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.

14 thoughts on “PHARMACY’S PARADOX February 14/2018

  1. re. pharmacy’s financial model tied directly to the cost of drugs and not to the value of services, yes, it is recognized as an issue by associations

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  2. Is anyone interested in remuneration reform when it comes to pharmacy practice? Doubt it. The advocacy bodies are scrambling to come up with ideas like MedsChecks for patients on opioids, or payment models for minor ailments. Meanwhile the existing MedsCheck program has not even been evaluated to see if there’s any value in it. Fee for drug dispensing and fee for “cognitive service” remuneration models incentivize McDonalds-style care. Would you like a MedsCheck with that? No, thank you. Keep writing, Bill.

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    • I appreciate your remarks as always Suzanne. There are no easy answers to the predicament that pharmacy as a profession has gotten itself into. I have witnessed this decline over 50 years now (yes I am a 6T8 grad).
      The reason I keep on writing about the things I do is because I believe there is nothing worse than hypocrisy, and there is plenty of it in pharmacy today. I mostly feel sorry for the young grads who do not know what they are getting into, and i feel anger at all those who profit from their innocence, starting with the fat cats in academia.

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      • If all pharmacists and pharmacies were in favour of this approach, ie. a national drug plan and pharmacist compensation unshackled from the cost of drugs, then perhaps CPhA and others could get the grassroots support needed to make a push. The political will is getting stronger, province by province. We need to measure pharmacist and pharmacy support on the grassroots level (which I think is there, or will be in Ontario very soon) and all agree to unite on this issue. Bill, maybe you can use your social media presence to get that out there ?

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      • Who is a stronger lobbying group politically? NPAC (i.e the chain gang) or CPhA? How well aligned are the goals of NPAC and CPhA? There are nuances between the business of pharmacy and the profession of pharmacists. I am always optimistic that pharmacists will unite towards a common cause – but I don’t trust NPAC to do the same.

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      • I’m thinking NPAC, CPhA and staff pharmacists should be aligned on this one. Having each one of our financial futures, store or professional, tied to drug cost is a downward trending game. If pharmacy/pharmacist services were to be separated from drug cost, of course a new competitive battle might ensue between employer and employee. That will always have to be worked out, and some would hold advantages, but the ship we collectively sail right now is headed for a reef. Currently. If pharmacies go down, pharmacists go with them. Lets get along for now to fight amongst ourselves another day.

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      • Randy,

        You’re falling into the trap of asking someone else to clean up this mess. Honestly the none of the associations require pharmacists to have decent jobs. CPhA can just make money by selling textbooks and scaling down its staff.

        All these associations are saying that “hey we are in this together” and “we are working as hard as we can”

        What if they don’t succeed? Because the pharmacist advocating for us are full time politicians and NOT full time/ part time community pharmacists they honestly just want status quo.

        Trying to galvanize people on Bill’s blog …. is quite a lukewarm attempt. Pharmacists are their own worst enemies. They always want SOMEONE else to fix the problem – it’s literally their career to go – hey doc fix this. K thanks.

        No responsibility whatsoever. Better to have it all crashing down and if you’re a good pharmacist you stay alive.

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  3. Would the situation be the same in BC? Do you know how many IPGs are in BC or if there is any restrictions for the number of IPG licenses per year in BC/Canada? Very insightful blog. Thank you for your time and efforts

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    • I think the percentage would be less in BC than Ontario. But I do know that many IPGs go to Alberta and SK first as the qualifications are easier there, then move to Ontario or BC as soon as possible after licensing. They hate the climate. There are no restrictions to the percentage of IPGs allowed into Canada that I know, but their ability to get a license is a provincial responsibility. There are many IPGs here in Ontario now with doctorate degrees making $15.00 per hour as pharmacy assistants. A travesty to them.

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