Friday, August 6, 2010

The Future of Retail Pharmacy

$4 Generics

Free Antibiotics

Free Diabetes Medication


All across the pharmacy blogosphere, pharmacists and technicians have complained that these developments in retail pharmacy are steps on the road to the end of the profession as we know it. Pharmacists are being devalued by giving away product and professional services for free, and it seems like there's nothing we can do to stand in the way of our corporate masters instilling these plans.

I'm going to just lay it out there as I see it, and you can agree, disagree, discuss it, whatever. The retail pharmacist is on the way out. I don't know how much longer it will be before it happens, but I truly feel that it will eventually happen and probably within my working lifetime.

Let's just take a step back and look at how retail pharmacy started.

Back in the day, retail pharmacists possessed one special skill that no other professional had. Pharmacists could compound medication. A physician would write a prescription for a specific ointment, solution, or other dosage form that needed to be specially prepared before dispensing to a patient. Pharmacists filled that role. They were needed. No one else had the training to make complicated compounds. It was all up to the pharmacist.

As the years passed, drug manufacturers started to make their own pre-packaged dosage forms. Slowly, the need for specialized dosage forms for patients decreased as most patients could be treated using the manufactured products. Compounding started to go away, but the convention of a retail pharmacist remained. Doctors still wrote prescriptions, and pharmacists still filled those prescriptions. However, instead of using their specialized skills, they simply pulled a product off the shelf and stuck a label on it.

To make themselves feel more useful and professional, the notion of counseling on medication came along. Pharmacists felt they really should be doing more than sticking a label on a bottle, so they decided that their new professional role would be medication counseling. However, medication counseling isn't something that is unique to the profession of pharmacy. Doctors can counsel patients on medications. So can APRNs, physicians assistants, nurses, and pretty much any health care professional. You might be able to make an argument that a pharmacist undergoes more intensive schooling about drugs than any other health care professional, and therefore, they are best fitted to provide counseling. Regardless, unlike compounding, counseling is not a skill unique to pharmacists.

It shows too. Feel free to disagree with me, but from my perspective, I do not think that most retail pharmacists are presently capable of providing medication counseling to patients above and beyond any other health care provider. Some retail pharmacists take an active role in learning as much as they can about medications out of either curiosity or a feeling of professional obligation. Most others are just happy to count by five all day, and for the most part, their employers will let them. I think reading pharmacy blogs gives us a skewed perspective of the sense of professional responsibility and enthusiasm that most pharmacists have.

In my experience, most just want a paycheck. They got into pharmacy because they liked the idea of getting paid big bucks to count out pills all day. I'll admit that's the reason I went to pharmacy school. It looked like a really easy job that didn't have a whole lot of responsibilities except to not kill someone. Obviously, I wasn't quite correct, but my point stands. Most retail pharmacists do not choose the profession for the same reason that people choose to become doctors or nurses. Most retail pharmacists didn't choose retail pharmacy because they thought they were providing health care. They chose it because it was a science profession that got paid well and was on the outskirts of health care without actually being health care.

Again, I'm generalizing. This isn't why ALL retail pharmacists chose the profession, but in my experience, it really seems to be why the majority did.

Most pharmacists would rather not counsel. Now, if a law came out and forced pharmacists to counsel, I'm sure most of them would do so out of fear of losing their jobs. However, I think most pharmacists are just hoping that every customer that comes to pick up medication checks that little counseling denied box.

Since retail pharmacy is run by giant corporations like CVS, Walgreens, and Walmart, you can bet that unless there's some money involved in counseling, no corporation will truly start an initiative to promote counseling on all medications. Since giant corporations rule health insurance in this country, you can bet that they'll do very little to help pharmacies get reimbursed for standard counseling on all prescriptions. Unless some kind of law gets passed that absolutely demands counseling on all new prescriptions (and that law will be fought tooth and nail by the big corporations), you won't see big chain pharmacies really forcing their pharmacists to counsel. They'll pay lip service to the public, but their corporate policies will actually discourage services that don't provide monetary benefit.

If pharmacists are not compounding, and they're not really counseling, what purpose do we really have? Why do we get paid so much when essentially all we get paid for is to fill prescriptions? The answer is that we don't have a true purpose in the current pharmacy model. We're superfluous, unnecessary. Our 6 figure salaries are the biggest thing standing in the way of those giant corporations making more money. Since we no longer offer a service no other health care professional can provide, we can be phased out in favor of less expensive labor in the form of trained pharmacy technicians and increased use of robotics.

Is the elimination of the retail pharmacist the best thing for the public? Absolutely not. Mistakes will increase, and even if we are not using our clinical knowledge all that much, the fact that anyone who has gone through as much difficult schooling as a pharmacist has to have a certain degree of intelligence and responsibility that would serve well in any job. However, what's in the best interests of big corporations is rarely what's in the best interest of the general public. The corporations will try to make more money in any way they can, and customers will adjust to whatever future changes are made to the current retail pharmacy format. For all the talk about how the United States is the land of the free, the vast majority of the general public seems to simply adjust and accept whatever choices are taken away from them. If the corporations change and offer no other choice, the American people will go along for the ride. They might complain a little. They might say they liked things better the old way, but in the end, they'll just roll with the punches. Therefore, don't expect the public to put up much of a fight if retail pharmacists are greatly reduced or eliminated altogether.

I feel like I'm in a race against time. I truly think the days of the retail pharmacist as we know them are numbered. However, I don't know how much more time we have. Therefore, I'm hoping that my job will last just long enough for me to figure out what else I can do with my life that would provide some kind of service or benefit to the general public. I'll admit that if I thought the job would last forever, even as much as I don't believe in what I'm doing, I'd probably continue doing it simply because it pays well enough for me to live a nice, comfortable life. I don't think it will last forever though. I'm not even sure if it'll last another 5 years (for a variety of factors not just corporate elimination of pharmacists). There has to be something else I can offer that few others can. I think that's the secret to job security.


