David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at drugmonkeyrph@gmail.com.

David Stanley, RPh

	My athletic career in school was undistinguished, brief, and for the most part completely forgettable. Try as I might to become the next Johnny Bench, I realized sometime in junior high that if I was ever going to be able to feed myself, I needed to put away the baseball glove, pick up a book, and pretty much forget about my athletic endeavors. And that is what I have done, by and large, until about five minutes ago, when a memory from the athletic field came crashing through the walls of time.

	I once had a coach whose favorite saying was “little things make champions,” and I heard his voice, just now, inside my head. It set me to wondering where he has his prescriptions filled, because as I write this I’ve been on hold with one of the major chains for an eternity.

	My call started with a robotic voice that thanked me for calling. It showed its gratitude by immediately putting me on hold and keeping me away from any human contact.

	Before I began to write I had been surfing the web, where I came across the same company - the one that had just assured me my call was very important - boasting of its upcoming MTM expansion plans and fervently describing the future of pharmacy and the bold, cutting-edge programs that will be this company’s contribution.

	I have to admit, it can be scary stuff for someone operating one little store to see. My first thought was “What can I do to compete against this?”

	My second thought was “They can’t even answer the phone.”

	It has been 20 minutes now. I wonder what would happen if I were someone calling to ask what to do if Grandma just accidentally took too many amitriptyline tablets.

	This isn’t the first time I’ve been in a holdfest while trying to talk to a pharmacy, by the way. Unfortunately, it increasingly has become the norm. I have had this experience with every major chain in every part of the country, day or night, weekend or weekday. If I didn’t know better, I might think that the forces that control our profession just don’t care about taking their patients’ calls.

	That can’t be the case though, as the robotic voice periodically assures me that my call is very important.

	Perhaps this company just isn’t very good at taking care of what it claims is important. I have now waited for over half an hour.

	The inability to master Telephonics 101 (Put the Call Through) doesn’t seem to keep these folks from planning to execute bigger and better things, though. I’m back on the webpage that extols those cutting-edge MTM plans, and by golly, the enthusiasm is almost infectious. Except ... I’ve been on hold for over 30 minutes. It’s as if this company is excitedly planning its trip to the Super Bowl when it has forgotten how to put the ball on the tee to start the game.

	That old coach of mine was smarter than I ever realized.

	By the way, every word on that web page talks about cost savings. Not one letter is devoted to how the company’s MTM plans will improve patient care. Its silence on the subject of improving the quality of care given to its patients, coupled with the complete silence at the other end of the telephone line, speaks volumes about this company’s priorities.

	My plan to go up against this - to hold my own against the giant operators who use the ideas of the big thinkers in our profession to develop algorithms to put into high-powered PowerPoint presentations to display their strategic plans for the future - involves a 1990s-era answering machine.

	The answering machine is hooked up to the incoming phone lines at my store, but its answer-message is not the first thing you hear when you call. The machine is set to pick up after the third ring, and my staff knows they are expected to never let that happen.

	I’ve been here six months now, and that answering machine has gone off exactly once. With one exception, every call made to my store during business hours has been answered, by a human being, in three rings or less.

	Little things make champions. I get it now. I only wish that old coach of mine were here. I’d like to think I’ve finally made him proud. 

is a pharmacy owner, blogger, and professional writer in northern California. Contact him at drugmonkeyrph@gmail.com.

Articles

How can an independent pharmacy survive in the face of competition from the mega-chains? Here's a clue.

Hold the phone

Tuvalu, you see, is a country in crisis. At only 10 square miles and a highest elevation of just 15 feet above sea level, it has watched as the rising ocean waters have washed away more and more of its coastline every year, intruded into freshwater wells, and otherwise, bit by bit, made its islands a little less habitable every year. There is a very real chance that within our lifetimes, Tuvalu will literally be rinsed from the earth.  

