PHARMACY’S PARADOX February 14/2018

In almost all fields and professions, experience is usually considered an asset.  Everyone begins with some form of formal education or training and over time, and a life span, gains practical experience.  This is how the expression “an experienced plumber” comes about.  Or an “experienced cardiac surgeon”.  We all want the surgeon who has done 3000 open heart surgeries to operate on us or our loved ones.  Even the most brilliant recent graduate surgeon is considered secondary to the veteran successful surgeon.  How about jet pilots?  Same thing.  Notice how pilots are often ranked by the number of flying hours they have logged over their careers.

It seems now that pharmacists are fast becoming a noted exception to this rule.  A recent phenomenon is emerging with plenty of available evidence, which indicates that new inexperienced graduates, or recently minted International Pharmacy Graduates (IPGs) (now representing 40% of pharmacists in Ontario), are preferred to older experienced pharmacists with 20 or 30 years of experience.

What could be behind this strange paradox where experience is becoming a detriment over newness, i.e. either from a university setting or from another country?  The quick answer in one word is, money.

Many long term experienced pharmacists earn hourly rates above the more recent heavily discounted hourly rates that newly minted graduates will take in a desperate need to get working and to begin to tackle their massive student debts.

Same thing for IPGs.  Having come to this country with false promises of a shortage of pharmacists and high wages, these IPG pharmacists are now facing discriminatory hiring practices which exploit their plight, in order to drive down compensation levels to new lows.  Here in Ontario, there has been a documented case of a licensed pharmacist earning $20.00 an hour.  The guy was desperate, and the employer knew it.  Many IPGs who have yet to earn their licences for lack of language proficiency or for other reasons, are now being gladly recruited as pharmacy assistants.

With the stark reality that the profitability of pharmacy business, now being constantly and repeatedly eroded by governments looking “to lower the cost of drugs”, anything to lower operating costs is fair game for those who own and operate pharmacies today, mostly non-pharmacists.  Sometimes referred to as BPR.

In a recent example, one large pharmacy chain ‘let go’ 32 experienced pharmacists, paid their severance, only to replace them with recent grads or IPGs at greatly reduced hourly rates.  The guys in finance didn’t take long to calculate that the savings in compensation over time, would more than offset any immediate discharge costs, big time.  You can’t blame these number cruncher guys; this is what they are hired to do.

Heck, even President Donald Trump in his recent State of the Union address vowed that he “would lower the cost of generic drugs”.

As drug therapies occupy an ever increasing proportion of the cost of delivering healthcare, even more emphasis will be applied to reducing and controlling drug costs.  Unfortunately, pharmacists’ value and compensation has been tied directly to the cost of drugs for a long time now, and not to the value of the services they provide.

Hence lower cost drugs (a good thing), translate to lower compensation for pharmacists (a bad thing, at least for pharmacists).

Couple this with the reality that the profession of pharmacy is not controlled by pharmacists, but by big business interests, the future of the profession’s viability has definitely been put into question.

This is a tough reality to deal with.  As we enter into a future where automation, artificial intelligence, unsustainable healthcare costs, and internet purchasing prevail, serious second thought must be given by those contemplating a career in pharmacy as to what kind of future they are actually entering into.

Is anyone out there in academia, pharmacy regulation, pharmacy associations even talking about this, let alone addressing it?  Not likely.


FOLLOW THE MONEY TRAIL                  February 1, 2018

Over the last several months alone, the business of pharmacy (in Ontario at least) has been hit directly by at least three financial body blows.
First came the need to recover some 200 million dollars of anticipated savings, which the Ontario government had anticipated as a result of various interventions, but savings were not actually realized. Too bad for pharmacy, ‘well we will just take it off all future payments (ODB) until we get the $200 M anyways’, so says the Ministry of Health. Little discussion, polite chats with the OPA.

Then came OHIP+ which compressed fees and markups with a resultant massive financial plus to private insurance plans.

And now the Pan Canadian Pharmaceutical Alliance and their deal with the Generic Drug Association (to circumvent a tendering system) with the result that more dollars are saved by government, but extracted directly out of the pockets of pharmacy business.

In the face of all this, patient co-pays are not charged by the vast majority of pharmacy businesses, leaving money on the table which could legally be charged while sanctioned by government as part of plan design. These are legitimate dollars forsaken for the sake of competitive retail marketing strategies

It’s not over yet. Some big box stores and other members of BPR are discounting their professional fees to below $4.00. And some are even forfeiting the annual $100.00 deductible as a further customer incentive. This is called self immolation.

You heard it here first. The day of zero dispensing fees is not far away..

How can any service, professional or commercial, withstand this kind of financial punishment and survive? The answer is it can’t. Many small independents will go down like flies. But frankly, who cares? Government has no interest in preserving any particular kind of business or profession, pharmacy or otherwise. This is the reality of a market economy. Who cares that Blockbuster Video is just a memory? Whoops, there goes cable television. Government serves the voters and it will do anything to garner votes for the next election. This is government’s mandate, serve and then survive.

And then does the majority of the public really care that much about so called pharmacy ‘professional services’? Are people lining up to get those vital MedsChecks? Does the public know about, or even understand, the concept of pharmaceutical services? What does it mean to say that a pharmacist performs the act of ‘determining therapeutic appropriateness’? The standard public response…“Shouldn’t the prescribing physician ensure therapeutic appropriateness and if he/she isn’t sure, why am I being prescribed this drug in the first place?”

We have all been in one of those big box stores and witnessed people in a line up, maybe 20 individuals long, patiently waiting to hand in their prescriptions. The pharmacist and half a dozen assistants safely locked up in a 10’ by 20’ glass box in an assembly line. So much for fast friendly service. It’s saving money that drives these folks to patronize these establishments. And who cares if the actual pharmacy/dispensary is bleeding red ink? A few bottles of vitamins and some multiple item shrink wrapped H & B items and the consumer/patient encounter becomes profitable. Eggs, milk, & bread have been traditionally sold below cost by the grocery/BPR industry for many years. One bag of Frito Lays and the deal is profitable.

The problem is that as a result of a thousand small steps, the profession of pharmacy is on its knees, and the only ones who really care are individual practicing pharmacists. BPR is ambivalent. Pharmacy is a loss leader anyways, and the more subdued and plentiful pharmacists that are available, the more work and less compensation can be extracted from them. This is the environment where 80% of pharmacists toil every day.

And all those lost dollars? Where will large employers/pharmacy owners, (BPR or larger independents) attempt to recover those lost dollars? Through lowering costs surely.

Pity those pharmacy techs who have suffered a raw deal since day one. Both pharmacist compensation, already at historic lows and unemployment at historic highs, will continue along the same trend lines.

Instead of glamorizing pharmacy through such anachronistic events like White Coat Ceremonies, Isn’t it about time that we recognize the moral duty to inform those first year students entering pharmacy schools of exactly what they are getting into? How do those deans, professors, and association/regulatory boffos sleep at night with all of these elephants in the room?

Unfortunately, too many vested interests in the status quo to really hope for some awareness which could lead to real change.