RESILIENCE…DO PHARMACISTS HAVE IT? billbrownblog.com May 27/19

Resilience sounds like such a positive word.  The word connotes ‘toughing it out’, not being a ‘quitter’, strength of mind & spirit, and all the characteristics associated with personal development, and leadership.

Recently there has been some urging from many circles to look for some positive stories in pharmacy, to look at the bright side, and to focus on solutions rather than the same old harping and complaining about the state of affairs.  Who could argue with this call for the positive rather than dwelling on the negative?

In a recent piece in the Globe & Mail,

https://www.theglobeandmail.com/opinion/article-put-down-the-self-help-books-resilience-is-not-a-diy-endeavour/

The argument is presented that research shows that resilience depends more on what we receive and interact with than what we have within us.  Surprise.

Extrapolating this to the pharmacy naysayers who write or comment on the present state of the pharmacy profession, there may be some downside to this urge to “make the best of things” and to looking for ways of finding solutions to the many problems pharmacy faces from within.

Looking for solutions solely within oneself is not going to cut it.  Eight five percent of pharmacy is now controlled by Big Pharmacy Retail (BPR), and not only in Canada.  Look to what CVS has done to the pharmacy profession in the US since Aetna purchased it.  Look at the situation in the UK with Boots since it was bought out by private equity firm Kohlberg Kravis Roberts.  Pharmacy is really BIG business.

Accepting what is dealt out in life, or love, or work, and then toughening it out through some association with this being a sign of strength of character is exactly what controlling parties wants.  The dynamics never change in such a scenario.  The oppressed party keeps on buying self help books, and things remain much the same.

The message here, and it is a positive one, is that all the will power, strength of character and resilience in the world are never going to help if one stays in the same place and accepts the environment presented.  It’s the people and the circumstances and the support systems around a person that will move that person from a cesspool of self pity and unhappiness, to a place where self fulfillment has a chance.  Without a change in environment, one may look tough, but one will remain on the losing side of the court.

Everyone knows what needs to be done to return pharmacy to the  profession it once was, but steps to get there appear steep, long & daunting

The pharmacy associations like the OPA do not appear to be heading in a new direction any time soon, and to representing the interests of everyday working pharmacists, despite ever-increasing pressure to do so.  If anything, recent political events in Ontario and Alberta would suggest that these powerless bodies continue to get caught flat footed by government.

The regulatory bodies like the OCP have zero interest in sustaining a professional working environment where pharmacy professionals can thrive and exercise their professional duties.  They continue to define their role in the narrowest of terms, even as the profession continues to slip ever further under the control of commercial vested interests.   Reminds you of the band on the Titanic

Hope.  Recently it appears that some International Pharmacy Graduates (IPGs) are beginning to look at opportunities back in their home countries, now that they have accepted that they were duped by BPR and the regulatory bodies into believing there was a pharmacist shortage in Canada.

More.  Career advisers are beginning to take a second look at suggesting pharmacy as a wise career choice.   Some of the news stories and comments have reached  young people and they are beginning to listen.  These comments are making a difference.   Saving even one student from a poor career choice is worth it.

It is acceptance, delusion and misdirected hope which have contributed to some of the worst catastrophes in human history.  So, it’s OK to get mad and to speak out.  Then to search for ways to change one’s environment to where talent, determination, strength of character, and yes resilience matter.

Be Careful What You Wish For May 8/19

It has been somewhat of a surprise that there has not been much more outrage/comment about recent proposed changes to the Ontario Drug Benefit Program coming out of the Ministry of Health & Long-Term Care.  These are pretty big changes.

First news, which came out of the OPA, was gushing with delight and self congratulating superlatives re the government’s decision to begin to allow pharmacists to prescribe and treat some 30 odd minor ailments.  On the surface this seems a very positive development.  Finally, pharmacists get to employ some of that knowledge which they garnered over years of university study.  So far though, only a tepid comment by government that it will pay for these services, but nothing about how much.  I am guessing a lot less that the $30 odd bucks a doc gets.  Same diagnosis, same outcome, but different remuneration levels?

Unfortunately, recognizing that 80% of all pharmacists toil as unrepresented retail employees of Big Pharmacy Retail (BPR), really clerks with not even minimum protection under the Employment Standards Act, what does this new era of professional privilege entail for the everyday working community pharmacist?

Here is a recent comment by a practicing pharmacist reacting to these new privileges which sums it up:

“Personally, as someone who has worked for years for a major retail chain, I feel absolutely no interest in this move towards diagnosing and treating minor ailments. We all already know what will happen is the Shoppers/Rexalls of our world.  They will require all of their pharmacists to take the courses and participate, then implement quotas requiring x number of billings per week, add no extra work hours thereby requiring you to squeeze even more into your workday, and share absolutely none of the extra profit the company may make with these billings. I will make no extra money with doing these services, but I will have the threat of losing my job if I am not interested in participating because they’ll fire me and hire someone who will. I will be taking on the additional liability for diagnosing and treating patients at no additional benefit to myself. Why should I be excited for this?”

A bit of a dispiriting  reaction, but then the truth always hurts.

Those bean counters at BPR are already cloistered in their subterranean chambers calculating how many UTI’s they can suck out of each of their employee pharmacists.  They work with algorithms not people.  They see big bucks here with no extra costs. Those lobotomized district managers will be marching up and down the aisles hunting for people coughing or scratching or whatever fits their dictated orders to set new quotas on.

So expanded scope is a great thing theoretically, but where the rubber hits the road, reality may tell another story.  More quotas, more work, less help, and maybe even less money.