So a crisis is looming that everyone can see but most choose to ignore, as it gets just a little worse, day by day, year by year, threatening to end a way of life. Do you see the parallels to your profession?  

"I am happy to report to you that we have constructed a new presidential headquarters during my last term," he says in his campaign kickoff speech. "We now have the space and infrastructure necessary to represent your interests to the world. I am also very excited to announce our new tourism 2025 project, which we expect will provide a much-needed boost to our economy by giving us world-class resort destinations to lure vacationers to our beautiful island. It is long past the time that we started to make use of our unique advantages to ensure our survival in the new global economy."  

Meanwhile, your well has just started to pump saltwater and the crops you planted last month are starting to wither. The tides are coming a little closer to your front door this year than last. Can you see why a person might be less than enthusiastic about the upcoming election?  

Now let's say Tuvalu is a one-party state, with no one else even pretending to represent the issues you care most about. It would be pretty easy to understand why people just might tune out politics altogether to focus on their day-to-day survival.  

Perhaps not so easy to understand for the chief executive officer of APhA, though. 

, Thomas E. Menighan says, "I can see how it must feel like a major disconnect when APhA is so focused on promoting consumer access to pharmacists' services while our own pharmacist members and nonmembers are struggling with workplace issues." He then spends the next paragraph explaining the importance of APhA's efforts to promote practice standards, extolling "the untapped potential that pharmacists have to offer to patients, and frankly to those who pay for care." 

Yup. And Tuvalu has a lot of untapped potential as a tourist destination also.  

APhA isn't ignoring your day-to-day struggles though.  

"APhA is focused on gaining recognition for the value of our services, not only as providers in Medicare, but in all sectors of health care and with other provider groups," Menighan says. "If we had all 280,000 pharmacists as members, we could probably tackle workplace issues too."  

You got that? The problem is you. You're not champing at the bit to give your money to an organization that admits it sees your day-to-day struggles, but chooses to put its primary focus on other issues. If only you would mail in a check and trust them when they say they would probably get around to addressing workplace issues, everything would be fine.  

We understand your problem, we're just going to work on other things, so vote for us!

" probably won't be a winning campaign slogan for any candidate this November, and it is not an effective recruiting tool for you, APhA. You are not entitled to my dues money or anyone else's just because you claim to represent the profession. Complaining that no one is following you does not constitute leadership. Leadership comes from giving people a reason to enthusiastically line up so you can all get to where you need to go.  

With 62,000 members (not all of whom are pharmacists) in a profession of 280,000, by this measure APhA is an unequivocal failure. Address the concerns of the people who actually fill prescriptions and deal with patients, and you will have so many members you will have to build another new headquarters. 

Until then though, you'll have to excuse me; I have to go put some sandbags around the pharmacy. The floodwaters seem to have reached the door.   

 is a pharmacist, blogger, and professional writer in Northern California. He can be reached at 

Suppose a country were facing a flood of Biblical proportions but determined to focus on bringing in more tourism; what would you say about its priorities? Now suppose that country were a professional organization and ... well, read on.

All wet: A pharmacy parable

Last month I was able to collect my reward for nine months of pharmacy action: my first paid vacation of the year. I decided to make clutter clearing the main goal of my time off and dove into a collection of boxes at the back of my closet to see what could be thrown away, sold off, recycled, or otherwise shown the exit from my life. A copy of a pharmacy trade magazine caught my eye and I took a little break from my cleaning to browse through the articles.  

I put that issue down, grabbed another, and saw this: "

There's a great opportunity to work across the whole spectrum of the healthcare channel...We can cooperate with other healthcare providers and academic institutions to support research to evaluate the impact of patient care initiatives

This is when I became concerned. Because one of those articles was written in 1997, the other exactly one month ago. Can you tell which is which?  

An integrated wellness approach to diabetes care can help patients not only improve their condition, but also lower their prescription costs

New legislation authorizing payment to pharmacists for diabetes care services has sailed through the state senate

Again, one of those quotes is 15 years older than the other. Any clue which came first?  

