Military Pharmacy Confronts Present,
May 15, 2006, AJHP News
BETHESDA, MD, 01 May 2006 — Pharmacy
and other health care issues that affect
one branch of the military affect all of
the armed services, said Captain David
E. Price, specialty leader and pharmacy
consultant to the U.S. Navy Surgeon
General. So, he said, pharmacy leaders
at the Department of Defense work
jointly to solve problems and plan
"Teamwork is not just a word with
us," he said. "It's a way of life."
In addition to monthly meetings with
his counterparts at the Air Force, Army,
and Coast Guard, Price said he is in
constant telephone and e-mail contact
with the pharmacy chiefs at the other
three armed services and Tricare
Management Activity, the health benefits
provider for members of the U.S.
"We believe in solving issues
together," he said.
All but one of the four armed
services pharmacy chiefs were appointed
to their positions in the past year.
Captain Mary Fong, a commissioned
officer in the U.S. Public Health
Service (PHS), assumed the pharmacy
program consultant and coordinator
position for the U.S. Coast Guard in
Military pharmacy, said Lieutenant
Colonel Everett B. McAllister, pharmacy
consultant to the U.S. Air Force Surgeon
General, is currently facing two
demanding missions: (1) providing
patient services to active-duty military
members and retirees and their families
and (2) ensuring that servicemen
deployed for wartime and contingency
operations have access to needed
"We tend to focus a lot on taking
care of those patients stateside," he
said. "But that mission is meant to
prepare us so that when we deploy to
places like Iraq that we have the skills
necessary to operate in that type of
Combating the pharmacist
shortage. The biggest challenge
in trying to balance both missions,
McAllister said, is retaining sufficient
personnel and recruiting new
pharmacy officers to stay fully staffed.
"You never have enough people," he
The military, the Navy's Price said,
has not been immune to the pharmacist
shortage that has plagued the nation.
"We are having trouble recruiting and
retaining personnel, which makes it
difficult for us to run our operation,"
"Ditto," McAllister remarked.
The Navy, Price said, started the
fiscal year with 142 pharmacists. But,
he said, he plans to lose 31 of those
pharmacists because of retirements or
people leaving the armed services.
The military is vexed by the high
salaries offered by community
pharmacies, Price said, making it
difficult to compete for pharmacists in
a tight employee market.
"The salary difference is huge," he
said, adding that the military is
working on increasing salaries for
While Price said he counts on
enticements like sign-on bonuses,
educational opportunities, and
student-loan repayment programs to
attract pharmacists to the Navy, he said
he emphasizes management and leadership
opportunities when speaking to pharmacy
students or new practitioners as the
more valuable incentives to join the
"We put a lot of responsibility on
new pharmacists," said Price, who said
he enlisted in the Navy in 1973 as a
pharmacy technician and worked his way
up "from the trenches."
"Not only are you responsible for the
pharmacy operation, but as an officer,
you're responsible for the area you are
assigned and the personnel that are
assigned to you," he said.
Because the Coast Guard has only 16
active-duty pharmacy officers,
pharmacists in that branch of the armed
services wear multiple hats, said Fong,
who has been with the Coast Guard since
Three of the Coast Guard's pharmacy
officers, including Fong, serve in
upper-level management positions, she
noted. The other 13 pharmacists oversee
pharmacy operations at 37 ambulatory
health care facilities.
In addition to being responsible for
more than two pharmacies each, Fong
said, the cadre of Coast Guard
pharmacists oversees pharmacy operations
at more than 150 independent duty
stations, including sea vessels called
"Because they are the lone person in
the pharmacy," she said, "they're
involved in everything," including
dispensing, procuring medications and
other supplies, facilitating the site's
pharmacy and therapeutics committee, and
coordinating quality improvement.
PHS in the military.
The Coast Guard's 16 active-duty
pharmacists differ from pharmacy
officers in the other armed services
because they are all PHS commissioned
officers detailed to serve in the Coast
Guard, Fong noted.
