It often seems that as the elephant in the room gets larger and larger, the tendency to look away, and to pretend that the elephant does not exist increases in direct proportion.  The dominant control of the profession of pharmacy by Big Pharmacy Retail (BPR), and the concurrent failure by the regulatory bodies to apply any influence to stem this control, and to put it back into the hands of individual pharmacist practitioners, is such a case in point.

Regulatory bodies like the Ontario College of Pharmacists (OCP) continue to justify their inaction by stating that it is their sole mandate to protect the interest of the public.  “Business models are not within the mandate of the OCP”, the OCP states.   Accepted.  But when the means to deliver standards of practice are not in place, then such models become condition critical and must draw the attention of the regulatory bodies, including the OCP.

Witness that within the next few months, it has been recently announced by OCP, that an initiative will be launched in collaboration with Health Quality Ontario to release a set of system-focused indicators for community pharmacy in Ontario.  An OCP spokesman recently indicated that this initiative is about improving patient and health system outcomes and establishing a way for everyone to measure the impact of pharmacy care in the community and to continually improve.  Who could argue with this one?  What a great initiative and dead on the mandate of the OCP…to protect the public’s interest.

In direct contrast to this highly worthy initiative are the hard facts of life.   The vast majority of pharmacists (80% or more) remain unrepresented retail employees of non-pharmacist owned mega corporations, whose single purpose is selling as much merchandise as possible in an ever increasingly competitive environment, now under fierce attack by internet shopping.  It’s total war for the consumer’s dollar.   We know the players, and we know their strategies.  One player alone, Weston Group, through its control of Loblaw and Shoppers Drug Mart must have close to 50% of the retail pharmacy market.  Chairman Galen Weston Jr. is the most important pharmacy leader in Canada today and he may not even know it.  Has anyone at OCP even met him?   Has anyone told him about the new quality assurance initiative?   Has anyone been to a Costco pharmacy lately with customers lined up at the counter 20 people deep waiting to benefit from a $3.89 dispensing fee?

In such a fierce retail environment, driving revenues and controlling costs are the two important orders of the day.   How is pharmacy affected by this reality?  Pharmacists are increasingly forced to work alone, without any tech support, meaning more time spent on technical functions like counting pills, wringing up sales, and bagging groceries.  All this, while at the same time performing flu shots on demand,  and meeting increasing quotas for MedsChecks and other assorted billable services which drive those important revenues.

How is it that the OCP can set out to create professional standards for quality pharmacy services and at the same time totally ignore the hard reality that most pharmacists working in BPR environments are considered (like all the other retail employees) a means of production?  This means driving costs of production as low as possible, while driving top line dollar revenue production as high as possible.  This quest is at the heart of retailing and it never stops.  Sales per square foot is a key retail measurement tool and it has no upper limit.

This is the conundrum, but what brings it to tragic proportions is the failure by regulatory bodies like the OCP to address what is an impossible situation.   This is not just about professional satisfaction, it is about human health.  Pharmacists are actually becoming sick both physically and mentally.  How can pharmacists deliver quality professional services like “therapeutic appropriateness” when they are checking 200 Rxs an hour with no help?

It is well within the regulatory bodies’ purview to set standards like the number of prescription an hour which a given pharmacist can safely fill and still meet minimum professional standards; they just don’t want to tackle BPR.

So much effort has been put forth to create the professional title of ‘Pharmacy Technician’.  What a tragic joke, as these people cannot find work, or when they do, they are not financially rewarded for their status but still must now pay OCP increasing annual dues.

The talk has started that the self-regulation of professions like pharmacy and medicine should go under review.  Some may look in horror at the prospect of government oversight of pharmacy, but one must wonder if it could get any worse than the present untenable situation.