The Hidden Cost of Managing Pain Without a Pain Pharmacist | TWIRx

0:01Hey, on this week in pharmacy, we are going to be covering a special edition. It's titled The Hidden Cost of Managing Pain without a Pain pharmacist. shout out to dr singh ping chow farm d and matthew her menu farm d they're going to be talking about hey what is the hidden cost of managing pain when you don't have a pharmacist involved this is big and it's prefacing a super opportunity for us to dig into pain management Not sure if you guys heard of the pharmacy debacle out on social media, on Instagram. It's happening on TikTok. Claudia Morandi, who's with the Doctor Patient Forum. She does some amazing work for pain management patients and advocacy for pain management patients.

1:01She took shots at pharmacists and Shane Jaraminski, our friend in pharmacy, Dr. Jaraminski, has come to the defense of our profession. And I reached out to Claudia, who's been on the Pharmacy Podcast Network before, and she has agreed, along with her associate, to come on and talk with Shane. And we may have some special guests accompanying Shane that are not verified yet. But I want you to know, you're going to want to tune in. This is going to be a big deal for us featuring this discussion. So today's discussion with regards to pharmacists who focus on pain management is a really good preface to this episode.

1:54Hey, are you going to the NACDS, the National Association of Chain Drug Stores, Total Store Expo 2026 in Boston? We will be in Beantown covering the event as press will be teamed up with First Data Bank in their booth. It's going to be a great time. If you're going to be in Boston, make sure you reach out to me. Make sure that you get scheduled in with the Pharmacy Podcast Network's podcast press coverage. Hey, we also have a special episode feature, second part of today's twerks, U.S. News Best Hospitals Report from U.S. News and World Report, 2026-2027. we're going to go through what are the best hospitals out there right now and health systems out there.

2:40And are you working at one? If you are a pharmacist at one of these hospitals, actually, I'd like to hear from you. What makes a hospital system a good place to work at as a pharmacist? Today is August 20. I'm sorry, 20. What am I saying? Today is August 7, 2026. This is This Week in Pharmacy.

3:11Thank you.

3:38Welcome back to another episode of, you know, I've been thinking about what to call this series because I previously have another series called Open Convergible Club Series. And I'm thinking maybe I'm just going to call this Pain Conversation because what I'm really doing right now is to invite insiders in the field and have a really good conversation on what's happening in the pain management realm. And so today I invited my friend who is also a pain management pharmacist who is working in a hospital right now. And he is a pro in pain management because we both passed the BCPMP, which is the new board exam on pain management.

4:20I'm not going to steal his thunder. Hi, Matt. Welcome to our podcast. Thank you so much for having me, SingTing. Really excited to be here. Thank you. Pleasure is on me. So can you tell us about how you end up in pain management or I guess how do you choose pain management in the beginning? Yeah, of course. So it's kind of an interesting route I took, a more untraditional route that I love to share with students because everybody thinks you need to go right into a PGY-2 after you finish pharmacy school or PGY-1, then PGY-2. But when I actually graduated school, I was working in retail pharmacy already and I decided that I was going to stay in retail for a little bit and pay off some of my student loans because that was just more pressing at the time.

5:02I basically did that. I worked in retail for in total my life, I've almost worked in retail about like eight years now, but at the time I worked for about a year after school, 100 % as retail pharmacist, and I kind of was hustling on the side too, still trying to like do a lot of publications and work with the really amazing antimicrobial stewardship team at the VA in Providence, Rhode Island, headed by now Dean Kerry LaPlante, a pharmacist out of University of Rhode Island. So we were doing some manuscripts and I was really working hard to get like published a lot, kind of get my foot into the door in like a clinical way.

5:37And it was when I was working in retail pharmacy, I had a lot of interactions with patients for opioid use disorder, as well as chronic pain. There was a clinic right down the street from us at the CVS that I worked at that was mainly buprenorphine prescribing. So there were a lot of encounters I had with patients where it would be either patients getting like buprenorphine for opioid use disorder or even sometimes like just like different counseling for chronic pain with like opioids for patients. So it was kind of a combination of that. And then during pharmacy school itself, one of my good friends and I, we actually worked on this proposal to send to professional sports teams because we found that there was a like a niche area for a pharmacist helping with pain management because at the time it was kind of the opioid epidemic where we kind of saw these little like stories of players getting like certain amounts of opioids and just like the substance use disorder aspect of it as well so we felt that there was like a niche area for a pharmacist and we sent a proposal to like the NFL at the time.

