Transcription of Dr. Jim Krebs for the show Maine’s Pharmacy Experts #164
Dr. Lisa: As a physician and a small business owner I rely on my Marci Booth from Booth Maine to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marci.
Marci: When was the last time you took a break from what you were doing, from the work that was piled up on your desk and just looked up? I know that during the course of my days I often forget to take a moment or 2 to just breathe, look up at the sky and dream. Terrible that I have to remind myself to breathe but when I do I feel energized because in those moments I’m able to let go of the daily grind and think more about what I want to accomplish, how I want my business to grow.
Sometimes those are the aha moments. If we all took a few moments out each day to stop what we’re doing and dream a little about our business futures not only would we feel a great sense of calm but we may come to realize that these dreams can in fact come true.
I’m Marci Booth. Let’s talk about the changes you need, boothmaine.com.
Speaker 1: This segment of Love Maine Radio is brought to you by the following generous sponsors: Mike LePage and Beth Franklin of RE/MAX Heritage in Yarmouth, Maine. Honesty and integrity can take you home. With RE/MAX Heritage it’s your move. Learn more at ourheritage.com.
Dr. Lisa: As a family physician for many years I have had the good fortune to interact with pharmacists in lots of different ways in the hospital setting and also in the community. Today, I’m going to interact with 2 pharmacists who are far more than just your average pharmacist I believe. You’ll understand as you get to hear more about them. We have Dr. Jim Krebs and is it Dr. Akayla Stewart at this point? Dr. Kayla Stewart.
Kayla: You can say it again if you want. It sounds really nice.
Dr. Lisa: I’m sure. Dr. Kayla Stewart. Dr. Jim Krebs is UNE’s Assistant Dean for Experiential Education and Dr. Kayla Stewart is a University of New England graduate and now an Apothecary By Design pharmacist. Thanks so much for coming in and taking time out of your busy schedule and talking to us about this really interesting collaboration that the University of New England has with Apothecary By Design and also about pharmacy education in Maine.
Dr. Jim: Right, thank you Dr. Lisa.
Dr. Kayla: Thank you.
Dr. Lisa: Pharmacy has really come a long way, I think, probably since you, Jim, were studying this at the University of Rhode Island.
Dr. Jim: Absolutely. Traditionally we were in a dispensing role which is what most people are familiar with, the community pharmacy. They see us behind the counter in a white coat. Really now we are direct care providers. Having a provider status we can meet with our patients one on one 15, 20 minutes, an hour and chat specifically about their disease and drug therapy but the goal being to really reduce hospital admission, decrease health care cost and just have better outcomes for our patients.
I think a lot of people will be surprised to see that they can find … To go to their pharmacist to get immunizations and have changes in the drug therapy in collaboration with the physician or PA or nurse practitioner now so that has greatly changed.
Dr. Lisa: I can attest to that. As I was saying, when I first started in medicine the way that I understood my relationship with pharmacy was much different than I understand it now. As I’m seeing a patient now if I have somebody that I know is going to need more counseling on a medication, I actually have said to them before, “Look, here’s some basics on this medication I’m prescribing but the pharmacy really can give you a lot of great information.” Sometimes it’s more user friendly. They don’t feel quite as intimidated as sitting there with their doctor.
Dr. Jim: Actually. I mean we are considered the drug information expert so our patients really should count on us for that information. That’s something we rely on heavily in pharmacy education is a lot of time and communication and how they can communicate directly with their patients in a simple language that the patient feels comfortable with so that they can retain that information and hopefully improve the outcome.
Dr. Kayla: I think that’s incredibly important. There are so many different walks of like that come through. You may even council a nurse on a medication that they’re not as familiar with but as far as the patients go, making sure that they can understand what you have to explain to them is incredibly important. I think that’s an awesome thing. I really enjoy doing is relating to different kinds of people and making sure they feel comfortable with all the medications that they take.
Dr. Lisa: Kayla, you are originally from Windham. You went to the University of Maine and you are part of the second graduating class of the University of New England. Is it the School of Pharmacy? Is that what it’s officially called?
Dr. Kayla: Yeah, the College of Pharmacy.
Dr. Lisa: College of Pharmacy. How did you decide that you wanted to go into this field?
Dr. Kayla: I got my undergrad at U Maine in biochemistry. I really liked science. I started kind of practicing and studying for my masters in biochemistry and I realized that I didn’t really enjoy working alone in a lab with test tubes and with no one to interact with so I started looking for other opportunities for me to still use my science background but actually meet patients and make a difference. I looked into Pharmacy School and I did a tour at UNE and it was everything I was looking for. The faculty was incredible and I just knew that pharmacy was going to make a lot of sense for me professionally and personally. Once I finally started studying pharmacy I realized that it was exactly where I needed to be.
