Introduction

Earlier this year, Florida lawmakers overwhelmingly passed a measure to broaden vaccination rights for the state's pharmacists.

If the bill is signed into law by Governor Rick Scott, which seems likely given the lopsided vote, pharmacists in the Sunshine State will, for the first time, be granted the authority to administer both the shingles (zoster) vaccine and the pneumococcal vaccine. Currently, 46 states and the District of Columbia permit pharmacists to administer the shingles vaccine, and 47 states and DC allow them to give the pneumococcal vaccine, according to the American Pharmacists Association. Before a compromise was reached, however, the Florida vaccine bill had faced stiff opposition from the state's doctors.

Nationally, other issues continue to strain relations between physicians and pharmacists. These issues go deep enough to make what happened in Florida seem like a minor skirmish in a much larger battle.

At the heart of the more fundamental battle is how states should draw the line that defines and separates the physicians and pharmacists.

Pharmacists argue that, given their modern training, they can and indeed should do more to assist in patient care. Given unmet patient needs, they say, especially in the area of primary care, pharmacists have a larger role to play in managing and modifying medication therapies, typically in some form of collaboration with the prescribing physician.

On March 14, for example, the American Pharmacists Association and 9 other pharmacy groups sent a letter to the American Academy of Family Physicians (AAFP) objecting to the "simplistic characterization of pharmacists [as] 'dispensing the prescription written by the physician'," wording included in a recent AAFP position paper on pharmacists. In response to such objections and assertions of greater authority, doctors worry that pharmacists are blurring the line between the 2 professions.

The Vaccine Debate in Florida

Part of the conflict played out in Florida.

To be sure, the Florida vaccine legislation didn't have an easy road. The Florida Medical Association (FMA) objected to draft language that made it unnecessary for patients to obtain a physician script before going to their local pharmacy to be vaccinated.

By leaving doctors out of the loop, the FMA argued, the bill endangered patients. Doctors also worried that the proposal didn't do enough to ensure additional vaccination training for pharmacists, which the FMA said would also pose a potential threat to patients.

The conflict came to a head during a Senate debate. In the end, the 2 sides agreed to a pair of amendments that bridged the gap between them: In the revised version of the bill, patients must obtain a physician script before going to the pharmacist for the shingles vaccine, although not for the pneumonia vaccine.

Also, pharmacists who administer either vaccine will be required to enroll in continuing education, taught by the FMA. (Florida pharmacists -- like those in the other 49 states -- have long held the authority to administer the influenza vaccine without a script.)

For the moment at least, the hackles raised on both sides of Florida's vaccine debate have been mostly smoothed, in line with the other states that have debated the issue. But the national conflict between pharmacists and doctors continues.