A Day in the Life: A Compounding Pharmacist

Ruth Fields January 29, 2016

Photos by Kelly Sue Photography

It’s the busy cold and flu season, but Steve and Cindy Oatman, owners of Medicap Pharmacy in Conroe, graciously invited the Postcards team to tag along with them for the morning.

8:00 – Medicap Pharmacy opens at 9:00, but owners Cindy and Steve Oatman have already been at work since about 7:30. Steve is busy working on his compounded prescriptions, including some that take as much as 30 minutes to prepare. “It’s hard to do it once we open,” Steve says, “so I come in early or stay after we close.” A registered pharmacist, Steve is one of the few pharmacists in Conroe who does compounding, or custom-mixing of prescriptions. “Everybody refers to it as compounding, but it’s preparing medicine specifically for a patient,” he says.

8:10 – Before the Postcards team arrived, Steve used an electric mortar and pestle to mix two powders together in cream form. Now, he transfers the mixture from one syringe to another to ensure the compound is evenly mixed. He notes this patient-specific drug preparation is, in a way, a return to yesteryear, when there were fewer manufactured drugs available. “Thirty or forty years ago, most prescriptions were made like this. I once had a co-worker who went to pharmacy school on the GI bill after World War II. When he came out of school, there weren’t as many drug manufacturers. He had a pharmacy in the Heights during the 1940s and 1950s,” Steve says. “He even sugar-coated his own tablets.”

8:15 –Cindy, Steve’s wife of 22 years and business partner for 13 years, readies the pharmacy for opening. “We want to hurry and get caught up before we open the store and the phones start ringing,” she says. Cindy wears many hats at Medicap. A registered nurse who once worked for the renowned heart surgeon Dr. Denton Cooley, Cindy is qualified to counsel patients about their medications and is committed to providing exemplary service. She also administers flu shots (and sometimes other vaccines) in a private consulting room.

8:20 – Steve is still busy in the lab. He estimates about five percent of the prescriptions filled at Medicap are custom-mixed for patients. He explains that doctors who want their patients to receive drugs not available from pharmaceutical companies often suggest they have their prescriptions filled at one of the few compounding pharmacies—like Medicap—in the Conroe area. For example, if a doctor wants to prescribe a drug for a small child that is not available in liquid form, Steve can make a suspension formula. Likewise, a patient may talk to his or her physician about getting a prescription in another form (such as a suspension or a cream) than what is commercially available. If the doctor is agreeable, and if the drug will be stable in the new form, Medicap can prepare the prescription. In addition, a physician may want to treat a patient with a combination of medications, such as a cream that contains both antibiotic and antifungal drugs. “We can’t duplicate something that’s already on the market,” Steve says, “but we can mix different products together.” If drugs are not commonly used together, Steve checks to make sure there will be no adverse reactions between them.

8:30 – Steve finishes a preparation and reports to the front of the store. Meanwhile, the Medicap staff begins to trickle in, staggering their arrivals so they won’t all be on lunch break at the same time. One of the pharmacy’s certified pharmacist technicians begins processing prescriptions that were called in since the store closed yesterday.

8:45 – All the computer screens in the pharmacy are being used so last-minute tasks can be completed before the store opens. Meanwhile, Cindy unpacks a drug order and tells about the couple’s decision in 2002 to open their own pharmacy. Steve had been working at the pharmacy at Conroe Regional Medical Center, but began to consider opening his own pharmacy. “We decided if we are going to work this hard, let’s work hard for our family,” Cindy says. “It was a decision made with lots of prayer.” At the time, the Oatman children, Daniel (now an architecture major at the University of Houston) and Sarah (now an allied health major at Sam Houston State University) were six and seven years old.

8:50 – Cindy explains that, because neither she nor Steve have business degrees, they didn’t know how to open a business. So they decided to purchase a franchise, ultimately choosing Medicap, because they liked the company’s family values. “The nice thing about being part of a franchise,” Cindy says, “is they negotiate insurance contracts and the cost of medications for us. It’s a big buying group.” Sometimes, she says, this buying power can result in discounts that can be passed on to customers. On occasion, customers can pay for their prescriptions themselves for less than their insurance co-pays.