6:39And we got addresses for like all the executives and we didn't hear back, but it was an interesting like development into this interest for pain management. And then I think I started looking at the late, great Jeff Feudin and a lot of his online presence at the time. So he was really one of the big innovators, I think, for pain management, as well as Mary Lynn McPherson too, in palliative care. So I think the two of them really inspired me the most to like look at this niche field and kind of pursue it. You know when you bring up Dr. Feudin and Dr. McPherson they are likely the cornerstone of a lot of the pain management concepts that we're still currently using you know with opioid conversion especially I know this is a forever controversial topic so to speak some of us like it some of us are still a little apprehensive even for me like when it gets to certain doses sometimes it doesn't really follow the conversion anymore there's a lot of other things like even buprenorphine it's something that Dr.

7:43Fuden also looked into as well so yes I am glad that they inspired you now how did you bridge your career from retail back to residency because I always hear from others that the mindset adjustment is so difficult. So how did you get around that at the time? That's a great question. So it can be overwhelming at first. I think because I came out of school and I was pretty a recent graduate, that allowed me to kind of keep that student at heart mindset. And I still keep that mindset today because there's days where I just, I'll learn something completely different. Like last week, for example, there was a patient that we were consult for that I was pregnant.

8:25So like I have to see a variety of patients and there was stuff that I knew, some stuff that I didn't know. Ironically, I like brought up like pregnancy categories and like that's not even a thing anymore. So like there's a lot of stuff that I'm always learning every day and relearning. But I think that was one of the biggest things for me was being fresh out of school. I will say like during interviews, there were times where that was like used against me, right? Like sometimes it'd be like, well, why didn't you go right out of school into residency? And not every institution, not every program would say that.

8:56It's different for everyone. So I come from like a, I try to look at it from a whole, like a whole perspective, like someone's background maybe. But I pretty much just used it as a way of gaining more experience because I was literally managing other technicians and even interns at the time when I was working in retail pharmacy. So in a way, it's a big difference when you're working full time versus in residency because you're not having to manage other people necessarily. necessarily, maybe as a PGY2, you'd be making like a PGY1 or like helping educate or helping with students too. But I kind of used that as an advantage to like my knowledge of being able to take on a leadership role in retail pharmacy.

9:34And then at the same time, I kept doing research in addition to that. So I think had I not done research and tried to keep my foot in the door in a clinical manner, I don't know if I would have like had as much of an opportunity for my PGY1 because I ended up doing my PG-B-1 at the Providence VA where I was doing so much research. So getting my name out there and being really present and just having more opportunities and trying my best to seize the opportunity in the right moment, I think, helped me a lot in my career, definitely. I hope that P4s and people who are currently working in the retail route, hoping to bridge back to a residency route, I hope they all hear your answers because this is something that they need to hear a lot of times.

10:22What I seem to come across on LinkedIn and really talking to other colleagues is like, you know, once I'm in retail and, you know, how do I get back into the clinical route, right? but you know it's about how we approach what we have learned and all those skills like like you were saying the skills that we learn in retail those are very valuable and it's also so unique so I hope that everyone who's listening to this right now take notes because that is so important for interview questions for residency I'm not gonna lie it wasn't easy there were nights where I would close the pharmacy then take a red eye for an interview for PGI one so like there were definitely sacrifices like of your time as well.

11:08I at the time my responsibilities were like mainly myself like I didn't have like a family yet or like an animal. It's a it was just the right time for me but there were moments where it was like quite stressful with like the balancing of both but it can be done. Thank you and I do want to start shifting gear to our conversation today about the value of pain management pharmacist because it's something that when I talk to a lot of you know non pharmacist colleagues when I tell them that hey you know I'm a pain management pharmacist they're like oh you're a pain management pharmacist what are you doing you know they have all heard of pharmacists but when it comes to pain management pharmacists that role sounds like it's kind of rare like sometimes people don't necessarily come across and so they don't even know what our job entails sometimes so with that said do you feel like pain management pharmacists in general do you feel like we are underutilized or do you feel like pharmacists are underutilized I think that's a better question are pharmacists underutilized in the pain management realm yeah Yeah, that's another great talking point.

12:25So, I mean, like I jokingly said to my wife yesterday, we could solve so many problems if we all just put each other in a room and went around the circle and shared what we can actually do. Because like there's a lot of just unknowns, I think, to each. We've become such the healthcare system. I'm not going to go on a soapbox, but like basically like we have so many different skills from different people, right? But we don't know what these skills are necessarily from each individual person. For example, some of my social workers on our palliative care team actually are quite clinical as well. So you can actually have a variety of skill sets from different members of your team.

13:03And if you share those experiences, or maybe you could shadow the person for the day, learn quite a bit of what their abilities are. I can tell you in my system, when I first started, I jumped right into our outpatient clinics, chronic pain, as well as the palliative care clinics. and there was never a pharmacist in these kind of roles before. And I think they just, people just weren't aware that, you know, pharmacists could do these kind of different roles as well as inpatient too. But I just basically took what I had from my prior experiences in residency and just applied it to my current role.

