The Pharmacy Chick

Flying the coup in retail

What is the next big thing?

Filed under: Uncategorized — pharmacychick at 5:38 pm on Monday, May 25, 2009

I think its safe to say that we all look forward to big things, whatever they be, in our lives.  Weddings, vacations, holidays, all drive some excitement for us to look forward to.  I thing that big things drive our economy as well.  In the 80’s it was electronics.  Our economy was driven to new heights with all things computer related.  Everybody wanted a home computer, video games and cell phones.  It begat new industries and a zillion jobs, (many of which have evaporated unfortunately).

I was thinking about “big things”in pharmacy recently.  Not all big things are good for the profession but I have lived thru several of them  For me, the first big thing was computerization.  As I mentioned before, when I was just starting out, we filled everything on typewriters, bates stamped and hand priced. Computers changed everything in the pharmacy procedure wise.   Then it was the introduction of Third Parties.  This was a big thing that definitely was not a positive thing for pharmacy.    Next, I believe it was the corporate takeover (or the death of the independent rule) of the profession.  OBRA took every pharmacy and forced it to remodel down on the same level as the rest of the store. No more feeling safe a few steps up.

More recently the profession has been manipulated by HIPAA and all of its machinations that make our day long and arduous.  And, while I cannot speak for all pharmacists, I think one of the most recent big things was the introduction of vaccinations done by pharmacies.  As small as it seems, it is the first time a pharmacist has performed a PROCEDURE and gotten paid for it. 

So, the question that hangs in the air now is, WHAT is the next big thing?   I dont think it will be MTM,  if it is, its very slow to take off, but I could be wrong.

Our economy certainly could use a BIG thing to get it moving….something never seen before, transforming culture and business, and desired by everybody.

What do you think the pharmacy next big thing could be? should be?  that you want it to be?


Comment by Cathy Lane RPh

May 25, 2009 @ 7:14 pm

I’d like to see continuing education learning start in last semester of school based on a personalized learning program as trialed in Wisconsin and Ohio.

Comment by CZ

May 25, 2009 @ 7:30 pm

Could be: Mega-corps gobbling up and obliterating the very thought of independent pharmacies.

Should be: a halt of “Could be” (see above) and breaking and spinning off the mega-corp pharmacies as independents.

Want it to be: You probably call it MTM. I call it consultative pharmacy – appears to be the same thing.
Can you imagine a pharmacist billing an insurance co. for a medication consultation and actually getting PAID for it by the insurance? I think we’ll sooner see pigs fly.

Comment by The Ole' Apothecary

May 25, 2009 @ 8:22 pm

Walgreens just started a new system called POWER. It seems to be a massive increase in central prescription filling that is supposed to allow pharmacists to practice clinical pharmacy. While this may not be good for the pharmacist job market, it may reduce or eliminate the paradigm of Fast Food Pharmacy, i.e., you don’t get your medication right away in all instances, but are instead directed to a drug expert who can help you sort our your drug therapy. isn’t this the goal of pharmacy education? I want my “pharmacy on a collision course with reality” challenge to end with pharmacy being the winner over the present reality.

A clinical pharmacy association projected that by 2020—just 11 years from now–135,000 independent pharmacist practitioners will be needed. What else could this mean except pharmacists setting up shopt like, say, optometrists do? I walked by an optical center in a mall just yesterday, and reminded myself that the optometrist’s office is set up like a doctor’s office, with patients waiting to see the optometrist and a shelf full of medical records in the background. If this isn’t the end point of the “next big thing,” namely clinical pharmacists hanging out their shingles, then all of this transformation of pharmacy is nothin more than a prelude to the demise of the profession.

Comment by John Johnson

May 26, 2009 @ 8:38 am

I agree with the Ole’ Apothecary. I think that the Power program will cost jobs and ultimately lead to the demise of the profession. It won’t be long before you go to the pharmacy and there will not be a pharmacist there. If you have questions, you will have an 800 number that you can call. We may end up being on staff at MD offices with the advent of electronic prescriptions and increasingly complicated formulary issues, but that is a long shot. I think we only have maybe 1 or 2 generations before the # of working pharmacists will decrease dramatically – along with salaries. Please prove me wrong!!

Comment by Cathy Lane RPh

May 26, 2009 @ 9:02 pm

Are we more concerned about our high wages, or job satisfaction and doing what we were ‘trained’ to do? Is it that the possible future prediction of demise of our profession, or the demise of our current profession AS WE KNOW IT? Worst case scenario–demise of our profession, less worse, perhaps, ‘as we know it’.

One might have thought I threw out a red herring with mention of continuing professional development (CPD) as an alternative to earning and reporting continuing education ‘credits’. It has the potential to help individual pharmacists become proficient in an area of pharmacy practice, develop an area of expertise, if you will, so that individuals pharmacists are sought after as clinical specialists ‘the oncology pharmacist’, the ‘topicals’ pharmacist, the Parkinson’s disease specialist, diabetes educator, immunizations specialty, etc.