Dr. Lisa: Jim, you also have a Master of Science in Medical Education and Leadership from the University of New England, College of Medicine. For you education and communication has been very important for quite a while.
Dr. Jim: Yeah, I think even from the beginning I think our pharmacy education teaches us about the importance of educating our patients and other health care professionals. Early in my career I was involved in Brown Bag Series in the mid coast area. At each hospital we’re responsible for educating physicians, nurses, pharmacists, various health care professionals on drug therapy. That even led me to go to Saudi Arabia where I was a part of a program with the royal family. We were there to educate the Saudi pharmacists and Saudi students to help take over the pharmacy and this was in many disciplines. Eventually Saudi took over their own health care system instead of having the westerners run their health care system.
That led me eventually to UNE. UNE has been a wonderful experience where I really thought it was my time to give back. Starting at the college in 2008 as a founding member I was greatly involved in hiring faculty and recruiting the first class of students. It’s been wonderful to educate the students but that led me to think, “You know what? I need a few more skills.” So I did complete a Masters on Medical Education at the University of New England at the College of Medicine.
That was an amazing actually online program where … There’s anywhere from 8 to 10 students in your cohort so I worked with physicians in many disciplines all over the world. Being the only pharmacist in there it was incredible dialog between us on how we’re going to educate the next generation of health care professionals.
Dr. Lisa: I’d like to back up and learn a little bit about what it takes to get your doctorate in pharmacy because this is something that I think people don’t … We think about people who have medical degrees or people who are doctors, who are dentists or vets, veterinarians but it’s a lot of work to become a doctor of pharmacy and it must require not only time spent in the classroom but also hands on time.
Dr. Kayla: We absolutely spend a lot of time in practicum, in labs. We had an incredible opportunity at UNE to really work in a real life setting. We had this incredible laboratory, the Hanford Lab, right? We had labs where we would practice counseling patients. We had actual patients come in for some of our classes so that we could counsel them, practice, really become more immersed in the actual practice of pharmacy as opposed to just the lecture and the didactic portion and along with the things we did in school. We had a number of rotations outside of school that allowed us to really expand ourselves as professionals.
Dr. Jim: To elaborate on that UNE it’s a 4-year doctorate degree. Students can come in either with 2 years of prerequisites but most of our students come in with a 4-years bachelor’s degree already. The curriculum is a total of 4 years where the first 3 years involves primarily work in the classroom with a little bit of internships we call experiential learning. The whole final year, the fourth year, is experiential. Every 6 weeks our students have a new experience. They work under the leadership of a pharmacist throughout Maine, the country, throughout the world to complete those internships. They can be anywhere from an institution rotation at a hospital to a community pharmacy like Apothecary By Design. They can be in Thailand or Spain for global education which is programs that Kayla and I both have participated in.
Dr. Lisa: What types of things can you learn in Spain for example about pharmacy that you couldn’t necessarily learn in Brunswick?
Dr. Jim: I’m going to let Kayla answer. She was really engrained in it there.
Dr. Kayla: That was by far one of the most incredible experiences and I think that it really has made me a better pharmacist as a result. I think the importance of studying not only another culture but their health care how they practice providing for their patients, how they practice pharmacy over there is really incredible.
They have a universal health care system that we are moving towards now. It’s really important for us to learn from people that have already established this kind of health care system so that we can improve upon our own.
I think one of the other things that I really took from my experience was understanding what it’s like to not be understood. I think that that translates everywhere but especially in pharmacy I’ve met a number of patients that don’t speak English as their first language or aren’t as able to understand medical terminology. Really understanding what it’s like to feel as if nobody understands you. I think that that has really opened my eyes to the kind of patient care I need to provide for my patients and it needs to be very individualized.
Dr. Lisa: As you’re talking about this I’m thinking about some of the work that recently they’ve been doing with doctors really across the country and trying to help them understand the importance of medical literacy, of health literacy and terms that doctors think about like congestive heart failure. When you say that to a patient they’re thinking, “Oh my gosh, my heart is failing? What does that mean?”
Some of the things that have long been held … Have made doctors into gods these things are falling that we now know. We can’t just be throwing out terms just because the vocabulary sounds kind of specific and good to us. People need to understand what’s actually going on with their own bodies. They need to participate in their own care.
