Retail Pharmacists Overeducated?

"After having been through pharmacy school and having worked retail for a year I remain unconvinced that retail pharmacists can't be replaced by robots, certified techs or some combination thereof. While I can describe several instances where I made meaningful interventions the fact is that I'm over educated for 99% of my actual job. Six years of doctoral level training simply isn't needed to count by fives, put pills in a jar, sit on hold with insurance companies and politely explain to customers that you have no idea why greeting cards aren't on sale this week. Even the bulk of counseling can be reduced to bullet points that any literate person could read off a computer screen or brochure.

Personally, I feel that the future of retail pharmacy lies with technicians filling prescriptions and a couple of pharmacists sitting in a district call center fielding questions about the more challenging issues regarding drug interactions and complex disease states.

Highly educated professionals should handle issues that require a significant knowledge base, not do menial tasks like order entry and prescription filling."


That was a comment left by an anonymous poster to my post about agreeing with The Angry Pharmacist. I think this is a poor and potentially dangerous attitude, so I want to address it.

First of all, I'm sick of my job being demeaned by uppity pharmacists who think you're only truly practicing pharmacy when working in a hospital or clinical environment. Retail pharmacists are looked upon as the dumb pharmacists. It's insinuated that all we do is call insurance companies and count by five, and therefore, we don't really have to know anything about drugs to do our jobs.

Let me state that I could have been whatever kind of pharmacist I wanted. If I wanted a clinical job, I could have gotten one easy. I probably would have been accepted to any residency to which I applied. School was fucking easy for me. I studied for a couple hours the night before exams, and still breezed through with a 3.7. I'm not a dumb pharmacist. I know drugs, and the stuff I don't know about them, I can learn as quickly as anyone.

I chose retail because I like it better, and I believe I make more of a difference in people's lives as a retail pharmacist than I would in any other area of pharmacy. I see my patients several times a month. Some of them, I see nearly every day. I'm on a first name basis with many of them. I've talked to them. I know their histories. I know their families. They come to me when they have questions about their medication. Hell, they come to me when they have questions about their general health. I've earned their trust because I work hard, and I care about them.

Do you know how rewarding it feels when one of your patients visits the pharmacy for no other reason but to tell you that the OTC recommendation you made for them worked really well? Do you know how good it feels when someone comes up to you and says, "My doctor said I should take this, but I wanted to check with you first because you know more about this stuff than he does." ? I don't need to be making interventions to feel like my job is meaningful. Simply caring and being an easily accessible, trustworthy source of information is meaningful enough.

Let me break it to you... No matter where you work, your job becomes routine and mindless. Whether you work in retail, a hospital, long term care, consulting, etc. your job ends up becoming a lot of the same things over and over again. After a little while at any job, we all stop using most of what we learn and instead become experts at the small percentage we have to know. Think about it... What do you really do in a hospital job? You input and check orders all day.

"But wait... I'm responsible for aminoglycoside dosing. I'm using what I learned in school."

I can teach a high schooler with first year algebra skills and no knowledge of pharmacy how to dose aminoglycosides. It's not rocket science. Every hospital has their own dosing parameters for the pharmacists to follow. The job is given to the pharmacists so that the doctors don't have to waste their time figuring it out on their own.

"I round with the medical team and give my advice on how to treat patients."

Sure... I guess you can say that's making a meaningful contribution while using your education. However, I've been on rounds with pharmacists, and most of them don't speak unless spoken to. Occasionally they'll get asked about which antibiotic to use in a certain situation or whether a particular drug needs to be dose adjusted in renal function. The pharmacist may or may not know the answers to these off the top of his head, and if he doesn't, he'll simply look it up. If the pharmacist can look it up, then anyone can look it up, and if that's the case, what makes the pharmacist so special?

"That's not the case for me though. I have the respect of the medical team, so they listen when I make suggestions."

That's the point I'm trying to make. Any job is what you make of it. I can work in a hospital and not do much more than input and check orders all day, and I'd still get a paycheck every week. In much the same way, I could count by fives all day and still get my paycheck working in a retail pharmacy. However, that's not all I do. I choose to interact with my customers. I choose to help them understand their medications. I choose to listen to them when they're crying on the phone to me about how their doctors don't listen to them. I choose to stay up to date on new drugs. I believe that's part of my job. I suppose it doesn't have to be, but I do it anyway.

Because of that, I can't be replaced by a robot or a tech. Sure, they can type up a script. Sure, they can count out the pills and slap a label on a vial. However, they don't have the knowledge to know if what they're doing makes sense. Furthermore, they can't provide the same kind of advice that I (or any pharmacist) can.

You take pharmacists out of pharmacies and prescription errors will go up 10 fold over night. You make customers call some remote call centers in order to ask a pharmacist questions about their medication, and you'll find that they'll be hesitant to do so. Just like you or I wouldn't be so keen on calling a doctor we've never met face to face for medical advice, patients won't want to call a pharmacist they've never seen before.

If you're still not convinced (and I'm sure you won't be), then I hope you don't end up becoming the victim of a prescription error made by a pharmacy technician who didn't know what he was doing. Maybe you'll bring in a prescription for Coumadin where the doctor mistakenly wrote "take 1 tablet 3 times a day" on it, but since the tech doesn't really know how Coumadin is supposed to be dosed, he typed it as it was written, and the robot dispensed it as it was typed.

Or maybe your doctor puts you on Coreg for a heart problem, but you find you get really dizzy shortly after taking each dose. Maybe you'd love to ask the pharmacist if that's normal, but alas, there's only technicians at the pharmacy, so they wouldn't know to tell you to try taking your Coreg with food because taking it with food slows the rate of absorption but doesn't decrease the extent of absorption.

Or maybe it'll be 8:00 PM on a Saturday night, and your baby will be running a fever despite the antibiotics the pediatrician gave him the day before. The baby won't stop crying, and your doctor can't be reached on the weekend, so the only person you can turn to is a community pharmacist who will be able to tell you what dose of Tylenol you can give the baby.

You're right though... If all pharmacists did was count by five and call insurance companies, we wouldn't be needed. If you take pharmacists out of pharmacies, you'll get the same kind of service from pharmacies as you would get from a fast food restaurant. I don't know about you, but I'd rather not treat my medications like fast food.