Monday, April 7, 2008

The Pharmacy Alliance

I've never addressed this topic, which seems to be running rampant across blogs over the last few months. I didn't really know what to say about it. However, I'm going to try to put something into words, and I must warn you, it probably won't go over very well.

I respect all the pharmacists, technicians, and students that are taking part in this new Alliance. I admit that their intentions are quite noble, and if they succeed in reinstilling dignity, self-respect, and integrity into the profession of pharmacy, it will be better for all of us.

I'm not a member, and here's why: Honestly, I can't see how this is even going to come remotely close to making any kind of difference. What has any pharmacy group really accomplished over the last few decades? We have APhA, ASCP, ASHP, etc. What do these groups really do besides meet maybe once a month and eat dinner (which is usually sponsored by some drug company, which seems hypocritical to me)? I guess they put on their fair share of CE's for pharmacists, which is always good. However, and maybe I'm too young to have an appreciation of this, how have they advanced the profession? Oh wait... that's right. Pharmacists can now give flu shots. Hooray!!! That puts us on the same level as medical assistants! Score one for the home team.

It's my personal belief that the profession will be changed by a few highly motivated pharmacists who will go out and fight to start up a clinical pharmacy program, an anticoagulation clinic, a diabetes or asthma education program, or an extensive community pharmacy based medication therapy management program. Pharmacy groups will not be the ones that enact change because, quite simply, they have no way of affecting the people and companies that are running our profession.

Do you think Walgreens gives a shit about The Pharmacy Alliance (or any pharmacy group for that matter)? How about CVS or Rite Aid? They don't care. They don't have to. Why would they listen to any of our demands? How would we make them listen? Strike? There's no pharmacists' union, so that's kind of an impossibility. Besides, it's unethical for pharmacists to go on strike.

Personally, I like my job. I'm fine with just about every part of it. Perhaps it's because I don't work for Walgreens or CVS. I think my company treats me fairly well. I know I'm paid pretty well, and while I get angry or frustrated with some customers, for the most part, dealing with the public is enjoyable. I often complain about my job, well... because everyone complains about their job. When it comes down to it though, there are probably only a couple minor things I would change (a lunch break would be really nice, and some retail pharmacists actually do get one).

I can't speak for other parts of the country, but in my area, there are plenty of other pharmacies to work for besides Walgreens, CVS, or Rite Aid. Any pharmacist looking for a job has heard the horror stories of working at these places. Therefore, if they still decide to take a job with one of these companies, who can they really blame if they're miserable? Furthermore, what's stopping them from trying another retail company? And if they've tried a ton of retail companies, and they can't find a single one that provides a positive working experience, maybe they just have to face the facts that they don't really like retail pharmacy and are better suited for something else.

In any case... I wish The Pharmacy Alliance luck, and I truly hope they can succeed in getting us extra pharmacist help, lunch breaks, and some more respect from our store managers. I'm rooting for them. I just won't be fighting along side them.

18 comments:

Anonymous said...

I think the problem with pharmacy is that it's just a job to many of us. Look at physicians. They have a strong group, the AMA. Most doctors are vocal about the way they are perceived and treated. Why? Because they invested too much time into it ( 4 yrs of undergrad, 4 yrs of med school, rotations, and residency). My thinking is that they HAVE to be involved so all that schooling/training is for nothing.

Pharmacists on the other hand, don't invest so much time. Those that do (professors and pharmacists that did residencies) are usually more vocal. Too many of us go to pharmacy just for the easier lifestyle and good pay. We don't go in for the profession.

Pharmacy Mike said...

Doctors have an inherently different profession than pharmacists. Doctors are there to diagnose and treat illness. That's what they've been doing since the dawn of medicine. The very nature of their job is clinically oriented. A doctor can never be replaced by a machine or someone less skilled.

Pharmacists originated out of the need to prepare and compound drugs. That was their special skill. However, the profession has evolved in such a way that compounding and creating tablets is rarely needed. Now, our job is pretty much focused on dispensing. That's the role we provide.

Pharmacists like to talk about expanding their practice into a more clinical area, but we must realize that this wasn't the original intended purpose of pharmacists. We're trained well enough in school that we can kind of branch out in that direction, but our main purpose will, for the foreseeable future, be about dispensing.

Let's not kid ourselves either. The nature of retail pharmacy isn't the real problem most pharmacists have with it. They simply don't like working their asses off for 12 to 14 hour days under enormous stress from lack of adequate help and without barely a single break.

