: No water in the well

When Ontario Premier Kathleen Wynne took office approximately a year ago, the civil service sent her a briefing memo:

‘Ontario cannot meet its deficit reduction targets over the next two years without making drastic cuts to spending—including slashing the healthcare budget’.

This is not a political statement, it’s an economic one: governments do not have any money.  In fact government is spending money not yet earned by people yet unborn. The biggest portfolio, and growing, is healthcare.

When so called Drug Reform occurred in Ontario in 2010, the government took $ 800 M out of retail pharmacy with a pledge to reinvest about $ 100 M back through payment of professional/cognitive fees to pharmacists …Medscheck being the prime program.  It appears that about $ 80 M has been invested so far.  Unfortunately not a cent went to pharmacists; all of it went to pharmacies, aka pharmacy owners the majority of whom are not pharmacists.

This investment of $ 80 M has occurred with no mechanism in place for measuring the return on investment for this cash outlay.   Now the government is attempting, after the fact, to determine what that return if any, is.  A task force/study group of learned academics/experts has been formed to accomplish this task.  We wait with baited breath for the report.

This late reaction from government has been partially driven by some evidence that there has been considerable abuse of this new privilege, and that the government may be, to some extent, wasting precious healthcare dollars.  The ‘3 minute Medscheck’ comes immediately to mind.

The question is: Why would pharmacists, given this golden opportunity to demonstrate their extensive cognitive skills, learned over years of study, and enhanced by legislature enabling a wider scope of practice blow it?  Even if this is only partially true?

The answer is that practising pharmacists did not create this unfortunate situation.  Practising pharmacists are eager to utilize their new privileges and to do less of the mechanical aspects of dispensing which now can be transferred to regulated pharmacy technicians.   The problem continues to be that although practising pharmacists do the actual cognitive task (even when not done to practice guidelines) payment is made to a completely different entity; this other entity is called the pharmacy.

50 % of the pharmacies in Ontario are owned by pharmacists (though they actually fill only about 20% of prescriptions).  So in these cases it is actually pharmacist owners (while wearing their business owners’ hats) who are contributing to the problem.

The large majority of practising pharmacists, working in the other 50% of pharmacies which are owned by chains, grocery stores, or big box merchandisers are employees.  As employees, their employment circumstances are dictated by their employers and the priorities and business imperatives of their employers.  The rest is history, as has been recounted so many times in these blogs and the many comments which follow these blogs and written by pharmacists.

Back to the title of this blog: no water in the well.   There is very little to be gained by going to the MOHLTC along with the other 1199 other lobby groups asking for more money for anything, especially payment for cognitive skills the value of which may be difficult to quantify on the short term, and which are currently under a cloud of suspicion as to return on investment to the government.

If the compensation and working conditions of practising pharmacists are going to change for the better any time soon, it is to the non pharmacist employers/owners that advocacy must be directed.   This does not have to be necessarily conducted within a union environment which may not be possible.  This advocacy will require tact and development of new tools which must be developed by the pharmacy associations of Canada on behalf of practising pharmacists and directed towards the pharmacy owners, whether pharmacists or non pharmacists.

In the meantime the question continues to be debated among pharmacists: Do practising pharmacists expose the problems with billable services under the present paradigm where the services are performed by pharmacists, but are paid largely to non pharmacist owned businesses?  Do we go to the press?

The danger remains that the longer practising pharmacists remain silent and appear complicit, when the facts do come out, it will be practising pharmacists who take the hit, with consequences that could set back the movement towards professional services several years.  Big retailers will hiccup, adjust their business models and then keep moving forwards in their quest for increased shareholder value The profession of pharmacy will be collateral damage.

This is a case of high stakes kiss and tell.

The major issue that must be dealt with by all pharmacy associations today is the direction of their advocacy efforts.   Is there any question which well has the water?

Chain pharmacies must not chair pharmacy association

The majority of associations, of which there are thousands in Canada, exist to serve their members and their members’ interests.  Members decide an association’s mandate, mission, and focus…or this is how it should be.

