THE PHARMACY PROFESSION & THE EVENT HORIZON September 20, 2018

You know the pharmacy profession’s future is looking somewhat dim when people continue to proselytize that you should look at the cup as half full, or to put on your rose coloured glasses, or to examine your feelings and start thinking positively.  The big put is to “just get involved” in your association, or latest committee, or attend a conference, or seek representation on your regulatory body.  All this to suggest that if you just keep moving, turn on and tune out, it will all go away somehow.

Maybe.  And then maybe not.

The past reactions to a few blogs on the Canadian Healthcare Network (especially the comments from readers both young and old) have been especially angry and despondent re the profession of pharmacy and what it has degraded into.  But this did not just happen recently.  This was a gradual process which started exactly 64 years ago when the 1954 Pharmacy Charter was enacted.

Think of this date 1954 as an ‘Event Horizon”.  An event horizon is that special place in space where objects, as they are sucked towards a black hole, cross a point, and once they cross it can never turn back.

The 1954 Pharmacy Charter recognized the looming danger approaching by the entry of big business interests into pharmacy.   From that date forward all pharmacies were to be owned and/or controlled by pharmacists, and corporations had to have a majority of directors as pharmacists.  Great idea, except for the ‘grandfather clause’ stating that all existing pharmacies (pre-1954) were exempt from this provision, and could be sold to anyone, pharmacist or not.  From this single grandfather clause provision, motivated by the greed of those pharmacists involved and in power at that time, today we are rewarded with Big Pharmacy Retail (BPR) which has taken over the profession.  Even the provincial regulatory bodies quake in their boots in the presence of BPR.

Fortunes were made selling a single pre 1954 existing pharmacy to a grocery chain or big box merchandiser etc.   From that single charter purchase, a non-pharmacist retailer could open hundreds of locations across the country to the point where today BPR controls 85% of pharmacy across the country.  With this kind of clout, BPR can exercise the Golden Rule: ‘He who holds the gold makes the rules’

It was pharmacists who allowed this to happen.  It is pharmacists today, ensconced in the multitude of pharmacy associations national & provincial, regulatory bodies, and academic institutions, which continue to sustain the status quo and to gain succour feeding off the existing system.  Pharmacists did this to themselves and continue to put personal gain above the interests of the profession.  Hence professional fee discounting, fierce retail competition and plummeting compensation.  A race to the bottom, and no end in sight.

What to do?  The event horizon analogy, dictates that there is little one can do except to get sucked into the vortex.

In fact, there is much that can still be done in spite of the consequences of the mistakes that were made in the past.  The first and most important thing is to refuse to accept the status quo.  Radical thinking and disruptive actions are required.

Over and over, ‘pharmacy advocates’ come up with weird ideas and initiatives which deny the reality that the profession of pharmacy is not controlled by individual pharmacists; pharmacy is controlled by BPR.  BPR are not bad guys, they just have a different agenda from pharmacy professionals and the two often have diametrically different mandates.

First thing.  Severely limit the number of graduates coming out of pharmacy schools across Canada.  Some schools should be shuttered.  How much worse must the present pharmacy reality be for recently graduated PharmDs with six years of education, $150,000 in debt which they can never pay off and working in a 10’ by 20’ cubicle in a grocery store?  The professors and deans will squeal like crazy of course.

Second, shut the door tightly to any further foreign trained pharmacists.  Zero.  No more International Pharmacy Graduates get licenses.

These two actions will begin to tilt the supply and demand curve back towards pharmacists and away from BPR as retail employers.  It will take 10 years to have an effect.  BPR won’t like this as it was BPR who encouraged opening the floodgates to international graduates for good reason, to depress wages, and it worked big time.   Tell the IPGs working today in Toronto for $30 an hour with no tech support that immigrating to Canada was a great idea.

Third, encourage all existing pharmacy students to parlay their degrees into new directions, not necessarily retail pharmacy which is a dead end professionally which will destroy their souls within six months of graduation.  Law, business degrees, politics, education, anything but not the black hole vortex of retail pharmacy controlled by non-pharmacists totally consumed with commercial interests.

Fourth, put pressure on the regulatory bodies to tackle the real issues confronting pharmacists today, those which are having a negative effect on the public interest; tackling things like fee discounting, unlawful rebates, performance quotas, dangerous working conditions, etc.  There is much that these regulatory bodies could do if they had the guts to do it.  Requiring mandatory cannabis education to qualify for licensure (while both medical and recreational cannabis may never be sold in a pharmacy) is a good example of wrong-headed focus.

Fifth, inundate the so called pharmacy associations, with letters, phone calls & emails to turn their attention towards the interests of individual pharmacist practitioners, and less to the interests of pharmacy businesses large & small which employ these pharmacists as essentially retail employees.   Are they ‘pharmacist associations’ or are they ‘pharmacy associations’?

Agreed, some of these suggestions may never come to fruition, but at least they speak to developing the right attitude, an attitude of not complacently accepting the status quo and developing a willingness to do anything to avoid the despair and complacency prevalent today.   Take action against the realities facing pharmacy today, and avoid delusional Pollyanna thinking wherever it comes from.

Naval gazing, denial, and especially false rosy outlooks are never going to cut it.