Saving Lives: The Role of The Pharmacist in HIV

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Today with I chat with the amazing Amina Abubakr.

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What you will learn

  • Role of Pharmacists as Healthcare Providers
  • Find out more about Avant Institute
  • Why Troy Medicare is different
  • Who are Safari Doctors

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Transcription

Michelle:
Hi, this is Michelle Sherman, president of Michelle Rex pharmacist consultant. The conversation with dr a Buka bar, a pharmacist who from North Carolina who has been doing extraordinary work both here in the US and internationally as well. So welcome to the show dr Buka bar. My pleasure. Thanks. Thanks for being a guest. And let’s just get, get started with the conversation. Tell our listeners what you feel the practices and how you got into pharmacy.

Amina:
Sure. So I graduated our pharmacist school in 2005 and I just had this passion in that thing, two communities and being of service. So I’ve always been a servant leader and any opportunity that I can serve just brings me a lot of joy. So in 2009, I had an op the opportunity to open my own pharmacy simply because I could not find what I was looking for. And so I just took the risk to open an independent community pharmacy. So this April we make 11 years and being part of the community has really enabled us to serve, connect, grow and learn so much about healthcare in general

Michelle:
And how to fix that. And, and that’s, you know, such a courageous step to get into independent pharmacy because at the time when you, when you opened your pharmacy, we really started seeing these shifts in the PBMs becoming these mega behemoths and re pharmacy reimbursements dropping and the shift in specialty pharmacy. And I know you’re, you’re, you’re an HIV pharmacist and that’s a big focus of the practice at your pharmacy that taking that step, you know, getting out of the safety of being a chain pharmacist or working for somebody and taking that step to chart your own course and follow your own path is such a courageous step. And clearly it’s, it’s been very rewarding for you and and especially for your patients. So how do you see these changes in healthcare and all the pharmacists that I, I come across are desperate to make changes. Where do they go to make changes and how do they deal with these challenges that face us every turn?

Amina:
I think what was an advantage for me was the firm belief that pharmacist value has not yet been understood with the rest of the healthcare ecosystem. And I wanted to challenge that. I knew that the status call was making us believe that pharmacist were linked to a product. And I knew the value that we brought to healthcare had nothing to do with the product because everything, even when I was a chain pharmacist, it wasn’t the prescription that I was dispensing that allowed me to connect with the patient. It was the dialogue that I was having. It wasn’t that they were doing well because they knew how to read the directions, but it was the time I took to understand the disease stage, the complexity. Well, I knew it was that touch and that knowledge I had to give to these patients beyond the product. Right. So because I firmly believed in that, it gave me the confidence to try because also in the area, I know you said that and you’ve told the listeners that yes, I have an HIV practice. So growing up in Kenya I had witnessed, you know, the

Amina:
HIV crisis and we lost a lot of people and there was so much that was not understood when I was in pharmacist school and I did a rotation in infectious disease and I focus on HIV. My goal was to really be able to help these patients. You know, I believe they were misunderstood because we were segregating patients in the hospital. Nurses were not able to touch this patient that would, you know, families will be told not to share any betting or a room with an HIV patient. So it bothered me the more I learned about HIV and I wanted to have that impact. So by doing that, I had connected with my patients that I was serving in the community and they would invite me to talk to other patients. So I started participating in group meetings and then they connected me to their providers. When they connected me to the providers, that’s when I really knew the value I brought in the house system because the HIV patients I was serving were very complex.

Amina:
So either the HIV specialist has them on an amazing regimen and the viral load is suppressed, but then the patients are seeing primary care, they’re seeing endocrine, they’re seeing mental health, and then no one is taking care of all that collectively, you know? And so I knew that here comes our value and that gave me the confidence when I opened the pharmacy that my value is to really connect with one healthcare provider at a time because they do not, they didn’t know what I could bring to the table because for the longest time, who has really advertised for pharmacy, it has been the big change. Nothing against them. We need convenience. There’s some patients, if you’re a young patient taking birth control or one, you know, one medication and you’re not really complex, those are set up for those individuals. You know, it’s convenience in an app, but if you’re a patient that is complex, taking multiple medications, complex disease States, you need more than the convenience of a drive through an easy access, right? You need someone on your team. And that’s who really I wanted to focus on.

Michelle:
No, absolutely. I think, I think you’ve nailed it. You know, we as pharmacists are extraordinary healthcare providers and we have been over the years the worst advocates for what we do. And I look at these challenges that, that people see with PBMs and low reimbursements to really cause the seismic shift in pharmacy so that we can really do what we were trained to do and be the healthcare providers that really, really are the core of changing healthcare in this country.