The payment for services legislation. Are you being paid for diabetes care services? Didn't think so.  

Einstein's theory of relativity predicted that time travel is indeed possible. Long story short, he concluded that if you could manage to move faster than the speed of light, your perception of time would change. That a month in your fast-moving rocket ship might seem like 15 years to those moving slower than light.

I remembered this as I continued to read and slowly began to suspect my closet had become a time portal.  

We are going to move away from the old practice of pharmacy, which was primarily transactional, to more of a personal relationship...This is a completely new pharmacy, health, and wellness experience with a focus on health outcomes

And this, about an organization that had "

taken the wraps off its long-awaited 'Pharmacy of the Future,' a radically redesigned pharmacy that unites new concepts...The new format affirms in dramatic fashion the company's intention to evolve its pharmacy practice beyond simple drug dispensing into the realm of integrated patient care and disease management.

One of those quotes is 14 years old. I'm not telling you which. Either these magazines have indeed mastered time travel, being published last month while bearing dates from the '90's, or, despite almost a generation of promises heralding a "pharmacy of the future," from the perspective of the retail pharmacist, very little has changed.  

Sadly, I realized eventually that it wasn't the time travel.  

I wonder whether the "pharmacy of the future" manager who said in 1998, "We're doing this for one reason, to help us free up time so we can spend more with the patients," is actually spending more time with patients in 2012?  

I'd be confident in betting the answer is an emphatic "no."			

The "pharmacy of the future" has turned out to be about more prescriptions, fewer resources, metrics that measure not time with patients but prescriptions out the door, and flu shot quotas. 

The most dramatic change in the profession has not been the elimination of "count, pour, lick, and stick," it has been the addition of one more stick - that of an arm or two between an ever-increasing number of prescriptions. I don't remember reading anything about that in 1997.  

Of course there's always next year, or the year after that. I'll put this magazine on a closet shelf and report back to you next time I feel like a little decluttering. Things will surely be better by 2027, right? 

 is a practicing community pharmacist in California. He can be reached at 

When pharmacy trade journals are talking about the same issues and the same solutions as they were 15 years ago, more than just the times are out of joint.

Let's do the time warp again

Members of seven Southern California locals of the United Food and Commercial Workers (UFCW) have voted to reject a contract offer from drug retailer Rite Aid and to authorize union leaders to call a strike if an agreement can’t be reached. 

Although specific numbers weren’t immediately released, the union called the vote, which took place from July 26 through July 30, “overwhelming” and said in a statement, “The members’ emphatic rejection of Rite Aid’s demands and their vote for strike authorization will push management toward negotiating an agreement the workers can ratify.” 

According to the same statement, the UFCW says that Rite Aid is seeking 34 concessions from workers, including: 

• Effective elimination of healthcare for workers' spouses and children

• An increase in out-of-pocket costs for healthcare benefits of up to $10,000 a year

• Virtual elimination of all accumulated sick leave pay

• Reduction of the number of hours workers are allowed to work

• Elimination of the 40-hour work week and 24-hour guarantee for part-time employees

In a statement of its own, Rite Aid announced, “The specifics of our proposal are matters we will be discussing at the bargaining table with the Union as we continue to work hard to reach a fair agreement for all involved. 

 “We’re disappointed that the Union has called for a strike authorization vote and think such a vote is premature, especially since the Union hasn’t even given us a counter proposal to our first proposal.” 

The proposal would affect all store employees except store managers, including pharmacists, at Rite Aid locations from Kern County south to the Mexican border. The soonest a strike could begin would be August 8, 72 hours after the current contract extension is set to expire. 

The union is also currently in negotiations with CVS/Caremark. 

Members of seven Southern California locals of the United Food and Commercial Workers have voted to reject a contract offer from drug retailer Rite Aid and to authorize union leaders to call a strike if an agreement can't be reached.

