Tuesday, July 12, 2011

Chains...what are they good for?

I'm a huge fan of the social media. It gives me a chance to throw ideas out and see the response of others who are active in the social media. I try to share my thoughts at least once a week on my blog, but life gets hectic and sometimes I have trouble sitting down to put together a post.

As a result, I have become a huge fan of Twitter. I can share quick thoughts and get feedback almost instantaneously. Recently I made a comment about chain pharmacy ruining the profession of pharmacy. A fellow Tweep asked me to explain. I was going to send him an email, but then it struck me that the topic could be something I could use for a blog post, so here it is.

Let me start out by saying that chain pharmacy has put a lot of food on my table and made a lot of house payments for me. I have worked in the chain environment for the first sixteen years of my pharmacy career. I have learned a lot from these experiences. When I started, the chains weren't too bad to work for, but over the years I have witnessed the profession of pharmacy devolve into its current state.

What is now accepted as pharmacy practice in the chain pharmacy setting is a far cry from what it once was. Marketing ploys have changed the profession of pharmacy into simply a retail job. This post will focus on some of these ploys that have taken pharmacy to unprofessional place that it is today.

First up... insurance contracts. I can assure you that an independent pharmacist wasn't the first person to sign an AWP - 17% + $1.50 contract. It was the big boys. The ones who are able to withstand the lower reimbursement rates because they get larger discounts by buying in bulk. Smaller operations were forced to accept the low rates or risk being dropped from a PBM's network. Now the PBM's have developed multiple reimbursement formulas that capitalize on multiple reimbursement formulas. AWP, WAC, GEAP, FUL, and MAC may look like alphabet soup to you, but to the PBMS it's a means to guarantee that they will pay the least amount for a medication that they can. Some insurers have gone as far as to establish their own MAC lists. Good luck getting a copy of that list. In the take-it-or-leave-it world of PBM contracts, most pharmacists sign the contract without even reading the reimbursement rates. And we can thank the chains for starting us down that road.

Next on the list... gift cards and coupons. Pharmacy is a medical profession, not a marketing ploy. But rather than growing pharmacy business by offering superior medical care the chains decided to start bribing patients to come to their establishments. Transfer two prescriptions and get 25 bucks in gift cards became the norm. These days the chains use the gift cards to handle complaints from customers. That's right, I called them customers and not patients. Patients have relationships with their medical professionals. How many district managers have ever used the term patient counts? It's always customer counts. That's how they view the phamracy patrons.

Next up... 24 hour pharmacies. Other than emergency departments, what medical professionals are open 24/7? Let's expand the question to professionals in general. How many lawyers have 24/7 hours? Or accountants? Yet pharmacists are working in these conditions all over the country. And if you've been paying attention to the news, you'll see that there have been a number of pharmacy robberies lately. Should medical professionals be putting their lives at risk so that Henry can pick up his Vicodin at 4:00 AM?

Ever see on of these... drive-thru pharmacies? Some will argue that drive-thru pharmacies offer a convenient alternative to people who may have difficulty walking back to the pharmacy department. Ask a person in retail pharmacy who actually utilizes the drive-thru. Rather than helping a very small segment of the patient population, drive-thru windows have advanced the notion of fast-food pharmacy.

Speaking of which... 15 minutes guarantees on prescriptions? Thank you Rite Aid for that wonderful idea. While I have worked at pharmacies that have been able to have wait times of less than 15 minutes, it was never guaranteed. The guarantee puts an extra level of stress on the medical professionals who work in the pharmacy. Can you imagine your dentist promising root canals in 15 minutes or less? You would question how professional the service would be. Enough said.

These are just some examples of what the chains have done. There are many other things that the chains have promoted that have helped to devalue the profession of pharmacy. Feel free to share them with me.


OldRPhBS said...

Everything you say is correct. Your 16 years is the correct time frame. It has gotten lots worse in that time. There is another entity to share the blame though. We are to blame too for allowing it. For years we have sold our services to the highest bidder. As long as the money was good, we would do it. In 1974, my 1st job was $15k/yr and that was good pay. I have gone part time now but last year was ~$125K and that is nothing tremendous. My wife makes more.

Mike said...

Well said. It's frustrating that the pharmacists who are the professionals are not making many of these decisions. It's even more frustrating that the profession is being divided. By competing against each other in such non professional ways we have no leverage against the insurance companies who are dictating what they will pay.

The Redheaded Pharmacist said...