Amina:
You know what, I got in trouble one time, Michelle, because I said it was a blessing in disguise, right? It was the rise of this, what I would say draw Chrissy. And all these unfair things that were happening that really forced us to what we now call innovation, you know, and certainly open doors that we would have never opened had we have been comfortable.

Michelle:
Oh, absolutely. It’s much easier just to sit back, fill the prescriptions, feel comfortable with what we do every day. But this, this is, this has forced us to, to look at non traditional pharmacy, if you will. And I don’t know why it’s called non traditional because we provide, provided this extraordinary extraordinary care forever. I mean, I’ve been doing HIV since like 1987 and you’re absolutely right. Taking care of these patients is, is so complex that HIV is the easy part, but the link to all this is the pharmacist and this changes in our role. And actually getting paid for that role is absolutely critical. And when they say drug prices are so high and the healthcare system is so costly, they need to realize that using us to do what we do is what’s going to change everything.

Amina:
Yes. And so when I look back on my journey just in the last 10 years, right? We’ve had the most transformation in our practice the last five years. So our pharmacy right now, my role is more one, they call me the chief of happiness. That’s awesome.

Amina:
Well, my job is to make sure we are building a systems that will allow our pharmacists to thrive and really flex their muscle of that knowledge that they have, that no one else in the healthcare has it. So I always tell pharmacists when we collaborate with providers, we’re not trying to be the same. We’re really trying to bring a unique expertise of what they don’t have. We are diversifying their care team, right? We know most about all these medications, their interactions. And so we create that stickiness with the providers and then they need us. So over the past five years, we’ve grown in a team of 15 pharmacists now in our organization, and only about three FTEs are actually dispensing.

Michelle:
No, that’s, and that’s extraordinary. I mean the shift from like a product focus, putting the pills in the bottle and getting that to the patient to actually providing care and those kinds of services to the patient. I think that’s everything. And if you, if you look at your patients, I’m sure they have extraordinary relationships with you and your pharmacist, but also they feel comfortable, they feel healthy. And so do the providers that you you team up with?

Amina:
Yes, we were able to give them outcomes, revenue and avoid penalties for this value based systems. So we figured that that was where we really belonged. All the pieces of the puzzle for successful programs were addressed and we were just thrilled and they are allowing us to grow because they are telling the next physician, they’re telling the next nurse practitioner and embracing us and that’s how we’ve grown.

Michelle:
Oh that’s, that’s, that’s just extraordinary. And why I wanted you on the show also is you know, this, this realm of consciousness and you just nailed it. You’re the chief of happiness. I mean if, if you’re not happy, your team isn’t happy, how can your patients and the providers and the people you work with be happy so it’s like a paying it forward to everybody that you work with to have good, good outcomes in care and we can’t look at our patients is like pieces like the healthcare system does. I mean patients have like 10 providers. I have HIV patients that have an ID doc, a cardiologist and nephrologist, urologist. We’ve broken our patients into body parts and nobody looks at the whole patient and now

Amina:
That’s where I feel like our true value is, is the contribution to taking care of the whole patient. Especially now that health care plans are being measured on value and outcomes and suddenly the new trend of taking care of the social determinants of health. But as pharmacists, especially in the community, we always knew there was so much work to do beyond that prescription. We dispensed in the community. We knew patients who didn’t have food, we knew patients that were going through her. So no distress, you know, that life happens, divorce, death, you know, things that are happening. We were seeing how drugs were affecting compliance, you know, and all those adherence. He knew so much, but that information wasn’t valuable back then because we were on a fee for service and we were a product. But now if you want outcomes, you have to address social determinants and we now can contribute because pharmacists have the most access. Patient can see their primary care provider maybe if they’re lucky three or four times a year. But you tell me how many touch points their pharmacist has, whether they’re coming in for an over the counter, a flu shots, monthly prescriptions. Those touch points allow us to gather so much information and be able to take care of the whole patient cause we know what’s going on.

Michelle:
Oh absolutely. Absolutely. And the shift and this, this evolution of pharmacy has been quite rapid and, and quite extraordinary. So for us as pharmacists in a national setting, we have to keep fighting. What, what is the status in North Carolina for like pharmacists being recognized as health care providers working under collaborative practice agreements and that kind of thing? Has it, has it evolved to the point where you can do that? And it’s recognized at least by the state.