Pharmacy has dozens of associations.  Every Canadian province has its own association.  Then there is the National Association, the Pharmacy Foundation Association, the Hospital Pharmacists Association, the Pharmacy Technicians’ Association, and the Chain Drug Association etc.  All this is indicative of an institution/industry/profession that is highly fragmented.  But the really big split occurs between the commercial/business side and the professional/clinical side of the profession. The interests of these two large sub groups are often at odds.

The Canadian Association of Chain Drug Stores (CACDS) and its little brother the Ontario Association of Chain Drug Stores (OACDS) are powerful associations which represent the business interests of their members, chain drug stores.  Their name says it all.  Originally a small tight group, the CACDS appears to have broadened membership to include any pharmacy business with more than one location.

Chain Drug Stores (CDS) employ about 80 to 85% of all practising pharmacists in Ontario, and likely Canada.  CDS, (meaning grocery stores, box stores, and so called ‘franchised stores’),  are accountable to their shareholders first…not pharmacists, not regulatory bodies, not patients (who they prefer to refer to  as ‘customers’ or ‘guests’ or ‘consumers’.

CDS today control the profession of pharmacy, and there is growing evidence that this is not in the best interest of pharmacy patients, nor governments/payors.  For sure this is very much not in the interest of the profession of pharmacy.

So why does the OACDS have a seat on the board of directors of the Ontario Pharmacists Association?

The OPA declares itself to represent all pharmacists including hospital, students, chains, independents and now technicians, even though many of these entities already have their own associations.  No wonder governments are sometimes confused.  How many associations do we need?   Nevertheless, the OACDS is an ‘association’, not a pharmacist.  Why does an ‘association’ have an OPA board seat?

One might assume that the reason the OACDS is on the OPA Board is to protect the interest of its members.  One might further assume that a key role of the OACDS is to convey OPA activities/decisions/directions back to the OACDS membership.

With such a wide representation by varied and often conflicting interests, it becomes difficult to understand how many critical agenda items of vital interest to practising pharmacists such as:  3 minute Medschecks, professional services quotas, compensation issues, working conditions, forced flu shots, performance metrics etc, could ever be discussed at an OPA board meeting, let alone addressed. So of course, these subjects are largely ignored.

It is encouraging to see that the OPA is now addressing the critical issue of Pharmacist Billing Numbers ((PBNs) by forming a task force to do some ground work on this important issue.  If/when achieved, PBNs will represent a major shift in power dynamics from the non pharmacist corporate pharmacy owners to practising pharmacists.

This begs the question: How will this issue be addressed by the OPA Board when it is clear that different board members will have diametrically opposing views on this issue?  Clearly those with the power want to keep it, and those without the power want to get it. If the OACDS represents those who have this power, it will not likely be in favour of anything that sees that power slip away to practising pharmacists.  PBNs would be a huge headache for Big Pharmacy owners

If any of this makes sense, it begs a further larger question:  How, if the OACDS takes on the position of Chair of the OPA for 2014/2015 (as it might), how could the OACDS champion and advocate for PBNs?  How can the OACDS do this knowing that PBNs are not in the interest of the OACDS members?  … especially knowing that whoever champions this issue will be facing formidable challenges politically and organization wise?   This challenge will require passion, conviction, and an iron will.  How can the OACDS possibly lead and accomplish this very difficult task when it is clearly not in its interest?

I submit that the OACDS as OPA chair cannot even attempt this task.

I submit that the OACDS should never chair the OPA, not in 2014/2015, not ever.

I further submit that the OACDS should not even sit as a permanent board member of the OPA

If you agree, or disagree, with any of this, please make your wishes known to the OPA.  If you are a member, then tell your district representative and the OPA CEO.  ddarby@opatoday.com

If you are not an OPA member, send an email to the CEO anyway and express your opinion on this important matter.  Do it today and certainly before the OPA Annual Convention in June.