Southern California Rite Aid workers vote to reject contract offer; strike looms

According to a press release that found its way to my e-mail box a few weeks ago, this group of Walgreens employees said "attempts to address their grievances directly with management through established channels were rebuffed and the employees felt strongly that seeking representation ... was the best course of action to ensure safe working conditions." 

The employees sought union representation in February 2011. And as soon as your eyes hit the words "union representation," I know a lot of you stopped reading. I've heard it all before. Unions are not for professionals. Certainly not for those who hold doctorates in one of the healthcare sciences. They are a relic of a past age suited at most for the hourly wage slave.  

I'll ask this question, though, of my friends working for Walgreens, and I'll open it up to the other two major pharmacy chains, and the rest of my colleagues behind the retail prescription counter as well: 

As you stand in front of your computer screen at work, watching your clocks and graphs turn from green to red, seeing the unfilled prescriptions line up beside you, hearing the three phone lines ringing, and feeling your empty stomach and full bladder, do you feel more like a professional or a pieceworker? By the way, your district manager just called. He said if your metrics don't improve, there will be serious consequences.  

While you ponder that, I'll tell you that after 9 months of hard work, those masters and doctorate degree-holding healthcare professionals got themselves a contract that not only addressed their concerns; after three years, it will have them making 11.2% more, to boot. 

I'll also tell you that those professionals aren't pharmacists. They're nurse practitioners who work at the company's Take Care clinics in Illinois.  

That sound you just heard was that of a profession that barely existed a generation ago taking steps toward passing yours by. As pessimistic as I've been accused of being, I'd say their glass is at least three-quarters full. I'll bet those nurse practitioners go to the bathroom whenever they want. I'll also wager their lunch consists of more than a Snickers bar and a half-empty cup of cold coffee gulped down between patients.  

So you can keep on telling me about how unions just aren't right for pharmacy while simultaneously whining about everything that is wrong with your work day. You can keep right on with the same tired arguments year after year that something has to change, while year after year things get a little worse. Go right on hoping for change while dissing the most obvious vehicle that will bring about change.  

Or maybe you could reach out to the Illinois Nurses Association, the California Nurses Association, the National Union of Health Care Workers, or any other outpost of organized labor, and ask them if they have any interest in reaching across state and professional lines.  

And you can keep asking them until they say yes. I've been a member of the United Food and Commercial Workers for 6 years now, and I did a good deal of work on this article during my lunch break. My regularly scheduled lunch break.   

is a practicing community pharmacist in California. He can be reached at 

We've already felt the pain. When will we go for the gain? How many physical breakdowns, ruined home lives, and professional traumas is it gonna take before we finally say enough is enough and ORGANIZE?

Stand up and make yourself heard

It started in January, when a group of pharmacies stopped filling prescriptions for anyone not paying the full cash price at the time of dispensing. Third-party payers owed the pharmacists too much money, customers were told, so they would have to save their receipts and send in claims themselves. It would mean a wait of up to two months to get their money back.  

By April though, things had deteriorated. The national pharmacists' association sent out a call for pharmacists in two major cities to join in a protest, and once again prescriptions became cash and carry. 

Some of you now may have your mouths open in disbelief, unable to imagine the American Pharmacists Association sticking up for the interests of its members so forcefully.  

You would be right, of course. It was the GPhA that went to bat for the profession - as in the Greek Pharmacists Association. The pharmacists who stood up for themselves were doing so in the birthplace of democracy. When I read this story, I wondered whether maybe we could hire some of these GPhA guys to come over for the next Express Scripts shareholders' meeting.  

I've heard many people say that pharmacy is the doormat of healthcare, that ours is a profession of codependency, giving to others to the point of destroying our own interests. Not very long after I read about those Greek pharmacists, though, I saw another story of how some of our colleagues got a little creative in protesting the state of their profession.  

Watch out for pharmacists who have had enough: They can find some imaginative ways of registering their dissatisfaction