Anonymous said...

Unfortunately my friend I have to agree. I think it may be closer than you think however. It only takes a stroke of a state governer's pen to sign an amendment allowing dispensing by non-pharmacists and the game is over.

I graduated in 1997 and even while I was in school there was legislation on the table here in Ohio that would have allowed dispensing by nurses. This was in an era where the economy was booming and government deficits and corporate profits were far less of an issue.

You know large companies have stacked the Boards of pharmacy with their stooges and lobbyists who have the ears of politicians are already whispering the idea of the savings by eliminating the need for the some 300,000 pharmacists with perhaps someone with a technician certificate.

The profession is lost. To all you young students out there I would seriously consider changing my major.

The Redheaded Pharmacist said...

I personally think that pharmacy and healthcare in general is at a major crossroads right now. What the healthcare system as a whole will look like in 5-10 years is anyone's guess. That uncertainty extends to what will happen to pharmacists as well. If the profession doesn't step up and prove it's worth and value in an increasingly evolving healthcare system then we might find that we are simply phased out of the system completely. My personal guess though is that any major change that would eliminate retail pharmacist jobs completely would be too great of a shock to the drug delivery system to happen too quickly but it could gradually happen over time. I just hope that I can work long enough to save a little nest egg for myself and also figure out what I want to do next if retail pharmacy is really on the decline. But the timeline for what is going to happen and what that means for all of the retail pharmacy jobs in the country is anyone's guess. I am trying to be optimistic though and simply think that retail pharmacy will evolve going forward and that pharmacists will evolve with it instead of us being left behind! Only time will tell!

Anonymous said...

I can say this much, Wal-mart is starting an initiative that will make all new prescriptions receive counseling or sign a refusal. Now at the same time they are cutting our tech help so not sure how this is gonna work out.

Anonymous said...

Meh, I can see salaries decreasing (already are) and maybe significantly. But I don't see any way that any legislator would dare eliminate the position of the pharmacist. Our healthcare system, despite its flaws, is still the best in the world and pharmacists do in fact save lives every day. You know this. The media and public would go effing nuts if someone with a 2 year tech school was dealing out medications.

Maybe I'm completely naive (been working in a pharmacy for 11 years, pharmacist for 3) but I don't think we're going anywhere.

Anonymous said...

I wish I had time to leave a longer comment but I just wanted to comment my two cents as well. I too cannot see pharmacists going anywhere. Hours and wages cut slightly, increased responsibility for techs, but never completely phased out. We are crucial part of the health care system that can't be replaced easily or at all.

Anonymous said...

I've been a retail pharmacist for a supermarket chain for 17 years now, and things are definitely changing. Sure, I counsel here and there (as necessary) and compound once in a while, but I pretty much count by fives (at the speed of light) and deal with insurance plan issues all day. I only feel secure because my partner and I fill 1300-1400 rxs per week, and I take care of my customers. I am good at my job, but have become a victim of corporate policy. Changes are coming. Payroll is being cut, our promised raises for being immunizers and meeting sales goals are being stalled. It seems that any opportunity to short change the rph is happening. Yeah, I read about tech-check-tech and removing rphs from the store, but we are needed. WE are the ones who catch doctor errors, WE are the ones who accept liability for each rx filled (do you think a tech will?), WE are the rph cops watching out for drug seekers (do you think a tech or store manager will?). People need us to help with all the concerns for them and their families, a tech does not have our knowledge base to do our job. We are not easy to replace in the healthcare system as our role is expanding not shrinking. The problem always comes down to money. We have a decent salary, but a lot of pharmacies are loss leaders. The retail chains keep us to bring in business that the store feeds off, and some of us do make a profit (just not enough of us). How long we will last is anyone's guess. We have value, but are we valuable enough to keep going forward?

Anonymous said...

I too agree that pharmacy salaries will reduce and wouldn't be replace the pharmacist by technician. I have a question here, does online pharmacies will do well going forward? Please comment on this

Anonymous said...

It's kinda of why I'm running away from Pharmacy Practice in general. Some law changes and cert. techs are dispensing. The pharmacist lobby is nothing compared to chain drug store lobby. And they could care less about lawsuits from errors. If I store has 200 rph hours a week that is ~600k a year in payroll not including benefits. That will pay off alot of angry and injured customers. Public will like it becasue you can staff more poorly paid techs so the wait times will be less and no rph will be hassling them with questions.

Anonymous said...

The answer if pharmacists will be around is answered by the question, what benefit are they? List all the studies that show pharmacists save lives, money, morbidity etc. If u know of a bunch, then the profession is safe, if not whaddya need em for?

Anonymous said...

Excellent post. I'm reading this a year later, and the urgency I feel to get out of the profession is great. What's interesting about pharmacist as a profession is the large of amount of tasks that we perform in a day. Answer phones, take prescriptions, fill them, keep up with inventory, answer patient questions (most of the time irrelevant to pharmacy), please the corporate monkeys, fax doctors, vaccinate. What other "healthcare" professional does all of this in the course of their workday. We as pharmacist wear so many different hats, and we are told to continually put more on. The profession does seem to be in danger. A breaking point will eventually be reached. Number one, pharmacist will begin leaving because of all of the extra responsibilities that we continue to take up. Or number two we a phased out and forced to use our knowledge in a different area of healthcare. I agree that the knowledge and experience we bring to the table is unique and valuable. But were that knowledge will be utilized remains to be seen.