13:33The areas of underutilization, I would say, so I can like lump it into two different buckets. There was an inpatient bucket and then there was like an outpatient bucket in my mind. From the inpatient side, I think, you know, some of the areas of interest just for my area or work would be perioperative care. So like post-acute care, PACUs, and perioperative medicine. I think pharmacists, and especially with a pain management background, would be an interesting position to have in this area. And I remember actually interviewing at a facility up north in, I think it was Mass General, that was hiring for this kind of position a couple of years ago.

14:10And it's still growing and developing, but I do believe there's a significant value for the pharmacist, especially with a PGY2 in pain or palliative care background. And then another area of interest, this is like selfish, but gene therapy. So gene therapy with sickle cell is a very niche area that's growing quite fast. And I think obviously having a hematologic background, but also having a training in pain management would be an interesting kind of like pairing for someone that would maybe be undergoing gene therapy that has sickle cell disease. And I think what we'll see in the future definitely will be more and more patients receiving this kind of curative therapy.

14:46Once the costs kind of go down and allow health systems to receive some sort of compensation, there has to be some sort of mutual agreement with them and the insurance and the drug company themselves. But this is another area of interest. The biggest area, though, I would say on the inpatient side would be transitions of care. And this is kind of a bridge between inpatient to outpatient, but I'll just lump it into inpatient for a second. This is the highest opportunity for, I think, mistakes to kind of start to happen when someone is being discharged. And I think because it's almost like that game where you tell someone something on the telephone, then they tell something to someone else.

15:24They repeat the same message over and over and over again, and it gets lost in communication. And I think this happens with, like, say you're the specialist team. You put a recommendation in. it could be in text, but that gets communicated to the primary team. And then that primary team maybe perceived something in their own sort of way. And then that gets prescribed to the pharmacy. And then the pharmacy may be like, then there's like, there's just a lot of room for error where they don't have it in stock necessarily, or maybe it's not covered by the insurance. And then the aspect of the counseling of the patient before they're discharged, like it's very situational, right?

15:58If someone is taking chronic opioids for cancer pain, like they're not going to really like taper like opioids but if they're having like a surgery that they don't have cancer related pain and it's a surgery that you'd expect their pain to improve on they're going to be like tapering like opioids or it's a short course of opioids right so it's a very different patient and i think just sitting with the patient and educating them on like the different aspects of like not only what an opioid is but also like maybe if you're on two different types of opioids like a long acting and a short acting where this might have been started up for the first time while you've been in the hospital and it's been given to you by a nurse, right?

16:34Like everything's been given to you. You haven't had to do anything yourself yet. And now you're kind of being like going back into the real world, right? So there's like a lot of opportunity for the pharmacist in a transitions of care role, but I think also like the pain pharmacist can definitely assist in that role. And I see this at my hospital because I do it a lot too. So I can, I can see it firsthand. You touched on so many high points just now, and I just want to point a few things because it's really valuable, and I want the audience to actually hear it again, is how much value is transition of care?

17:14And it is something that often falls in between silos because the way that clinicians are thinking is you know it's in your inpatient or outpatient and when we're done with the job inpatient right and then the patient is being sent off to outpatient and you and i have a discussion before that we are very lucky to have like almost like a closed loop system where you know we have our associated clinics to capture those patients within the same system and i could only imagine how things are like if they are maybe you know they're going back to private sector or individual clinics that are not really associated by any hospital systems and how easy things can really fall through the crack the other thing i also want to comment on which really resonates a lot with me is the education portion because a lot of times when I talk to a patient I keep things very open and I start with a very basic I would ask them has anybody talked to you about the pain medications you're taking I'm not even talking about like the opioid medications you're taking I'm just keep it as simple as they can because I don't want to assume that they already know a lot and so when you really ask the very fundamental basic question they're like no I was just sit there for 10-15 minutes and really giving them the high points of okay this is short acting and this is long acting and when you see the light bulbs moment in their eye then you know that this is the piece that nobody really talked to them about which is very understandable because I work in an inpatient setting and a lot of times time is of essence we may not have the luxury to really sit down and talk to patients unless you are the designated role being in the pain management field but i also feel like this is something that is often missed like you said but it's so important because there's a lot of research that shows that patients may not have as high of a health literacy like we would think and when we're dealing with opioid which is such high risk it's something that we just should not skip the counseling and unfortunately in the system we're skipping that a lot yeah yeah and also just touching on like what you said like that's such a great point about like healthcare literacy.

19:53I mean, sometimes I have conversations with other providers from other sites around the world, I guess, like around our country more. And I don't think that we always appreciate understanding what someone's baseline healthcare, like health literacy is, because like I said, there's patients where they just don't understand the long acting and a short acting at the same time. Then you add on all these adjuvants that it seems like a perfect scenario, right? So like have someone on like all these non-opioids and then like try and avoid opioids. There's instances where I have someone with cancer-related pain where sometimes they're on one medication because it's such a difficult, it's very challenging to bridge the gap with the healthcare literacy.

