I once heard a pharmacist remark that they are in a losing battle because the nature of business conflicts with the nature of the profession of pharmacy. The nature of business is making profits. In retail pharmacy profits are made by filling as many prescriptions as possible with as little help as possible. But the nature of the profession is health care. Health care practitioners promote health and well-being. Pharmacists make clinical decisions and judgment about medication therapy – which drugs are appropriate for an individual and which are not, how to take medication properly and how to recognize the side effects. In fact, the principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication which improves patients’ quality of life. Ah, there’s the rub: the provision of conscientious clinical care and the business of retail pharmacy, in its current incarnation anyway, do not mix.
The complaints of retail pharmacists are fairly universal. After spending six years and thousands of dollars earning a doctorate in pharmacy, pharmacists use their extensive knowledge of pharmacology and their clinical training to stand on their feet twelve hours a day arguing with insurance companies on the phone. Oh, and directing customers to the cereal aisle. In between phone calls and customer interruptions they find the time to input, fill and check prescriptions, make sure techs aren’t making medication errors, giving patients the wrong information or escalating a situation with an irritated customer. Meanwhile, the market forces are closing in on them. Endless mergers mean that pharmacy chains are consolidating power within a short list of companies who decide how business is conducted. Mergers amongst pharmacy benefit managers and insurance companies give them an ever-growing influence over the direction of the profession. Pharmacists are nervous over the move towards automation, the increasing role of technicians, the mushrooming of pharmacy programs and the influx of foreign pharmacy grads flooding the market with hungry newcomers willing to work longer and harder for less. All in all, the picture for retail pharmacists is not a pretty one.
Some say the golden age of pharmacy is over. The squeeze is on for pharmacists to crank out the prescriptions, sacrifice quality to quantity, bend over for management and insurance companies and de-emphasize their skills as drug counselors and educators. But as blogger Pharmacy Mike wrote, “Maybe big box stores are not the best future for all of us highly educated drug experts.” Maybe not, indeed. Costco, Walgreen’s Wal-Mart and CVS will continue to push pharmacists out of the equation because increased use of automation and mail-order mean less labor and less labor equals higher profits. The hope for pharmacists is not to rail against the pressures of the retail business model but to expand their considerable skills and knowledge into a completely new direction.
Last week I wrote about the turf war that’s heating up between physicians and non-physician providers like nurse practitioners, physician assistants, dentists and chiropractors. Due to the state of our healthcare system there are millions of neglected or underserved people in need of care. The time is ripe for the development of new methods of healthcare delivery. We don’t lack competent providers who can step up and meet the need. We lack leaders who can face up to the arrogant posturing of medicine. Pharmacy must take its proper place within the medical community and demand the right to diagnose and prescribe. By deferring to the American Medical Association, pharmacy has given up its only true professional responsibility related to pharmacotherapy. Pharmacists can’t be first-rate drug therapists until they practice drug therapy. And the job of dispensing drugs in a retail drug store has almost nothing to do with pharmacotherapy.
There’s a lot written in the pharmacy blogs about the dreadful situation retail pharmacists find themselves in and many say they are “stuck on the sidelines” with neither the will or the power to do anything about it. But the winds are beginning to blow in a different direction. The Pharmacy Manpower Project’s 2009 National Pharmacist Workforce Survey indicates shifts in the pharmacy profession toward more patient care. Despite the economic situation, the study results show that pharmacists are in high demand and that the profession has the “capacity for contributing to the reforming healthcare system to meet patient care needs”. The survey surely reflects the fact that as the Affordable Care Act is phased in, some 33 million people will have expanded access to insurance coverage. That, along with an aging population and increased incidence of chronic illness, which is almost always treated with medication, suggests we’re going to continue to need pharmacists. Maybe those increasing numbers of pharmacy graduates will have something to do, after all.
Speaking of pharmacy schools, the need for pharmacists to increase their clinical opportunities and influence is not wasted on administrators. Some pharmacy schools have blended a PA program with the PharmD program, the perfect stepping-stone to pharmacists being able to prescribe in their own right. This is the only sensible future for pharmacy and educators know it.
As the market forces the profession on to a new tack, pharmacists may breathe a little easier. All is not lost. But as the current business model dies, countless pharmacists will be affected. States have individual pharmacy associations and the national organization, the American Pharmacists Association (APhA), is the largest association of pharmacists in the United States; the structures exist for pharmacists to come together and influence legislatures, both state and federal, to make changes. But out of about 269,000 pharmacists in the country, only 60,000 belong to the APhA. Pharmacists often say they are the introverted type – not joiners, and they’re notorious for not organizing. But consider the Tea Party. No matter how you feel about them or their backers, Tea Party activists literally commandeered the machinery of the Republican Party on the local level in order to elect their representatives and enact their agenda. Their influence on the system, for better or for worse, is obvious. Real change comes from the bottom and it would serve pharmacists to take over their associations in numbers. Many may not be convinced of the need to get active or of its potential but the time is coming when more will find themselves compelled to go to a meeting, write an email or make a phone call. Change is in the air but things will likely get worse for the profession before it gets better. And nothing motivates a person to action like an empty pocketbook.