In 2016, I found care management.

And then I sat on it for 24 months.

Not because I was lazy. Not because I didn't understand it. Because I was terrified.

I'd spent 15 years in pharmacy — 8 different jobs — and every single one had taught me the same lesson: stay in your lane. Fill the prescription. Stay in the box.

So when I discovered that there were programs — real, billable, Medicare-funded programs — where a pharmacist could manage patients monthly, review medications, educate, motivate, and actually do the work we were trained to do... I froze.

Because doing something about it meant having a conversation that put me outside the box of pharmacy. And nobody I knew had ever done that.

Was it fear? Absolutely.

Was it imposter syndrome? Every day for 24 months.

Was there proof it was possible? None. Zero. Not one pharmacist I could point to and say "they did it, so I can too."

And so I researched. I read. I planned. I built presentations. I made lists of 15, 20 things I could offer a physician office.

But I never started.

What finally broke me out wasn't a certification. It wasn't a course. It wasn't confidence.

It was desperation.

My mom — in one of what felt like a hundred conversations about whether I was ready — finally said: "Go have the conversation."

I said I wasn't ready.

She said: "Go have it NOW."

And I did. It was ugly. It was imperfect. I walked in with a 20-item list that confused everyone in the room. But the physician already knew me. She trusted me because I'd been the retail pharmacist who always called — about clarifications, prior auths, refills. I'd been helping her practice for years without getting paid for it.

She asked me a question I couldn't answer: "Why do you sit in the basement?"

She meant it literally — every hospital she knew kept the pharmacy in the basement. But she also meant it metaphorically. Why was I keeping myself small?

She said yes to a 25-patient pilot. Not because my pitch was good. Because the relationship was real.

That's the part nobody talks about. The first yes doesn't come from a perfect presentation. It comes from trust you've already built. You just have to be desperate enough — or brave enough — to ask.

The door was always there. I just couldn't see it until I was desperate enough to look.

If your door is sitting right in front of you and you're doing what I did — researching, planning, building slide decks, telling yourself you need one more certification — stop.

Go have the conversation.

🎧 This week on The Dose, I tell the full story — the fear, the 24 months, and the day the compass stopped spinning. Listen here.

—Thea