I welcome your comments on this important subject



How valuable is your pharmacist brand?

A brand is a promise.  When we purchase an item or service with a strong brand name, we expect no surprises.  The brand speaks for itself and ensures unwavering consistency.  The most valuable brand in the world today is Coke; the Coke brand name alone is valued at $80 B.  Another strong brand is ‘Big Mac’, (in my opinion a facsimile for food), but it is a consistent product right around the world.

Services & professions can represent brands as well.  When we visit a lawyer we expect that a degree of competence can be assumed; we count on it.

When a pharmacist graduates from an accredited university anywhere in the world from Karachi, or Alexandria, or Michigan State, or Toronto, etc and goes on to pass all qualifying exams, and is duly licensed as a BScPhm or PharmD, the pharmacist becomes a brand.

This means that patients make an assumption as to competency, professional responsibility, patient centricity, empathy etc and thereby brands the pharmacist in their minds.  A promise is struck between the patient and the pharmacist…theoretically.

Unfortunately, thousands of times a day pharmacists break this promise across Canada.  Each time this happens the pharmacist brand gets whittled away a little.  Today there is a great deal of effort being expended to build and strengthen the pharmacist brand.  As the role of pharmacists expands, as a result of expanded scope of practice, this becomes a high priority.

Pharmacist Awareness Month is an example; but do we really need a whole month?

The pharmacist brand has become tarnished.  Nowhere is this more evident than in dealing with governments.   Pharmacy associations approach governments professing to represent professional practising pharmacists and their value proposition, but what governments see is big business, commercial interests and powerful retail lobbyists.  Governments see through the façade, usually made up of a delegation of independent pharmacists with no big pharmacy chain in sight. Who do they think they are fooling?

The pharmacist brand is also becoming tarnished with the public.  We keep hearing how pharmacists are the “most trusted” professionals.  Trusted re what?  Trusted more than physicians performing open heart surgery? Trusted more than the dentist drilling in your mouth?  Trusted more than the car mechanic who replaces the brakes on your car?

This pharmacist trust thing is a perfect example of polling firms structuring a question in order to get a preconceived desired answer.  Let’s get real please.

Every time pharmacists allow commercial interests to over ride their professional patient centered obligations to their patients, pharmacists tarnish the brand for themselves and every other pharmacist in the profession.

Every time that pharmacists remain silent or recommend a useless cough syrup, an ineffective herbal remedy, a ‘cleansing flush’, a ‘fat burning’ potion, a mega vitamin etc…actually more than half the stuff that junks up the hundreds of feet of shelving and end displays surrounding the dispensary, pharmacists tarnish their brand.

Every time pharmacists put on a jacket festooned with logos like Healthwatch, Costco, WalMart, No Frills, Loblaw, Sobeys, Rexall etc pharmacists send a mixed message about their brand.  Is the pharmacist a professional along with all this entails?  Or is the pharmacist an employee/merchant of Super Duper Drugs and is promoting the commercial interests of the employer?

Notwithstanding that pharmacists have a legal obligation to serve patients’ interests first, and that this obligation is enshrined in their license to practise which is  provided by their provincial regulatory bodies, pharmacists surely  must have an obligation to themselves and to their profession and to hold themselves to an even higher benchmark.

Why do the regulatory bodies, which have real leverage, continue to sit back and do nothing to assist practising pharmacists in their struggle against non pharmacist pharmacy owners?

We keep talking about control of the profession being lost to vested interests.  We are now fighting to get it back.  I will say it again here: PBNs (pharmacy billing numbers) are a critically important step in this process; nothing will achieve as much as achieving PBNs towards this goal of regaining control.  The battle to achieve this goal will not stop, but until then….

Pharmacists can control every aspect of their daily professional lives.  They can protect their personal brand…the one they studied years to achieve and spent $100 K to attain.  Pharmacists must refuse to do anything they are not comfortable doing in the interest of their patients.