And let’s not forget what the OCP is going to do with this one.  Although pharmacists may now hold a PharmD, it’s pretty well a foregone conclusion the OCP will mandate all manner of “mandatory” courses before allowing pharmacists to exercise any new practice privileges.  This kind of stuff is like honey to a bear to bureaucrats like the OCP; it just puffs them up.  Look to even more new hires at the OCP, and even higher annual fees  to pay for all this in the near future.

Then there is the small matter of $140 million that the Ontario government wants to take out of pharmacy, on top of the 700 Million already take out since 2015.  Is this after or before any compensation for minor ailments?

MedChecks are cooked. Done, Finished.  Pharmacists did this to themselves.  Some through sheer greed, but most through being forced trough BPR quotas to produce as many as possible with no attention to quality.  This golden goose has laid its last golden egg. The gravy is gone.

The so called “transaction fee” will cost another 17.4 million…minimum $1,000 a month right off the bottom line of the average pharmacy.  Bang.

The LTC game now goes under capitation.  Great idea for government but it may spell history to the business model of the big players in that game.

And to top it all, now that government has seen all those CBC/Global News programs on TV, there is going to be a whole heck of a lot more oversight over these pharmacy guys who appear to be crooks by inclination unless you watch them like a hawk.  Just watch those documentary reruns and see those pharmacists in their undershirts peeping through their front doors and complaining that it wasn’t their fault

Well at least the OPA is “disappointed”.

Hope some of those pharmacy undergrads are reading some of this stuff & may give them consideration for a mid course correction.  Just don’t tell the professors sipping coffee in the staff common room enjoying tenure and dreaming of retirement life at the cottage.

MISPLACED RULING HURTS PHARMACY & PHARMACISTS

Sometimes an incident occurs in life which crystallizes all that is wrong or all that is right about a given situation.   A recent ruling by the Complaints Committee of the Ontario College of Pharmacists (OCP), and subsequently upheld by the Health Profession Appeal & Review Board (HPARB), against an Ontario pharmacist is one of these crystallizing moments.  In this case this ruling could not better exemplify all that is wrong with the OCP (and with HPARB).  It’s a classic.

http://www.canadianhealthcarenetwork.ca/pharmacists/news/professional/pharmacist-who-didnt-fetch-canada-post-package-faces-college-complaint-44140?utm_source=EmailMarketing&utm_medium=email&utm_campaign=Pharmacy_Newsletter

The piece, published on the Canadian Healthcare Network (CHN), garnered 109 reader comments, maybe a record.  All comments were highly critical of the ruling and came from incensed pharmacists right across the country.

In law, “Justice must not only be done, it must seem to be done”.  In this case not only was justice not done, but a great injustice was perpetrated, not only on the unfortunate pharmacist involved, but on the pharmacy profession as a whole, and indeed all pharmacists across the country.

First, the incident involved an individual who was neither a patient of the pharmacy nor a customer of the pharmacy involved; the individual was a post office customer.  Under what jurisdiction did the OCP exercise its duty?  Why did the irate customer complain to the OCP in the first place?  The incident whereby the pharmacist did not “fetch” the parcel on demand did not involve a patient/ pharmacist encounter.  The irate customer could have complained that she was not satisfied with the retail service she received from an employee to the owner of the store, a retail service matter, not a professional misconduct matter.  The pharmacist’s reaction or behaviour had nothing to do with his professional duties as a pharmacist.  Maybe if he wasn’t wearing the ubiquitous white coat, she might not have known he was a pharmacist.  The white coat and the pharmacy setting made him the target for her misplaced and rude behaviour and subsequent complaint.

What if the incident occurred in a parking lot, or between disputing neighbours, or between spouses?  Where does the jurisdiction of the OCP to meddle in the lives and personalities of pharmacists’ end?  What did this incident have to do with the pharmacist’s lack of knowledge of jurisprudence?  This was not a statutory or legal issue, it was behavioural on both the part of an irate customer and a store employee.

The OCP could have simply indicated that this incident did not fall under the definition of a pharmacy activity and was therefore not within its purview.  But no, in its over zealousness to appear to always be “acting in the interest of the public”, the OCP did not hesitate to take down the pharmacist and apply ridiculous punishments which went far beyond what was justified under the circumstances.

The compulsion for the pharmacist to attend a ‘Managing Conflict when People are Angry Course” borders on imposing mind-bending central state tyranny.  The course happens to be given by a company which one of the HPARB panel members was once a VP of.  Conflict of interest anyone?

What business does the OCP have trying to alter the behavioural characteristics of its members, most of whom are less than perfect.  This ruling could not reveal more how far off track the OCP is in exercising its mandate.  The OCP does nothing to attempt to impact on the total loss of control of the profession to big business interests but chooses to focus on hammering a frustrated pharmacist trying to deal with an unreasonable angry retail customer.

He probably does not have the money or the time, but if this unjustly persecuted pharmacist took this matter to civil court, the outcome would likely be very different.  Wouldn’t this be a neat thing for the OPA to support and drive?  Just dreaming in technicolour of course.

The other aspect of why this whole incident sparks such an angry reaction from the pharmacist community has nothing to do with the OCP.  It has to do with what pharmacy has become, largely a retail business with employee pharmacists required to suck up to customers lest they take their business elsewhere, or to the internet.

Professionals are supposed to be frank, and sometimes firm, with their patients.  Ask any physician or nurse how often they need to be less that smiley and effusive when dealing with patients in the patients’ own self interest.

This philosophy does not apply to lowly retail clerks who are expected to ‘run and fetch’ whatever is demanded of a retail customer.  Anything short of grovelling could cost a clerk his/her job, or in this case the intervention of his regulatory body’s unjust and self-fulfilling judgement, and it did cost him his job too.  Time for the notion of pharmacy self regulation to be reviewed for this, and for so many other reasons.