Maybe the ‘rise’ of POWER too neatly circumvents incentive or opportunity for career development proposals, but still the hospital pharmacy environment promotes specialization e.g. infectious diseases, cardiac diseases, managerial-types, (dispensing and order entry on the night shift, anyone?). One hospital pharmacy I worked supported board certification as pharmaceutical specialists for their staff, but providing educational materials (cheez, those alone cost $500 or more), testing access, and a little bonus for becoming ‘certified’, And, yes, I’ve seen in-patient ‘robots’ that ‘select’ and collate a patient’s daily med requirements to be sent to nursing units which eliminates one of the major tasks that I used to get paid as a ‘temp’ in hospital–checking things, emergency boxes, carts, filled orders, etc.. (Not the most pleasant chore in the world–but, why should I be complaining about what I do to put food on the table?) Less simple is how to bring in a temp to enter orders and figure out how to provide individual hospital pharmaceutical care programs for short-staffed institutions.

Why can’t a similar scenario for POWER (robotics and clinical specialists) play out in retail? Too much individual-driven skillset development?

For years, hospital pharmacist take-home and benefits weren’t as great as retail (especially in so-called ‘not-for-profit’ hospital businesses), but both settings have their pluses and minuses with ever-increasing wages in hospital (supply and demand was driving that) over the past 5-7 years.

Variations of POWER have been around for some time e.g. in the Veterans Administration, which by the way, several years ago when I did a rotation at regional center was what I observed for many patients as essence of the acronym SNAFU. From what I heard, there were a lot of unhappy patients yelling at call-center pharmacy personnel, late deliveries, difficulties with getting refill authorizations, etc. and the job was 9-5 M-F off on holidays–in other words, not a whole lot of recourse for ’emergencies’ of any type, which sort of forced patients, or the patients ‘resigned’ themselves to learning how to plan ahead. Anyway, my rotation experience was of a giant piece of farm machinery (not as modern as John Deere or Kubota) that slowly turned into motion every Monday morning, turning and turning up to full-speed by 11, then slowing down for lunch hour, and then resuming speed for 4 more hours before ‘turning in for the night’. But, patients eventually learned how to deal with it. (I’ll never forget how noisy the work environment was, and how ‘POed’ pharmacy personnel would be by the end of the day.

I see the major impact of POWER to pharmacist as further encroachment on pharmacist autonomy as to how individuals perform their work, and re-emergence of that old chestnut from the ’80’s about lack of choice in HMOs, PPOs. We’ve learned to survive, and demand reimbursement for the favorite dentist no longer covered by ‘the plan’–NOT.

I see the major impact of POWER to the majority of patients, further efficiency–in the future as the ‘bugs’ are worked out everyone ‘gets on board’, just as we still have bugs in our present system –but, hey, let’s move onto the next ‘big thing’ before we make full use of what is available.

Comment by RPh1982

May 27, 2009 @ 5:10 am

Power will change things, and because it is controlled by nonpharmacists it will not be for the better. I have tried to make my retail experience clinically relevant because I have repeat face to face interaction with customers on a frequent(sometimes daily-sigh) basis. Most of these people will not navigate through a phone menu or bother with the internet. Corporate pharmacy cares about the bottom line, eliminating salaries, not about the profession. This is the next big thing, and it is decisively not good.
I have said more than once (maybe a zillion times) that when pharmacies began being run by non pharmacists, it was the beginning of the end of pharmacy. Here we go. hang on.

Comment by Dr. Grumpy

May 28, 2009 @ 8:47 am

Doctor’s practices are often run by non-medical imbeciles. It’s the reason I left MegaNeurology, Inc. to go into solo practice 8 years ago. And I don’t regret it at all.

Comment by chris

June 3, 2009 @ 5:19 am

I wonder what the future holds over here, the company bottom line focus is in direct competition with our NHS focus. They want minimum staffing hours and only have checking technicians in extremely busy stores, usually at the expense of pharmacist hours. Whereas the NHS wants us doing monitoring, reviews house calls (potentially), prescribing for minor ailments etc. How can we do all this additional stuff without additional hours. There is 5% script growth annually here, so a pharmacy doing 1500 items a week now, will be doing 1800 in just 5 years time.

Looking back at my records which go back about 10 years, we were originally doing roughly 100 items per day, we are now doing 300-350, staffing levels have not changed since then, and we are now expected to do additonal services on top of this. How can that make sense to anyone?

Comment by Megan

June 19, 2009 @ 5:40 pm

I am pretty sure it’s going to be MTM, at least it’s nearly guaranteed to be in MN. Since the fantastic people at the U of M came up with it in the first place, they’re pretty much at the forefront, and it’s slowly spreading around them. (WI started a pilot program last year, but MN already has medicaid on board willing to pay for it with certain requirements.) Hopefully, I will have a secure job with a good salary long enough to pay back all my loans. That is my only prayer to the gods of pharmacy at this time. 🙂

Student Megan

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