Pharmacist Billing Numbers (PBNs) …a matter of control.

On Friday June 20th, at the OPA Annual Conference in Niagara Falls, the subject of PBNs will finally be addressed.  A one hour panel discussion has been scheduled. Much has been written on the subject of PBNs by me, and many other practicing pharmacists over the last several months.

There have been many opinions expressed from “going all the way” to maintaining the “security” of an hourly wage, regardless of how low such hourly rate may go.

A special task force was formed by the OPA led by former Loblaw senior executive Dean Miller.  The task force has toured the province seeking input from pharmacists on this matter.  In addition, a survey has been conducted seeking further input from pharmacists across Ontario.  Such an important issue and only one hour has been allocated?  One wonders how much time has been allocated for questions or debate.

This is no small matter.  I believe it is the is the most crucial issue that pharmacists across Canada must address eventually as a major step towards determining their own destiny, and taking back their profession from the vested interests… namely Big Retail Pharmacy which is controlled by non pharmacists.

One approach is to ‘follow the money’.  Right now all the money that enters the pharmacy equation comes from governments, third party insurers or the private payer… in that order of magnitude.

All these payers want to spend as little as possible while gaining the best deal possible.  Governments have no money.  Third party insurers live and breathe cost cutting, and the private citizen always looks for the best deal possible.

In spite of all the pleading, begging and advocacy efforts of the pharmacy associations directed towards these payers with a message asking for financial support for pharmacy professional services, this effort continues to be an uphill battle.

Some money is finally coming across from governments, but it is begrudging.  Recent evidence suggesting that governments may not be getting the best deal out of this expenditure is now threatening not only expansion, but the maintenance of these dollar flows.  Think the three minute Medschecks.  Unfortunately corporate greed by way of quotas, performance metrics and other assorted commercially driven initiatives are slowly killing this small golden goose that pharmacists have worked so long and hard to get.

It is acknowledged that all these payers know that all the money paid out for pharmacy services never goes to pharmacists; it goes to big businesses, which are getting bigger and bigger.  Every profit dollar ends up as a dividend to ever demanding shareholders, and never to practicing pharmacists.

Payers know that ‘patient care’ is not what drives pharmacy today; it’s big business interests.  Four or Five big corporations control 80% of the pharmacy market in Canada today.  One mega corporation Loblaw, alone now controls 35% of the entire Canadian market

For this reason alone, payers will continue to squeeze every dollar out of pharmacy.  Politicians may smile and act polite to the pharmacy association delegates who approach their thrones.  Politicians may speak at pharmacy conferences about the importance of pharmacy in the healthcare matrix, but their fingers are crossed behind their backs and their fists remain tightly clenched to their purse strings.

Knowing that whatever dollars enter the pharmacy equation end up in the hands of non pharmacist owners first who are accountable to their shareholders, pharmacists’ compensation becomes just another cost of production and must be kept as low as possible.  In the offices of these corporate human resources departments, pharmacists are just other employees considered overpaid at any wage level.

The money gets squeezed as it enters the tube and it gets squeezed as it passes further through.

In this paradigm, control of the actual dollars becomes critical.   I have referred to this before as the concept of ‘possession is nine tenths of the law’.  It also means that under this scenario, the financial well being of practicing employee pharmacists will be under constant compromise.  In the highly competitive retail marketplace, compensation will likely be subject to further deterioration.

By now many pharmacist/readers (if they get this far) will be shaking their heads and ready to shout, ‘Bill, it’s about patient care, not money’.

But I maintain that pharmacists cannot deliver optimum patient care, or gain patient respect from patients or physicians, if pharmacists do not first have self respect.

Self respect means being recognized by patients, the patient/public and payers for the value pharmacists make towards patient well being.  How can pharmacists and physicians begin to confer as equal partners in healthcare delivery issues when physicians make 10 times the compensation of pharmacists?  Physician compensation has doubled over the last 5 years; pharmacists’ compensation has gone down by 35%.  Let’s stop kidding ourselves

This deteriorating paradigm will not change until pharmacists take control of the dollar flow.

As I have stated many times in my blogs and at meetings I have been allowed to attend, this is not about money as much as it is about control.

Once pharmacists control their professional lives, they will gain self respect.  With self respect comes recognition of value and then exceptional patient care will flow from this.

Patient care is not last; it is embedded inside the circle.  When one part of the circle becomes compromised the other sections suffer as well.  Abundance of evidence exists that this is happening today as a result of commercial interests controlling pharmacy services.

It will be practicing pharmacists who get led to the guillotine when the truth becomes known, not the pharmacy owners who to this day are not subject to the strict regulatory scrutiny that pharmacists  are subject to.

On a daily basis and thousands of times a day, practicing pharmacists are caught between a rock and a hard place: …compromise their professional integrity or risk their employment security.  This is an open secret.

Pharmacists, seize the day! Grab control of your professional lives.  Demand your own billing number and become the independent professionals that you were educated and licensed to be.  The place to begin this battle is at the June Annual Conference during the PBN panel discussion.

The OPA professes to represent the 14,000 registered pharmacists of Ontario (though only about half are OPA members).  Let’s make sure the OPA gets the m

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