Martha P. Frankhauser
MS Pharm, BCPP, FASHP, FAzPA
By: Joseph Cusimano, PharmD candidate (Class of 2018), CPNP-OSU Collegiate Chapter President
Over the holidays, I had the pleasure of conducting an informational interview with Martha (Martie) Fankhauser, MS Pharm, BCPP, FASHP, FAzPA about her 40-year career in neuropsychiatric pharmacy and academia. I first met Ms. Fankhauser at the Arizona Pharmacy Association (AzPA) Annual Conference in 2016, during which she gave two lectures and co-presented the Psychiatric Certificate Program, and have stayed in touch with her since.
Ms. Fankhauser’s career in pharmacy began in Kansas, though it can probably be traced back to her father’s family-run pharmacy. From high school to college, she took an interest in psychology as well; as such, it was only natural that she would one day combine her family’s trade with her interest in how the mind works. She completed a BA in biology and a BS in pharmacy in 1974 and worked in both community and hospital settings after graduating. With the help of a friend (pharmacy is a small world!), a pharmacy director at a mental health facility in Charlotte, North Carolina, she joined the field of neuropsychiatric pharmacy as a clinical pharmacist in 1977.
For Ms. Fankhauser, patient education was the most rewarding part of the job, and she would later develop a medication education program for the in-patient setting. After attending a state psychiatric meeting in Athens, Georgia, she discovered that there were others pharmacists like her in the country—real, psychiatric pharmacists. “I vividly remember that experience because, prior to that, I didn’t know anybody else like me.” In those days, neuropsychiatric pharmacy was still in its infancy; the College of Psychiatric and Neurologic Pharmacy (CPNP) did not yet exist. She and her colleagues began holding a “special interest group” in psychiatry at ASHP annual meetings, which would later develop the board certification in psychiatric pharmacy (BCPP).
Out of all of her duties her favorite was educating patients, and her passion for education would only grow. After moving to Tucson in 1980, and completing her MS Pharm and psychiatric residency, she became a Clinical Professor in the Department of Pharmacy Practice and Science at The University of Arizona College of Pharmacy from 1982 to 2010, and retired in July 2010. She worked part-time at the Arizona Smokers Helpline for several years to help people stop using tobacco. Since 2014, she works part-time to serve patients at an integrative medical-psychiatry clinic, Assurance Health and Wellness (AHW) in Tucson, Arizona. AHW was the first integrated medical-psychiatry clinic in Arizona, providing a 9 week wellness program focused on helping to empower patients to take responsibility for their nutrition, exercise, sleep habits, and substance abuse. Ms. Fankhauser sees patients individually, taking time to teach them about medications and supplements, going over their lab results, and making recommendations to improve their health. Reflecting on her experiences, she went on to describe how rewarding her practice was: “I can honestly say that it’s the best job that I’ve ever had. I absolutely love teaching and having time with these patients…I feel like I know them, and they know me.” Patients that “graduate” from the program can come back to the AHW clinic as alumni, and she continues to keep in touch with these patients. “You can see just how much they’ve learned. I can ask them, ‘OK, today we need to make some serotonin. What foods and vitamins do you need?” The clinic also has a gym and a kitchen, with an nutritionist on staff. The focus is truly on comprehensive care, and her expertise as a neuropsychiatric pharmacist is key. “It’s very broad based, and that’s why I like it. I have a lot of input on the health and wellness of our patients.”
While at the University of Arizona College of Pharmacy, only half of her salary was provided by the academic appointment. The rest came from clinical opportunities in the area, from practicing at a developmental disabilities clinic to working in numerous mental health clinics and hospitals as a consultant. I was interested in learning more about the work as a consultant, so I asked her to delve into more detail on that. “I had to learn how to write up my job description, what I would do, and put a price on it.” However, her services had to be reimbursed directly by the agencies, since they were not covered by insurance. Despite the financial challenges, she was able to offer her expertise to mental health agencies for 30 years while working at the College of Pharmacy. The funding also helped to develop a neuropsychiatric residency program and expand psychiatric pharmacy services in the community.
Upon retirement in 2010, she developed a private consulting practice and receives referrals from medical and psychiatric professionals in the community. She has a website (www.martiefankhauser.com) describing her neuropsychiatric pharmacy services and people pay her directly for her time based on an hourly rate. “I enjoy having people come directly to my home. We sit at the dining room table and have a 1-2 hour session. A lot of it is education. Nutrition is huge, and that underlies a lot of issues. People often aren’t eating the right foods, or are restricting foods in their diet.” As I learned in the AzPA Psychiatric Certificate Program, blocking the reuptake of serotonin within the synaptic cleft doesn’t work well if the body cannot biosynthesize enough serotonin in the first place. For example, when an SSRI prevents serotonin from recycling in order to increase the amount of serotonin left in the synaptic cleft, the neurons can actually become depleted of serotonin if endogenous synthesis can’t keep up with demand, leading to therapeutic failure. It’s this kind of life-saving clinical expertise that only neuropsychiatric pharmacists are able to offer. Ms. Fankhauser’s focus is on preventative approaches to health and teaches that “many symptoms such as anxiety, depression, insomnia, cognitive difficulties, and headaches can be due to nutritional, vitamin, mineral and hormonal deficiencies and substance use that can be corrected without using psychotropic medications.”
