The ‘McDonaldization’ of Pharmacy

About 15 years ago noted author Eric Scholler wrote a terrific bestseller, first serialized for Rolling stone Magazine in 1999, called ‘Fast Food Nation’.   His lecture summary is also available on YouTube and is very powerful to experience.  The comparison between the fast food industry and modern chain pharmacy is remarkable.

The implications for the profession of pharmacy today are very disturbing if present trends are not altered, especially in light of the many recent takeovers by big chain pharmacies.  Market concentration continues to get tighter: Loblaw takes over SDM, Rexall takes over Dell, Sobeys takes over Safeway etc…all of which puts more power into fewer and fewer hands.

Scholler’s thesis investigates the beginnings of the ‘Fast Food Nation’ within the context of post-World War II America; and examines the specific mechanizations of the fast-food industry, including the chemical flavoring of food, the production of cattle and chickens, the working conditions of the beef industry, the dangers of eating processed meat, and the global context of fast food as a North American cultural export.

Scholler refers to McDonalds Restaurants a great deal in his book.  For purposes of this blog, you can replace McDonalds in your mind with your favourite chain drug store operation.

It was really Ray Kroc (circa 1955) who was the architect of McDonalds.  Kroc is legendary, and it was his ‘genius’ that spawned the modern day fast food industry.  Kroc brought systems to the food industry.  The central credo was ‘conformity’ which allows a consumer to purchase the same product anywhere in the world and have exactly the same ‘experience’.

This is a direct quotation from Kroc:

“The organization must not trust the individual.  It is the individual that must trust the organization”.

Any of this making the tiny hairs on the back of your head stand on end yet?

The systems characteristic of the industry are low wages, systems which allow for employees to be quickly replaced if they quit or are fired, central office driven protocols for every single act in the process of product delivery, supply management, & low price points.

The industry does not welcome creativity which it considers dangerous and could erode the brand.  Everything is minutely controlled and enforced to centrally driven protocols and standards.  The continued utilization of robotics and mechanization is critical to reducing the human element as much as possible. Judgment is disdained in favour of systems, policies & procedures, manuals, and algorithms.

Employees are told what to do and what to say at all points of the product delivery chain. Tight control is maintained by rigourous enforcement of all systems by well chosen and singularly focused ‘district managers’ aka the storm troopers/systems enforcers.

The whole objective is to rely heavily on all things non human as much as possible which ensures low compensation costs, consistency of the value proposition and protection of the brand.

Does any of this remind the many practising pharmacists out there of what it is like to work for Super Duper Drugs today?






How does the profession of pharmacy, which is moving more and more into the realm of professional services and clinical judgment, fit into a matrix of tight control and a protocol driven environment?  Think quotas, performance metrics, labour scheduling tools, reporting structures, uniforms, branding, image, etc.

What Scholler discusses in his thesis is pretty consistent with other products besides fast food, like clothing, haircuts, footwear, furniture etc.

The disturbing reality is that this has happened as well to pharmacy, a profession with a long and proud history, so quickly and all for the sake of commerce and the interests of shareholders, who are neither pharmacists nor their patients.

Pharmacists must take back their profession by every means at their disposal.  Pharmacists must get active politically and insist their associations lead the change and course of events before it is too late; it is already 11 PM.

Pharmacists need to do all this before the profession becomes just another McJob with the status and compensation that goes with it.

If none of this scares pharmacists to initiate the revolution that Ken Burns has recently referred to, nothing will.


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