The reality is that customers are always right, but patients are not.  Too bad this poor guy had everything stacked against him, and not a single person or entity came to his aid.

Wonder if they will review this case in pharmacy schools as an example of what graduates can look forward to.

THE FACE OF PHARMACY

March has arrived and once again we get to celebrate Pharmacist Awareness Month; some believe it’s a bit over the top that we need a whole month?

“March is Pharmacist Awareness Month (PAM) — the perfect time to celebrate pharmacists’ expertise and the important role they play in delivering quality care to patients!”

The quotation above is taken straight from the OPA web site.  Pharmacists and patients are encouraged to “rethink pharmacy”.  The message emphasizes that pharmacists play an “invaluable role”, an “important role” in quality healthcare delivery.  If pharmacists play such an important role, how come we have to keep telling people about it?  Over and over again pharmacy appears to be proselytising its own importance to an indifferent audience.  Certainly there appears to be a reluctance to actually pay real money for these “important services” by governments or by patients themselves.

What an irony then that, almost timed by design, the Toronto Star and Global News should publish the results of an extensive investigation into widespread fraud by pharmacists in the Greater Toronto Area.  And we are not talking pennies here, we are talking hundreds of thousands of dollars and in some cases millions.  The journalism piece names names and shows pictures of the pharmacists involved.  We can see their faces and see where they live, in the mansions that they presumably bought with the stolen money.

On three successive evenings, Global News methodically reviewed the intricate ways that “crooked pharmacists” and “pharmacist fraudsters” have stolen money from the Ministry of Health, Ontario Drug Benefit Program with wanton abandon.  Often with little shame, these individuals’ defense is “depression” or “it wasn’t me, it was the hired help” or “my husband wasn’t working, and I had four kids at home”

This stuff is excruciating to watch. The clear suggestion by the investigation is that this is just the tip of the iceberg.  The ODB is not set up as a forensic agency, it is set up as a payer for goods and services, largely based on an honour system.  This means it is wide open to abuse by “unscrupulous pharmacists”.  Where are the often quoted “most trusted, most accessible” professionals?

The other message/suggestion in the investigation is that the Ontario regulatory body, the OCP, is real soft on these individuals, and although they are found guilty of professional misconduct, these bad apples are largely fined and lose their licenses for a year or so.  Eventually they all get their licences back and presumably go back to their criminal ways.  No one goes to jail.

How come a punk who robs a convenience store for $100 to buy drugs spends six months in prison, but a “healthcare professional” can rob the public purse of a million or two and gets only a slap on the wrist?

Interestingly the OCP was never interviewed for this investigation.  As usual, the solemn OCP brown stone mansion on Huron Street in Toronto is shown, front door shut but not a person in sight.  Likely privacy is sighted as the reason for silence.  Yet it is this body that licensed these individuals in the first place, and it is this same body that allows them to return to practice and own a pharmacy after a relatively short period of atonement.  What assurances does the OCP have that these individuals will not re offend?  Why are they not barred from the profession for life… right across the country?  How come some of these perpetrators once actually sat on OCP council?

Pharmacy has been around for a long time.  This ‘problem’ appears to have reared its ugly head to this degree in more recent times.  Where’s the variable and where’s the constant?  The OCP is now raising pharmacist annual registration fees by 20% to help cover costs of more intensive investigations into professional misconduct?  So the ‘good guys’ have to pay for the sins of ‘the bad guys’.

Unfortunately, the faces of these people become the faces of pharmacy.  This may not be fair or even accurate, but these are the faces that millions of viewers see and lay judgement on.  The power the media has to make a specific statement is considerable.  Those that don’t like the message sometimes call this “fake news”.

The fact is that the story is not about pharmacists, it’s about pharmacy owners, who in the cases of the examples given, happened to be pharmacists.   So were they crooks who became pharmacists, or pharmacists who became crooks?  The distinction is an important one.

But it is hard to deny the ‘truth’ when you can see the guy standing in the doorway of his house, in his underwear, and you can look him straight in the face.

Pharmacy certainly has an image problem.  How unfair for all the regular pharmacists who toil in the trenches day after day for reduced compensation and under terrible working conditions, not to mention the new innocent grads about to enter the meat grinder.

Too bad it’s all happening during Pharmacist Awareness Month.   How about we shorten it to a week?

 

 

 

 

Who does the OPA really represent? billbrownblog.com January 24/2019

I recently watched the YouTube video which the OPA published entitled The Voice of Pharmacy.  Here is the link: https://youtu.be/IFd47I5udgA

It is over an hour long so you do have to invest some time.  Let me say at the outset that this piece is not meant to be a criticism of the video or the OPA.  In fact I was impressed with the sincerity and candor that was displayed by the three presenters, always in a frank and unscripted manner.  The video did reinforce a clear conclusion to me though.

For those who may be interested, here is a brief summary of the contents of the video from my perspective.  I believe the video clarifies who the OPA advocates for, though I am not sure if this was the intent of the video.

The video title is The Voice of Pharmacy, which surfaces the first question.  What is meant by ‘pharmacy’?

The presenters emphasize that the OPA represents the interests of both large corporations (non-pharmacist owned), and independent pharmacist owners. In fact the last several chairmen have all been independent owners from Small Town Canada.

The important Owners’ Council is made up of 24 members, 12 each from ‘corporate pharmacy’ & independent owners.  The emphasis is on representing the “pharmacy system” while it was not made totally clear what ‘system’ actually means.

