Taking a road less traveled: 2015 Distinguished Alumnus Pamela Schweitzer
The 2015 Distinguished Alumnus of the Year is Rear Admiral Pamela Schweitzer, PharmD ’87. The recognition by the Pharmacy Alumni Association is given to the School graduate who has made outstanding contributions to the profession of pharmacy, to society, and/or to UCSF.
A generation ago, Schweitzer was awarded the Bowl of Hygeia, the highest honor given to a graduating student. Since then, she has blazed a path to become chief pharmacy officer and assistant surgeon general in the U.S. Public Health Service. She leads more than 1,200 commissioned corps pharmacy officers, who are charged with promoting public health, conducting research, providing patient care, and assisting in emergencies.
And that role is in addition to her other full-time job with the Centers for Medicare and Medicaid Services (CMS), where she is a technical director in the Medicaid division that provides oversight, guidance, and funding for information technology systems including eligibility and enrollment systems as part of the Affordable Care Act.
In recent years, Schweitzer has also been honored as:
- 2014 American Pharmacists Association Distinguished Federal Pharmacist
- 2013 Indian Health Service Pharmacist of the Year
- 2012 U.S. Public Health Service Pharmacist of the Year.
Having formally received her award during the School’s recent alumni weekend, Schweitzer spoke with us about a career in pharmacy that has taken her from remote Indian reservations in South Dakota and Arizona to a leadership role working to improve health and pharmacy practice nationally. Her account, liberally spiced with “How cool is that?” and “Doesn’t that sound like fun?” reveals an undiluted enthusiasm for making a difference.
One Distinguished Alumnus recruits another
While both her grandfather and father were community pharmacists, Schweitzer was drawn to the profession herself when she learned about its modern clinical role from her cousin’s husband, Paul Lofholm, PharmD ’64—the School’s 1976 Distinguished Alumnus of the Year.
“[Paul] talked to me about managing patients’ care, managing diabetes and asthma,” she recalls. “In other words, it was a lot more than just filling prescriptions. It was working with physicians, being able to change doses, and knowing what drug to select. It was a different perspective.”
“He’s a clinical pharmacist, and as soon as I talked to him, I knew that’s what I wanted to do.”
Admitted to Lofholm’s alma mater (UCSF was the only school she applied to), Schweitzer got her first taste of public service at student outreach activities and health fairs. Then, after a post-graduate residency at UC Irvine, she applied to the Indian Health Service (IHS) via the U.S. Public Health Service Commissioned Corps and accepted an offer from the Pine Ridge Indian Hospital in South Dakota.
Advantages of the road less traveled
The plan, as Schweitzer told the School’s graduating class of 2015 in her commencement address last month, was to do two years of service and return home to California. But she quickly discovered the advantages of taking the road less traveled. She and her husband enjoyed fossil hunting and flying the uncrowded skies (Schweitzer has a private pilot license) over the Black Hills and Badlands.
She also quickly saw the value of her interdisciplinary UCSF training in her new setting. “At UCSF,” she recalls, “the pharmacist was included as a member of the health care team. As a staff pharmacist, I regularly interacted with physicians, department heads, and administrators. This was not a common occurrence outside of that unique setting.” But having worked with medical students at UCSF, and having done rounds with attending physicians, “You see how they think and learn to communicate with them,” she observed.
At Pine Ridge, she went from staff pharmacist to inpatient pharmacy director within months. Another big benefit of the remote location: “There were these gaps to be filled because it was an underserved area.” She was soon asked to take on an additional role in disease prevention and health promotion—a role she now addresses nationally—splitting the time with her clinical practice.
“I don’t think I would have had this role elsewhere,” she says. In an urban medical center, health promotion would have been a separate job in the community. In rural health services, she notes, “You have an opportunity to have many unique experiences.”
“I have the best job ever ... I get to help influence change in a positive way, to improve health and the health care system in our country.” —RADM Pamela Schweitzer, PharmD ’87
Her next stop was a 120-bed Veterans Administration Medical Center in Hot Springs, South Dakota (population 3,711), where she became chief of pharmacy services with a mandate to create a new program and a culture of clinical pharmacy in which pharmacists would routinely interact with physicians in medication management.
“It wasn’t like the VA now,” she recalls of the early 1990s. “Several pharmacists had come from the retail pharmacy sector and were filling prescriptions. They would rarely question a physician’s order. I remember the first time I contacted a physician to clarify an order, he said, ‘Well, what is this all about? Why are you coming and talking to me?’ But over the next few years we had pharmacists integrated into teams. The first person I hired is now the pharmacy director and they have impressive clinical programs.”
