So You Want to Be a Pharmacist?

Who wouldn’t be happy to be a pharmacist? They’re prestigious professionals of the medical field – white coat, license, good pay and benefits. What’s not to love? But stress within the profession is increasing and with big chain pharmacies gobbling up the independents at an alarming rate, it’s not hard to understand why.

The good news: US News & World Report names pharmacy as one of the best careers of 2009. They cite the expanding role of pharmacists, high demand, increasing number of pharmacy schools and good salaries as reasons for their nomination.

The bad news: Pharmacy falls off the list when US News &World Report releases their article about the 50 Best Careers of 2011. No explanation offered.

The good news: In 2004 the journal P & T reports that 80% of pharmacists in independent settings and 78% of pharmacists in hospital settings are satisfied with their jobs.

The bad news: In 2004 P & T reports that only 53% of pharmacists are satisfied with their jobs in retail settings.

The good news: Pharmacy benefits for some 200 million Americans are administered by pharmacy benefit managers (PBMs), third party companies that use their clout to obtain lower prices and benefits for customers like drug discounts, rebates and mail-order services.

The bad news: Independent pharmacies as a group are blocked by antitrust laws from negotiating collectively with the PBMs. They sign contracts with the big three, Medco Health Solutions, Caremark and Express Scripts, but have little to say about the terms. PBM schemes to save money, such as mail-order drug services, are driving independents out of business. Big chains cut staff and personalized service to keep up.

The good news: 60% of US pharmacists are employed in retail outlets like Walgreen’s (5000 stores), CVS (4100 stores), Walmart, Target, Rite-Aid, etc., that provide money-saving offers to increase their customer base. That means many $4.00 prescriptions, 90-day supplies of prescribed drugs, mail-order services, 15 minute prescription fill guarantees and drive-through convenience for you and me.

The bad news: The National Community Pharmacist Association (NCPA) has logged thousands of complaints from customers who are frustrated by the lack of service when they’re forced into mail-order service as a cost-cutting measure. They’re aggravated by shipping delays, confusion on prices, incorrect orders, late refills and the inability to reach a human being on the phone at their PBM. Naturally, when there’s a problem with mail-order, customers want retail pharmacists to fix it. Lean staffing practices mean pharmacists already have only 3 minutes to dedicate to each prescription. Reported errors make up about 3% of the total, meaning actual error rates are much higher. Now Rite-Aid is advertising 15 minute guarantees. Are they kidding?

The good news: Big chain stores offer competitive pricing on drugs. Some stores are open 24 hours. When visiting these stores customers can also shop for groceries, clothing and household items. There’s LOTS of these stores in urban areas; they’re easy to get to and have ample parking. A recent Walgreen’s commercial depicts that renewing a prescription is so easy, you can do it on your cell phone while mountain climbing in sub-zero temperatures.

The bad news: Big chain pharmacy has a narrow focus on efficiency, reducing their in-house pharmacies to assembly lines. CVS pharmacies in Georgia have been fined by the state’s Pharmacy Board for not having enough pharmacists on staff, which means your prescriptions are being overseen by pharmacy techs instead, with 2 years of education. Pharmacists don’t have time to counsel their customers, meaning there is a gap between the proposed expanded role for pharmacists and reality.

More bad news: Big chain pharmacies are plagued by high pharmacy staff turnover rates and low job satisfaction levels. Pharmacists in the big stores work long shifts on their feet without lunch breaks. Their jobs are largely about navigating through conflicting rules of the various insurance companies as opposed to serving the needs of patients. Increased use of pharmacy techs by the employers means more management responsibility for the pharmacist while their wage/benefit packages are driven lower. Why get into this lousy business, anyway?

The good news: Pharmacists still have the ability to make positive changes in their profession by changing their focus. Many pharmacists like to think of themselves as non-political and they’re notorious for not organizing. Letters to the American Pharmacists Association on critical issues from large numbers of pharmacy professionals DO have impact, as do emails and phone calls to state boards of pharmacy and lobbying efforts to pressure state politicians on matters of pharmacy legislation. Medication therapy management programs may seem like distant dreams until groups of concerned pharmacists come together to find ways of making them happen. And instead of watching independent pharmacies go the way of the dinosaur, pharmacists need to capitalize on what makes service at the smaller stores different – why someone like me should never find a reason to patronize a big chain store for my prescriptions again. In short, show the world why the neighborhood pharmacist is indispensible to every healthcare team and every customer. Proclaim the value of personalized pharmacy service and education from every rooftop! Take this story, for example: one night at an independent pharmacy in Kansas, pharmacist Brian Caswell sent a customer to the hospital after he had come in complaining that he didn’t feel well. “I took his blood pressure and knew something wasn’t right,” Caswell says. “He came back days later and says he could have dropped dead from cardiac arrhythmia. Now I have a customer for life. Can mail-order do that?”

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