There is also a clear message that the advocacy effort is with government and pretty well always involves economic issues that affect pharmacy owners.

Although the Owners” Council is self-sustaining, efforts to set up a Pharmacists’ Council made up of staff pharmacists have not been successful.  There was little uptake, and the whole effort is in hiatus at present.  Problem is that these unrepresented retail pharmacist employees apparently have little flexibility to attend meetings.  These individuals represent 80% of the 16 to 17 thousand licensed pharmacists in Ontario today.  It may also be that employers (BPR) are not that nuts about facilitating employee pharmacists attending meetings about issues like compensation & working conditions.

The OPA positions itself as representing the interests of owners, pharmacists, technicians and students.  Multiple approaches and diversity are what this is described as.

Not their fault, but the OPA admits it really has no negotiating power or authority to deal with government, or anyone else for that matter.  The government is just being nice in meeting with the OPA; it does not have to, and when it does, all discussion are covered by a non-disclosure agreement (NDA).  So no one really know what goes on behind the scene.

The video reveals that in original discussions with the government about the flu shot, the government initially wanted to reimburse zero for administering the flu shot.  The government’s argument being that the pharmacy would more than make up for any costs through increased store traffic and thereby sell more frozen pizzas, Cold-Fx, fat flushes, cough syrups, lamb chops, barbequed chickens etc.  The OPA prides itself in finally negotiating a begrudging $7.50 fee…it could have been zero.  Fact is, most pharmacists hate giving the flu shot (a technical act), but pharmacy owners, especially Big Pharmacy Retail (BPR) love them for the very reason government stated…increased store traffic, marginal no cost revenues & quotas to ensure targets are met.  Flu shots may be a small win for pharmacy owners, but the bane of employee pharmacists.  When government thinks of pharmacy it sees Big Pharmacy Retail, not individual healthcare professionals.

Then this zinger.  Apparently the two key initiatives which bind all pharmacy stakeholders together are: Preferred Provider Networks and Cannabis distribution from which pharmacists are presently excluded. What?

Some might have thought that compensation down 40-50%, ever increasing quotas, abysmal working conditions, 12 hour shifts, no breaks, random terminations/job security, no tech support, little or no respect from the employer, might have made the list of issues on the minds of at least some pharmacists today.  Nope.  None of these make the list of issues of concern to the OPA today.  The word ‘quotas’ never came up once in the over one hour video.

And therein lies the problem.  The OPA is a voluntary organization which depends on member fees for survival and credibility, but membership is probably less than 50%.  In an effort to represent the “Pharmacy System”, whatever this term means, the OPA fails to address the everyday issues which affect 80% of potential members.  In fact, these everyday issues are largely the result of the loss of control of the profession to non-pharmacist owned mega corporations…who sit on the very Owners Council in order to ensure their corporate interests are protected.

Really, one has to feel sorry for the OPA; it simply cannot win this game, and it’s not for lack of trying or hard work.  These are good people; they are just misguided.  Why not simply rename itself the Ontario Pharmacy Owners Association, charge $5,000 a year membership fees and then get on with it.

How can the OPA ever hope to garner the support of everyday working community pharmacists who suffer the consequences of issues and policies of other members (BPR) of the very same organization?

The lamb and the lion cannot sleep together

 

A PHARMACIST’S CONUNDRUM in 2019 JANUARY 1ST, 2019

It often seems that as the elephant in the room gets larger and larger, the tendency to look away, and to pretend that the elephant does not exist increases in direct proportion.  The dominant control of the profession of pharmacy by Big Pharmacy Retail (BPR), and the concurrent failure by the regulatory bodies to apply any influence to stem this control, and to put it back into the hands of individual pharmacist practitioners, is such a case in point.

Regulatory bodies like the Ontario College of Pharmacists (OCP) continue to justify their inaction by stating that it is their sole mandate to protect the interest of the public.  “Business models are not within the mandate of the OCP”, the OCP states.   Accepted.  But when the means to deliver standards of practice are not in place, then such models become condition critical and must draw the attention of the regulatory bodies, including the OCP.

Witness that within the next few months, it has been recently announced by OCP, that an initiative will be launched in collaboration with Health Quality Ontario to release a set of system-focused indicators for community pharmacy in Ontario.  An OCP spokesman recently indicated that this initiative is about improving patient and health system outcomes and establishing a way for everyone to measure the impact of pharmacy care in the community and to continually improve.  Who could argue with this one?  What a great initiative and dead on the mandate of the OCP…to protect the public’s interest.

In direct contrast to this highly worthy initiative are the hard facts of life.   The vast majority of pharmacists (80% or more) remain unrepresented retail employees of non-pharmacist owned mega corporations, whose single purpose is selling as much merchandise as possible in an ever increasingly competitive environment, now under fierce attack by internet shopping.  It’s total war for the consumer’s dollar.   We know the players, and we know their strategies.  One player alone, Weston Group, through its control of Loblaw and Shoppers Drug Mart must have close to 50% of the retail pharmacy market.  Chairman Galen Weston Jr. is the most important pharmacy leader in Canada today and he may not even know it.  Has anyone at OCP even met him?   Has anyone told him about the new quality assurance initiative?   Has anyone been to a Costco pharmacy lately with customers lined up at the counter 20 people deep waiting to benefit from a $3.89 dispensing fee?

In such a fierce retail environment, driving revenues and controlling costs are the two important orders of the day.   How is pharmacy affected by this reality?  Pharmacists are increasingly forced to work alone, without any tech support, meaning more time spent on technical functions like counting pills, wringing up sales, and bagging groceries.  All this, while at the same time performing flu shots on demand,  and meeting increasing quotas for MedsChecks and other assorted billable services which drive those important revenues.