The fact that psychiatric pharmacy services can’t be reimbursed by insurance exemplify the need for provider status. As Ms. Fankhauser put it, “We’re still not being paid for what we know.” Even when pharmacists are reimbursed for services, the pay is far less than the knowledge base required to provide those services, let alone the time involved in providing them. “There’s such a great need for comprehensive medication therapy management that includes behavioral health, but we need the insurance companies and Medicare/Medicaid to see us as professionals; as members of the healthcare team, with the right reimbursement rates. We know that we can help decrease healthcare costs, prevent hospitalizations, and improve outcomes—especially if we were reimbursed better for the services that we can provide.” Due to the current reimbursement structure, which relies upon dispensing, most pharmacists serve as the last line of defense in verifying the accuracy and appropriateness of a prescription. However, she believes that we can have a much greater impact by employing our cognitive skills from the very beginning, but we need financial compensation in order to provide those services. “If we were treated like part of the team before that prescription gets sent, I know that we could prevent a lot of problems. I think that we need to be where the patient is being seen. By the time a prescription gets to a dispensing pharmacist, you’re hoping that everybody has looked at it, and nobody is scrutinizing it the way that we could do it.”
It’s no secret that working in academia requires time and dedication. “When I became faculty, I remember the reality check—you’re accepting a position that’s not 8am-5pm. Before, I had worked in hospitals and clinics where you could just come in, work hard, then leave.” As an academic pharmacist, splitting herself between the classroom and the clinic, she developed strong organizational skills, as well as time-management. “It never ended. I rarely took vacations—almost never got sick. When I retired in 2010, I realized that I was probably burning myself out. How did I do all of this stuff?” In addition to teaching courses on topics in neurology, psychiatry and pain management, she developed and was the director of a neuropsychiatric residency program for 12 years, organized an annual conference on neuropsychiatric pharmacology, and served as a preceptor for students. “Not everyone can do faculty work; I think that it’s a unique desire to want to teach, do research, mentor students, and have a clinical practice. I don’t think that we always get recognized for all of that. A lot of positions in academia are promoted based on research dollars and papers published, and I took the route of a career focused on education and mentoring.”
Throughout the interview, Ms. Fankhauser emphasized the importance of strong communication skills for a career in neuropsychiatric pharmacy practice. Empathy, compassion, and a desire to meaningfully connect with patients—all of these qualities are essential to the success of a neuropsychiatric pharmacist. She noted that almost every pharmacist that she’s talked to in this field has some kind of personal connection to the work. “They have a personal interest, and when it catches, when the pharmacist enjoys it, people are tremendously motivated and excited about it.” She touched upon the importance of teamwork as well, and the role of pharmacists as drug experts. Psychiatrists, nurses, and pharmacists each have an essential role to play, with mutual respect for each other’s discipline.
Previously, I had spoken to Dr. Chris Thomas, PharmD, BCPP, BCPS, President of the College of Psychiatric and Neurologic Pharmacists, about the future of neuropsychiatric pharmacy. His vision included a shift from the institution towards the community, and Ms. Fankhauser agreed. “I think that it’s possible that we’ll see more and more community pharmacies involved; after all, that’s where most patients come to get their medications… Even if you’re not practicing in a psychiatry clinic, you’re still responsible for those patients.” Whether you’re interested in working in a hospital, ambulatory care clinic, or community pharmacy, there are ample opportunities to ensure the best possible care of psychiatric patients. “When I think about specializing in pharmacy, I think that psychiatric patients have to be served in the community. What other specialty serves a wider range of people that need help?”
Finally, I asked Ms. Fankhauser for her advice on what pharmacy students should be doing now to prepare themselves for careers in her field. “Seek out faculty mentors from the people that teach it. Discuss what it’s like to have a career in our field, look into attending meetings at conferences, and be active in CPNP.” Professors like Dr. McAuley, Dr. Hartman, Dr. Maguire, and Dr. Emptage (to name a few) serve as instructors during the CNS module, and students should feel encouraged to reach out to them. OSU has recently joined the number of pharmacy colleges across the nation with a collegiate chapter of CPNP, and getting involved is as easy as joining a committee, attending meetings, and volunteering your time and effort. Real life experience is important, and she emphasized that you don’t need to have a psychiatric rotation to gain psychiatric experience. “I always ask students, ‘OK, you’re doing internal medicine; how many psych patients did you see? How much discussion was on them?’ I think that our patients don’t get looked at us much, except during psych rotations. You can start by trying to get exposure in any setting.” Communicate your interest in neuropsychiatric pharmacy to your preceptors, and ask about opportunities related to what you’re passionate about. If you’re in the community setting, ask about how to triage a patient expressing suicidal ideations. If you’re in the ambulatory setting, include questions about mental health during your review of systems. If you’re in the hospital setting, ask to round with the stroke service. “Another example is for pharmacists to get involved with community, state, and national organizations that serve neuropsychiatric patients.” Ms. Fankhauser has served as a board member for the state Tourette Syndrome Association and the Autism Society of Southern Arizona and provides educational programming for professionals and the community. There are always opportunities to get involved, and pursue your passions!