That's the real problem everyone has with retail pharmacy. Most people don't really care that we aren't doing MTM. In fact, I would go so far to say that most pharmacists would prefer not to just so long as they could fill prescriptions in an environment that didn't leave them feeling exhausted at the end of the day.

Anonymous said...

Too bad the folks at APhA will never understand what you have hit on, Mike... that our primary role is dispensing. Yes, dispensing hundreds of prescriptions a day under horrible conditions is a pain, but it is a job that the public needs and it is more than enough to keep us pharmacists busy.

The role of dispensing is not going to go away. Someone has to do it. Unfortunately, too many of our colleagues (ones that likely don't spend much time on the front lines) believe that our lives will be made better by eliminating the profit from dispensing... then adding on even more responsibilities to an already maxed out workload.

the technician extraordinaire said...

I live in Suburbia, 15 minutes, if that, outside of one of the larger cities (one of top 20 in the country). I work at a chain pharmacy right down the street from my house. Our options in this area? There's 6 CVS's within a 10 minute radius, and a bunch more within 15 minutes. There's at least 7, if not more, Rite Aid's in the area (there were a lot of Eckerds that were right near RA's ... in fact, one Eckerd was literally 1/8 a mile from a Rite Aid ... so there are now 2 Rite Aids that you can stand at one and see the other across the street and up a short way). Walgreen's is almost complete with their 2nd store in the near vicinity, and shortly, there will be more. They've just purchased, I believe, two more locations in the area. One is taking over at a former grocery store plaza.

This is why I joined The Pharmacy Alliance. There are 4 independent pharmacies in the area. None of them hire any new blood; their techs have been with them for years. They don't offer the same benefits as my company does, and being that I tend to be somewhat clumsy, that relatively cheap health insurance does help. The only thing I think I'd have a better chance of at an independent is being paid fairly.

These are the reasons that I'm happy to join TPA. There's good things (benefits; proximity to home) at CorpoPharm), and bad things (wages!; lunch breaks, which I don't even get; restroom breaks, which we all have to struggle to find time for; and so on). I think TPA could possibly bring things all together for us all.

Anonymous said...

You forgot to mention that being a part of the TPA Yahoo! group means getting posts e-mailed to you that have been composed entirely in capital letters by people that are apparently new to e-mail. I would say that 85% of the posts were complaints of some sort regarding personal issues (not global pharmacy problems) and the remaining 15% were of the "you go girl/dude" variety. This is not a group of change. Change is done through individual choices to practice pharmacy the way you want to practice- create your own future.

Paul Trusten, R.Ph., Acting Secretary, TPA said...

Mike,

Thank you for your excellent comments on The Pharmacy Alliance (TPA). We will be the first to agree with you that previous pharmacy organizations have done little to advance the dignity of the pharmacy professional. That's why we have come into existence. We are not topheavy with distant types who do not represent the individual practitioner. We ARE individual practitioners who are equally dissatified with the mainstream pharmacy organizations, and are going to write a set of principles toward which other individual practitioners can point, at the grass roots level, to foster conditions we have called DSI (dignity, self-respect, and integrity).

Until now, pharmacists and technicians have acted alone in their efforts to improve the way they are treated. There has never been any real support. We will represent that support, and we will be action-oriented.

I can understand why you don't know much about us, because we haven't even had one meeting yet, and our principles, which we call "The Bowl," haven't been written in final form. Our first meeting will occur a week from Saturday, April 19-20, 2008, at the Holiday Inn On The Beach, Galveston, Texas. About 17 of us are on our way there. At about the same time, our Web site, www.thepharmacyalliance.com, currently under construction, will be launched.

We are extremely new. We have only been communicating and organizing since last fall, so I can understand how our apparently inchoate nature has turned people off. But, we expect that to change. All important movements started small and unimpressive. Two things come to mind: those two bicycle makers from Ohio, and the two guys in the garage in California.

Thank you for discussing us on your blog, and please, stay tuned to our Web site and also our mailing list site at http://health.groups.yahoo.com/group/ThePharmacyAlliance/

theangrypharmacist.com said...

Extremely well put.

Anonymous said...

Mike, I am a member of TPA. I joined for the sole reason that you pointed out. There are no pharmacy organizations that do a wit for the working pharmacist's demise. In fact, they avoid even discussing the matter.

