 Pharmacy Today November 2010 www.pharmacytoday.org