20:34This is where language barrier plays a role in Miami. I would have never expected this when I moved to Miami, but there's a large percentage of patients that are Haitian Creole speaking. and that's something that the Haitian Creole dialect does not always translate to English like very well so emotions feelings are not always very very obvious in the Haitian Creole language and sometimes patients almost feel like they're being a burden if they talk about their pain and express like feelings of sadness or grief so if you don't have the kind of knowledge and perception or awareness I would say as a like healthcare like professional when you're talking to someone is that's of this background you might miss some areas but going into the outpatient kind of bucket now i think the outpatient area really would stand to benefit from more like primary cares that maybe they want to engage in like pain management but they don't really have the backup and i think the the va does a great job of this because like like i did my training of pdri1 at a va and a lot of my like ambulatory care knowledge came from that setting and it's so collaborative.

21:40Like we had the interdisciplinary clinics too for chronic pain as well. And that was run by a primary care. At the same time, they had patients like psychologists, had psychiatrists, physical therapists, occupational therapists. So they had a full team that could kind of support them. And I think that the pharmacist could also be like the backup for the primary care in the setting kind of as well. And I think it's a huge area of opportunity as well for like a rural rural setting or a community that maybe they don't have access to as many specialists, where it might be a little more limited. And you could kind of flex that collaborative practice and really help kind of be the backup to that primary care, not only clinically, but also regulatory as well.

22:20You could kind of own the regulatory aspect of pain management prescribing of medications too, whether it's like compliance with like urine drug screens or controlled substance agreements like being signed. Just doing more of that background training would be very valuable for, I think, the primary care that there's so many things going on where they're maybe not able to give every patient as much time, especially with interviewing, motivational interviewing in this area. I think pharmacists will play a huge role in too. Yeah, there's really a lot of area that sits in the outpatient setting that a outpatient pharmacist, I guess outpatient pain management pharmacist can really provide a lot of value and it's almost like we go in tandem because you know we think about how to streamline things being a pain management pharmacist we are so well versed in interpreting urine drug screening and interpreting PDMP which is something that I know for some of the physicians they would delegate that to someone else I would imagine if you delegate it to a pain management pharmacists when we really look at the data holistically instead of just looking at the first three lines and just call it a day like that also provide a lot of value because every little piece of you know let it be urine drug screen or prescription drug monitoring program they all fall into the bucket of universal precaution i think that's a best way to call it it's just like antimicrobial stewardship you know in antimicrobial stewardship we check for the we check for whether or not bacteria is sensitive to a certain antibiotics and it's a very similar sets of rules just in different contexts in pain management we still want to check the prescription drug monitoring program and the drug screen to really make sure that we're doing things safely especially when we prescribe opioid.

24:25Something that I also like when you point out just now which again really hits home is the cultural competence. I haven't heard of this topic on cultural competence for some time now because a lot of times we're just broadly talking about pain management but when we really talk about like especially in America where it's you know we have different ethnicity city, so many different people speak different languages. I come from a family that, you know, we speak Cantonese. My mom, when she called me, she can't even say some of the, you know, drug names. And it's a very, it's a very important thing to notice and pay attention to the cultural competence perspective, because the way that, especially how I can speak for some of the Asian culture just like you were saying is that we would think that especially in the older generation we think that having pain or having any kind of mental health issue it's a shame we're not even thinking that it's it's something that we can openly talk about because if we talk about taking psychiatric medications people would think that there's something wrong with you and we grew up with that kind of mindset grew up with that kind of culture and when we come here where people openly talk about that talk about pain management or talk about mental health that's a that's a almost like it's a cultural difference that we need to pick up on from patients so that's something very important and I'm glad that you pointed out.

26:09Yeah no you hit it you hit the nail on the head spot on it's almost like it's a very I think with age too. Like you said, there's different like age groups that they view it almost as a shame. Like there's something that's something that's wrong with them. Maybe talking to someone is like a sign of weakness. Like these kind of areas that are really important that we can kind of break those, break down some of those barriers. And it's just one more thing that is the bucket of like complex psychosocial management. I mean, that's why like pain used to be so black and life and now we're like taking this more like holistic approach to it so it's a great it's a there you do a whole nother podcast on that alone absolutely it's all kinds of gray we are all navigating in this realm now we talk a lot um about how patent pharmacists can provide value just now and and all these gaps that we can potentially fill in and i want to talk more about and again shift gear a little bit and building up a conversation I was having in the last time with another pain management pharmacist she's actually a residency director I want to talk more about the education because you were mentioning that for a pain management pharmacist there is the inpatient there is the outpatient and there's this you know silo it's called transition of care so for someone who is exploring PGY2 pain management which we only have maybe like 30 ish programs right now and a lot of times only like half of them are being filled what kind of guidance or advice can you give them so to help them navigate what would be the best programs or what should they ask themselves or ask their peers more as they're figuring out what program is suitable for them?