Amina:
So North Carolina is one of the most progressive States. So we’ve always had a method which pharmacists could be recognize using a collaborative practice cause we’ve had what we call the CPP clinical pharmacist practitioners when you have a supervising provider under a limited scope. So North Carolina has always had that. However, what I’m finding now with the population health and taking care of value based, the collaborative practice agreement is not as it’s not a barrier, right? Because you are able to integrate into a care team and just take care of population health. It’s kind of like the advance MTM using things like a clinical services agreement, you know, or being a pharmacist being employed into a primary care and taking care of those patients that are not achieving goals through health coaching. Yes. So there are the avenues have opened up beyond just a collaborative practice agreement that you’re allowed to modify drug therapy and change. But there’s a whole new world of just coaching to get agencies at goal because this provider belongs to an ACO and they’re responsible for outcomes. So they want to diversify their care teams and bring in pharmacist on board.

Michelle:
Yeah. And it makes, it makes a huge difference. Like here in California also, pharmacists are recognized as healthcare providers. There’s a lot that pharmacists can do to be part of that team, to provide those coaching services looking towards outcomes and then getting reimbursed for that. And you know, I think the, the latest, greatest thing that’s happened in California is SB one five, nine, the prep and pet bill that went into effect with pharmacists can, we’ll be able to like furnish prep and pep

Amina:
Exciting. That’s why I always tell my students as a preceptor, you know, yes there are bad things happening, but you know what? Bad things have always happened in the world. Right. But it’s really those moments that if, and I love that your podcast is called conscious pharmacists, stay aware, you know, being conscious of what’s happening around you and how you can impact which is now opening these other doors. And when the next five years pharmacy will always be here, it’s just going to look different and make it’s going to be a service based pharmacy.

Michelle:
Oh absolutely. It’s always when I’m, when I talk to patients or I’m doing seminars and things is always to let them know that, you know that bag that you get at the end of the month from the pharmacy and you know, we know so many specialty pharmacies just automatically refill patient’s prescriptions every month and deliver them to the door and everything. But so many people don’t even ask the patient if they’re actually taking the pill. There’s no like communication with the patient. So while the pharmacy record might show this patient’s like a hundred percent adherence, they get the prescription refilled on the 30th of every month. Nobody’s even bothered to ask the patient if they’ve actually put the pills in the, in their mouth. So they might have $40,000 worth of drug stored in the cupboard, but are they even taking it? So having those conversations, it’s like that big is like a loaded gun.

Michelle:
Yes. How do you take care of it in the best way? And you know, when you look at what people see as the complete disaster of pharmacy, I think it’s the absolute most exciting thing because this is way innovative. Creative people can create their own blueprint to actually make outcomes of priority and actually make a difference in the health of one patient at a time. Changes your whole community. Yes, absolutely. So when we look at outcomes and look at Medicare, I know you’re, you’re a part of Troy Medicare can, can you tell, tell us what is Troy Medicare and how does this differ from some of the other plans and things out there?

Amina:
So when I started understanding the whole healthcare ecosystem, the first, it was a shift of Hey, this brings tremendous role and I do want to get paid for it. And we were able to make that work. So that shift into the medical side, I was privileged to understand how things happen in the medical side, how they get reimbursed, the challenges. So I understood pharmacy in the front, front line, then I was able to understand the medical side. Now what connects pharmacy and medical is a payer. Correct. So following and understanding now in the back is the pair. So I was fortunate when trying to solve this issues. I was having a dialogue with a fellow independent pharmacy owner and we kept talking about how do we fix reimbursements? And I, that’s what he was telling me was like, how do we fix reimbursements? We have to fight for reimbursement.

Amina:
And I said, I really think the cheese has moved. Do you know that cheese has moved to the, to the service side? So working with is actually more important. Not that it’s not important to fix reimbursement, but we can’t get any more outcomes to get paid just to fill a prescriptions. But then the founder of a company called [inaudible] Medicare, also known as ambulance. He shows up in our dialogue. He says, why don’t you two get together and form your own Medicare advantage plan? And I thought clearly this guy’s out of, he’s crazy cause I’ve done a lot of innovative things, but I never thought about owning a plan. And he said yes because you have to look that Medicare is now looking for innovations in the pair side. So when I got involved in it, Whoa, I’ll tell you Michelle, that brain, you know when you talk about the stars in your brain, wow.

