“The pharmacist of tomorrow is going to be unrecognizable to most of us. He might not be a vending machine, but he’s not going to be that quiet old white-haired guy up behind the counter, either.”  —  Jim Ammen as quoted on QuoteSea.

W.C. Fields in The Pharmacist, 1933

The profession of pharmacy is rapidly changing in the 21st century. Gone are the days past when there was a pharmacy on nearly every corner in town and the Rexall brand was known in every household. Independent druggists were first line caregivers in the community, often prescribing medications for illness and ailments when patients could not see a physician. Community pharmacists were seen as a pillar of society… independent, highly visible in the community and usually considered well off financially.

Hospital pharmacies, on the other hand, were usually found in the basement, with an existence almost unknown to physicians, nurses and patients alike. The hospital pharmacy existed, in the mind of many people, solely to perform the dispensing and delivery of prescription medications as ordered by the physician. And likewise, the hospital pharmacist often had an image to match. Their salaries even lagged behind those pharmacists in a community setting until fairly recently. But hospital pharmacist stepped up to the challenge.

Times are a changin’…

Hospital pharmacists began performing many clinical functions supporting the delivery of care in addition to the delivery of drugs. An increasing level in the sophistication and number of pharmaceuticals required an increasing level of knowledge and sophistication on the part of pharmacists as well. While the community pharmacist was still counting by fives and ‘lickin and stickin’ labels, hospital pharmacists were taking on greater roles in drug delivery and patient centric clinical functions. Adding to that the increasing numbers of chemotherapeutic agents, radiopharmaceuticals, biopharmaceuticals, nuclear pharmacy and technological advances in drug delivery have made hospital pharmacy a specialty at the very least.

We now see community pharmacists suffering from numerous attacks on their livelihood. Increasing numbers of third party payers, decreasing margins and higher stress and demand in the prescription filling process have fueled the frustration of many pharmacists:

“The word out in the pharmacy community is that the small pharmacist was sold down the river by the drug companies and the PBMs (pharmacy benefit managers)” — Doug Larson

“I’ve been a pharmacist for 40 years now, and Monday morning I didn’t want to come to work because I knew what would await me. Basically, we’ve got a travesty on our hands” — Charles Pace

“It’s every independent pharmacist’s worst nightmare. There isn’t one component that’s working. It’s so extensive that it’s hard to imagine it’s going to get fixed — Todd Brown   (all quoted from QuoteSea/pharmacists)

These and many other unrepeatable quotes and comments are being heard daily from pharmacists who are overworked and under appreciated, being pushed along towards burnout and increasingly locked into the ‘golden handcuffs’ of the chain pharmacy bullies of the industry. Is it any wonder community pharmacists are complaining?

“I’ve tried to maintain an uneasy balance between your friendly unassuming neighborhood pharmacist and Anthony Perkins in ‘Psycho‘ – Roger Bart, (check the date) September 29, 1962!!

Anthony Perkins as 'Norman Bates' - 'Psycho' 1960

Many of the remaining independents are on the verge of financial ruin. Those who work in chain drugstore settings are frustrated, confused and tired of the ongoing abuse they receive. It’s amazing that we don’t have more pharmacists going postal or psycho as a result of the stressful conditions they work in.”

What will it take to bring about the necessary change in the profession? Payment for cognitive services or medication therapy management services is a step in the right direction. Recognition as healthcare providers by healthcare, governmental and third party payers would also help change this environment. But what will be the driving force to secure the future of community pharmacy?

You Are!

We, who want to be the pharmacists of tomorrow, are going to have to step up and take the lead toward securing the profession. We can’t count on professional associations and lobbyists to do it for us. Many of our professional associations are being managed by non-pharmacists (and we complain about non-pharmacists in corporate managerial positions). New pharmacists coming into the ranks must be prepared to recognize the opportunities that exist. And like the rest of us, they also need to stand up for what is morally right for the profession. We all need to take a lead on providing care that is patient oriented and always look out for the patient’s interests, even when it might be contrary to the ‘business as usual’ profit driven policies of corporate pharmacy. Doing so will win their confidence and secure their advocacy for the services you provide them. If your patients are being served appropriately and their needs taken care of you can be sure their voice of support will be heard.

Step up and do the ‘next right thing’ when it comes to taking care of your patients. Look forward to and expect the changes to take place, but only after you have done your part. Our future will be what we make it to be. Each of you in the profession of pharmacy has an obligation to stand for what you believe. After all, if you don’t, who will?

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