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    Are community pharmacists an endangered species?

    The importance of taking the long view

    The way I see it, retail pharmacists are no longer relevant in healthcare. They have allowed themselves to be relegated to the position of overeducated technicians.

    It didn’t have to be this way. In the 1960s, pharmacists had a chance to step up to the plate and become responsible for medical and pricing decisions, but they decided to defer to the powers that be and allowed pharmacy associations and universities to make decisions that were detrimental to the business of retail pharmacy.

    See also: What happened to community pharmacy?

    Wrong turn at the crossroads

    Pharmacy associations and universities tried to turn pharmacists into professionals by having them charge a professional fee when they dispensed a drug. This effectively limited the potential for profit on the drug involved. At that point, retail pharmacy lost control of its business.

    Universities were teaching pharmacists more and more skills that they had no time to use in their practices — even if pharmacy boards had permitted, which they did not.

    For example, pharmacists were taught that clinical pharmacy is the highest form of pharmacy practice. But now, in the retail setting, there is no time to use this training. Pharmacists are totally overworked by managers who are only concerned about the bottom line.

    This bottom line has been affected by “professional fees” and illusory AWPs that have no relationship to what manufacturers actually charge for drugs. The manufacturers could offer pharmacies a discount and still make a huge profit.

    This discount situation actually benefited PBMs and insurance companies, which soon realized that they could demand large discounts from drug manufacturers by threatening not to put their drugs on their preferred lists. At the same time, retail pharmacies were locked in at a low “professional fee.”

    Now the PBMs and drug manufacturers are enjoying the profits that retail pharmacies could have shared if they had not accepted the “professional fee” in the 1960s.

    See also: Is community pharmacy a dying profession?

    When the profit motive is all

    The profits generated by the manufacturers are phenomenal. When a drug manufacturer can pay a fine in excess of two billion dollars for illegally promoting off-label use of its drug and still stay in business, something is wrong with the system. Now some manufacturers are buying up generic drugs and pricing them with massively high AWPs, and nothing, apparently, can be done to stop them.

    In order to increase their own income, the universities went to an extended curriculum, resulting in the PharmD, which they said would make the pharmacist a professional. The universities continued to entice students to come into pharmacy by promising high salaries. They have been successful in recruiting, because now any person can get student loans and can go to school for six to seven or more years.

    Upon graduation, pharmacists are saddled with high payments and big debt. With many independent pharmacies now out of business because of reduced profits, pharmacists then have to accept positions in megapharmacies, where even with that doctorate degree all they can do is try to keep up with the prescription output required by management to sustain business.

    This requirement for prescription output is driven by the “professional fee” and the artificial AWP.