Amina:
So if we want to fix healthcare, you have to fix it at a plan level. So we were able to sit down with actress and look at the waist in Medicare. Yet these patients aren’t getting what they need and no one is really motivated to lower the cost of care because when you lower the cost of care, you make less money. So we won’t fix it. So that’s why Troy. So Troy really means it’s kind of from the Trojan horse that’s going to get in the system. We’re going to learn about the system and we’re going to fix it. So Troy Medicare is the first Medicare plan that has no DIR fees. These are fees that are getting a lot of independence out of business. It is the first Medicare plan that is going to pay fairly on a cost plus model. So no smoke and mirrors about AWP minors and you don’t even know what you’re making.

Amina:
So it’s the first plan to use NAIDOC, which has always been used by Medicaid systems. So it’s a cost plus. So no pharmacy would actually lose. But the beauty is we also have a per member per month fee for care management because we believe healthcare is delivered locally. In order for you to really touch those patients. We don’t want it to be a call center out of a different state calling your patients. So each pharmacy who has an Troy attribute in life received about $30 per member per month to be able to care to care for these patients. That’s, that’s extraordinary. I mean, there’s nothing like it in the system at all. Yes, and I will go was if this plan, and it’s actually a very rich plan. So we removed all what we call the fat that is going towards big companies and big pharma or big whatever. We just removed it and say pay the frontline providers, the pharmacist. So the budget is really shifted into highlighting pharmacists as providers and paying them directly.

Michelle:
Wow. That that is, that is just extraordinary. There is how the system should work.

Amina:
Yeah. So we hope that other other systems can look at it and say, wow, why is every patient so doing well on Troy? Why is every physician for the partner? Maybe we should copy Troy and if they copy Troy with fixing the system.

Michelle:
Oh, absolutely. Absolutely. So is this, is it a local plan like in your area?

Amina:
So it’s plan, you’re allowed to be in a few counties at a time. So we wanted to start small and build a very strong infrastructure and we want to grow nationwide, but it’s capital is the limiting factor. And so most investors in Troy are physicians and pharmacists because we wanted to have a true transplant plan. So in order to grow, you always want venture capitalists on. But venture capitalists exit strategy may not always be best for what we need. So that’s what we’re growing small. So it’s a grassroot movement and we already have aligned different States that we have strong boots on the ground. These are pharmacists that are very involved in their communities, could be a providers with the hospitals and health systems. So yeah, we wanted to pace ourselves and do it right.

Michelle:
That’s extraordinary. I mean, this is this, what you’ve created at Troy is truly a groundbreaking innovation to not, not only just for pharmacy, but I think for, for patients because so many Medicaid patients get the short end of the steak, it’s just like you say, there’s so many players involved. I mean, I think that’s right through our entire system from the payer through to the providers to pharma, the PBMs and everything that they, too many cooks.

Amina:
Yeah. So if you think between the layer of a, okay, Medicare has this funds to give it, you know, to offer services, but Medicare doesn’t offer services directly. So they contract a plan, a plan, contracts, a PBM, a premium contracts providers, and then providers, which are medical providers and pharmacists and then to take care of the patient. So why was it, why is it necessary to have all these layers if we can just be transparent.

Michelle:
Exactly. And you know, if you could, if you could do that and actually effect outcomes cause at the end of the day that’s, that matters to the patient is are they getting better? That’s why I like the, the value based model or they’re getting better. And you know, for many pharmacies who are looking at the product and the revenue and the reimbursement, it’s all about just filling prescriptions. And my philosophy as a pharmacist, it has always been less as more if I can get you off as many prescriptions as possible. That’s the goal.

Amina:
Yes. Or the least. If you look at the healthcare spending, 10% is medications, 90% is everything else. So we need to figure out how to move pharmacists to the 90% of healthcare. That’s where we can impact and shrink the 90% so if we want to save healthcare dollars, it’s no prescriptions because prescriptions is only 10% of healthcare spend. And I think people

Michelle:
And you know, a pharmacist, they don’t really realize that if we weren’t so obsessed about the drug price, which is outrageous, but that’s not the part that matters when you look at the hospitalizations and you know the drug interactions and the drug related mortality and morbidity, it’s just too terrible what’s going on. So we fixing these failures or breakdowns in the system is what’s going to make us healthy. Absolutely. And when we look like what you’ve done like in right in our own communities starting in the community pharmacy and then branching out it’s, I always tell patients and you know, providers I work with like a healthy patient is a wealthy patient and that doesn’t really mean anything to do with their bank balance. Right. If we can keep them healthy. And that’s why the chronic care management program that I created, I called it the Boone to pharmacist care program because that’s spirit of Ubuntu and paying it forward. Like what happens to me happens to you and it happens to all of us is really what matters. Because if I can make a patient feel better and do better with their drugs, they can work, they can take care of their families who then make a difference in their community and it just goes on and on and on.

