I was working at my desk one day when I heard my boss come into the lunch room and put his feet up on the table. “Man,” he said, “I sure could make a lot of money if I didn’t have to pay my employees!” All munching and wrapper-rattling ceased for a moment. I mean, what do you say to that? Nobody runs a business all by himself. A person may act as a leader or the creative force behind a product, but it takes a team to turn someone’s ideas into reality. Aside from a whole lot of stupid in the boss’ comment there was an even bigger dose of arrogance. But this was the 80’s, an era of union-busting, easing of child labor and anti-sweatshop laws, cutting of job training programs and replacement of thousands of federal employees with temporary workers who would not have civil service or union protections. A decade of anti-labor legislation and rhetoric would set the stage for the current situation of wage stagnation, loss of pensions and benefits, off-shoring of jobs and unemployment.
Fast forward 25 years to 2011. The governors of New Jersey, Wisconsin and Ohio all fought to abolish collective bargaining rights and limit health insurance benefits, sick leave and vacation time for public workers. The governor of Maine removed a mural from the Department of Labor that depicted the history of labor in his state. The governor of Texas claimed he worked a “Texas Miracle” in employment, which turned out to be a lot of low-wage positions without health insurance or other benefits. The governor of Michigan is being sued over legislation which bans labor agreements in construction projects paid for by the state. The governor of Florida supports legislation to block state and local government from deducting union dues from employees’ paychecks, making it harder for unions to collect operating funds. Within three months of taking office, the governor of New Mexico had five suits filed against her for firing the entire Public Employee Labor Relations Board which enforces public sector bargaining rights and handles disputes. So would you be surprised if I told you that Slate Magazine recently reported on the growing trend of replacing pharmacists with robots? Me neither.
Whatever your view regarding unions, they set the bar for wages and benefits for workers across the nation, public and private. When unions are weakened, wages drop and benefit packages shrink. Workers are being vilified to justify paying them less, as in New Jersey where the governor referred to teachers as “thugs”. Professions held in esteem when I was a kid – teachers, firefighters, cops, nurses and civil service workers –
are no longer seen as valuable. There are fewer of them and they’re paid less. If you think pharmacists aren’t vulnerable to the same kind of treatment, think again. The trend in pharmacy is away from service-oriented community drug stores and toward the big chain model where the emphasis is on filling prescriptions – lots of them – and little else. Pharmacists don’t have time to do anything else. They have about 3 minutes, on average, to correctly check and fill each one. More often, insurance companies are referring their customers to mail-order pharmacies where face-to-face interaction is cut out altogether. The PharmD degree has become the education standard but practicing retail pharmacists don’t have the opportunity to use their clinical training on the job. Pharmacists are marginalized, their skills underutilized. Although, as Slate reports, pharmacists spend “years learning about the deep connections between pharmaceuticals and human biology”, most of that training isn’t used on the job. Instead, they spend their time on more menial tasks – calling doctors, checking on insurance coverage and dispensing medications. Much of their job is repetitive and that, according to Slate, makes them ripe for replacement by robots: “Most major retail chains also operate “central fill” facilities—huge, automated plants that crank out thousands of prescriptions and send them out to all the stores in a particular region. More than likely, the pharmacist who hands you the medicine played no part in dispensing it.” And robots are more accurate than humans, with automated mail-order operations making one mistake for every 1000 prescriptions filled vs. one error for every 55 filled at a retail pharmacy.
The Redheaded Pharmacist, whose blog I read regularly, disagrees with Slate’s opinion that robots will eventually take over: “Forgive me if I find it hard to believe a robot will….help an old lady with exactly 18 questions about stool softeners. And I didn’t even talk about other functions of pharmacists like compounding, dose adjustment calculations, answering clinical questions, and of course flu shot administration. If we really are at risk of being replaced by machines then the position of pharmacist has been marginalized to the point where we don’t matter anyway.” And that’s exactly the point. Professionals of all stripes ARE being marginalized and marginalization, at least in the case of pharmacy, will lead to automation. Forget the fact that pharmacists spend a lot of their time straightening out insurance snafus and keeping people informed. Lack of service is already the problem most complained about by mail-order pharmacy customers. As robots are phased in, pharmacy customers will have fewer and fewer resources available when they have problems or questions.
The Redhead is right when he says that pharmacy is at a crossroads. If robots can dispense better and retail employers aren’t interested in pharmacists playing a bigger role in their customers’ medical care as counselors and educators, then it’s up to pharmacists to get serious about carving out a niche for themselves. They can do a lot to improve medication adherence, reduce complications, monitor and adjust drug regimens
for chronic conditions like HIV and cancer, administer vaccines and educate the public on the drugs that are prescribed for them. Pharmacists can fill the ever-widening gap between health providers and those with little or no insurance coverage, but first they have to overcome this image of pharmacist-as-pill-counter that persists in the minds of employers and patients. In this environment where workers have less respect than ever, pharmacists must demonstrate their value to the community. Tomorrow when you call an airline or a credit card company and can’t get an actual person on the line, you will be reminded of one thing – the human factor is vital. The lack of it is what is wrong with American business, including health care, today. Pharmacists have to show management that strengthening the human connection is actually good for business. As Karel Capek, the Czech author who popularized the term “robot” said: “Robots are mechanically more perfect than we are, they have an astounding intellectual capacity, but they have no soul.”