28:08Yeah I think whatever like you want to feel comfortable with the program that you're gonna obviously choose for your PGY too and there's a lot of ways to go about this. For me it really started off during my I went to mid-year for my when I was a PGY1 and I went to a roundtable discussion and little to little to what I knew a roundtable discussion is usually like practicing pharmacists or a lot of PGY2 directors. And I mean, like, it was a blessing in disguise because I was, you know, just a PGY1. Like, I didn't know much about pain at the time. I thought I knew some stuff, but I was just sitting in on this kind of, like, broad discussion of, like, which drugs were approved at their hospitals or which, you know, like, why was naloxone events occurring?

28:51You know, it was a really, like, an amazing experience to hear it from all these different PGY2 directors. And I started talking with one in particular, which it was ironic because I thought I was going to be like, I came from a VA. I was like, I want to do a PGY2 at a VA. And I started talking to one of the directors, Dr. Joe Camilleri from UF Health Jacksonville. And we just really hit it off. Like it was very, like a lot of mutual interests and very, very personable and professional at the same time. I just felt like we just had a good connection from my PGY2 director. And I said, you know what, I'll give it a try.

29:25He's like, trust me, you're going to want to interview at our program. And I'm like, all right, like, I'll give it a try. like let's see what it's about and I interviewed at a bunch of different programs VA's and like non VA's like UF as well as like Johns Hopkins like I was very blessed I was very very fortunate to be selected for my PGY1 and then you go into PGY2 and you have a lot more opportunity like I was very fortunate to have these interviews at these different sites and I think when I was interviewing you start to learn to like ask different questions when you're like interviewing obviously the dynamics of like the directors too but clinically like what do the different rotations look like at that site so you can start to see like certain programs my program in particular had like a wide variety of exposures so at UF Health Jacksonville we had inpatient exposures where you could do a trauma or you could do acute pain service or you could do palliative care inpatient or like sickle cell management within acute pain and then like outpatient exposures as well we're like very opportunistic there so So we had chronic pain you can do.

30:28We had even exposures for addiction medicine as well, and palliative care outpatient. There were just a lot of different opportunities. In addition to Dr. Joe Camilleri, I was also working with Brittany at the time, where she was a pain stewardship pharmacist at UF Health Jacksonville. So she was also like a co-director for me and monumental in my training. And I learned a lot about pain stewardship as well. So by having that exposure to not only inpatient, at the more select like consult service level, but then also pain stewardship, creating policies, creating rules, working with collaborative teams, you know, like committees to create rules and policies and seeing the larger impact on patients and then the outpatient perspective as well.

31:12And then on top of that, I got to be trained also by like an NP on top of that with our physicians for our acute pain services. So when I was interviewing for different programs, I would ask this kind of questions. And I would understand maybe there was a flavor for the whole program towards more of a tilt in one direction, right? And everybody's going to have different interests. And I just wanted to go into a program that kind of allowed me to try out every sort of like area of pain management, palliative care, and then see what I liked. And then I knew when I was going to my like next job as a pain stewardship pharmacist, I'm kind of a hybrid role.

31:50So I do like pain stewardship but I also flex time with our consult services so I think like my training really allowed me to be that flexible as well as the sickle cell knowledge too from my training in Jacksonville I don't know that I probably could have learned a lot because I have learned a lot on the job with our hematologist who's been here for like 30 years but I believe that that background knowledge really helped set me up for my current role with like so heavy for sickle cell disease. Thank you for sharing that and you packed a lot of like different perspective for like a let it be a P4 or a PGY1 who is interested in pain management.

32:35Just to kind of recap some of the things which I also think that it's very valuable is the experience with palliative care, inpatient, outpatient, you know, all of these are, they have different set of almost like rules and, you know, different settings and they have different dynamics. So it's important to feel it out. And there's also a big part, which is stewardship. You and I, you know, we have talked a lot about the idea of stewardship and that's another ball game, right because it's it's almost like you're not just dealing with a clinical situation but you are also figuring out a systemic level kind of solution on how to tackle this recurring problem so it's not just a one-off consult but you're figuring out with the team and so that involves leadership and negotiation and also process there's all kind of skill sets that's required there and of course sickle cell is something that I never really got a chance to learn back in residency or even in my current setting which is also something that is almost like a another niche that someone can really specialize in so I'm glad that you were pointing all these out because my experience interacting with a fourth year or a first year resident they a lot of us don't know what pain management entails and this what you said just now was what a pain management pharmacist can potentially do and i think it's very important for a resident or a fourth year to experience just a little bit of everything because in reality you likely won't be doing everything but you really want to see you know which one really you gravitate towards because I like to tell this to my students and and residents that if you are spending eight hours a day to work might as well find something that you really find yourself passionate about so before we wrap up we also want to talk about a recent board exam which is the bcpmp exam that matt and i are very fortunate that we took our first pass and we also passed the exam so matt i know you're working on something very exciting for the exam can you tell us something about it Yeah.

