Tuesday, October 26, 2010

State of the Profession......The Future

Over the past few weeks, I've tried to present the profession of pharmacy as I see it. You may or may not agree with my views and that's fine. Depending on our practice setting and the patients we see, we will have differing views on where the profession stands currently.

But if we just look at where we are now, we are missing one of the key points I wanted to address with this series.

It doesn't matter where we are or how we got here. We can't change the past. All that matters is where are we going from here. So today I'm going to throw out some of the topics that seem to dominate the headlines when it comes to the practice of pharmacy and share my thoughts on them.


A few years ago, several pharmacy outfits decided that it would be a good idea to offer generic medications at rock bottom prices. Four bucks for a month's supply of pills.

One of the consequences of these programs is a decreased profit margin on prescriptions. In order to maintain a profitable department, pharmacists have been forced to fill an increased volume of prescriptions in order to cover the costs of operating the prescription departments.

When you look at a pharmacy's P & L statements, the largest expense (after medication costs) is the pharmacist salary. You can hire four to six technicians for the price of one pharmacist. Don't you think that the non-pharmacist members of management are looking for ways to decrease or eliminate the need to pharmacists?

I'm not saying that we need to worry about this over the next year or so, but if you are not prepared for this we may see ourselves phased out of our own profession. Pharmacists need to start speaking up to our legislators and boards of pharmacy in order to make sure that the corporations don't phase us out. I hope I'm wrong on this issue.


In 1996 the APhA House of Delegates decided to push for pharmacist immunizations. After 14 years, pharmacists are able to give vaccinations in all 50 states.

So flippin' what?

How has this advanced the profession?

Pharmacists are now able to provide the same service that physicians and nurses have been doing forever. Doesn't really differentiate us, does it?

In fact, the beauty of pharmacist immunizations is that we can't bill for the act of giving the shot. When a physician gives a shot, they bill the insurance for an administration fee. Do pharmacists?

For the increased liability exposure, pharmacists receive absolutely nothing.

Medication Therapy Management

This is my pet project. I see this as the future of pharmacy.

MTM actually utilizes our unique skills as medication experts. But how do we market this? How can we get patients to want to pay us for these services.

Our profession has been tied to a product for so long that people are almost shocked when we say that we want to bill for the information that we possess. They think that the cost of the medication entitles them to all of the information that we can provide. Maybe if we actually made a decent profit on the product. But $1.85 profit on a script is going to get you $1.85 of info from this pharmacist.

We need to promote the informational side of what we do, but not give it away. OBRA 90 requires us to provide specific information during a counseling session. Anything above and beyond that should be compensated by either the patient or their insurer.

So far, I have not seen a successful model to follow in developing MTM services. I hope to be able to report back in five years and say "this is how I built my successful MTM business". We need to share our successes so that all of us may benefit.

Corporate ownership of pharmacies

North Dakota has it right. Pharmacists should be in control of the profession, not companies.

Pharmacist prescribing

Makes total sense to me. I mean, we are the medication experts. Heck, freaking nurse practitioners and physician assistants have prescriptive authority. And we don't? Hell, insurance companies have more prescriptive authority (via formularies) than pharmacists do.

APhA and other pharmacy organizations, this is a huge issue where we would like to see measurable progress that is reported back to us.

Pharmacists need to have a voice as our profession moves forward. Unfortunately, too many of us have settled for the nice lifestyle that our salaries allow us to have and are afraid to speak up on matters that affect the profession. We live in fear of losing that paycheck if we say something that our boss doesn't like.

It's easy to sit back and complain to our techs and fellow pharmacists about issues surrounding the profession of pharmacy, and then do nothing about it. It takes some gumption to actually speak out and make your opinion known about the direction of the profession.

It's us, the pharmacists, who will determine the future of our profession. There's one catch. You have to find your voice, then use it to be heard.


WorriedOldPharmacist said...

I just wonder about the over supply of new pharmacy grads the institutions are pushing out. I have heard these 2 discouraging points that I admit I haven't personally confirmed... In Ohio there will be 900 new pharmacy graduates all looking for work which at the moment there are no openings for. And also I heard rumor that there are grads out there now offering up their services for under 6 figures just so they can get hired...

The only rose in the whole thing is that almost 70% of new grads are female and that will buffer some of the lack of job openings as they go in and out of the work scene as they raise families.

What are your thoughts on this aspect of the profession?

lovinmyjob said...

I totally agree that pharmacists have become to comfortable with receiving a paycheck to rock the boat. How do we solve this issue when the economy is down and has been for long enough that even our "secure" jobs are being effected? As the previous comment points out, there are too many grads coming into the job market. There are too many new schools of pharmacy opening. Over the past few years there have been 2 colleges of pharmacy open just in our local community. In my particular company and district we have more pharmacists than we have positions for them. We are being asked to take vacation days just so these "extra" pharmacists can work. I have offered up the suggestion that pharmacists be paid as hourly employees rather than salary so that we can take unpaid time off, but this suggestion was shot down for some reason. I for one am willing to take unpaid time off. I saw the current financial down-turn coming a long time ago and was able to become debt-free before it happened. Why do companies not want to pay us hourly? The main reason is that they know we put in more time than "salary" calls for. It would end up costing them more in the long run. Also, if we are hourly then employment laws would apply to us. Meaning we would be required to take a lunch break. Not too many companies out there are willing to shut down to allow this.
As for billing for our services, this is what we do every time we receive a dispensing fee. Our companies are the ones contracting for such low fees. If the employers are willing to take whatever the insurance companies offer then of course they will offer the lowest possible price. The problem is that this fee doesn't appear anywhere on the patient's receipt so they have no clue that it even happens. All they see is their final price. Very few insurance companies give their client an EOB for their rx purchases. Charging a fee for administering vaccinations is happening. My company charges a $25 fee, but only if the patient's insurance doesn't cover it. So needless to say it doesn't happen much.
I didn't mean to ramble like this. I just wanted you to know that I agree with your outlook for the future, but at this point I don't have any suggestions.

duke said...

