Stop Accrediting Pharmacies…a not so radical idea

There was a time when accreditation of pharmacies by pharmacy regulatory bodies made some sense; not so anymore. The “pharmacy” was a bit like a laboratory or a pharmaceutical manufacturing facility.  Accordingly the physical plant had to meet certain criteria as to size, adequate equipment, hygiene and so forth.   Hospitals continue to be accredited today because clearly the provision of hospital services like surgery cannot be performed without the hospital and the vast amount of equipment within the hospital itself.

Today, as the pharmacy profession moves in a new direction towards becoming a knowledge based profession, the importance of the physical plant has become greatly diminished.  In fact, an argument could be made that the physical pharmacy plant is actually acting as an impediment to professional development; it is undebatable that it acts as an impediment to direct remuneration, and accordingly control and independence.

The pharmacy has become an anachronism, perhaps even an albatross.

In reality, the existence of the pharmacy as a legal entity, a licensed location, or an “accredited” facility is serving to retard the progress the profession of pharmacy.  Pharmacy urgently seeks to move towards becoming knowledge based, independent of inventory (even drug inventory) and independent of location or physical plant.

Incredibly today, “pharmacies” (which are things not people) are reimbursed for professional knowledge based services, but more incredibly, there is no mechanism for reimbursing the professional who delivers the actual service herself.  This fact alone works to entrench the balance of power away from the service provider to the owner of the physical plant who, in the vast majority of cases, is not a pharmacist and whose single focus is the sale of as much stuff as possible, much of which is totally not health related, and often actually exacerbate diseases like diabetes, heart disease, hypertension etc.  How can this be good for the patient or the pharmacist?  It solidifies control away from the pharmacist to the non-pharmacist owner with all the subsequent horrors (quotas, forced flu shots, performance metrics etc.) that we are witnessing today and we get to watch on CBC TV nightly.

If accredited pharmacies did not exist, it would be impossible for governments or any other insurers to pay them; it is not possible to pay or even acknowledge something which does not exist. This would mean that payment for services rendered would have to be made to whoever provided the service of value, i.e. the only legal entity standing, the licensed pharmacist.

One of the darkest periods in pharmacy’s history occurred when pharmacy corporations, pre 1954, were grandfathered and subsequently were allowed to be sold to non-pharmacists.  Every entity in the Big Pharmacy Retail (BPR) Club…Rexall, SDM, Costco, Sobeys, Loblaw, Metro etc. owe their existence today to this loophole, which allowed these big corporate retailers to purchase a single 500 sq. ft. drugstore incorporated pre the 1954 charter.  These entities now control 85% of the pharmacy business in Canada, while occupying maybe 50% of actual physical locations.  Owning a pre-1954 chartered pharmacy was like owning a gold mine, and big bucks were paid for these old numbered corporations.  The loss of control of the pharmacy profession can be sourced back to this single point/event in time.

By cancelling the whole notion of accrediting pharmacies, BPR would be left with plenty of real estate, bricks & mortar, inventory, and lease liabilities but no connection to the profession of pharmacy except through the pharmacist on duty on location.  In other words, the physical location does not become a pharmacy until the pharmacist enters the building.  And when the pharmacist leaves, only a shell is left behind…not a pharmacy.  The notion of goodwill is largely eliminated.

With this one bold move a paradigm shift would be created.  The balance of power would move markedly away from pharmacy owner to pharmacy services provider in one fell swoop.  The profession has the power to do this.  Sure there probably will be some regulatory legal hoops to jump through, but it could be done if the resolve was there.  It makes eminent sense.

All the players who have big stakes in the status quo would resist fiercely… like BPR operations who would see hundreds of millions of dollars fall off their balance sheets.  And the regulatory bodies/colleges of pharmacists who would lose the fat fees associated with accreditation.  They would all offer huge resistance.  There would be much weeping and gnashing of teeth.

But the Colleges of Pharmacists could easily be appeased in order to get them on board and to allow them to continue to live according to the comfort & style they have been accustomed to.   Simply double the individual pharmacist /registrant’s annual fee; it would be worth it in order to create this kind of shift in power, the shift practicing pharmacists are seeking.  An extra $500 bucks a year per registrant that could move the agenda forward decades in terms of shifting the control of the profession of pharmacy back into the hands of pharmacists.   In terms of direct benefit to pharmacists, this extra $500 would be a far better investment than the one presently made to pharmacy associations who appear powerless or unwilling to improve the professional lives of practicing pharmacists.

This is a case of pharmacists learning at how to play the game, and then changing the rules of the game in their favour.  What’s so radical about this?  What will it take to begin this dialogue and make it happen?


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