FOLLOW THE MONEY TRAIL

FOLLOW THE MONEY TRAIL             billbrownblog.com               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.

12 thoughts on “FOLLOW THE MONEY TRAIL

  1. Mr. Brown, Sir!

    What a great blog. I actually learned a few “aspects” and things for a change and am enlightened, all thanks to your doing.

    Got your helmet fastened for the assault force about to storm your residence? 😉

    Kim

    Liked by 1 person

  2. Ok I’m going to say it…and I’m a pharmacist….are we even needed in this day and age? I’m being serious. Maybe things are heading for that inevitable conclusion. Discuss.

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    • I am at the tale end of my career in pharmacy so the end of this story won’t affect me, but it breaks my heart to see so many talented young people being duped by academia and various vested interest into entering what they deem to be a tunnel into the future but in reality is a dead end. I feel angry at the professors, bureaucrats and other assorted apparatchiks; i do not know ho they can sleep at night.

      Liked by 1 person

  3. Bill, another “tell it like it is” blog from you is always the highlight of the day for me. There is enough professional apathy going around, and your words are refreshing. I am conflicted about whether this profession is worth fighting for, or whether I just need to accept the inevitable. While I try in my small way to “make a difference” – collective mediocrity within the profession overwhelms me. Thanks for “keeping it real!”

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  4. 2 questions I have on this subject. Was there ever truly a pharmacist shortage or was it a long term game plan to flood the market in order to drive down wages?
    And with so many new independents opening up and waiving all kinds of fees, (even in some cases the entire $100)just how are they making any money at all considering their low Rx volumes. Time someone took a serious look at that.

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  5. The shortage was real, but totally and intentionally manufactured. Once the box stores, big food etc looked at the analytics which showed that adding a ‘pharmacy department’ boosted overall revenues by as much as 10%, they all wanted one. How many corners do you know where you can stand and swivel 360 degrees and see 5 or 6 pharmacies? Many manned by PharmDs staring at a screen surfing the internet.

    The regulatory bodies (OCP etc.) got totally sucked in by BPR and flooded the market with IPGs who now suffer from abysmal wages and terrible working conditions. Do regulatory bodies confess to their incompetence? No, they just keep collecting those mandatory fees.

    Government even went one step further towards lunacy and opened a second school of pharmacy in Ontario. Can anyone believe this? Yes, when you realize that the hefty tuition fees paid by pharmacy students subsidize airy liberal arts subjects like International Women’s Studies, Gender Studies, Pronoun Selection Options, etc.

    The reason we are seeing so many independents in the face of bleak reality is that many IPGs simply would rather work for themselves at even a starvation income, rather that succumb to the oppressive environment under BPR.

    This is called a ‘distorted marketplace’.

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  6. I have been a retail pharmacist for over 25 years and have recently had to move for my husband’s job. I quit my job thinking I’d find another part time one in our new city. But I find myself very reluctant to do so. I don’t miss being yelled at by doctors and patients, ringing in chips and tampons at the till and not getting a decent break the whole 8 hour shift. Not to mention how busy and stressful the job is.
    I do feel very guilty about not going back to work though. I spent most of my life either training to be a Pharmacist or being one. But the state of pharmacy in Canada is just getting worse and worse.
    Maybe it’s time to retire….

    Like

    • Michelle,
      Sounds like this is a good time for a career change. Why not take time to lean how to play the piano or the guitar (if you don’t know already) ….or just smell the proverbial roses?

      In order to destroy a man (or woman) you only need to make his (her) work meaningless for him (her).
      …..Dostoevsky

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  7. Very well put. You’ve provided clear insights into the state of this profession. I graduated with a BScPhm from the University of Toronto in 2014. My cohort fought for a pharm D designation, which we got (for the incoming class and after). However, that advocacy seems to have been pointless as wages have continued going down and having a pharm D hasn’t benefitted my juniors at all and had simply saddled them with more tuition debt and increasing competition for jobs in hospitals. When I graduated, there were few jobs in my hometown of Scarborough as well as the larger GTA, and what you could find would not pay enough to cover the exorbitant tuition fees that I continue to struggle to pay back. I moved to Alberta immediately after graduation because I thought there would be greater opportunities for decent pay, worker rights, and greater career development. But, much of the same issues exist here, and the trajectory seems to be leading towards the state of the GTA. I had hopes for a long career in pharmacy. But, with little hope for a reversal in this course, I don’t see that future anymore. I’ll need to find a new goal to aspire for. To all students considering this career, please reconsider. If this is your passion, then by all means do what you love. But, do your research and realize that the pharmacy you know today will most likely not be the pharmacy of tomorrow, and it’s unlikely to improve for the better. Not unless pharmacists organize ourselves against those who have taken our profession away from us.

    Liked by 1 person

    • Bashir,

      You graduated in 2014; I graduated in 1968. I offer you the benefit of many decades of experience. I was lucky. I left store level pharmacy pretty soon after graduating and spent my working career in various senior management positions. I am not complaining, as I had a reasonably successful career. But I was going into law after graduating from pharmacy but followed the management route at the last minute; I have always felt a little regret accordingly.

      My advice to you is this …cut your losses. You have a long career ahead of you. Do not waste another minute pursuing a career in pharmacy. Parlay your degree with something else….an MBA or law degree and enjoy the rest of your life.

      A lifetime of regret, frustration and unhappiness is a huge price to pay for an early mistake. It is far from too late for you. Take the route less traveled and it will make all the difference.

      Like

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