If you are worried about getting paid for MTM and immunization admin--as well as the liability issues of immunzation, then why would you want to prescribe? I would expect even more liability and less chance of adequate, if any compensation.

Now, if we are through here, I've got to check my account to be sure my auto-deposit has arrived. ;-)


Anonymous said...

I agree to some extent....

Tech check tech - only feasible in hospitals/institutions in which the end user is not the patient. After all, the nurse administering the furosemide should know how to read/scan the bar code!

Immunizations - providing this service makes entire sense to me.Today, obtaining access to medical services is an obstacle, so making routine preventative services available without needing to access those via our professional abilities is a public health measure. Think of it the same way Plan B became a pharmacist dispensed product.It needed more availability - thus the pharmacist.Immunizations are just a bit more training.Likewise, routine bp monitoring, cholesterol checks, A1c measurements, etc all should be included in our preventative scope of service.

MTM - this is a great concept, however, unless we have complete access to all patient records - we will always be hindered in providing competent care.We cannot rely on patient history, nor can we do the required physical exams & diagnostic testing which is involved in diagnosis.Honestly, with drug info so available online, there is not much reason for a physician to not have the necessary tools.

Why would you withhold any information just for pay? Drug information is the total reason for our being! The better the public is informed, the better we've done our job.Perhaps we need to be more focused on drug information within the community?

I agree that pharmacy ownership should be in control of the profession, but lets get real. How many solo pharmacies are able to carry the stock & pay the salaries of all those required to provide the service?I work in a small pharmacy, but I don't know any individual who can afford to carry the $750,000 - 1K that sits on my shelf everyday.

This, I believe, must be tied to pharmacy reimbursement.We need to get away from an AWP - %. Additionally, I believe we should not allow insurance companies to have ownership in any end user provider, whether it is a pharmacy, lab, physician group or hospital.This is a global concept, not just within our profession.

Its a complicated problem & one not easily solved.But, lets not go toward the simplistic solutions which become territorial.Lets expand our thinking to what is best for the patient and providers.

PAS said...

This is something of a personal viewpoint, but there seems to be a gulf between the scope of practices of a CPhT and that of a full R.Ph. I sort of see a possible role here, perhaps revivig the bachelor's level of a pharmacy degree, creating a sort of Pharmacist's assistant. Between the scope of practice of a tech and an RPh. I don't know if it's viable, but I can see a role in relieving the workload dumped onto a pharmacist that can't be done by technicians.

I work in the dark side though. My view of retail is somewhat skewed by that.

I really think that the pharmacist is a massively overlooked health resource. Services like MTM somewhat address this - but I find it more practical to view a pharmacist as nearly an MD, if one were to specialize exclusively in just the pharmacotherapy aspect of medicine. The scope of skill and knowledge is certainly comparable. Very frequently, many prescribers have a remarkably poor grasp of even the common medications they prescribe. Drug-drug and drug-disease iteractiona are frequently overlooked.

We also have such a rich library of medications. There are a few gems out there that are grossly underutilized, particularly older medications. I think a great step would be to see RPhs and MDs working in conjunction to identify therapeutic possibilities, rather than sticking to the MD's handful of preferred medications, that results in so many patients being cookie-cuttered in their regimens, and uneccsarily resorting to higher cost medications.

Buy Chantix Online said...

I am agree with your post that pharmacy ownership should be in control of the profession.

pharmacy chick said...

I may finish reading your post, but I quit right after "immunizations" for you MTM is your pet project. for ME its Immunizations andWE MOST CERTAINLY DO GET PAID FOR ADMINISTRATION. No shot leaves the pharmacy unless either the ad min is paid by the insurance OR the patient. During Flu season we have over 100 insurers nation wide that pay for admin fee included in the shot. Its a separate contract aside from normal rx processing. I wish you luck in MTM, its not my thing, I dont have time for both so I chose this specialty. I do shots for vacationing people, and have contracts with businesses to provide those imm's for employees travelling on company business. Its advanced MY professional image even if you dont necessarily agree :-)

Anonymous said...

I've been in the business > 20 years, granted mostly in hospital, but six figures on graduation though a 2009 expectation, is unrealistic. Maybe some form of greed is driving the profession, and why we can't get pharmacists in our tiny critical access hospitals, but why promote this incidental measure of inequity?

Frequently, the service are under-utilized of a full-fledged pharmacist whether experienced B.S. or fully-trained PharmD (with residency or other practical experience). The pharmacist assistant idea might put more teeth into the idea of a commensurate pay-scale.