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.

11 thoughts on “THE PHARMACY PROFESSION & THE EVENT HORIZON September 20, 2018

  1. Hey there, Bill; great column (again).

    You mention in your opening paragraph: “or seek representation on your regulatory body” and I almost fell laughing. Because, if you dig into that idea, you’d see that from the Ontario perspective, you have to read/sign/undertake with the College, if running for council and/or you get elected, to forego all those ideas for change you may have had and represent THE PATIENT above all. And that means, if the current thinking at OCP is “A” but you don’t agree, you still vote for “A”.

    It has become so ironic that the professional members of OCP council campaign to, and are elected by, pharmacists and pharmacy technicians, and yet they are to channel their efforts towards all those who had nothing to do with electing them in the first place: the public. Another large piece of the “problem puzzle” because with BPR taking over boards of associations ( and even councils now), they control via strategic committee positioning, how the profession “moves.” Example: stack a Discipline panel with BPR pharmacists on a topic relevant to kickbacks, etc. and watch if an appropriate penalty comes out of it, even given the publishing of previous “general deterrent” decisions on similar fact.

    But I digress…

    The pre-54 Charter issue was recently raised yet again at OCP council, and it was voted down as “not being an issue”. That tells you, right there, who’s in control. It’s one thing, back in the day, to allow for a pharmacy where an operator died, to be transferred to allow continuance of operation…but how many times should that pharmacy be allowed to be sold, especially when it doesn’t remain in the family, under protection of the “pre-54” exemption in section 142 of the DPRA? I mean, come on…really?

    Requiring a majority of directors to be pharmacists, as well as the majority of each class of shares to be held by pharmacists, but exempting this latter requirement for one class of pharmacies, could be argued to be discriminatory against certain members of the profession who pay the same level of licensing fees. But if a decision is to be made that appears might conflict with BPR’s business plans, then it’s discriminatory. (Well, I guess one way to eliminate that fight, is stack up the decision maker with your own representatives. Try suggesting to the OCP that the composition of council should be balanced and not allow one specific chain or organization to predominate…see how far you get with that one).

    Stay well, keep on writing, my friend!

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    • Thanks for all this Kim. I always learn something from you. I was not aware of this forced voting compliance with OCP policy. Much like governing political parties.

      I believe I read recently that in BC only 10% of pharmacists actually voted in their recent regulatory body’s election. They were trying to figure out why such a low participation rate. My guess is that in Ontario the rate is no different.

      No wonder why. It’s all irrelevant.

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      • ALSO:

        If you then search the OCP website for the March 2016 Council Agenda, the Minutes from the December 2015 meeting were approved in that agenda (item 9.5B, Apx 3). Very good comments were made as to why there was no need for the pre-54 protection given the OCP now has jurisdiction over all pharmacies whether operated by pharmacists (as most are required to be), or not.

        So the current requirements are for a pharmacy to have a majority of BOTH directors, and shareholders, to be pharmacists (refer to the Drug and Pharmacies Regulation Act, section 142). But the pre-54 charters don’t need the shareholders to be a majority of pharmacists (142.(4)).

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    • Thank you as always Suzanne. Many people do not know the profound impact that the 1954 charter has had on pharmacy. I know of one tiny little 800 sq ft pharmacy (pre 1954 charter) in downtown Toronto that was sold to a major food chain in the early 70’s for 2 million dollars ( a fortune then). The store was immediately closed, but that charter gave the food chain the right to put pharmacies in every one of their stores. Surely this was manipulation of the spirit of the law at its worst.

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  2. I’m not sure there is much individual pharmacists can do now. We’ve tried rallying, talking to our elected officials, sending emails to our associations (as you suggested). But, all they have to do is ignore us, or do a survey, or act like they are looking into things, and then do whatever they want with us.

    All of the power lies with the institutions because pharmacists don’t have a proper unified group to advocate for us that has any form of real lobbying power. And, if I’m not mistaken, we are unable to strike if we wanted to, which removes the only real bargaining chip we would have had to in these relationships.

    Universities will never cut their class sizes because why would they? They get the money, whether or not there is a market for the increasing number of students they churn out. I feel for these students coming out and finding no work besides part time, temporary, or relief jobs that pay them well below what their education level (and student debt) should entitle them to. And, that’s if they are even fortunate enough to find work, which many are not.

    Government and regulatory bodies won’t control the number of registrants because, again, they get paid their fees whether there is a market for these new registrants and it helps the hands that feed them (i.e. those also paying for the majority of pharmacy licenses) . And, BPRs just sit on the sidelines reaping the rewards of their many years of undermining the profession, only having to do a bit of nudging in their chosen direction now that they’ve almost taken over pharmacy entirely.

    I agree with you. The blind optimism I see from some of my colleagues is actually kind of sad. You have to accept the reality if you plan on changing it. It feels like those pushing forward are trying to make the best of the situation as is, which is fine. But, they have to realize that their efforts will be wasted if they don’t try to reclaim some power and control over the decisions being made as to what pharmacy is and will be. Because, as it stands, pharmacists have essentially zero say in that, as demonstrated through the fact that no pharmacist will be among the advisory council in implementing national pharmacare. No power, no say.

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    • Bashir,

      We appear to agree on all fronts. The present and the future for the profession does appear bleak. Too much damage has occurred over too long a period of time. Power centres like BPR, academia, regulatory bodies continue to feed off this transformed thing we use to call the profession of pharmacy.
      They will milk it to death if necessary.

      My focus will continue to be expose this charade to as many prospective students and present students as possible. If I can save even one student from the dismal fate which will surely be theirs, I will be satisfied.

      No pharmacist is on the advisory council for National Pharmacare because government does not believe pharmacists have anything important to say that is not likely to be in the interest of pharmacy business owners who predominantly non pharmacists.

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      • Godspeed. Keep informing. You’re doing a great service by bringing attention to issues that new and prospective pharmacists should be aware of.

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  3. This last article really was quite informative. So we were the makers of our own
    demise. Need to find a way to turn the tide. I have to believe its not too late. Thanks for your excellent articles.

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  4. Do you anticipate national pharmacare being implemented soon? Would this be the event that devastates pharmacies since this would mean the end to the generic rebates?

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