How is it that the OCP can set out to create professional standards for quality pharmacy services and at the same time totally ignore the hard reality that most pharmacists working in BPR environments are considered (like all the other retail employees) a means of production?  This means driving costs of production as low as possible, while driving top line dollar revenue production as high as possible.  This quest is at the heart of retailing and it never stops.  Sales per square foot is a key retail measurement tool and it has no upper limit.

This is the conundrum, but what brings it to tragic proportions is the failure by regulatory bodies like the OCP to address what is an impossible situation.   This is not just about professional satisfaction, it is about human health.  Pharmacists are actually becoming sick both physically and mentally.  How can pharmacists deliver quality professional services like “therapeutic appropriateness” when they are checking 200 Rxs an hour with no help?

It is well within the regulatory bodies’ purview to set standards like the number of prescription an hour which a given pharmacist can safely fill and still meet minimum professional standards; they just don’t want to tackle BPR.

So much effort has been put forth to create the professional title of ‘Pharmacy Technician’.  What a tragic joke, as these people cannot find work, or when they do, they are not financially rewarded for their status but still must now pay OCP increasing annual dues.

The talk has started that the self-regulation of professions like pharmacy and medicine should go under review.  Some may look in horror at the prospect of government oversight of pharmacy, but one must wonder if it could get any worse than the present untenable situation.

 

PHARMACY, TRUCKING & the OCP

Although not so obvious at the outset, there are a lot of similarities between the trucking industry and pharmacy.  The trucking industry (or the transportation industry) is all about moving stuff from one place to another, and big players in this industry focus on tonnage and distance; they mostly worry about their trucks.

The more trucks the better and keeping these big machines in top notch shape is paramount; regular servicing is the standard.

When it comes to the drivers’ concerns, the same level of care and investment falls far short.  Long shifts and great distances are standard fare for drivers, who are notoriously out of shape due to lack of exercise, fatigue and consumption of junk food.

Is this beginning to make some sense when comparison is made to pharmacy & pharmacists?  Replace pharmacy for truck and pharmacist for driver.

It was not that long ago that pharmacy regulatory bodies were obsessed with details about the actual ‘pharmacy’.  The number of square feet of counter space, beakers, scales, square footage etc. were critical issues.  These aspects have seen less emphasis lately as the notion of the pharmacist as a knowledge worker is promoted, and compounding becomes a specialty activity restricted to a small minority of pharmacies.   But still, regulatory bodies like the Ontario College of Pharmacists (OCP) see fit to charge pharmacy owners annual pharmacy accreditation fees in excess of $1,000 per year.

What are these fees for?  Maybe just a convenient revenue generator?  And still this is not enough.  This year the OCP has dictated that annual member fees will be going up 20% over the next couple of years in order to finance the increasing number of complaints and disciplinary issues the OCP has to deal with.  What a sad comment on the profession of pharmacy.  What has caused this degradation in the moral fabric of the profession, and this spiked increase in assorted misdemeanors involving (ever more frequently) members of OCP council and its very leadership?

This website has been inundated over the years, but much more so lately, with lamentations from pharmacists mostly working for Big Pharmacy Retail (BPR) re compensation decreases as much as 40% from five years ago ($32/hr is fairly common in Toronto today) and abysmal working conditions.  In the name of saving labour costs, it is common to witness pharmacists working alone (no technicians or assistants), trying to serve a dozen patients at a time, perform flu injections, and bag groceries all at the same time.  No bathroom breaks, no meal breaks.  And for this you need a PharmD?

To add insult to injury, while under these terrible conditions, retail pharmacists will now be subject to measurements for productivity and proficiency by both the insurance sector (who is looking to save money for their clients/employers), their direct employers (like SDM), and by the OCP whose stated sole interest is the safety and health of the public.

Back to the trucking analogy.  How can the regulatory system be so concerned about ‘pharmacies’, which are 90% owned by non-pharmacists, and be totally  unconcerned about the health and well being of pharmacists who have to deliver the goods?

When confronted with this issue, the OCP is resolute that its responsibility is solely the welfare of the public, and that business models and the inherent structures of such models are not its concern or responsibility.  In fact, new incoming council members are specifically directed that their personal opinions are not relevant when it comes to fulfilling the mandate of the College, and strict adherence to the edicts as set out in the college’s policies is to be the guiding principle at all times.  Just read & follow the rule book, innovation is neither requested nor welcomed.  In British Columbia the voting turnout for the last council election was something like 8%.  Wonder what the percentage was in Ontario.

The problem here is the narrow interpretation of what is in the public’s interest.  If the health & well being of the pharmacist fulfilling the professional act is of no importance, then how can the pharmacist be judged on his/her professional competency?  How can we have road safety if we have great trucks being driven by overtired amphetamine stoked drivers?

Such factors as the number of prescriptions filled per hour, level of technician support, flu shot injections, and the capability to perform so called therapeutic appropriateness, must all be of concern to the OCP if it is truly concerned about the public’s interest.

To state sole interest in the public, while having no interest in the pharmacist’s capability to do the work, makes no sense, and reflects an institution which is locked in its past.

It is really time to reconsider the efficacy of self-regulation in both pharmacy and medicine; it’s just not working.

 

 

 

 

Pharmacists on track to be tracked October 29, 2018 billbrownblog.com

Just when you thought the pharmacy world couldn’t get any wackier, bingo, it does.  This week the Canadian Healthcare Network ran the following headline:

“Shoppers Drug Mart (SDM) To Begin Tracking Pharmacy Performance”.

