The profession of pharmacy faces formidable challenges.  Many of these challenges stem from the loss of control of the profession to vested interests.  These vested interests include Big Retail / grocery /box stores, i.e. merchants whose prime business is selling as much as possible while tightly controlling costs.   As the pharmacy profession moves ever more closely to a clinical services orientation and away from a purveyor of goods, practising community pharmacists and big retail pharmacy will diverge further apart.  It bears repeating that a profession that does not control the professional services that it is highly educated, trained and licensed to perform, ceases to be a profession.  The pharmacy regulatory bodies have the power to intervene but continue to turn a blind eye towards the big players.  The regulatory bodies may soon rue the day, as media and governments challenge their privilege, as well as the lack of exercise of their responsibilities.

As big retail pharmacy imposes more retail systems like quotas for billable services, performance metrics, forced flu shots, etc, enforced by non pharmacist store managers/district managers, the stress on practising pharmacists approaches a crisis.  These are not pharmacy’s best hours.

But, among all the vested interests which live off the pharmacy profession, the race for the bottom of the barrel has without dispute been won by the so called pharmacy relief agencies.  These organizations have capitalized on the surplus of pharmacists, and the desperation of some pharmacists (not exclusively, but primarily new grads and International Graduates) to drive compensation and working conditions to the lowest possible levels.  And just when we thought the bottom had been reached, we discover a new low.  Rates of $28 / hr have now been posted in Toronto.   This rate is lower than some RPTs are earning in hospitals today.   Compensation levels are a measure of the value of a profession; these low rates have done much to denigrate the profession.

These agencies will stop at nothing to promote their narrow business interests.  One agency advertised that it will guarantee that any pharmacist placed through its agency will complete two Medschecks during the assigned shift.  What happens if the criteria for conducting a Medscheck are not met during the shift?  A guarantee being a guarantee it must be assumed steps have been developed by this agency to get around this problem.

Do the math.  An 8 hour shift at $28.00 / hour equals $224, minus a ‘refund’ of $120 for the guaranteed Medschecks, equals $104, or an effective rate of $13 / hr.  This rate remains above the minimum wage in Ontario or this agency would have a legal problem.  How do we assume our position as equals in healthcare provision when pharmacists have been driven to such low values?  This is not pharmacy’s finest hour.

In a current ad for a pharmacy technician by one of these agencies the following headline was displayed: “Wanted, the Wayne Gretzky of Pharmacy Technicians; must be better than the average pharmacist”.  This insult got a few pharmacists’ attention and the OPA was notified.

To its credit, the OPA followed up with this particular agency, which then ignored the Association and persisted with their insulting ad.   In the final analysis, there is nothing anyone can do to stop these agencies from degrading the profession of pharmacy at will.

These relief agencies are parasitic opportunists who care nothing about the pharmacy profession, which they are turning into a commodity; lowest price is their value proposition.   Do they even bother to verify the credentials of the pharmacists they place? Professional qualifications, experience, PharmDs mean nothing to them; pharmacy licenses are all the same, and plugging a shift is their game.

These agencies live off the spread they contract between their client pharmacies, and the actual rate they reimburse the contracted pharmacist.  Once they peg the contracted rate with the pharmacy owner, they hunt for the lowest rate they can find a desperate pharmacist will accept.   This is very similar to the migrant workers and the California grape growers.  We have all seen this movie.

In the final analysis, all pharmacists must  take considerable responsibility for the existence of these relief agencies.  The responsibility is with pharmacists who allow themselves to be degraded in this fashion.  Certainly times are tough, but a little bit of effort and pharmacists could find their own placements and at least earn the agency spread for their own account.  In other words, cut off their inventory.

The second level of responsibility is to pharmacy owners who utilize these agencies.   This very often includes independent pharmacist owners who have lost their ethical responsibility to the profession, and are driven by greed.  Big retail pharmacy does not even give this issue second thought; in fact these agencies are often preferred service providers to these large businesses.  Low cost pharmacists, with no benefits, no statutory obligations which can be turned away at the last minute; what a great deal for these big retail operators.

Here is a great opportunity for the Pharmacy Associations to take over this function.  There will always be a need to provide such services between pharmacies and pharmacists; this can’t be rocket science, and it can represent something concrete associations can do for their members relatively easily.   The sooner the better that a matching service be controlled by pharmacists and their associations.   Let us hope that we can make these agencies part of history soon.  In the meantime, all relief pharmacists should refuse to serve as cheap inventory, and pharmacy owners should avoid utilizing their services.

This call will not likely be heeded by big retail pharmacies, as it does not serve their need for the relentless pursuit to drive down costs, which is what they consider pharmacists’ compensation to be.  But at least independent pharmacy owners, still controlled by pharmacists, should have some moral obligation to put some balance into their business and professional obligations.

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