Regarding TPA, it is a start up organization with a world of work to do. I think we have critical time table in which to either succeed or fail. I disagree with everyone's statement that the role of dispensing will continue to be around. In fact, my guess is that the demand for dispensing pharmacists is going to decline over the next ten years. We will be replaced by kiosks and centralized filling. The multitude of Walgreens, etc. will only be facades to sell the myriad of non-health related products. Mr. X will drop off his prescription, it will go to a centralized filling facility, staffed by a fraction of the current pharmacists, then he will pick it up at a kiosk. Maybe there will be one pharmacist at every 5 locations to fill stat orders.
Thus, our dilemma. Accept the fact that the management of big Pharma only wants us to be peddlers of a commodity, or take back our role as a integral part of the care system. That cannot be done in most circumstances in retail. We must start at the bottom and change upward. TPA may be able to do that. It will take numbers of participants to make it work.
Everyone's choice is to continue on with the same or try and extract change. I choose, at the very least, to try. As goes retail, goes pharmacy. The public's view of pharmacy as a profession is based entirely on their observation of the retail pharmacist. Unless we change retail, then the independent, the hospital pharmacist, the consultant,the whatever, will all be viewed the same. As purveyors of a commodity and will be treated as such and compensated on that basis.
Blog on. It's your right and I enjoy your comments, but alone, you stand absolutely no chance of fostering any change. All of our careers are at stake and we are running out of time.

Myron Bryant, R.Ph.

Pharmacy Mike said...

I still want to know HOW the group is going to change the way Walgreens manages its business.

If Walgreens wants to go to centralized filling and kiosks like you say, then what can we do to stop it?

Personally, I don't think any big chain will be taking that route in the near future. I think it will hurt their business because patients visit a pharmacy and expect to see a pharmacist. I think once you start removing pharmacists from pharmacies, you start losing the customers' trust.

Walgreens and CVS love to tout how their pharmacists are readily available to answer questions and counsel patients on prescriptions. These supposed kiosks would effectively eliminate this.

Moreover, it would be an inconvenience to customers in that it will take more time to send a prescription to a centralized location for filling. Unless the insurance companies are willing to cut the same kind of deals as they do with mail order prescriptions, there's no benefit whatsoever for a customer to go that route.

With the every increasing elderly population taking more and more meds, I see no way that there can be less of a need for dispensing pharmacists over the next 10 years.

I'm not saying it's a bad thing to want to expand the profession. I believe whole heartedly that we should try to. I just don't see how some organization is going to do that, especially considering all I ever hear anyone talking about is how they work too hard, with too little help, and too few breaks. I don't see pharmacists climbing over each other for the chance to take on a more clinical role in retail pharmacy.

Honestly, I think what everyone is really crying about is that their jobs are too tiring and stressful. They don't care about expanding the profession. They just want more help, so they're not as stressed out.

Anonymous said...

Mike, Walgreens has beta tested the kiosks. WalMart has done the same in North Carolina. Their mission is to improve the bottom line and pharmacists' salaries rank among their highest labor costs. Look at the journals. What do you see being advertised. These robots and kiosks are not being developed for fun. They are for utilization.
Walgreens will change their tune just like WalMart did regarding their big lie of "we buy American". You might finish your career sitting at a phone bank, but I assure you it will not be dispensing medications under the current business plan. This plan is too high of cost and is being undercut by the mail order and imports. It is doomed.
The solution again, is to change the publics perception of need. Then Walgreens will be forced to staff their pharmacies or be displaced by the first competitor that does. Its dog eat dog.
TPA cannot directly force change. That will have to come by the cumulative force of will exerted by individual pharmacists. TPA will foster that will and promote change. We will also give you more specifics after our first meeting this next weekend. We will fill our "Bowl" and come away with a plan to attain our goals. My hope is that we are not too late.
Join Us!

Myron Bryant

Pharmacy Mike said...

I think the goal of The Pharmacy Alliance should be to make an argument that there is a financial incentive for these companies to maintain an adequate number of pharmacists and techs at each pharmacy.

You have to speak in a language the big corporations can understand. You have to get public opinion surveys that show people are much more likely to use well-staffed pharmacies than pharmacies that use a central filling system. You have to find studies showing that the presence of a pharmacist greatly increases sales of over-the-counter medication.