I think the chains have focused too much on profits and not enough on patient care, employee wellbeing and satisfaction, and the resulting state of retail pharmacy is a far cry from years past. And the chains thought that signing these terrible insurance contracts would be their ticket to drive out the little guys but now they realize that they can't survive making next to nothing on prescriptions. What happens in the next couple of years will be critical for the future direction of the profession but I am really worried things are only going to get worse. Healthcare has been ruined by factors like government regulation, insurance companies, a constant threat of litigation, and healthcare workers are caught in the middle between the bureaucracy and shortcoming of the system and the patients who need medical care. I've personally noticed how much more difficult retail pharmacy has become in recent years and I fear it is only going to get worse. They chains have definitely had an impact on retail pharmacy and the profession of pharmacy in general. And unfortunately for all of us that impact is almost universally negative.

bcmigal said...

Thank you retail pharmacy chain of mine for the varicose veins, back problems, high blood pressure,gerd, and insulin resistance that you have helped me develop over the years. And for shaming me when I cannot do the work of 4 people. For constantly reminding me of how readily and easily I can be replaced. For threatening to put me in the float pool or send me to the store from hell if I did not give flu shots, Pneumovax, and tDap. For simultaneously heaping more work upon us while decimating the staff.
And for making me hope that after I retire (if I do not have a stroke on the job), I will never again set foot in a pharmacy.

Anonymous said...

Congrats on the transition to inpatient pharmacy Eric! I hope you find a great deal of job satisfaction in the position...

Chain pharmacies have turned pharmacy into nothing more than a commodity.

I worked retail all throughout school and now I am in an inpatient position and could not be happier. I do not deal with any insurance and my duties focus on improving patient care and improving the use of evidence based medicine throughout the hospital...what a novel concept:
"pharmacists focus on patient care and drug utilization in a health system"

Anonymous said...

Just heard today that our Pharmacist will be expected to deliver up to 30 flu shots per hour, while maintaining a script count of at least 300 fills per shift - with a hour cutbacks on seasoned staff being supplemented with kids and no Pharmacist overlap. The stress is already becoming unmanageable. The louder they bark,the further we jump,knowing full well that it only serves to convince Corporate that their demands CAN be satisfied. At the cost of increasing misery and cutting corners on regulations,record-keeping,accuracy,service,safety,....I'm sure they're RITE!!!

pharmacy chick said...

I never would have imagined that 24 years into pharmacy that I would still be standing on my feet for 13 hours without a sanctioned lunch or break either.

secondly the profession degraded itself when it started hawking vaccines like toothbrushes..on demand. "ok I'll take this deodorant, 2 toothbruses and 1 tetanus shot..right now". WE used to do them by appointment. not good enough anymore. ON DEMAND.

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Anonymous said...

Chains are terrible, sucking the life blood and dignity out of community pharmacy. I do not understand why folks spend all this time in school and money in student loans to be a pill jockey in a grocery store with terrible working conditions.

We are professionals, I understand people need to pay the bills but putting up with this shit day in and day out is crazy.

I was speaking with one of our interns yesterday and she was asking me about practice settings. I was honest in my opinions of the future of retail pharmacy and the terrible working conditions. She commented on the fact that all the pharmacists at our hospital get one hour lunches, couple breaks and the day is a mix of sitting at a desk and walking/standing in the units. Mix of clinical duties, distributive duties, and teaching duties.

I tried to enforce to her the idea that this is not some magical setting. This is how pharmacy should be practiced and the conditions that a professional should expect.

Giving flu shots on demand, battling insurance, being yelled at regarding copays, and running a cash register (ringing up booze and tobacco)......all this has absolutely nothing to do with pharmacy, yet in chain retail you have to deal with all of it while trying to check 300 scripts/day without doing anything close to a full DUR.

lovinmyjob said...

I have worked both chain and independent. They're all the same. When I see independents hawking "weight loss" programs and bio-identical hormone therapy, etc it shows that everyone wants their piece of the pie. Everyone has done their share of devaluing this profession.

Anonymous said...

I lasted 6 months in retail and that was back in the early 80's. I have been in hospital pharmacy ever since then and have never looked back. Why just today, I changed 4 doses due to renal function, dosed 2 patients on vancomycin IV, and probably answered at least 20 clinical questions for doctors and nurses. I review microbilogy reports daily, along with platelettes under 100 and INR > 3.5 and I am not a Pharm D or so called "clinical pharmacist", I am just your average staff pharmacist in a great hospital. These jobs are out there, you just have to look for them. Your wage may be a bit lower, but your satisfaction will be amazingly higher, your stress levels lower, and you may even enjoy your practice. Good Luck to all...and for those who love retail, you have my blessing, no offense intended, its just not for me..