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    • DavidLever
      Today’s (10Mar2016) headline in the Drug Topics emailed newsletter: “Report: Supply of pharmacists outnumbers jobs. In November, the nationwide supply of pharmacists exceeded the amount of available jobs….” That pretty much says it all about the future of the pharmacy profession… bleak to none. Amazingly, Froedtert & Medical College of Wisconsin are opening a new pharmacy school in Wisconsin and a year-round pharmacy school will open in Miami, FL next fall. This is in addition to all of the other planned new pharmacy schools. The “Miami plan” must be to get PharmD pharmacists to the unemployment line one year faster. There needs to be a mechanism in place to regulate this craziness, such as a CERTIFICATE OF NEED being issued before a pharmacy school is even eligible for accreditation). Pharmacists’ job opportunities are only going to get worse, along with their working conditions, salary, etc. With robotics, telepharmacy with automatic dispensing machines, abolishing the pharmacist-technician ratio, etc., the need for pharmacists will greatly decrease in the near future - and there is already a surplus of pharmacists. Maybe the soda fountain will make a return in community pharmacy, and waiters and waitresses will now be called doctor.
    • Dr. Phil Hopkins
      I graduated from pharmacy school in 2006. At the time, a huge pharmacist shortage existed. I was eager to expand my role of pharmacist and became one of the first immunizers (and shortly after an immunization pharmacist trainer) in the corporation I was with. While it's easy to place the blame for what's happened on the metric obsessed corporate overlords (and they do deserve some blame), the reality is that pharmacists themselves contributed heavily. High salary coupled with high demand apparently buys a great deal of apathy because people always forget things will likely change. All it takes is doubling the number of pharmacists being cranked out (Tennessee went from one to six pharmacy school in the last 10 years) I mentioned immunizations earlier because I was horrified that I had colleagues who were flat out refusing to get trained or would only do it unless they were paid more than the six figure salary they were already receiving. (Eventually the company issued the edict: get certified or get employment elsewhere, which I was fine with). Bottom line: I worked with too many pharmacists who only wanted to get paid a lot of money to look in pill bottle. They didn't want to engage in clinical offerings. Many didn't even want to talk to patients unless they absolutely had to. And the majority didn't want to know anything about the business end of the operation, as long as their salary and bonus kept on rolling in. Then 2009 hit: Walmart gave us $4 generics, the first glimmerings on mandatory mail order took an amazon.com bite out of brick and mortar establishments, insurance reimbursements continued to drop (see Walgreens loss to Express Scripts in 2011). And, of course, the economy collapsed on top of all that. The resulting cuts, from which we never recovered, turned me into a highly paid SuperTech with pharmacist powers. I took a year off and then went back with another company, accepting the new situation. Until things change, though, until chain pharmacists step up the plate en masse and pursue clinical offerings as a serious means of driving business unit income, the downward spiral we are on in chainland will effectively continue.
    • Mr. BTaffin
      Interesting that you talk about the dying profession. I wanted to be more clinical and went back to medical school to get my MD degree. I now have a wellness company and medical practice. My wellness company focuses on assisting retail pharmacies to offer clinical screening and drug monitoring programs by partnering with my company Wellspring Medical. The programs provide opportunities for the pharmacists to offer cardiac and pulmonary screening programs, weight loss programs, and smoking cessation programs, all of which generate revenue. I wish more pharmacists would take the time to get involved. Some have but I have had pharmacists tell me they don't have the time to work with patients. I tell them the risk of NOT doing these programs will certainly lead to their demise. Pharmacists need to integrate themselves to be more clinic versus technicians.
    • Anonymous
      I would like to ask a simple question; "What is the difference between working in a Chain Pharmacy and being in Prison?" --Less and less all the time. Like prison, we are under constant surveillance. We have no latitude about what we do at work. Our guards--err, management--treat us with contempt, disrespect, and sometimes hostility. It does not matter if we perform well or poorly, since any excess income we generate goes to the corporation. Actually, making this comparison slanders prisons. At least prisoners get to eat, and go to the bathroom. We actually do not have a problem with pharmacy. The real problem is that the United States no longer follows its own laws, or even its own principles. USA Today says that, between Walgreens/Rite Aid and CVS, the chains control 99.4% of retail pharmacy business. The Anti-Trust Enforcement that should have made this type of hegemony impossible was simply not done. CVS and Walg-Aid are both breaking every human rights standard related to safe working conditions, violating the spirit of all our labor laws, while using lawyers to finagle the lettering thereof. With impunity, they are discriminating against older employees and cynically using the machinery of 'quality improvement' as a means to keep employees in line and fire anyone they want (without improving quality). The Labor Department is asleep at the wheel--But not just for Pharmacy. Our story is being repeated in many other industries across the country. Generally, people who still have a job rightly feel that their backs are against the wall, their rights are being taken away, and that the rich and powerful do not care. The US is rapidly approaching a crisis point in many areas. What's a druggist to do? I have a few ideas; 1) Start a personal corporation, possibly in your spouse's name. Corporations have more rights than people at this point, so get yours today! 2) Find a pharmacy niche, and fulfill the need. You might be able to start a business on the side, such as diabetes supplies, orthotics, specialty pharmacy products, or even manufacturing. 3) Do not perform services for which you are not paid. There is no need to go out of your way to do MTM, vaccinations, Health testing, etc., if you work for a chain. Someone else said that "the only reward for increasing your work output is that you will have to do it constantly, for less money for the rest of your future." We know that we must take our time at work. Slow down. Your patient's lives depend on it. And if your chain does not provide adequate staffing, frustrated customers will be better off going somewhere else. 4) Hire a lawyer and sue frequently. It only costs about $1000.00 to put a lawyer on retainer. You spend more than that on mandated CE and licensure fees every year. If you have your lawyer respond to each illegal threat of coercion with a friendly lawyer letter, you will gain new respect from management. 5) Complain frequently to your Board of Pharmacy and Health Department. Don't bother with the corporate complaint ladder. Complain directly to the Board of Pharmacy and point out to your State Health Dept how your employer is endangering the public health. Ask your lawyer how to get the largest possible hush-money settlement from your former chain employer. Is all of this making you nervous? Are you worried about losing your job? Well I have news. Your chain pharmacy has already taken away your retirement and is probably planning to fire you anyway, as soon as you get a bit of seniority, or if they find someone to work more cheaply than you. You might as well start doing what is right, and start right now. Get your lawyer lined up, take notes and pictures, and make them pay. Do it now. If you wait, they will coerce you into years of sweatshop labor and compromised ethics, then fire you with nothing to show for it. Ask any old pharmacist. They will tell you this is true.
    • SandraLeal
      It's important to be recognized as providers! Support HR 592 and S 314 to be included in the Social Security Act. Payment is shifting from product to value. It's important for us to be able to change how we do business or we will be left out.
    • SandraLeal
      It's important to be recognized as providers! Support HR 592 and S 314 to be included in the Social Security Act. Payment is shifting from product to value. It's important for us to be able to change how we do business or we will be left out.
    • LekeAlli
      Clearly pharmacists have abdicated the control of our profession into the hands of others. History is repeating itself as we are making the same mistakes of the 70s and 80s that allowed outside interests take over the control of our profession. The reimbursement rates nowadays illustrate how little our recognition and professional respects are. How do you explain reimbursements of 47cents or $1 by some PBMs. All thanks to the $4 business by Walmart. Other grocers like Publix and Kroger followed suit by giving antibiotics and some anti-diabetic drugs for free. Free!! That's how "respected" you are, when all your professional input into patient care counts for nothing and for $4 at most. Now some PBMs have taken the cue and now pay $2.30,or less,(costs and fees) per prescription. And we are still expected to counsel patients for the cents or negative reimbursements that we receive. And where is the APhA in all of these? Being sponsored by the same interests that are actively destroying the profession. Most state associations are not any better. But the bigger fault lies with most pharmacists, who refused to join their state associations and effect the necessary pressure needed for progressive changes. Unlike most healthcare professions, pharmacy has the least effect in advocacy. Most RPhs don't even know what that means, as long as they get a "good" pay with their chain drug or supermarket employers. That is where the greatest problem in the profession lies. How can you complain when the store manager talks down on you when your input to the company bottom line is equal or less to the lady in hardware dept. Something big has to change, but it will take more than getting more training or PharmD., otherwise we will continue the slide down to glorified shop clerks.
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