Dr. Jim: Absolutely. Something that you may not be aware of Dr. Lisa is that’s something we work diligently on at UNE. UNE is one of maybe 7 schools in the nation, or universities in the country I should say that have an interprofessional education collaboration. That means we are really fortunate at UNE that we have a College of Medicine, a College of Pharmacy, a College of Dental Medicine. We have social work, Pas, we have so many health care disciplines that we work together as a team to work on interprofessional education. A lot has to do with educating our patients together in terms that they understand.
One way that’s really amazing that UNE is really proud of is our simulation lab. I think it’s a new trend in medicine where we have in a sense a controlled environment where we have a patient that could be alive or could be a mannequin where we can go in and educate on challenging our difficult cases. It could be a language barrier. It could be maybe a complicated delivery or it could be education for a patient with diabetes. It gives us a chance to really practice that role in a safe environment, to not feel threatened.
Me as an instructor it’s really wonderful to go in there and say, “They don’t know what congestive heart failure means. How are you going to explain it to them?” The students are like, “What do I do?” I’m like, “You’ve got to figure it out. You have this patient right in front of you. What are you going to say them?” They figure it out. It’s pretty amazing actually.
Dr. Lisa: This one thing is also wonderful to hear from you, Jim, because you obviously have quite an extensive educational background yourself and you were able to be there ground floor, let’s create a pharmacy school. Let’s do it in a way that makes sense for today’s students like Kayla when she was going through. I mean that’s a really exciting opportunity and one that I think doesn’t exist everywhere.
Dr. Jim: It doesn’t. I felt really privileged to be a part of that system. When I joined UNE in 2008 I really felt it was my time to give back. I still believe passionately that what we are doing for our profession is amazing and what we are doing for the state of Maine is equally important. For many years we had the brain drain. There was not College of Pharmacy in Maine so our students would leave to go to Boston or Rhode Island or Connecticut and then not return. I thought that was really, really important after being a pharmacist in the 90s where we had a huge shortage.
It’s been really invigorating. I think the thing we really focused on is our commitment and our relationship to our student that we are student focused. One of the things that we find really important from our students is their engagement with the faculty. They feel that it’s a really nurturing environment for learning. They’re just not a number. I think we are a family and I think Kayla can attest to that that our faculty have an open door policy that we’re committed to our students and to our profession in Maine.
Dr. Kayla: Yeah, I would absolutely agree. I established a number of relationships with faculty that really do transcend the relationship traditionally seen between a student and a professor. You really have the opportunity to speak with them about not just the test you took last week or the questions you got wrong, but hey, I’m applying for a job, I need help. I don’t know what salary to ask for. I don’t know what job I need to look for. Those sort of guiding mentorship type relationships and I’ve met quite a few faculty members that have definitely influenced my career and how I practice and given me somebody to look up to and really interact with even after school has ended.
Speaker 1: There was a time when the Apothecary was a place where you could get safe, reliable medicines carefully prepared by experienced professionals coupled with care and attention focused on you and your unique health concerns. Apothecary By Design is built around the forgotten notion that you don’t just need your prescriptions filled. You need attention, advice and individual care. Visit their website Apothecarybydesign.com or drop by the store at 84 Marginal Way in Portland and experience pharmacy care the way it was meant to be.
Experienced chef and owner Harding Lee Smith’s newest hit restaurant Boone’s Fish House &Oyster Room, Maine seafood at its finest joining sister restaurants The Front Room, The Grill Room and The Corner Room. This newly renovated 2-storey restaurant at 86 Commercial Street on Custom House Wharf overlooks scenic Portland Harbor. Watch lobstermen bring in the daily catch as you enjoy baked stuffed lobster, raw bar and wood fired flat breads. For more information visit www.theroomsportland.com.
Dr. Lisa: Kayla, I would think that it would also be very interesting for you as a student have experienced say the Hanford Pharmacy, the Walgreens, Apothecary By Design and to really see that there are different business models, there are different patient-provider interaction models and have the opportunity to decide where you best fit.
Dr. Kayla: I think that’s where the experiential education became extremely crucial in understanding not only pharmacy but myself and where I wanted to practice. I went to a number of incredible sites. I was in Norway, Maine at a small hospital, Stephens Memorial and it was a beautiful commute. It was in the fall so all the leaves were changing.
I was in Spain. I went to Apothecary By Design and I saw pharmacy practice in so many different lights and it was incredible to glean a little bit from each of those sites and really incorporate that into how I practice and really how I wanted to continue my career. I think it was absolutely the experiential education that showed me the parts of pharmacy that I didn’t necessarily knew existed or knew were so amazing.