First of all it should be noted that this really is LOBLAW not “Shoppers Drug Mart”.  SDM has really become just a brand, a very powerful brand albeit, but it is LOBLAW, the owner of SDM, that controls and manages SDM.

Second, it is likely ‘pharmacists’ that they want to track not ‘pharmacies’.  Same old challenge separating a ‘pharmacist’ from a ‘pharmacy’.  We know what a pharmacist is, and a pharmacy is just a space (a retail store) with lots of stuff (most of it not health related) on shelves.  Pharmacies in Canada are overwhelmingly owned and controlled by non-pharmacists; in this case Loblaw Companies Limited which is a subsidiary of George Weston Limited, Executive Chairman & CEO, Galen Weston Jr., the most important and powerful pharmacy leader in Canada today.

How the heck do you track a pharmacy?  It is individual pharmacists that LOBLAW wants to track.  To separate the wheat from the chafe, and to set standards which become minimum requirements for continued employment.

As an aside, LOBLAW has 135,000 employees, the vast majority of which are represented by the United Food and Commercial Workers union.  I wonder what would happen if LOBLAW attempted to track performance measurements on even one of these 135,000?

So a more accurate headline might have read: ‘Loblaw To Begin Tracking Pharmacists’ Performance’

A great deal of negative reaction from pharmacists flooded this news, but one particular comment really captured the tragic comedy that the pharmacy profession has become, as the once proud profession has become totally controlled by non-pharmacist corporations, collectively referred to as Big Pharmacy Retail (BPR).

The comment, with minor editing:

“I was left alone on a Saturday night with no assistant from 5 PM onward. I was bombarded with blister pack change requests, drop in requests for the flu shot, phones ringing off the hook, and customer inquiries. At one point I had 7 people waiting at the pick-up counter and 3 people in line at the drop off with 2 phone lines ringing. I wonder what kind of rating I would have had from that night alone. No breaks, no help, no raise in 5 years. It’s a sad state for the retail pharmacist, and then SDM pulls this stunt with a service survey?”

Does anyone believe that this is the exception?  As retail margins and market share continue to come under fierce competitive pressures, and from frontal assaults by online shopping, the pressure to maintain profitability becomes intolerable. Hence, the pursuit to produce more revenues with less cost of production becomes the core driving force.  Those ‘district managers’ (aka the swat teams of the retail offensive) run on high adrenaline 24 hours a day

The immediate question surely must be, what exactly does LOBLAW want to track?  In the case of the example of the pharmacist quoted above, how much more productivity could be squeezed out of this one individual?  If it is quality of patient care that is being measured, how is this squared by the need to cut labour costs through cutting hours and not replacing personnel who quit?

While such efforts to track and measure pharmacists by LOBLAW (and Green Shield) become the new reality for working pharmacists, the Ontario College of Pharmacists (OCP) is also working on an initiative to establish quality indicators for pharmacy care.

http://www.ocpinfo.com/library/other/download/quality-roundtable-synopsis.pdf

Will these OCP inspired measurements or indicators conflict with the ones that LOBLAW demands?  How do the values and obligations of a healthcare profession dovetail with the imperatives of a massive retail conglomerate like Weston/LOBLAW?

In the interest of the mental health of pharmacists (in Ontario anyways), would it be reasonable to ask the Ontario Pharmacists Association (OPA), who allegedly represent the interests of 10,000 members, to lead an initiative with the objective of creating a forum to bring together LOBLAW and the OCP to create a common set of measurements and indicators of success?   Please excuse my sarcasm.

Let’s keep this simple.  A ‘pharmacy’ does not legally exist unless there is a licensed registered graduate pharmacist on the premises, no matter whether it is an 800 square foot pharmacy, or a 200,000 square foot super mega drug food combo.  BPR believes it owns thousands of pharmacies, but really these are all just real estate/buildings which cannot even open their doors without a pharmacist present in the building.  Pharmacists remain the means of production.

Here is a suggested response to this initiative to track individual pharmacists’ performance based on arbitrary measurements, which make no sense in face of the already brutal working conditions most retail employee pharmacists working for BPR endure every day.

Ignore the whole thing.  Pull Martin Luther King Jr…peaceful protest.  The issue is one of control.  Control of the profession is long gone, (just don’t tell the OCP) but control of you as a person must remain with you.  Just do your job according to the obligations you undertook when you became a pharmacist to ensure maximum patient care.  Focus on your professional duties.  In the end they can’t fire everybody.

 

Cannabis, Cannabis, Cannabis: enough already. October 15, 2018

 

This stuff has been around for 5000 years at least.  It’s called grass, or weed, or pot, or hash or dope for a reason; it makes people dopey.  Some people like feeling dopey and that’s OK as long as they don’t harm anyone but themselves.  The latest move to decriminalize cannabis is an overdue idea as it is widely used for so called ‘recreational’ reasons.  To some people, feeling stoned or dopey is their form of recreation.  Apparently as many as 4 million Canadians use pot regularly, in spite of its illegal status.

While anecdote is not evidence, there are some documented experiences of patients using so called ‘medical cannabis’, especially in treating chronic pain, nausea during cancer treatment, and some forms of epilepsy gaining some benefit, largely from the cannabinoid component in weed.  This is a teeny fraction of cannabis users (about 120,000) and for them the term medical marijuana may not be an oxymoron.

For everyone else, the term medical marijuana is an inside joke.  It is ‘medical’ if the person says it is, kind of like ‘medical bourbon’.  It’s all in the eyes of the beholder.  The CMA remains doubtful about the usefulness and/or efficacy of medical cannabis.  Only 10% of physicians will even touch the stuff.  So why does pharmacy keep talking about it?  The main reason is as always money, big money.