Amina:
Absolutely. No, it’s, it’s a, it’s a great concept and it’s almost like we’re going back to the olden days taking care of each other literally.

Michelle:
Absolutely. Absolutely. And you know, it, it all boils down to being conscious. How do we as pharmacists feel within us, like, like you, the, the, the, the happiness, the chief of happiness. If, if, if you’re happy and your team is happy, your patients will be happy and everything moves forward a positive direction when everything’s negative. And how do you, how do you grow businesses by cutting, cutting, labor, cutting, firing people, shrinking. You can’t shrink your business or your concepts to grow them.

Amina:
I know. And that’s why I, when I look at what we’ve been able to do with a small organization, we know this is possible across the country if we really have the right

Michelle:
Leadership in these organizations. No, absolutely. Well, I mean, I, I, I’m, I’m like totally like stoked with, you know, the work that you’ve done and with, with Troy and you know, I work with a lot of like thought leaders here in California. So if ever we can collaborate with, with you guys to do something like that on the West coast, just, you know, let us, you know, let us know. I mean, I think if we all work together, that’s how, that’s how this, this chain reaction is just going to escalate. We’re stronger together. Definitely. No, absolutely. What, what, what is the avant Institute and how does that play into the work that you do?

Amina:
Sure. So at heart, I’ve always been a teacher. You know, I, my favorite quote has always been, you know, he who learns, teaches. So I watched a lot of our pharmacists have been my students, you know, I’m a preceptor and out of the 15 pharmacist we have, all of them were students at RX clinic pharmacy except maybe three. So I love the fact that I could get a student in, teach them about what’s happening and then watch them grow. So in order for me to scale my love of teaching, I wanted to have a place that pharmacist who are looking to understand what’s happening and how they can impact their community and they want it to learn from us. We opened the avant Institute because as I was doing this things and speaking around the country, people were filling me and say, Hey Amina, could you help me do this? And I thought to myself, literally, even if I give you an hour of my time to really condense what I’ve done the past five years for true transformation and making it a sustainable business, you need more than an hour from me. You know, there are many pieces that I have to teach you because in a speaking, I can only show you the highlight, but there’s a lot of underneath this huge mountain, there’s a lot underneath it that I have to have a place. And that’s how we got there.

Michelle:
Nice. That’s, that’s, that’s incredible. Yeah. And, and, and you’re right, people think, Oh, that, that doesn’t sound too difficult because you stand up there for an hour and you talk about all the extraordinary work and it seems so easy, but people don’t see the blood, sweat and tears and what’s under that iceberg.

Amina:
Yes. And we want it to make it more immersive. So avant Institute was really built to create an immersion, right? So it’s, that’s why it’s over three days, most of our trainings that are onsite. So we bring folks to our clinic. We bring all the stakeholders that make this work and teach folks from ground up. You know, how, how to contract, how to negotiate, how to build an extraordinary team, how to understand the services, how to pitch it to the provider. What is it that they’re buying, you know, and how do you sustain your value by by working with this collaborators. So we had to do that and have people fully immersed rather than being lecture style.

Michelle:
Yeah, that’s, that’s amazing. And in the, in the resources and everything, I’ve put links to that as well. So anybody who’s listening if to get more information, they can, they can go on and, and, and get more details about that too.

Amina:
We’ll have online edition now just to get folks who are not sure where, what direction they want to go and they can explore. We have free resources out there, but we also have CES. We are now ACPE accredited. So if people are looking for a CE that are showing the wave of the future and they can also find them online.

Michelle:
Oh, amazing. Extraordinary. Now I can see why you’re the chief of happiness because you, you, you soothing just so much more than your community. Which, which brings me to my next question and some really amazing, extraordinary work. Tell our listeners about Safari doctors.

Amina:
So I was born and raised in Kenya and I have witnessed disparities firsthand. And so my father grew up in a small village in Lama, which is a very remote part of Kenya. And over the years, nothing has changed. They do not have clinics, there’s no providers. And so about five years ago one of a very close friend and a cousin, she was working in New York city and she just called me and said, Amina, I’m not fulfilled, you know, so I’m going to go back home and try to make an impact. She is not a medical provider. She was actually a journalist and she said, I just want to go home and do something meaningful. So when she got back, she realized healthcare was still in disparity. So she formed Safari doctors. The Fari means a journey, you know, and we thought about the journey of health care, right?