Dr. Jim: Thank you Kayla. I think what we do is really, really important. I mean as I said earlier, students have to complete 6 internships or rotations. They do gain something a little bit from each of them. It’s pretty amazing now we’re in autumn and they’ve just been doing this for 3 or 4 months. They’re still a little nervous. For me to see where they’re going to be in February, March, April it’s amazing just the maturity and growth that comes along. May comes around it’s like, “Wow, they’re ready to practice” and it makes us feel really good.
Dr. Kayla: You would think that after all the school that you have completed those first 3 years before you go off that you would be fresh and ready to go and know everything and then once you get into practice you realize that nothing is like the book. It’s really a different kind of learning altogether. There definitely is a transition between your first rotation where you’re nervous and you don’t even know where to start. Everything that you’ve practiced in your books, “No, this doesn’t really apply here. Clinically that’s really not relevant.” It definitely is a huge transition as a person, as a professional to start at week 1 in your first rotation and then actually finish your last rotation and think about sitting for your boards and taking care of patients. There’s an incredible evolution in that last year.
Dr. Jim: It’s really wonderful. Nothing makes me happier to have a student say in September, October, “Dr. Krebs I don’t know what I want to do.” I’m like, “Great, because you’re going to figure it out by May.” I’ll see them in April and they’ll be like, “You know what? I’ve taken a position here” or “I got accepted to a residency.” It’s amazing the growth that occurs in the last 9 months of the education.
Dr. Kayla: It’s terrifying too because you go out, it’s your last year of school. You should be thinking about getting a job. You should be thinking about applying, residencies, interviews, and it becomes very daunting. I know when I first started my first rotation I went to Spain and I thought I’ve been doing everything wrong. I should be living Spain. This is amazing. I love it here. I almost tossed my passport in the river and stayed but I knew I had to finish school and I came back and I was so lucky to have had Apothecary as my first American rotation.
I didn’t realize how incredible pharmacy could be. As much as I loved it before I came to Apothecary and I realized that these people are on the phone for an hour with insurance companies to get a paid claim to go through. They are talking to patients. They are on call on the weekends to make sure if patients have problems or questions they are available to answer them. I was very lucky because I thought … I came back from Spain and had that post Europe depression deal. What am I doing with my life? Apothecary was incredibly inspiring.
Denali she was my preceptor at Apothecary, one of the pharmacists there, she became an inspiration to me, a mentor and a friend. I knew after the first week that I needed to work there. I finished the rest of my rotations and I loved them. I learned a lot at every one. Always in the back of my mind I knew Spain was not an option at this time so I thought, “If I’m going to stay here I would just love to work at Apothecary. I would be just so lucky to have that opportunity.” A position opened up and I snuck right in there and I haven’t had any regrets.
Dr. Lisa: The main thing I think is … I mean the main connection I think becomes more important that we realize. I know that Jim you’ve worked up at Mid Coast and now you’re at UNE and apparently you and I knew each other unbeknownst to me at a time when I was prescribing medicine when I practiced in Yarmouth.
Dr. Jim: It was all appropriate.
Dr. Lisa: Yes, I’m sure … I’m assuming I did a good job with my prescriptions. It really is interesting to me that especially in Maine people are more connected than we realize. I mean you can meet somebody and then 10 years later you can actually put a name to a face. The relationship becomes so important especially, Jim, you are in South Freeport is that where you live?
Dr. Jim: Yeah, the connections are incredible. I mean I came to Maine in 1994 when I had my BS in pharmacy and I worked for [inaudible 00:53:08] Hospital but I also worked per diem for Hanford Pharmacy and I traveled throughout the state because there was a huge pharmacist shortage. I got to meet pharmacists and people from all over the state and it’s amazing 20 years later of who knows who. I think that’s been part of my –
Dr. Kayla: It’s kind of scary.
Dr. Jim: It is scary. It’s part of my success at UNE is the connections. I think that’s part of UNE’s branding is about our connections but it is really important especially in Maine. I think old school is who you know but I think it’s more about the relationship you build with them but the connections are amazing, yeah.
Dr. Lisa: I would think also Kayla with you having been raised in Windham, I mean you work at Apothecary there’s got to still be people that you know from –
Dr. Kayla: All the time. I run into people who knew my nanny or lived next door to my uncle and it’s an incredible … I bring up, “Hey, yeah, I work at Apothecary.” “Oh, really? I know somebody that works there.” “Yeah, my friend writes prescriptions and they send him over there all the time.” It’s just you never can escape it and that’s one of those beautiful things that you always have support no matter where you are in Maine anyways. I’ve always felt like anywhere I turn I’m going to run into somebody who knows somebody. It’s incredible.
