Tuesday, December 6, 2011

Frogger, RPh

Have you ever tried to boil a live frog? Just throw the frog into a pot of boiling water. It doesn't work because the frog's survival instincts kit in a it will try to escape. If the water isn't too deep, it will be able to leap out and survive.

But if you put the frog in the same amount of lukewarm water and gradually increase the temperature to a boil, the frog is not able to detect the temperature changes and will be boiled alive.

I've heard this several times over the years without thinking much about it. This past week, the president of our facility shared it during a meeting of our management staff and a thought immediately jumped into my head.

This is the world of retail pharmacy. Pharmacists are the frogs.

If you think about how the world of retail pharmacy has evolved over the past 20 years, I think it's easy to see how the pharmacist is getting slowly boiled. Many factors have come into play that are cranking up the heat on our professionals in the retail trenches.

Let's take a look at some of them. While in and of themselves they aren't necessarily bad (in fact some are good), the combined effects of all of these have turned up the heat on community pharmacists.

  • Third-party insurers. These initially helped level the playing field for pharmacists since patients would pay the same price wherever they chose to fill their prescriptions. However the ever-decreasing rates of reimbursement have driven many pharmacies out of business. And those that remain must fill more scripts to bring in the same dollars.
  • OBRA 90. Mandatory counseling, DURs, etc for certain patients. While these are good, there was no increase in reimbursements to hire additional staff to safely fill the prescriptions. Rather than ensuring that every prescription would receive its due attention, I think that it can be argued that the pharmacist has been legislatively forced to have interruptions in their work flow in order to offer the required counseling. And what passes as counseling falls far short of the intent of the law.
  • Drive-thru pharmacy. One more drop-off and pick-up area. Usually without additional staff (or reduced staff after the first three months).
  • Gift cards for transferred prescriptions. More phone calls to distract the pharmacists from their primary duties. And one more place where an error in communication can occur.
  • Pharmacy-initiated refill requests to prescribers. While this may help with compliance for some patients, it adds another uncompensated task for the pharmacist to oversee. I'm sorry, but responsibility for refills should fall upon the patient. It's no surprise that our patients don't take ownership of their health because they aren't asked to do anything other than fork over their copay.
  • Immunizations are good. The interruption to workflow is bad. Quotas on immunizations (which I have heard rumors of) are unsafe.
  • Auto-refills (aka predictive refills). Similar to the refill requests. Good intent, but patients need to be responsible for their own health. In my experience, about half of the prescriptions that my retail pharmacies filled through these programs were returned after 7 to 10 days. The process of returning the prescriptions is just as, if not more, labor intensive as the original fill. More uncompensated work for the pharmacists.
  • $4 generics. Affordable medications can increase compliance, but the amount of staffing hasn't grown to offset the increased workload. More scripts, less help. Not good.
  • 15 minute guarantees. Only to be outdone by 10 minute guarantees. Sure. Why not? While we're at it, let's have corporate call to find out why it's taking so long to get the scripts out the door. One of my friends recently had a corporate person call to inform her that corporate was looking at the video cameras and the pharmacy pick-up lines were too long and wanted to know how she was going to rectify the situation.

The pastor at my church often asks us if we are being a thermometer or thermostat in our community. The thermometer simply is a reflection of the environment. The thermostat sets the environment.

In order to effect any change in the retail environment, we need more pharmacists to be thermostats. Speak up when necessary. Promote positive change for the profession.

Because if we continue to just be thermometers, we're a bunch of boiled frogs.


Noah Berkowitz said...

that is point of view from frog to your profession. keep posting :-)

Anonymous said...

As a fellow frog I have found the following tips to be essential to my survival:

1) people have no compassion or understanding for lack of staffing, high rx volume, etc. They do have a hard time arguing with " I'm sorry, it appears we are out of stock of your medication. It looks like it will be in tomorrow after 2pm"

2) mechanical failure works well also if you need to extend your wait time. Try: "Gee Mr/Ms IThinkImUrOnlyCustomer...I sure would love to have your eleven prescription transfers filled for you in 15 minutes but it appears as if our computers are down. How about I give you a call when they're ready?"

3) If they dont believe the "out of order" sign you placed in the drive-thru because you have no staff, simply hold down the button used to pull the drawer in so that it makes a loud whirring sound and say, "I'm so sorry Mr/Ms ImTooLazyToWalk I would love to sell you your prescription, but the drawer just won't open out! It just makes this loud sound!" They don't need to know you were pushing the wrong button.

4) Did you know that if the telephone or some other heavy object were to accidentally rest on the "in" button of your drive-thru you can actually burn out the motor or at least blow a fuse?

Can you tell that I'm not a fan of the drive-thru? As deconditioned and overweight as Americans are, you would think drive-thrus would have been banned by now. At least burn a few calories and walk off a little bit of your Big Mac.

The instinct to survive is an amazing thing. It really brings out my creativity. Just remember "out of stock" and mechanical failure are your two best tools to retaining your sanity.

pharmaciststeve said...

We Pharmacists have to learn that there is a difference between expressing concerns - usually about situations that may increase med errors and patient safety and COMPLAINING... complaining can be viewed as SELF-SERVING... which will seldom get you no where. Unless you send your concerns in writing (email)- keeping a copy on your home computer... it will be hard for it to come back at you as ".. I don't remember that conversation... that is not what I understood..." you know the drill. The HR dept can be your ally.. there only job is to make sure the company follows all the Fed/State laws and their own policies and procedures.

pharmacy chick said...

Well written, Very well written, signed ..another frog.
( is it just me or is it getting warm in here...?)

Anonymous said...

It's up to you pharmacists to make the change. This is why I will NEVER work retail pharmacy. I know we are professionals, but it's things like this that lead us into the thoughts of unionization. How would corporate like that? It will only end when you retail people decide enough is enough. ribbit!!

Phathead said...

You're missing one key component... lack of unity among the frogs.

There is no unified voice for the profession. In fact, most of the frogs are so disillusioned they have become bitter and skeptical of anything. If anything, they enforce the downward oppression of "frogs" by outside sources.