What’s a pharmacist? What’s a pharmacy?

There was a time not that long ago when a ‘pharmacist’ and a ‘pharmacy’ were almost synonymous.  Generally pharmacists graduated from a pharmacy college, became provincially licensed, opened a pharmacy store (more currently referred to as a practice) and then began their 30 or 40 year pharmacy careers.

Today, we do not refer to ‘a physician’, and then separately to another entity ‘the physician’s office’   People simply ‘go to the doctor’ wherever his/her location of practice might be.  It’s the doctor’s intervention the patient is after; the location is moot.

It is more than evident that today the pharmacy landscape is very different from what it was a generation or more ago. Now, pharmacists and pharmacies are entirely different entities.

In fact, in many cases, these two entities are actually working in diametrically opposite directions…and in some cases even cross purposes.

Practising pharmacists (though more highly educated), have remained largely unchanged, notwithstanding that demographics are quite different:

…more female than male dominated,

…high number internationally trained,

…employees rather than self employed,

…cognitive skills emphasized over technical skills.

The really big difference is the Pharmacy part.  In Canada today we have single pharmacy entities with revenues in the billions of dollars & with over 1,000 locations.  One single pharmacy entity will soon control over 35% of the entire nation’s pharmacy business.  Some, including box stores, are amongst the largest retailers on earth.  Pharmacy has become a really big business and this trend is likely to increase.  Witness the US.

We still have small business pharmacies in smaller towns (those towns not yet large enough to attract a box store or chain store), and in secondary/tertiary urban locations.  Some of these smaller ‘independent pharmacies’ are into their 2nd or 3rd generations.  These independent pharmacies actually represent more than half of pharmacy locations (in Ontario at least).

The reality though is, that in spite of this 50% physical presence by location numbers, more than 80% of all prescriptions are filled by chain/box store operations

Clearly the pharmacy consumer has made an important decision.

Therefore, the challenge for pharmacists becomes:

The words ‘pharmacists’ and ‘pharmacies’ are used interchangeably as if they are the same entity when clearly they are not.

In government documents, in the press, in controlled circulation publications…everywhere and constantly, the words are used interchangeably.

This represents a major challenge.  It is licensed graduate pharmacists who do the actual work, not pharmacies: whether dispensing, cognitive services like meds checks/pharmacy opinions, flu shots, etc….but, the money is always paid to the ‘pharmacy’…by far & most often this is a corporation owned and controlled by non pharmacists.

Pharmacists remain the only professionals in Canada who have no means of earning a living without being employed by another entity…a pharmacy, through which they are then paid a wage determined by that pharmacy, which pharmacy in the majority of cases is not owned or controlled by pharmacists.

To repeat the point again:  It’s all about control and who has it.  Pharmacists today have little control over their profession. The control is in the hands of pharmacies.

The first step to get some of this control back…i.e. into the hands of pharmacists is:

To create a mechanism for pharmacists to be paid directly for the services they provide.  This includes all dispensing fees (no longer to be discounted for retail imperatives), cognitive fees, flu shots, meds checks etc.

One would think that this single item would be foremost on the agenda of provincial pharmacy associations…not setting fees, just advocating for a mechanism for pharmacists to be paid for services.  This single act would go a long way to shifting control back into pharmacists’ hands.  This is referred to as ‘Possession is 9/10ths of the law’.

Why is advocacy for direct payment for services not even being discussed?

Perhaps because giving up control is not exactly on the agenda of those who currently have it.  These same entities also control the agendas of the pharmacy associations

Notwithstanding these significant obstacles, this objective can still be achieved; it must.

More on this in subsequent blogs, but in the meantime, what are your thoughts & ideas?


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