Amina:
How do we reach these remote areas? How do we give them access to health care? So we got a boat that sales in all of these villages because it’s really remote that there are no cars at all. You know, it’s just a donkeys are the mode of transport. And so when we did that, it was amazing that we were able to start immunizing children and help them understand clean water and reduce diseases such as cholera. And it just grew. And then we thought, how do we take care of the whole community? We now started to partner with the veterinary providers because these animals, if not treated, they were using the same water sources as humans. So we’ve just been, it’s been an amazing ride. So every month we go to the villages. So we sail once a month for four days and every month we take care of about a thousand patients right now that they’re always looking forward to. And we’ve had great partners around the world. Once we were recognized by CNN heroes, a lot of people around the world have come in. So if some of you are interested in just joining one of the journeys last year I went with some pharmacist friends and it was amazing. We spent time there and of course we met at fun after this, after the service part we’re able to enjoy. And do safaris in Kenya. And so we became conscious tourists.

Michelle:
Oh, that, that’s it almost brings tears to my eyes too, to be able to do such extraordinary work in places that are so remote that don’t have the access to healthcare. And you know, the gifts that, that we have around us over here that we take. So for granted to be able to go and to serve, that’s what it’s all about. So it makes

Amina:
Really be connected to humanity. And I think that’s what fuels me. It’s all this we have is great and I’ll continue serving in many different capacities, but I would love to have just a holistic to life, right. To help those who have it and those who don’t have it.

Michelle:
Absolutely. Absolutely. And I think that that’s what makes us a healthy society when those who, who have whether it’s financially or, or with knowledge are able to give, and you, and you, and you help the communities that don’t have those resources or don’t have that access, that that’s what makes a happy society.

Amina:
Yes. And Safari doctor has evolved, not just from providing care. We’re now creating health ambassadors locally. So we are training the youth, you know, to take care of their community. So we’re not always dependent on foreign help, you know, again, it’s making them believe that they can take care of their community, that we can become a health ambassador. And on these villages that we are now serving, we connected all the youth using sports.

Michelle:
Oh, that’s amazing. Extraordinary, extraordinary. I mean, thank you for doing this and you know, showing pharmacists and the world that you can really like do something out there to make changes.

Amina:
Yes. Well thank you for having me. I mean biolog you know, we could talk forever.

Michelle:
Oh, I know. Oh my gosh. I mean we’ll, we’ll have to connect more and do more because I, I told you that it takes a life of its own because there’s, there’s just so much to talk about. I mean, the last question that I had for you, and clearly I don’t even know if you, if, if, if it’s even honorable because your work is so extraordinary and you do such good work is what, what’s the most rewarding experience in your field? So far, but you’ve done so much amazing stuff.

Amina:
I think the most rewarding is that in every position that I’ve been in and serving, I know I have touched a life. So whether is as the CEO of the company and growing the team or changing the policy in Medicare that allows an independent pharmacy to survive or a patient to be served differently or teaching. So through avant Institute we’ve taught about a hundred different pharmacies and we’ve had some schools their businesses or leave out of a business that they weren’t happy and do it. So yes, I’ve done a lot of things, but the common theme for me is that was someone else’s life better because I was part of that. Oh,

Michelle:
That is, that is truly, it’s absolutely beautiful and that’s how you pay it forward and make change. Extraordinary. Thank you so much. And to all the listeners out there, I’m dr Buka bars resources on listed on the show notes. If people need to get ahold of you, what’s the best way that they can do that

Amina:
Info@Avantinstitute.Com is the easiest way to get ahold of me because that’s where we condense all the experiences and teach through. Because if you call the pharmacy they’ll say, well we can’t find a MENA if you go, we can’t find a meaner. But because I bring all these down to avant Institute and I have my peripheral brain and right hand, Jessica was so responsible to respond and see what needs we could meet because some people are trying to open their pharmacy. So I’m trying to do clinical services. Some are trying to invest in Troy or bring Troy to their area. So whatever that is absolutely info@avantinstitute.com would they would allow. They know how to find me.

Michelle:
Excellent. Thank you so much and thank you for being on the show and to all our listeners out there, after you’ve listened to the show, you can see there is so much for us to do as pharmacists and the extraordinary work being done out there. And remember at the end of the day, it’s up to you be the change.

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