However, she said, PHS officers in
the Coast Guard are subject to the
uniform code of military justice, which
PHS commissioned officers detailed to
other agencies, such as the Bureau of
Prisons, Immigration and Customs
Enforcement, and FDA, are not.
PHS officers in the Coast Guard wear
the Coast Guard's uniform, Fong said.
However, she noted, their uniforms
bear the PHS insignia.
PHS officers in the Coast Guard can,
if approved by Coast Guard chain of
command, be deployed for PHS missions,
which last up to two weeks, Fong said.
Several Coast Guard pharmacists this
past fall deployed to
the Gulf Coast to aid victims of
Hurricane Katrina, she said, adding that
pharmacy officers have continued to seek
approval to deploy to hurricane-affected
areas as needs arise.
However, Fong noted, Coast Guard
pharmacists are first obligated to
ensure that their own facilities'
operational needs are met before they
are permitted to deploy for PHS
Coast Guard pharmacists are sometimes
called on to fill in for other pharmacy
officers or augment the pharmacy staff
at Coast Guard health facilities during
times of need, she said.
When Hurricane Katrina struck the
Gulf Coast in August 2005, Fong said,
the Coast Guard sent pharmacy officers
to augment the pharmacy at the aviation
training center in Mobile, Alabama. The
pharmacist there was overwhelmed when
beneficiaries, unable to get medications
at military installations affected by
the storm, converged on the small
Fong said she and the other two
management-level pharmacy officers also
fill in for Coast Guard pharmacy staff
members when needed.
Be all that you can be.
Pharmacists in the military, said
Colonel Isiah M. Harper Jr., pharmacy
consultant to the U.S. Army Surgeon
General, are expected to do more than
dispensing and providing clinical
"I'm looking for people who will be
able to train and lead others," he said.
"We want to make sure we sustain the
fighting force. So sometimes it's going
to require you to do other things
besides just be a pharmacist."
Military pharmacists more than ever
before are playing a major role in
medication logistics and inventory
activities, said Harper, who has served
in the Army for 26 years.
Pharmacists, he said, know
information about drugs that
logisticians do not, such as at what
temperature a certain drug should be
stored or that many drugs have various
For example, Harper said, a
logistician would not know that Bactrim
and Septra are brand names for the same
Since pharmacists know the
recommended dosage of a drug to treat a
particular disease, they are essential
personnel during inventory auditing and
ordering, he added.
For the first time during a war, Harper
noted, the Army has a pharmacy
consultant in "the field" in Iraq.
Lieutenant Colonel Brett Kelly of the
44th Medical Command from Fort Bragg,
North Carolina, Harper said, provides
critical information to him and other
military medical personnel about
pharmacy-related issues affecting
soldiers in Iraq.
The current wars in Iraq and
Afghanistan are also the first time the
military has been able to use its
pharmacy mail-order program to ship
medications directly to soldiers
serving in combat, he said.
When soldiers are transferred to
another location, they can easily notify
the mail-order program by sending an
e-mail from the military's Web site,
Although the program needs some
"tweaking," he declared, "it's going
Leading the way.
Military medicine, said the Air Force's
McAllister, "tends to lead or usher in
new changes and new paradigms" that
directly affect patient safety issues.
For example, he said, the military's
electronic medical records system gives
military clinicians the ability to
access any beneficiary's medication
profile from any military health care
"That enhances patient safety," said
McAllister, who has served in the Air
Force for 22 years.
Many drugs and vaccines on the U.S.
market today, Harper maintained, are
available to citizens because of
treatments first tested and used by the
He noted that the Strategic National
Stockpile—a national cache of
antiinfectives, chemical antidotes,
vaccines, and medical supplies that can
be deployed within 12 hours to anywhere
in the United States or its
territories—was based on a concept
developed by the United States Army
Medical Material Agency.
Harper predicted that military
pharmacy will play other vital roles in
homeland defense readiness.
"I see it coming," he said. "And we
are going to be ready."