9:00 – Medicap Pharmacy opens. The first customer of the day comes through the drive-through window, and the first in-store customer arrives a couple of minutes later. The drive-through is particularly popular among patients on rainy days, Cindy says with a smile, as well as at the end of the day when people are tired. Because of Medicap’s location at the edge of a parking lot, the drive-through window “works both ways, for passengers and drivers,” she says. If there are several cars at the drive-through window, Medicap employees will often tell patients to do a “victory lap” while their prescriptions are being filled.

9:15 – Cashier Edith Hernandez retrieves supplies from the back room. (As a courtesy to patients, Medicap provides measuring spoons and oral syringes for patients who have been prescribed liquid medications.) Edith is funding her own college education by working at Medicap. After she completes her studies at Lone Star College – Montgomery, she plans to major in biology at Sam Houston State University.

9:25 – A rattling sound can be heard in the pharmacy. It’s the automatic pill counter, which counts pills with an impressive 99.97 percent accuracy. When a certified pharmacist technician pulls a bottle from inventory, the machine scans the bar code, identifies the pill, counts the correct number and even suggests what size bottle to put the prescription in.

9:30 – Cindy calls a customer by name and asks about his grandson. “We treat everybody like family,” she says. One of the ways Medicap Pharmacy demonstrates this is through patient education. Steve, Cindy, and Sherry Berg, a registered pharmacist who works at Medicap, provide detailed information to patients about their medications and how they work, as well as possible side effects. “We have doctors who tell us they appreciate our pharmacy, because they know we will educate the patients about the medications,” Cindy says.

9:35 – A loud ding inside the pharmacy—an old-fashioned gas station bell—announces the arrival of another drive-through patient. Edith is tied up with a customer in the store, so Matt Redeo leaps into action to help out at the drive-through window. Matt is currently going through an on-the-job training program under Steve’s tutelage to become a certified pharmacist technician. This is a big move for Matt, a former Willis High School football player who previously worked in retail sales. In addition to providing training for Matt, Steve, a graduate of the University of Houston College of Pharmacy, is still a student himself. He often participates in continuing education classes for topics ranging from pet medications to hormone replacement therapy.

9:45 – A patient arrives for a flu shot. Cindy, who spent about 10 years as a nurse in the Army Reserve, has given many shots. Because she follows a doctor’s protocol, she can give flu shots without a prescription. (She can also give other shots—like the pneumonia and shingles vaccines—with a doctor’s prescription.) The patient’s insurance covers flu immunizations and will pay Medicap, so he receives the vaccine at no personal cost other than a slightly sore arm. Although Medicap has a private consultation room where shots are administered, Cindy has been known to give shots in the parking lot for patients who have limited mobility.

10:00 – The pharmacy is a hub of activity, but Cindy warns it will only get busier. It takes just 6-1/2 minutes to fill one prescription, but only one can be filled at a time; therefore, the Medicap staff has devised a triage system using color-coded baskets so the most urgent prescriptions can be filled first. Medicap strives to have all prescriptions filled within 15 to 20 minutes (30 minutes on a peak day), but gives priority to children and to patients who need antibiotics. “We try our best to give kids priority when they are sick,” Cindy says, “and frail seniors are just as important to us.” The pharmacy even delivers non-urgent prescriptions on Tuesdays and Thursdays to patients who cannot safely drive to the pharmacy.

10:15 – Kristen Moran, a certified pharmacist technician, tells us how much she likes working at Medicap. She left a large pharmacy chain five years ago and doesn’t regret the move. She says she likes being able to get to know her patients—“not only their prescriptions and medications, but their lives”—and the emphasis on patient care at Medicap.

10:30 – While prescriptions are being filled for customers in the main pharmacy, Cindy shows the Postcards team her “show and tell” drawer inside the private consultation room. There, she keeps such items as sutures, orthopedic rods and diagrams of surgical procedures. “We try to help patients better understand what they’ve just gone through,” Cindy says. She also helps explain their diagnoses. “If your doctor leaves you hanging, we can help you understand it better,” she says.

11:00 – The Postcards team leaves, but Medicap’s dedicated staff is still at work. They expect the day to get busier, with a final surge of activity at 5:00, which they call “happy hour.” Although the store closes at 6:00, Steve and Cindy—if they don’t have other commitments—will stay late to fill urgent prescriptions. It’s all part of Medicap’s commitment to exemplary patient care. “We care about them,” Cindy says. “Our patients trust us. I have boxes of Kleenex for people who have a bad diagnosis—and for good news, too! We believe God sends people here who need to be here.”