Pharmacists should begin by wearing their own plain professional jackets and not remain walking bill boards for their employers.   I know this is a tough one, but if all pharmacists did this, and did it now during Pharmacist Awareness Month starting Monday March 10th, what a powerful statement this would make re the independence of the professional practising pharmacist.  Do it.

You worked hard and invested plenty of dough to become a pharmacist.  Your brand is the most important professional asset you will ever own.

Don’t sell your brand cheap.


Pharmacist jackets need bigger pockets

The title of this blog is intended to attract a bit of curiosity, as well as a couple of other emotions.  Although it may initially seem funny, this piece is mostly tragic.

Occasionally I have received the accusation that my blogs lack data to support my positions.  I have been accused of using ‘anecdotal evidence’. i.e. not substantial

Of course anecdotal evidence is data. It is qualitative data which is directional and intuitive, as opposed to quantitative data which drives statistics.  Enough anecdotal evidence becomes compelling and takes on the characteristics of quantitative data…data which should create an impetus for action.

All this provides a segway to my piece today. The following italicized section is part of a message sent to all the pharmacists employed by a large grocery chain which has pharmacies in their stores, and which is a member of the Ontario Chain Drugstores Association.  The message was sent to a specific location falling behind expectations.

I believe it reflects the management style of this corporation and many other chain/box store/grocers, but even further speaks to the challenge we face within pharmacy today.

I have disguised the name of the chain and have edited the script to protect the confidentiality of those who sent me the original corporate communication whose employment security is at stake.

So here it is; some more anecdotal evidence which I will allow to speak for itself.

“Super Duper Grocery Marts management is not happy with the pharmacy department.  Losses this year will be over $X00, 000 and the current month is way behind budget.  Focus must now turn to promoting the business, to creating a turnaround, and to creating an unbeatable ‘customer experience’.

Every customer encounter must now involve an active process of selling OTCs, and the performance of a Medscheck or other billable service whenever possible.

Remember that physically placing an item in the customer’s hands increases the chance of purchase by 100%.

As a result of our current grocery promotions in the store, many customers will be in the store and some will be wandering through the OTC sections.

This is the direction to all pharmacists. There are four steps which must be followed:

  1. Engage potential customers in the OTC aisles. Do not wait for a question. Do not stay behind the dispensary.
  2. Provide your name and title.
  3. In one pocket have sufficient business cards, in the other pocket have pharmacy fridge magnets. Hand one magnet and one business card to every customer every time.
  4. Ask the customer to switch from their present pharmacy to our pharmacy. Tell the customer what great service our pharmacy provides and that they can shop for their groceries instead of wasting time waiting for their prescription. Emphasize the fact that our pharmacy does not charge the $2.00 co pay.

Smile and act friendly at all times.  Always try to generate revenue generating services like Medschecks, diabetes counseling and smoking cessation.

The goal is to reach budget. The company expects pharmacy to pull its weight.

And from the Area Supervisor:…just to be totally clear, any pharmacist who does not embrace this positive approach to increasing sales of OTCs  and providing more billable professional services, will be asked to seek employment elsewhere”.   

Now you see where the big pockets become an important issue…it’s to hold all of those fridge magnets.

Just when you think it cannot get any worse, a story likes this comes along and you just have to shake your head.

If ever pharmacists needed motivation to take back the profession of pharmacy from these vested interests, which treat pharmacists with no more respect than grocery clerks, then this surely must be the time.

Actually the grocery clerks in this particular chain are unionized and get lunch breaks, and formal representation when necessary.  So my comparison to grocery clerks is not accurate.  The clerks get more respect than the pharmacists.

But of course, this is just ‘anecdotal evidence’

PBNs (pharmacist billing numbers) will go a long way to shifting the power dynamic into the hands of practising pharmacists so that this kind of story can become history.

This must become a priority for all practising pharmacists.  Make your pharmacy association aware of your feelings on this.  Get active.  Become involved, and change the course of history.