Monday, January 14, 2008

Just some thoughts on the profession

A lot of prominent pharmacist bloggers have recently written about how the big chain pharmacies' (Rite Aid, CVS, Walgreens, etc.) emphasis on prescription volume is killing the profession. I just wanted to put my 2-cents into the ongoing discussion.

Now, what I'm about to say might ruffle some feathers, but I don't mean to be argumentative about the issue. This is just my opinion, and everyone else is more than welcome to their own.

The concern with a lot of pharmacists is that they are being stretched so thin by the prescription volume that they feel they are unable to effectively counsel patients, do DUR reviews, and other pharmacist things that the profession SHOULD include. They assert, and correctly so, that the department is not given enough pharmacist and technician hours to accomplish these tasks, and the lack of hours is making their days incredibly stressful and tiring.

I whole-heartedly agree with that part. Working in a busy pharmacy is very stressful. During a typical day, your lucky if you get 5 minutes to eat lunch, and you can forget about that being 5 uninterrupted minutes. Actually, more likely you'll eat something while working. Bathroom breaks are few and far between simply because in the 2 minutes it takes you to take a piss and wash your hands, you could have 2 calls you have to answer, a customer question, and 5 more prescriptions dropped off that you have to get done in 20 minutes. You spend most of the day hoping that no one will ask you a question about their medication because you just don't have the time to explain things to people. Moreover, the sheer amount of shit happening at the same time is maddening. It can be really hard to get a grip on the situation, and it only takes one tiny little problem to send your day spiraling out of control.

A little extra help would make the situation so much better. Just a few more pharmacist hours or another technician during a shift could relieve a lot of pressure and stress.

Here's the thing though... a combination of factors is hitting retail pharmacy all at the same time, which is makes this very hard for our employers. For one, third party reimbursements keep getting lower and lower. With a lot of plans, we're lucky if we make a 5% profit on each prescription, especially on very expensive medication.

Secondly, mail order pharmacies are really starting to cut into our prescription volume. Last week, my store filled nearly 700 fewer prescriptions than we did during the same week of 2007 (a 21% decrease). We can't explain the decrease other than we must be losing a lot to mail order. Every pharmacy in our chain is down. It's not just us.

Thirdly, pharmacist's salaries are still going up (although it has slowed down in the last couple of years). When I was going into college in 2000, I was told that pharmacists could make $75,000 to start. When I got licensed in 2006, I started at $102,000. That's nearly a $30,000 increase in starting salary in 6 years. We all know the reason for the skyrocketing salaries is the national pharmacists shortage. It's simple supply and demand. The supply of pharmacists is low, and the demand is high, so salaries have gone up. Many companies offer huge sign on bonuses for pharmacists working in certain areas simply because they are in such desperate need.

With decreasing reimbursements, decreasing prescription volume, and increasing pharamacst's salaries, I'd have to imagine that fewer staff hours is the only way our employers can go.

Speaking honestly here, and I don't care what it makes me sound like, one of the major reasons I chose retail is because of the money. In fact, my initial choice might have been solely because of the money. After working for 1.5 years, I've come to appreciate my job more and like it for other reasons. In fact, I'm certain I would like hospital or other clinical jobs far less than I like my current job. Those areas of the profession just aren't for me.

I'm quite happy with the money I make in retail. Afterall, isn't that what I really went to college for? I didn't go with the noble intentions of saving the world. I just wanted a well paying job. Unless you're good in business, you can't get a job like that without a college education. That's how I landed on pharmacy. I was always very good in math and science. I could have been a doctor, but I didn't feel like going to school for 8 years, then a year of internship, and 2 years of residency before even having a chance to make decent money. Shit, I'd still be broke and in med school right now if I wanted to be a doctor. I could do 6 years of pharmacy school though. That wasn't too bad, nor was the curriculum all that difficult.

What I'm trying to get at here is that while I would love the extra help, I'm not willing to give up my salary for it. In the end, that's what it would really take. Think about it... If your employer came to you and offered to give you tons of extra hours of help with the catch that you'd have to take a substantial pay-cut, would you accept the offer? I wouldn't. I don't think many would, though it certainly would be a solution to the stress.

I made about $115,000 last year. Now if my employer cut mine and every other pharmacist's salary to, say, $90,000/yr, and then took that extra money and put it into staffing, software technology, and other areas that would make the pharmacy more efficient at filling scripts, it would free us up to counsel patients, consult with doctors, and anything else that takes advantage of our clinical skills and training.

I would never do that though, no matter how much better it would make my job. I guess it's because I can tolerate the stress level, and I really don't mind sacrificing the clinical aspects of the profession in the name of filling scripts. That doesn't mean I blow off anyone with a question. I will take as much time as necessary to help someone understand something about their medication. However, it doesn't bother me one bit that I don't have the time to counsel every single person on all of their medications. I do feel appreciated and liked by most of my customers, and that's enough for me.

Now, I'll play devil's advocate for just a moment. I realize that cutting pharmacist salaries will decrease the number of new pharmacists coming into the profession, which in turn will increase the shortage at the absolute worst time (baby boomer's retiring and taking lots of meds). Therefore, I know the notion of cutting salaries wouldn't work in the long run. Moreover, there of course, is no guarantee that our wonderful employers wouldn't take the extra money and pocket it, or even worse, run a bunch more coupon promotions.

The situation is purely hypothetical from the vantage point of a pharmacist with very little real world experience and not a great deal of business sense. The example is just here to illustrate that a lot of us complain about the state of the profession while, at the same time, reaping the monetary benefits of it.

Then again, Walgreens, CVS, and Rite Aid could be turning bigger and bigger profits every quarter, and the problem could solely be with those corporations being run by a whole bunch of greedy bastards that want to milk us for every last dollar.

In fact...that's almost certainly the biggest problem with the profession.


Katie said...

I don't know... you could still start a pharmacist at 90k, and have as many takers. That is still a huge number compared to what alot of our peers start out at.

And I'm glad you admit it--one of the reasons we go to Pharmacy school (ok I'm in still in it) is that we know we are going to make enough to live well. Am I personally going into pharmacy 100% for the money? No, but I don't know that the abuse you read about in blogs is worth too much less.

Anonymous said...

I didn't enter the profession with salary solely in mind, but the possibility of that 'comfortable' recompense was an underlying factor-- I could do a professional and helpful job, enjoy privileges of working with others in the profession who shared common work ethics, and ensure that I could have opportunity to maintain a high educational level without having to beg for more work hours to break even. Starting out as a resident, then hospital staff did not net top $$$, but hey! my family had health insurance, and we were no longer eligible to apply for WIC. And, my first wages were 36-40k several decades ago, and am still not making what retail first year professionals are making (but, then, that's not a goal, either).

I have a suspicion that long-term goals of other pharmacists was not to eventually enter the upper class, but to live comfortably in middle- to upper-middle class, bearing in mind that the pharmacy school student selection process would probably pick out future pharmacists that would have similar altruistic traits; not just dollar signs in our eyes.

Kcfla said...

I'm not a pharmD, just a Cpht but you have a point.
Not only are the pharmacists' stressed out- but so are we. A year ago- we had 4 techs a day on. Which was plenty of help. Now it's 3 on Mon/Tues, 2 on Weds/Thurs/Fri. and one Sat/Sun. You get a rush (or a van from the local old-age home/assisted living facility and your screwed. And since I live/work in "God's waiting-room, this is very common. I've been working in the retail pharmacy business for 25 years. I've NEVER been as stressed-out/exhausted/frustrated as I have been the last year or so.And for a lot less $$$

Un-PC RPh said...

I have had all the exact same thoughts... get outta my head Mike!