I live in a community – that is, a community as opposed to say, a home made up of a nuclear family or a couple. I suppose it’s an unusual way to live. None of my friends or family members live in communities and I suspect that some of them regard my lifestyle as strange. But looking back over my life I see that I have always tried to create community in one way or another. From my days living in Chicago and San Francisco, then back to my home town of Albuquerque I have lived in seven different communal households, some successful and some dysfunctional, but always interesting and always, always enlightening.
If you look up the word “community” in the dictionary you will find one of its meanings is “a unified group of individuals”. Indeed, in my experience only the communities that come together over one unifying philosophy or practice thrive. People who cannot bridge their differences see only how they are not alike and those differences become wedges that drive them apart. But when individuals come together on common ground great things can happen. People linked by a common viewpoint can build the support system necessary to reach goals they could not accomplish on their own. There is, as they say, a definite power in numbers.
The pharmacy profession is under intense pressure these days. All 50 states have the same law: There must be a pharmacist present when a prescription is dispensed to the patient. This is, according to pharmacist and writer Jim Plagakis, the bedrock issue that defines pharmacists, and that definition is being challenged. Pharmacists all over the country complain about a workload that not only causes stress and inconvenience for individuals on both sides of the counter but actually endangers the lives of pharmacy patients. Pharmacy Benefit Managers (PBMs) have created a bureaucracy that exists only to drive profits and ultimately takes control out of the hands of pharmacists. Big chains cut pharmacy staffs to the bone resulting in prescription avalanches that justify implementing mail-order service or automation. The push, in other words, to cut pharmacists out of the process of dispensing prescription drugs all together is on, and with a vengeance.
The saving grace of the pharmacy profession lies in its untapped potential. As the author of The Redheaded Pharmacist blog has said, pharmacists are the “sleeping giants” of the medical field. Despite their rigorous education and expertise they are relegated mostly to the tasks of dispensing and distributing prescription drugs. Instead, their role could be expanded to protect public health by overseeing programs to advocate and administer vaccinations, to run cholesterol checks, blood pressure screenings, and to manage drug regimens for HIV or cancer patients. Few physicians take the time to make sure their patients understand the drugs they prescribe, so most Americans are dreadfully ignorant when it comes to the drugs they take. As the true drug experts, pharmacists should also be counselors. They are capable of much more than handing out information sheets and asking if patients have questions. They could help hospital patients understand the drugs they are given at a time when illness or injury makes them particularly vulnerable. They could counsel chronic patients outside the hospital to manage their drug treatments properly. They could even lobby for a class of behind-the-counter medications which they prescribe and dispense, taking pressure off physicians for the management of some conditions and cutting costs for the healthcare system by giving the patients the tools to better manage themselves.
Pharmacists are aware that their talents are under-utilized. Movements to give pharmacists greater responsibilities exist all over the country and models like Medication Therapy Management (MTM) are poised for institution and ready to go. But MTM remains on the shelf and pharmacy clinics are few and far between. The key to granting greater responsibility to pharmacists permanently is legislative change. Yet legislative change does not come easily and the wheels of the American Pharmacists Association (APhA), the largest association of pharmacists in the United States, grind exceedingly slow. The solution, at least in part, goes back to the discussion of community. Community – the coming together of pharmacists over the idea that they can and should play an expanded role in the medical field – could serve as the much needed vehicle of change.
Community IS powerful but making it a living, breathing reality is tricky. The call to change is certainly out there; problems and possible solutions are in every professional blog and online publication. In Alcoholics Anonymous is it said that the chances of making a lasting change before hitting bottom are practically nil. If that’s true, then what is the bottom for pharmacists? Pharmacists are notorious for not organizing and for better or for worse, unions are no longer popular in the American psyche. Only 11.9% of the country’s workers belong to one, according to the Department of Labor. A lot of pharmacists don’t see there’s much to be gained by joining a union. Many feel it would be wrong to strike under any circumstances. Others feel unions are only interested in their own political agendas. Still, most agree that yes, something must be done.
About 60,000 pharmacists belong to the APhA – less than one quarter of the total of about 270,000 pharmacists who are employed in the US. The APhA launched its initiative, Project Destiny, in 2008, designed to develop a “replicable, scalable, measurable, and economically viable future model for community pharmacy.” Although involved in establishing a new role for pharmacists, many see them as detached from the everyday problems that plague the profession. State organizations and local boards of pharmacy are not regarded any more highly; pedantic and made up of political appointees, they lack the perspective of pharmacists on the front lines and do little to address their grievances.
“Real change,” said President Obama, “comes from the bottom up, the grass roots, starting with the dreams and passions of individuals…” The same can be said for any group, any community. First there must be a common dream of how things could be, then a passion to do what’s necessary to make that real. It should be obvious to pharmacists by now that organization leaders aren’t going to do it. It will take a huge wave of fed-up pharmacy professionals who have hit their bottom and care enough about the profession to work for change. Let’s hope they’ll hit that bottom and bounce back without bottoming out – and soon.