The problem with public opinion is that it's fickle. People may be all outraged about something one day, but once they find out its more convenient and saves them money, they change their minds. Ask people of their opinion of Walmart, and most will say they believe it's a greedy and corrupt corporation that's ruining America. These same people shop at Walmart several times a week because you just can't beat their prices, and you can find anything there.

The same thing will happen with pharmacies. People will hate it, until it becomes easier for them, then they won't care. Therefore, you have to make a financial argument to the corporations running the profession.

That's what I believe... but I'm pretty inexperienced, so take it for what it's worth.

Anonymous said...

The only way to force a large corporation to change it's business practice is to hurt it's bottom line. I think we all know how that can be done and yet no one wants to do it. Form a union of workers and strike. Demand better working conditions. Just look at history and the only way to effect change is to change the law so the corporation has to obey or you punish them.

Pharmacy Mike said...

I don't think it's ethical for pharmacists to strike.

You can't deprive people of necessary medications just to make a point. We have to find another way.

Anonymous said...

Mike,

The purpose of a strike, in my opinion, is to make the corporate pharmacists come down and work the ranks again. Let them remember how it is to go without a lunch break or a bathroom break, what it's like for work to stack up to counsel a patient or go out on the floor to help them with OTC's. I don't agree with a strike either, and that is why I'm a member of TPA. I am hoping to find a way to effect these changes without the severity of a strike.

I belive that, in the future, certified techs will take over most of the dispensing functions (as they already have in many pharmacies) and pharmacists will be freed up for counseling and other clinical functions. Certified techs will undergo the education that pharmacists have in the past and pharmacists will become increasingly clinical. I am hoping that will extend the priviledges of prescribing.

I see TPA as a working organization for the rights and working conditions of pharmacists as opposed to the "other" pharmcy groups who basically educate pharmacists and assist big pharma in controlling our lives.

Long live TPA!

Ellen Luse
TPA member

Paul Trusten,RPh, Acting Secretary, TPA said...

I agree with you wholeheartedly, Mike, that pharmacists should not strike. I know nurses don't agree with me, because they have been known to strike. Me, I just think that the whole idea of striking for better working conditions is, well, boring. It gets patients mad and doesn't change people's minds. What I want to see happen is to change PHARMACY'S mind. I want to see pharmacists and technicians standing up for themselves, to have a set of principles to follow and an organization that supports them. And, that is only the beginning. To paraphrase the poem, "What rough beast, its hour come at last, crouches toward (Galveston) to be born?" We don't know what else will result from our meeting; that is the exciting part. I want DSI (dignity, self-respect, and integrity), as we call it, to be the catalyst for many new ideas on how pharmacy can stand tall. When Benjamin Franklin was asked about what the use was for one of his inventions, he replied, "What is the use of a newborn child?" Hey, my friend, join our organization! Then, come to Galveston and help us build this new thing.

Paul Trusten, R.Ph., Acting Secretary, TPA said...

Also, Mike, I agree with you that pharmacy was not "invented" for clinical practice, but we are being thrust into it. Laws and professional practice standards have changed. What hasn't changed is the practice paradigm for many pharmacists. As I see it, pharmacy is on a collision course with reality. The major national pharmacy owners, and the public, have to be set straight with the law and the emerging nature of the practice, not the other way around. And neither the owners nor the public like that idea, because it is all about control. They all want continued control of us. ENOUGH! We have been controlled enough!

It could be that pharmacists will have to go out of their way to educate the public on MTM, and demand to start doing MTM. Much will be up for debate and discussion at our first meeting and on our new Web site. I'm excited about TPA, but it also means that I'm going to have a lot of work to do.

Anonymous said...

I don't really understand the position of not wanting to strike. First it is not unethical. No one would be denied medication. Nurses strike, police don't strike but everyone has heard of the blue flu.
Management in most chains are pharmacists and they can come down and work and remember what it was
like to be under pressure.

Secondly it would bring the issue of workplace conditions to the public. They would be inconvenienced and would learn about the fact that their health is in danger from pharmacists with no rest or meal breaks and insufficient staff. It's about time that someone did a major story on pharmacy errors that didn't focus on the fact that errors are horrible but the fact that it is amazing that there are not more of them given the way pharmacy is practiced today in big box retailers.

Anonymous said...

what exactly do you mean by the horror stories of working at non-retail type places? what places are you referring to? If you have such a big problem with retail pharmacy why don't you just open your own pharmacy?