In reality, what most ‘users’ are after is the THC; the “good stuff” that makes you stoned.  The use/harm of cannabis is probably no worse or no better than the use of alcohol, another toxin widely used by people for ‘recreational purposes’.  Way too much money, police resources, courts and prisons and way too many ruined lives have been wasted since the prohibition of cannabis in the 1930s.  Criminalizing cannabis for political and misinformed reasons, has been one of the largest examples of wasted taxpayers’ money in history.

Cannabis legalization is coming to Canada on Oct. 17, finally legalizing the stuff.    Plenty of enterprises across the country, from growers to retailers to the tech and tourism sectors, to stock brokers and of course drug stores are all chomping at the bit to reap a windfall from legal marijuana. But there remain difficult questions about cannabis use in the workplace, in homes, & while driving or operating dangerous machinery.  How many lives may be lost on the roads before someone realizes that maybe this whole thing was rushed for political reasons?  It’s fine if people like being stoned while listening to Pink Floyd in their own home or at a party.  It’s another thing if a stoned truck driver hauling 100 tons of steel plows into a stream of stopped vehicles on a highway because of his reduced reaction time.

Globe & Mail October 15, 2018                                                                                              Cannabis makes it harder to identify and react to driving distractions that can result in crashes, a clinical trial at McGill University found. About 80 per cent of the participants, aged 18 to 24, also reported feeling less safe to drive after using the drug, including five hours later.

One thing for sure, lots of people are going to make many tens of millions of dollars on cannabis.  The stock market thrives on hype like this.  It reminds one of the heady days of high tech.  As always, the usual suckers are going to get burned badly.

So what is Pharmacy’s official position on cannabis?  To say it is total confusion would be an understatement.  Note that at this point in time, pharmacies are not even part of the distribution channel for either ‘medical marijuana’ or the recreational stuff.  Pharmacies are presently not in the loop.

But as pharmacy struggles to find a place in this Wild West cannabis landscape, it is torn between its professional obligations , and the dominating reality that pharmacy is largely now controlled by corporate interests (BPR) in search of profits from the sale of any products, even the many useless or even harmful products found in many drug stores today.

To illustrate this embarrassment to pharmacy, this week an email was sent out by the OPA (Ontario Pharmacists Association) re a deputation made on October 11th before the Standing Committee on Social Policy at Queens Park.  The delegation consisted of the Chief Pharmacy Officer and the Vice Chair of the OPA.  In this document the OPA clearly states that the 10,000 pharmacist members represented by OPA OPPOSE the sale of recreational cannabis products in pharmacies.  The deputation largely advocates that pharmacists be allowed to dispense medical marijuana; the document also alleges that cannabis is just another drug that pharmacists can and should be available to consult on.

OPA deputation October 11, 2018                                                                                                   “In the absence of an amendment we would ask the Ontario government to seek formal approval of the Federal government for provincial authority to task pharmacists with the dispensing of medicinal cannabis pursuant to a medical order

At the same time, we want to make it absolutely clear that the members of the OPA   DO NOT want to distribute recreational cannabis”

Of course everyone knows that this is NOT where the real money is.

In contrast to this position, the NPAC (Neighbourhood Pharmacy Association of Canada (hitherto known as the Canadian Association of Chain Drug Stores) made a submission recently to the government of British Columbia (as well as to other provincial governments) re cannabis regulation.  In this document, argument is presented that pharmacists should be part of the distribution channel for medical marijuana for the same reasons as the OPA submission did.  The big difference in this NPAC document is that the NPAC clearly states that its members (Big Pharmacy Retail/BPR and all the assorted pharmacy brands/banners) DO want to sell recreational marijuana, and a spurious argument is outlined to support the position that pharmacists know how to handle tricky goods.  So does the LCBO.

Recent submission by NPAC to BC government                                                                         “Our members strongly believe that the Access to Cannabis for Medical Purposes Regulations should be amended so that pharmacists can be authorized to distribute and dispense medical cannabis.  Pharmacies play a significant role in managing the distribution of controlled products and they would be committed to work with all levels of government to ensure that recreational cannabis products are also sold legally in pharmacies”

And of course everyone knows that this IS where the real money is.

The large majority of the 10,000 pharmacist members of the OPA work for NPAC companies.  What is their individual position?  Who really represents them?  What about individual choice?  Do pharmacists support their provincial advocacy body’s position or their NPAC employer?  Some may not want to get involved with cannabis at all?  Will they be granted this choice by their NPAC backed employers?

Recognizing this contradiction, does anyone know what most pharmacists really think about being involved in the sale of cannabis products?  The non-pharmacist pharmacy owners (BPR) know what they want; they see a great opportunity to create traffic and boost profits at the retail level and there is no way BPR wants to be left behind.

Additionally, what is the position of the Pharmacy Regulatory Bodies?  The OCP (Ontario College of Pharmacists) has declared its position.  As part of its ‘Opioid Strategy’, it will now require all Ontario pharmacists to complete formal cannabis education as a condition for licensure by the year 2020.  Why isn’t there compulsory education for other drugs?  What makes cannabis so special?  Is this just more politics and an attempt at appearing proactive?   Isn’t this a case of overreaching of authority?  Would this OCP licensing requirement withstand a legal challenge?

In BC only 8% of registered pharmacists voted in recent council elections.  The BC College of Pharmacists is puzzled as to why.  Wonder what the percentage is in Ontario.

All this for a substance which may never actually come under the control of pharmacists, ‘medicinal’ or recreational.  There is a good possibility that pharmacy may be shut out altogether…not even the medical stuff, let alone the recreational stuff.