35:19So through Pharmless Health, my company that created with my wife a few years ago, we created this program called Pain-Free BCPMP. So it is a resource for pharmacists that are trying to prepare for the BCPMP. And it really is like the firsthand guide of what everything that I would have wanted when I was studying for BCPMP. So it's got a 250 question like practice test and answer rationale like test bank, as well as a study guide with all the content pillars that met everything appropriate for someone preparing for the exam. And we even started to add in this one last exclusive feature, which is a one hour live Q &A with anyone who's a customer who purchases the pain-free BCPMP, where you can ask any questions you have regarding the BCPMP, anything that you have maybe that you were confused about while you're studying.

36:13and in sort of a live setting accorded for any sort of customers. But the main reason I started me on this path of creating this resource was, like I said, I really struggled when I was studying for it because I was balancing working at the same time and my personal life with my wife and our animals. It just started to really consume me. Even the process of creating the study guide took me months after the test. I think also too like when I took the exam there were a lot of things that I wasn't maybe expecting that I would have thought Weren't gonna be on the exams, you know Like if you're a PGY2 coming right out of residency so much clinical knowledge and you're gonna be like ready to go But just understand that this test is not only clinical.

36:55There's like also a lot of men. There's managerial questions There's ethical questions There's even some like legal questions to like regarding collaborative practice and just generalist stuff like that So it's really an all-encompassing exam. And I really just wanted to create a sort of resource that would compress the time that someone could use to study and not be lost when they were studying for it. Especially because I noticed that they extended the window to sign up for the exam this year. It's much, much larger. When we were able to sign up last year, I believe it was a shorter window of time, like two to three months.

37:30So you had to commit. Everybody was very eager, right? And that made you commit to studying. and this year it's the window to sign up is from February to August so you can literally sign up a month before the exam and like sit for it which was like very it's very very different so I think like I wanted to create a resource that compressed time tried to like honestly save someone money from like having to retake the test because the first time pass rate was 60 percent and a lot of the people who wanted to take the test were already practicing clinicians for like 20 plus years or like PGY2 backgrounds like yourself and I, where we're very eager to take the test and wanting to learn every day and like trying to, we're just going through different studies every day.

38:13It's very like student heavy almost like the knowledge is like we want to learn every day. So basically that is why I created like a pain-free BCMPMP and started to officially launch it a few months ago. I think it was back in February. I do remember when I was taking the exam and there are things that I just wasn't expecting to be in that much details. I know I'm gonna only say so much on this podcast without too much spoilers and looking back I do wish that there are more materials because when you and I take it the official materials weren't released at the time and so I think for the people who actually pass we really rely heavily on our existing knowledge and hope that you know based off of that we will be able to shine in the exam so for any of us who for any of us who are interested in finding out more of your study guide how can they get in touch with you and is there any like promotion that you have going on right now yeah so we're available you can reach us at info at farmless health.com or farmless farmlesshealth.com if you just want to find us on the web and we also like farmlesshealth.com slash offer if that's where you want to find a pain-free bcpmp but it's on the website and for like anyone listening to this podcast with singping like singping and i are like really good friends and like i really appreciate his knowledge and ability to want to keep learning through like pain management so anyone who takes the time to like listen to this podcast i would be willing to give like a special promotion of like 20 off for any of our products because i really want more people to get access to it.

39:56And that special code would be P-H-A-R-M-L-E-S-S 20 would be the special promo code. And like I said, anyone who is a listener of your podcast, I'll extend that offer and you can find us there. And I'm also on LinkedIn. We both love LinkedIn. I think it's like one of the best resources for pharmacists in this day and age. It's like almost Instagram too is very popular and TikTok is also really popular, but I live on LinkedIn. So you can find me on LinkedIn. It's just my, just look me up on LinkedIn, Matthew Hermineau. And I try to post a resource every other day or so. Like you could probably just binge my LinkedIn profile and like study for BC PMP through that as well.

40:35Yes. There's only, I think to my knowledge, there's only one Matt out there who is writing consistently on pain management. Just maybe just type Matt and then pain someone's gonna show up so thank you thank you and i'm really happy and i'm really honored to be talking to you today because you are someone who actually spend the time to not just practice but also spend the extra time to give back to the community by writing a study guide this is not an easy task and so there's a lot of work and dedication you put into not just this field but also giving back to just anybody who are interested in pursuing this field so thank you so much and it's my pleasure having you here today thank you so much for having me i really appreciate the opportunity talking you know on this platform and getting the word out trying to represent our community more.

41:39And I think we're growing and really inspiring a lot of like new pharmacists coming out of school and actively practicing. I'm just really happy to be a part of that. So thank you. And so guys, and I'll see you guys next time. Bye.

