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    Jumping on the cheapness bandwagon


    David Stanley, RPh
    Our salvation lies in cheapness. It is the way of the world, and embracing it is the key to our survival. Big box stores have replaced downtowns, plastic has replaced metal, and robots have replaced disc jockeys on the radio, all for the same reason. They are cheaper. Quality, as I'll bet you've noticed, is almost never a consideration in these decisions.

    Take a look around in the medical world and you will see we are no exception.

    Voicemail has replaced the familiar nurse on the other end of the phone when you call a doctor's office. A physician's assistant has replaced the doctor, and, closer to home, a pharmacy technician has replaced the pharmacist as the first point of patient contact.

    Why? Because robots, physicians' assistants, and pharmacy technicians are cheaper, and the powers that be have determined they can provide an acceptable level of service most of the time.

    The good ole days

    Remember, though, when the goal was to provide the best service possible all the time? For those of us of a certain age, it'll bring back memories of someone there to pump your gas, check your oil, and clean your windshield. They don't do that anymore because it's cheaper to just pay 1 person to sit behind a cash register and hope you can take care of the oil yourself. Quality is no longer a consideration.

    Don't worry, though, because we're cheaper too.

    Think about pharmacist-administered immunizations and how they have spread like wildfire through the country in just a few years. Now contrast that with legally mandated OBRA counseling.

    It's been almost 20 years since the law said you have to offer to talk to people about their new prescriptions.

    I'm going to go out on a limb and say the total effort your company has put into that service over the last 2 decades is a drop in the ocean compared to getting flu shots into people's arms. Do you have a counseling quota? Didn't think so.

    Wringing out efficiency

    So after a generation of telling the world counseling would be what would prove our relevance, the leaders of pharmacy have finally jumped on the cheapness bandwagon. They have finally figured out that counseling merely adds quality, while shots can be done profitably at the drugstore instead of at the doctor's office.

    My own physician once told me his office used to have flu shot clinics and "never made much at all" on them, while we are happy to collect 10 times more per injection than we make on regular prescription dispensing fees.

    The fact more people are now able to get their immunizations is merely a pleasant side effect. Make no mistake, this whole shift in our practice was about nothing more than wringing every last drop of efficiency out of the system.

    Meanwhile, there's been a customer on hold for the pharmacist for the last 5 minutes with a question. If the system has its way, that customer looking for the voice they've learned to trust will soon be connected to a call center hundreds of miles away.

    The upshot

    The good news is that the world of cheapness is not limited to injections. MTM is on the horizon, and that too can be done by us for less than a physician.

    It's a long way from the days when doctors could bar the name of a prescribed medication from even being printed on the label, but again, make no mistake, our increased professional responsibilities are merely a pleasant side effect for us. Every time you think people appreciate pharmacists solely for our drug expertise, remember your counseling quota.

    So for the future, my advice for pharmacy, along with the rest of society, is to think cheap. I'm sure if we put our minds to it, there's no limit to the things we can do for less than someone else. At least I hope so, because I can't make a living on providing advice on over-the-counter medications for free.

    My other piece of advice: try to work in some quality where you can.

    David Stanley is a practicing community pharmacist in California. He can be reached at
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    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]