All this hype acts to give a 5,000 year old herbal substance, known as cannabis a heightened position within society that it simply does not deserve.  In the final analysis cannabis is just dope by another name.  Enjoy it if it’s your thing, but remember it still stinks, turns your hair yellow, probably does nothing for your libido, and makes you slur your words…so please don’t glorify it

Those pharmacists who consider themselves to be ‘conscientious objectors’ when it comes to cannabis in any form, must retain the right to just say no.

 

 

 

 

 

THE PHARMACY PROFESSION & THE EVENT HORIZON September 20, 2018

You know the pharmacy profession’s future is looking somewhat dim when people continue to proselytize that you should look at the cup as half full, or to put on your rose coloured glasses, or to examine your feelings and start thinking positively.  The big put is to “just get involved” in your association, or latest committee, or attend a conference, or seek representation on your regulatory body.  All this to suggest that if you just keep moving, turn on and tune out, it will all go away somehow.

Maybe.  And then maybe not.

The past reactions to a few blogs on the Canadian Healthcare Network (especially the comments from readers both young and old) have been especially angry and despondent re the profession of pharmacy and what it has degraded into.  But this did not just happen recently.  This was a gradual process which started exactly 64 years ago when the 1954 Pharmacy Charter was enacted.

Think of this date 1954 as an ‘Event Horizon”.  An event horizon is that special place in space where objects, as they are sucked towards a black hole, cross a point, and once they cross it can never turn back.

The 1954 Pharmacy Charter recognized the looming danger approaching by the entry of big business interests into pharmacy.   From that date forward all pharmacies were to be owned and/or controlled by pharmacists, and corporations had to have a majority of directors as pharmacists.  Great idea, except for the ‘grandfather clause’ stating that all existing pharmacies (pre-1954) were exempt from this provision, and could be sold to anyone, pharmacist or not.  From this single grandfather clause provision, motivated by the greed of those pharmacists involved and in power at that time, today we are rewarded with Big Pharmacy Retail (BPR) which has taken over the profession.  Even the provincial regulatory bodies quake in their boots in the presence of BPR.

Fortunes were made selling a single pre 1954 existing pharmacy to a grocery chain or big box merchandiser etc.   From that single charter purchase, a non-pharmacist retailer could open hundreds of locations across the country to the point where today BPR controls 85% of pharmacy across the country.  With this kind of clout, BPR can exercise the Golden Rule: ‘He who holds the gold makes the rules’

It was pharmacists who allowed this to happen.  It is pharmacists today, ensconced in the multitude of pharmacy associations national & provincial, regulatory bodies, and academic institutions, which continue to sustain the status quo and to gain succour feeding off the existing system.  Pharmacists did this to themselves and continue to put personal gain above the interests of the profession.  Hence professional fee discounting, fierce retail competition and plummeting compensation.  A race to the bottom, and no end in sight.

What to do?  The event horizon analogy, dictates that there is little one can do except to get sucked into the vortex.

In fact, there is much that can still be done in spite of the consequences of the mistakes that were made in the past.  The first and most important thing is to refuse to accept the status quo.  Radical thinking and disruptive actions are required.

Over and over, ‘pharmacy advocates’ come up with weird ideas and initiatives which deny the reality that the profession of pharmacy is not controlled by individual pharmacists; pharmacy is controlled by BPR.  BPR are not bad guys, they just have a different agenda from pharmacy professionals and the two often have diametrically different mandates.

First thing.  Severely limit the number of graduates coming out of pharmacy schools across Canada.  Some schools should be shuttered.  How much worse must the present pharmacy reality be for recently graduated PharmDs with six years of education, $150,000 in debt which they can never pay off and working in a 10’ by 20’ cubicle in a grocery store?  The professors and deans will squeal like crazy of course.

Second, shut the door tightly to any further foreign trained pharmacists.  Zero.  No more International Pharmacy Graduates get licenses.

These two actions will begin to tilt the supply and demand curve back towards pharmacists and away from BPR as retail employers.  It will take 10 years to have an effect.  BPR won’t like this as it was BPR who encouraged opening the floodgates to international graduates for good reason, to depress wages, and it worked big time.   Tell the IPGs working today in Toronto for $30 an hour with no tech support that immigrating to Canada was a great idea.

Third, encourage all existing pharmacy students to parlay their degrees into new directions, not necessarily retail pharmacy which is a dead end professionally which will destroy their souls within six months of graduation.  Law, business degrees, politics, education, anything but not the black hole vortex of retail pharmacy controlled by non-pharmacists totally consumed with commercial interests.

Fourth, put pressure on the regulatory bodies to tackle the real issues confronting pharmacists today, those which are having a negative effect on the public interest; tackling things like fee discounting, unlawful rebates, performance quotas, dangerous working conditions, etc.  There is much that these regulatory bodies could do if they had the guts to do it.  Requiring mandatory cannabis education to qualify for licensure (while both medical and recreational cannabis may never be sold in a pharmacy) is a good example of wrong-headed focus.

Fifth, inundate the so called pharmacy associations, with letters, phone calls & emails to turn their attention towards the interests of individual pharmacist practitioners, and less to the interests of pharmacy businesses large & small which employ these pharmacists as essentially retail employees.   Are they ‘pharmacist associations’ or are they ‘pharmacy associations’?

Agreed, some of these suggestions may never come to fruition, but at least they speak to developing the right attitude, an attitude of not complacently accepting the status quo and developing a willingness to do anything to avoid the despair and complacency prevalent today.   Take action against the realities facing pharmacy today, and avoid delusional Pollyanna thinking wherever it comes from.

Naval gazing, denial, and especially false rosy outlooks are never going to cut it.