41:53Shout out to Matt and Singh. Thank you so much for that time and information, education. today's episode is brought to us by outcomes uh outcomes pharmacy management technology we just got back from thought spot 2026 in chorus thought spot gathering of independent community pharmacies and we were broadcasting and doing our podcast press from the outcomes booth you guys rock thank you so much for hosting us and also a shout out to first data bank we will We'll be at the NACDS, as we said, the National Association of Chain Drug Stores, the Total Store Expo, and we'll be embedded in the FIRST Data Bank booth.

42:46Excited to be there and meet up with our leading regional and national chain pharmacies. Hey, we have a special feature from U.S. News and World Report and the report on our nation's best hospitals for 2026. Without further ado. Hey, special segment on twerks this week. Welcome back, U.S. News and World Report. This organization, you can find more information at usnews.com. We have a 2026-2027 report helping patients and families find the best health care for more than 30 years and finding the best hospitals near you. I like the timing of this report because the Pharmacy Podcast Network is building an entire series on health system, hospital system-based specialty pharmacies.

43:45I'd like to welcome to the studios Chelsea Nguyen from U.S. News and World Report. Welcome, Chelsea. How are you? I'm great. Thank you for having me. Very welcome. All right. So your colleagues have come on Torx before. We talk about different things that you're covering. I think this is very important to have a non-biased reporting organization really digging into some of the data. And a lot of this data is coming from the people that we all serve, which is our patients and the people in our communities. So give us an overview of the U.S. News Best Hospital Report for 2026-2027. Yeah, so we have been doing this for 37 years now.

44:28And at this point, we are evaluating hospitals across 14 adult specialties and 23 common procedures and conditions. So that covers things like hip replacements, knee replacements, COPD, pneumonia. Some of the specialties evaluated include neurology, gastroenterology, cancer. And we use Medicare data. We track patient journeys so that we can see things like rates of survival, how long the patient stays at the hospital. We look at rates of readmission and all of that and more factors go into how we designate a hospital to be high performing or if we assign it a national ranking. I like the report in of itself.

45:24We know that pharmacists are working at these health systems and hospital systems, very different environment than our retail pharmacies or our long-term care consultancy or even our rare disease pharmacies. But there's a mixing because this is where healthcare happens in the community is at these hospitals. So let's go through some of this criteria of which medical centers made the 2026-2027 best hospital report and how you guys are coming up with the ranking. Yeah, so the honor roll is the top 20 hospitals in the nation. So this is the most exclusive, most elite list that we have that's highlighting hospitals that are are delivering excellent performance across almost all of the areas of care that we evaluate.

46:17So that includes the specialties I mentioned, it includes the procedures and conditions, and also this year includes maternity care. So these are going to be some of the largest referral centers, really large academic centers with a lot of intensive resources that are good for the sickest of the sickest patients who are really looking for high care. Chelsea, in our show notes for this week in pharmacies episode, I'm going to have a link to health.usnews.com forward slash best hospitals. And therefore, our listeners can jump in and check out some of the criteria. What I really like is how you break it down into different centers of excellence.

47:06heart arrhythmia and heart attack and diabetes and geriatrics. I think that this could give the public a lot of guidance as to where the strength is in some of these health systems. And no health system throughout the United States is the experts, is absolutely everything. But here in Pittsburgh, Pennsylvania, we're very proud of UPMC and Allegheny Health Network, two of our hospital systems, and they've done really well in cancer as well as pediatrics. And so tell us some of the examples, some of the champions, and anything that you can give our listeners in guidance to some of these premium health systems.

47:54Yeah, well, I think you hit the nail on the head earlier when you were saying that But you can look at the specific specialty or the specific procedure that a hospital is good at. Because even on that list of the top 20 for those honor roll hospitals, if they are high performing in every cohort except the one that actually applies to you, then you might be better off going to a different hospital. So I think that's one of the biggest advantages of how our site is set up and how our methodology is built to be very service focused. But yeah, there's a lot of high grade performers across the entire United States.

48:34We do have a regional ranking and we have a best regional hospitals designation as well. So that means that in every major metro area, there is a list of hospitals that are performing really well across a wide breadth of the procedures and conditions. So that is meant to give patients more options in the communities that they live in, because most people are going to seek care where they live. So, yeah, this year we have introduced four new regional specialty rankings. So that's in cancer, cardiology, heart and vascular surgery, orthopedics and rehabilitation. So it's a way to provide more options for consumers.

49:24Rehabilitation is so important in and of itself for after surgery or after reconstruction of something. And the information that you've provided really gives a lot of deep data. How are you collecting this data? What aspect of the patient is coming into this from like a survey perspective? Yeah. So for the adult hospital ratings and rankings, we don't collect survey data. We use claims-based data from Medicare. So it's an objective. You can see when the patient was admitted, when they might have passed away, when they had a specific surgery. So most of what we base the rankings on is the outcomes.

