The Flu Shot: Great intentions, not so great execution

Backgrounder:   Dr Yoni Freedoff’s recent CHN blog regarding his experience with the flu shot has provoked a great deal of response.  Briefly, his pharmacy-provided ‘vaccination record’ was attached to an advertisement ‘bag stuffer” for an OTC product with at best dubious efficacy.  He received his flu shot at a major chain drugstore.  In retail this is referred to as ‘cross selling’; elsewhere it could be referred to as an embarrassment.

In a recent CHN poll, 40% of responding pharmacists indicated that they had been ‘pressured by their employer to become injection certified against their will and as a condition of continued employment’.

The quick history on the flu shot, (in Ontario at least) is that the Ministry of Health was concerned that roughly only 30 % of the population was getting immunized.  If the flu shot was more accessible, then the percentage should go up.  Pharmacies were a logical distribution point as they are literally everywhere, including every grocery/box store/plaza.  Not a bad idea, if this would result in fewer visits to the doctor at $40, or the EMR at $300, especially if the pharmacy fee is $7.50.  Pharmacy Colleges/Associations, (for some reason) seized on this opportunity as representing a further enhancement of the professional status of pharmacists. In fact injections are mostly given by nurses and technicians…a technical activity and not a highly cognitive one.

In 2012, about 240,000 flu shots were done in Ontario pharmacies.  Not bad, until you discover that one particular chain drugstore operation did about 200,000 of those shots.

This chain did a great job of seizing on this opportunity to ‘create traffic’, which remains the holy grail in any retailing operation.  Store traffic creates the opportunity to generate revenue.  This year all pharmacy businesses are on the band wagon and all want to ensure that they do not lose out on their share of this great traffic builder.

The fact remains however that many pharmacists, then and now, do not see giving injections as something they are comfortable doing.  To them this was never part of the role they saw themselves playing as medication management health specialists.  Many pharmacists like this added dimension, but clearly a very large percentage do not.  This is not about whether pharmacists giving injections is a good idea or not. The travesty here is that they do not have the choice.  It now appears that doing injections, whether a pharmacist wants to or not, is a condition of further employment as a pharmacist.  This is coercion at best, and probably not ultimately legal.  It will be interesting to see a test in law if/when it occurs.  In addition, these injections are to be available at a moment’s demand by the retail patient/customer, regardless of the normal pressures in the pharmacy.  One surmises that giving flu shots real fast will become a real positive attribute for pharmacists.

All this surfaces an interesting question.  How would the public react if it knew that the pharmacist giving them the flu shot may be nervous, or reluctant, or in any way averse to doing this injection, and that this pharmacist may have been forced into doing it as a condition of continued employment?  How would the MOH react if it knew?

The flu shot has become a competitive ‘traffic builder’.  Another retailing term would be a ‘loss leader’, like bread, milk, and eggs.  And the pharmacist has become the executor of this new piece of competitive retailing strategy.  Further, the professional credibility of the pharmacist is being leveraged to cross sell products which may have little or no efficacy, but great profit margins (back to Dr. Yoni Freedoff’s experience above by way of example).

Unfortunately this is another example of the same old story….the inherent conflict between mass retailing and pharmacy as a profession.  No bad guys or good guys here. The bag stuffer is a great idea if one wants to increase the ‘basket size’ of the customer encounter…which always remains a retailing imperative; unfortunately it is not a clinical or professional imperative.

Once again this is an issue of control.  The profession of pharmacy has largely fallen under the control of vested interests, and pharmacists are the pawns on a big retailing chess board.  The sooner that professional associations and colleges recognize this, and begin to engineer control back to where it should be, the better.  Individual practicing community pharmacists must also take responsibility in their every day actions.

Control is often just forfeited, not necessarily taken by others.