The Spinning Compass

My husband said something last week that stopped me in my tracks.I was rambling — the way I do when I'm processing out loud — about pharmacy, about what I'm seeing in the profession, about the pharmacists I'm mentoring and the ones who are reaching out for the first time. I was trying to describe this feeling I keep hearing in discovery calls and DMs and emails. This restlessness. This sense that something is off but nobody can name it.

And Jeff, who is not a pharmacist, who has never filled a prescription or argued with a PBM or sat through a CE on sterile compounding, looked at me and said:"It sounds like pharmacy is a spinning compass."

I stopped talking. Because that was it. That was the exact thing I'd been trying to say for months and couldn't find the words for.

A spinning compass.

Think about what a compass is supposed to do. It points north. It gives you direction. You look down, you see the needle settle, and you walk.

But what happens when the needle won't stop spinning?

You freeze. You second-guess. You look around at everyone else walking confidently in their direction and wonder what they know that you don't. You start walking one way, then turn around. You pick up another certification. You scroll LinkedIn at midnight looking for a sign. You register for another webinar. You download another free guide.

And the needle keeps spinning.

That's pharmacy in 2026. Not because there aren't options — there are more options than ever. Retail. Hospital. Academia. Industry. PBM consulting. Functional medicine. Specialty. Telepharmacy. MSL. Informatics. Compounding. Long-term care. Ambulatory care.

Population health.

The problem isn't a lack of directions. The problem is that every direction looks like a maybe. And when everything is a maybe, nothing feels like a yes.

I spent 20 years in that spin.

Eight jobs. Eight different versions of pharmacy. Retail. Hospital. Mail order. Specialty. Nuclear. Long-term care. Each one started with hope and ended with the same quiet realization: this isn't it either.

It wasn't that the jobs were terrible. Some of them were fine. A few were even good. But none of them felt like mine. None of them let me use my degree the way I thought I would when I took the oath.

You know the oath. You stood in a room full of people wearing the same gown and you said you would consider the welfare of humanity and relief of suffering your primary concerns. You meant it. And then you got a job where your primary concern was volume metrics, prescription counts, and prior authorization hold times.

The oath said one thing. The job said another. And the compass started spinning.

Here's what I've learned after almost a decade on the other side of the spin.

The compass doesn't settle because you find the right job. It settles because you find the right structure.

Let me explain what I mean.

When I talk to pharmacists — whether they're in functional medicine, antibiotic stewardship, pediatrics, geriatrics, food-as-medicine, deprescribing, or any other clinical niche — they almost always describe the same frustration. They know how to care for patients.

They know their stuff. They have the clinical depth. But they can't figure out how to get paid for it in a way that's sustainable, legal, and doesn't require them to beg for a seat at the table.

They have the knowledge. They don't have the infrastructure.

Care management — chronic care management, remote patient monitoring, principal care management, whatever combination fits — is that infrastructure. It's not a niche. It's a backbone. It's the billing structure that sits underneath whatever clinical expertise you already have and turns it into a recurring, insurance-reimbursed, physician-contracted practice.

You don't change what you know. You change how you get paid for it.The functional medicine pharmacist who wants to manage patients holistically? Care management gives her the billing codes.

The antibiotic stewardship pharmacist who thinks his niche is too narrow? Care management gives him the framework to monitor chronic disease patients who happen to need his expertise.

The food-as-medicine pharmacist who wants to help patients get healthier through nutrition? Care management gives him the monthly touchpoint and the revenue model.

The compass wasn't spinning because you didn't know what you wanted to do. It was spinning because you didn't know how to structure it.

I stood in a room at the ASCP Regional Meeting in Connecticut two weeks ago and watched it happen in real time.

I was doing an express talk on care management. And as I was talking — not about disease states, not about clinical protocols, but about positioning and implementation and how to get paid — every head in the room started nodding.

Not the polite, I'm-being-a-good-audience nod. The real one. The one where someone's brain catches up to something their gut has been trying to tell them for years.

They already knew how to do the work. Every single person in that room could manage a patient's chronic conditions, review their medications, coordinate with their physician, and improve their outcomes. They'd been doing it for years. Some of them had been doing it for decades.

They just didn't know there was a structure that would pay them for it.

And when I showed them that structure, the compass settled. Right there in the room. I could see it on their faces.

That same week, we launched a waitlist for something called the Innovative Pharmacist Alliance — a group inside ASCP for pharmacists doing pharmacy differently. No website. No ad spend. No marketing team. Just a Google Form and a mission.

In less than two weeks, over 140 pharmacists raised their hand. Almost 70% of them aren't even ASCP members. They came from LinkedIn, from word of mouth, from pharmacists telling other pharmacists: something is forming and you should pay attention.140 pharmacists who are tired of the spin. Who want a direction. Who are looking for their north.

That tells me everything I need to know about where this profession is right now. The hunger is real. The talent is there. The clinical ability has never been the problem. The problem has always been the space between "I know how to do this" and "someone is paying me to do this."

That space is where I live. That space is what I built Tendco Health inside of. And that space is what the PIVOT Program is designed to close.

PIVOT isn't a course. I need you to hear that.

It's not more education. You don't need more education. You didn't need more education five years ago. You need implementation. You need positioning. You need someone who's done it — who is actively doing it right now, today, with real patients and real physicians in a real practice — to walk beside you and show you how the structure works.

That's what PIVOT is. Twelve months. One-on-one mentorship with me. Every framework, every template, every contract, every script. Plus my phone number and my time, personally, every month, making sure your compass doesn't start spinning again.

I built 14 frameworks over 8 years of doing this work. I didn't learn them in a textbook. I built them in the field — in physician offices, on patient calls, in contract negotiations, in moments where I had to figure it out because nobody was teaching it.

Now I teach it. Not theory. Proven practice.

PIVOT stops the spin.

Enrollment opens April 29th. Doors close May 4th.

If your compass has been spinning and you're ready for it to settle, this is your window.

Drop "PIVOT" in the comments or DM me. I'll send you everything you need to make a decision before the 29th.

And if you're not ready — that's okay too. Keep reading. Keep watching. Keep showing up here on Prescribed Change. When your compass settles, I'll be here.

But if you already know — if you've known for a while and you've just been waiting for the right moment — this is it.

The needle is pointing. Follow it.