50:17So that includes survival, readmission to the hospital, the length of time the patient spent in the hospital, incidence of surgical site infection after their procedure. So that makes up the bulk of what we're looking at nowadays. We also include some weight on the volume of patients that the hospital has served, as well as patient experience. And patient experience is a survey that patients fill out about what they experience at the hospital. So, yeah. Yes. And in this report, you can click on the honor roll criteria and it gives an immense amount of detail that we don't have time to go in today.

51:07It would be a whole podcast series if we broke into it. But it's so it's it's comforting to see where this list is being pulled from. And I'm appreciative of you explaining it, of how you're how you're gathering the data and how you're making that assessment, Chelsea. It's excellent. I like the in 21 of the 23 best hospital procedures and conditions ratings. Hospitals received 12 on a roll points for each high performing rating. Hospitals also received 12 points for a high performing rating in the 2026 best hospitals for maternity care. Six points were awarded for each high-performing rating in erotic valve surgery and TAVR because these procedures are alternative treatment approaches to the same underlying cardiac condition.

52:02And once again, the specificity is all here and you can drill down into this by selecting a specific procedure, condition and subject that includes psychiatric and rheumatology and urology and geriatrics like we were listing. How do you feel that this will apply to other organizations that are doing some ratings? For example, there's a criteria within the insurance world called star ratings. How does this, you think, parallel to those kind of rating systems? Yeah, yeah. So the CMS star rating has its strengths and weaknesses. I think in comparison to what we're doing, our results and our methodology is built to be more specific to the service line.

52:58I believe for the star ratings, if they have a measure like readmission, they don't necessarily subset it to something as specific as hip replacement like we do, which I think is more relevant for consumers when they're looking at a hospital on our website and they want to know maybe what the readmission rate is. It's going to be relevant for them in the procedure that they're actually interested in. So if someone wants to get a knee replacement, why would they really care about the readmission of a COPD case? You know, so that is one of the differences there. What else do you want to share with pharmacists that are listening that may be, you know, specifically working in health systems?

53:46How do you feel that this may help them in their careers? I have my ideas. I'll give my opinion after yours. Yeah. Well, we have been thinking about the systemness of healthcare more and more over the years as the healthcare industry becomes more consolidated. And one of the ways that we've been putting that into action is by expanding our methodology from just looking at the inpatient hospital experience to also capturing some of the outpatient experience. So for some of the procedures like gynecological cancer surgery, prostate cancer surgery, ear, nose, throat surgery that are more commonly done in outpatient settings, surgery centers, hospital outpatient departments, we've added a measure a few years ago that captures complications that happen after an outpatient procedure.

54:46So we're looking at incidents of patients in the 30 days after their outpatient procedure having to go to the emergency department or being admitted to the hospital. So that is something that I think we want to expand on in the future, capturing more of that outpatient experience as it becomes more relevant to the actual patient experience. I think I'd like to share and bring to the attention of our listeners, especially pharmacists out there. You are becoming specialists. We see that the Board of Pharmacies and some of the new criteria and certificates that are coming out are now digging into very specific medication management.

55:32And if you look at this list and you are interested in maternity care, if you're interested in oncology, if you're interested in really becoming an expert pharmacist in a specific subfield of care, geriatrics, for example, this list could be a guide as to which hospitals you would like to become employed by and go after in your career path. So if there is a hospital that is well known for a specific condition care, and you want to dig in, I would suggest using the link that's in your show notes. Once again, it's health.usnews.com forward slash best hospitals and look at those rankings and look at those listings and even reach out to some of those health system and hospital system directors and inquire if there are openings for positions that you'd like to continue to work in.

56:32Chelsea, so many of our pharmacists are starting to dig into very specific care treatment pathways and building their whole careers around becoming experts in something very specific. Yeah, yeah, that makes a lot of sense. And a lot of our cohorts that we're looking at have measures that are specifically tailored to that cohort. For example, there are specific cardiovascular transparency measures that are included in TAVR or aortic valve surgery. So I totally get it. Yeah. Well, I want to give a shout out to Ben Harder and his team. You too, Chelsea, of all of the work that you're putting into this reporting.

57:18We very much appreciate the reoccurring information that you're bringing to this week in pharmacy for our listeners. And we hope that US News and World Report will be back on Torx. Yeah, me too. Thank you so much. All right. We'll be we'll be back with more twerks.

58:05Have a great week. Wishing you a fantastic week. Hey, be on the lookout. Twerks, August 21st. It's going to be a big episode. Matchup between Shane Jereminski and Claudia Miranda. You don't want to miss it. And if there's anything that you think we should be reporting on this week in pharmacy, reach out to me at Uri, E-U-R-Y. That's Uri, my last name, E-U-R-Y at pharmacypodcast.com. Have a great week.