: 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?

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