“So, how fun is that?” she says. Granted, some interdisciplinary diplomacy was necessary, she recalls: “In the very beginning, some of the physicians were not pleased when I wrote a note in the progress section of the medical record. ‘Who told you to write in the notes?’ I realized I needed to change my approach, as they had not previously worked with a clinical pharmacist. It doesn’t happen overnight.”
She adds, “I would not have had this opportunity if I stayed in California, because clinical programs were already fairly established.”
Not a computer person, but…
During her residency at UC Irvine, she was assigned for one month to be the supervisor of the outpatient clinic. As Schweitzer recalls, “That month, they switched from paper to a computerized pharmacy, and I was assigned to implement it. It seems like every job I went to after that, I was there during the conversion from paper to a computer system. I don’t have a technical background, but you would never know it. I have been fortunate to work with really smart people during these conversions.”
Over the years, she implemented pharmacy automation and mail order prescription programs at institutional, regional, and national levels both to help patients access their medications and to generate efficiencies.
“Automation allowed us to move pharmacists into the clinics, seeing patients and working as a member of the healthcare team,” she says. She transitioned from a clinical role to more of an administrator.
As a clinician, she knew very little about billing: “I had to sell myself on the concept,” before tackling online billing of prescriptions, initially for one tribal facility in Arizona. But ultimately information technology was vital to generating revenue to provide for patients’ needs. New legislation had enhanced capitation (set amounts per patient) for the IHS with the ability to bill third-party payers for prescriptions.
“Up to then, we had limited budgets, highly restrictive formularies, and we were not always able to provide the drug of choice because we couldn’t afford it,” she says. Now, for patients with third-party coverage, facilities can be reimbursed for prescription drugs.
Eventually, computer person or not, Schweitzer became proficient at understanding systems and how to improve operations when tackling implementation at the regional and then national levels. Indeed, Schweitzer eventually became an IHS national medical informatics consultant and the national project lead for planning and implementing the electronic health record at IHS and at tribal facilities nationally.
IHS residency program: “beyond what we ever dreamed”
Another of Schweitzer’s career accomplishments is the development of a nationally coordinated top-quality IHS residency program that brings skilled pharmacists to hard-to-fill positions, further seeding clinical programs while also bringing visibility to the health service.
Hired for one year to get the program started, she eventually went on to billing and information technology roles, but kept the program going as a side project for another nine years before transferring it to another director. There are now 19 programs with over 170 residency graduates and a 75 percent retention rate of graduates in the U.S. Public Health Service.
“The program was successful beyond what we ever dreamed,” she says. “We maintain baseline data and track each graduate. They are located in underserved regions throughout the nation and many of the residency graduates are current leaders in the USPHS, too.”
In typically modest fashion, Schweitzer says, “The program continues to thrive. I passed the program on to an officer who has done much better than I did.”
Juggling national roles
Nowadays, given her concurrent national positions as chief pharmacy officer and CMS technical director, division of state systems, Schweitzer’s workday starts at 6 a.m. and extends to include West Coast committee meetings taken by phone in the evening. She’s on a headset much of the time, getting in some walking around the hallways in her building.
As chief pharmacist through 2018, she oversees the 1,230 commissioned pharmacy officers, people she describes as “… passionate, with a strong desire to make an impact on our mission to protect, promote, and advance the health and safety of our nation.” Having previously served on rapid deployment teams herself, assessing shelter medical needs during Hurricane Katrina, this past year she played a role in selecting the 53 pharmacy officers deployed to West Africa during the Ebola virus outbreak.
Recently, Schweitzer has given presentations on wellness and changing behaviors to improve the health of the population. She has also participated in national meetings on issues ranging from pharmacy’s role in addressing fall prevention in older adults to reducing opioid-related overdose and prescription drug abuse, as well as tobacco cessation and improving immunization rates. She has played a leadership role in workgroups discussing changes to reduce medication errors, such as the inclusion of drug indications as part of electronic prescriptions.
“They’re very nice and supportive of me at CMS—they know I have all these other responsibilities,” Schweitzer says. “I have the best job ever. … The best part is I get to help influence change in a positive way, to improve health and the health care system in our country.”
About the School: The UCSF School of Pharmacy is a premier graduate-level academic organization dedicated to improving health through precise therapeutics. It succeeds through innovative research, by educating PharmD health professional and PhD science students, and by caring for the therapeutics needs of patients while exploring innovative new models of patient care. The School was founded in 1872 as the first pharmacy school in the American West. It is an integral part of UC San Francisco, a leading university dedicated to promoting health worldwide.