I did a lot of traveling in Maine for my rotations. I did one in Calais and I reached out up there a friend of mine who went to Calais before me for a rotation had said, “Hey, there’s this really great girl, this lady Ede. She’s awesome. You’re going to love her. You should stay with her. Reach out to her. See if you can stay with her.” Because I had to find a place to stay for that 4 weeks I was up there.
I reached out and made a great friend in her. It was all because I knew a guy who had gone there before, who had met somebody and made a friend and connected me with them. I feel like a lot of my rotations have all been about reaching out to people that I know. Hey, I’m going to be in your area for the next 6 weeks. I need a place to stay. Everybody has always been happy to take me in even if it’s a friend of a friend.
Dr. Lisa: I’ve also found … I just saw a patient yesterday who I was in Girl Scouts with, 30 something years ago. I used to deliver babies of people that I went to high school with. I have found also that it really contributes to the sense that you do want to care for these people in your community, in your life because they’re important. They are your nanny’s friend or they’re somebody that went to school with your brother. I mean this is our community and being able to offer advice as a pharmacist or care as a doctor it’s something that you really want to be able to do.
Dr. Jim: Absolutely. You made me think, Dr. Lisa, students as we chat about career options and they’re like, “Jim, I’m not sure if I want to be a hospital pharmacist. I don’t want to be on call and I don’t want to work holidays.” I always say, “You know what? I never got frustrated when I had to work Thanksgiving or any other holiday because I was like I’m taking care of my community. Yeah, it stinks I’m not home with my family but you know what, it’s important that I’m hear.” I try to share that with our students. I hope they’re getting it.
Dr. Kayla: Yeah, yeah, I absolutely agree.
Dr. Lisa: Where can we find out more, Jim, about the University of New England and their Pharmacy School?
Dr. Jim: The best thing to do is go to www.une.edu and link on the College of Pharmacy. I really encourage people to drop by the college themselves.
Dr. Lisa: Kayla, can you remind us how we can learn more about Apothecary By Design?
Dr. Kayla: Yeah, you can definitely stop by. We love to meet new people and you can always find cool stuff at our retail location. You can visit us online at www.apothecarybydesign.com.
Dr. Lisa: Well this has been an exciting conversation for me. I always learn things when I sit down and talk to people about what’s going on and I think what’s happening here with pharmacy in the state of Maine is exciting. It’s exciting for doctors and health care providers but also for patients and community members. We’ve been speaking with Dr. Jim, James Krebs who is the University of New England’s Assistant Dean for Experiential Education and Dr. Kayla Stewart who is –
Dr. Kayla: Yay!
Dr. Lisa: Yay! Congratulations on that doctorate. I know you worked hard for it. Who is a University of New England graduate and now an Apothecary By Design pharmacist. Thank you for the work that you’re doing and for the education that you’re bringing to our community.
Dr. Jim: Great, thank you.
Dr. Kayla: Thanks Dr. Lisa.
Dr. Lisa: You’ve been listening to Love Maine Radio Show No. 164: Maine’s Pharmacy Experts. Our guests have included Catherine Cloudman, Greg Mitchell, Dr. Jim Krebs and Dr. Kayla Stewart. For more information on our guests and extended interviews visit themainemag.com/radio. Love Maine Radio is downloadable for free on iTunes. For a preview of each week’s show sign up for our enews letter and like our Love Maine Radio Facebook page. Follow me as @doctorlisa on Twitter and see my daily running photos as Bountiful One on Instagram.
We love to hear from you so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows. Also, let our sponsors know that you have heard about them here. We are privileged that they enable us to bring Love Maine Radio to you each week.
This is Dr. Lisa Belisle. I hope that you’ve enjoyed Maine’s Pharmacy Experts. Thank you for allowing me to be a part of your day. May you have a bountiful life.
Speaker 1: Love Maine Radio is made possible with the support of the following generous sponsors: Maine Magazine, Marci Booth of Booth Maine, Apothecary By Design, Mike LePage and Beth Franklin of RE/MAX Heritage, Tom Shepard of Shepard Financial, Harding Lee Smith of The Rooms and Bangor Savings Bank. Love Maine Radio with Dr. Lisa Belisle is recorded in the studio of Maine Magazine at 75 Market Street, Portland, Maine. Our executive producers are Kevin Thomas, Susan Grisanti and Dr. Lisa Belisle. Our assistant producer is Leanne Ouimet. Audio production and original music by John C. McCain, our online editor is Kelly Clinton.
Love Maine Radio is available for download free on iTunes. See the Love Maine Radio Facebook page or www.lovemaineradio.com for details.