James "Goose" Rawlings, RPh

You haul 16 tons and what do you get/Another day older and deeper in debt/St. Peter don't you call me 'cause I can't go/I owe my soul to the company store.

If you are a miner or have had family work in the mines, you and yours have my respect. Most of us never have had to work in such a difficult and dangerous profession, and we're fortunate. Thousands of people died and many more were disabled on the job, some for life. To compare this situation to any other is hyperbole, and probably should not be attempted.  

Most young pharmacists and pharmacy students would have no trouble making this connection. They do "owe their soul to the company store." Their debt? The guaranteed student loans for tuition, fees, and housing they owe the university they either graduated from or study at now. Tuition and fees are at record highs and increase every single year.  

The fees are the killer. Our local university, which is also my alma mater, essentially doubles the yearly tuition in additional fees for pharmacy students. Debt loads upon graduation are approaching the $200,000 range. Many of these students will be repaying debt into their 40s or until about the time their children start college. The way tuition is increasing, who knows what college will cost then. 

Add to this the increasing requirements for entry into a school of pharmacy. A four-year degree is now a prerequisite for some university professional programs. Professional organizations and academia are also placing increased emphasis upon the need for newly fledged pharmacists to enter at least one residency program upon graduation. A resident typically makes less than half a pharmacist's salary. While these pharmacists will be well trained, their ability to reduce their debt load will be on hold for a year or two. 

The president of our local university is leaving, and she gave her last "State of the University" address a couple of weeks ago. In it, she described the "clamor" over rising tuition costs and how future university leaders would have to address not the fee increases, but the furor over them. There was no talk about making college more affordable, just rhetoric on future damage control.  

I'll bet the coal-mine bosses back in the "16 tons" era had the same thoughts. Keep the workers under our thumb and make them think they have no options but to continue their existence just the way we want them to. Keep them poor, hungry, and dependent upon us. 

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Remember when hardworking coal miners "owed their souls to the company store"? Look a little closer to home and you just might find that someone you know is in a very similar spot.

Pharmacists: Who owns your soul?

This past year's events have had me thinking about protest.  

I watched an excellent series on the Vietnam War that talked extensively about the anti-war movement of the 1960s. 

The Occupy Wall Street movement and its series of offshoots had people talking, but I don't think any of it was remotely similar to what we saw in the '60s.  

Same story with the Tea Party; lots of smoke, no fire.  

The main reason I have protest on my mind at the moment is that I've been talking to Joseph. 

Joseph is someone I met through my job, and we just kind of hit it off. He's older, and he has a European accent that I couldn't place. He's a semi-retired professor from the local university, and a rabble-rouser also. One day he shared his story with me. He had been born in Germany in the late 1920s; he is Jewish. In 1938, when the Nazi persecutions escalated, he was part of the Kinder transport, an effort by the British government to save Jewish children living in German-controlled areas by transporting them to England. Over a 9-month period, Joseph and 10,000 other children were sent by their parents to England. Most, including Joseph, never saw their parents again–they had perished in the Holocaust. 

Protest, to be effective, must be for a meaningful cause and must involve real sacrifice. Joseph told me that protest always comes from the people on the bottom and works toward the top. He told me to get people moving, don't just sit around and wait for change, because it will never happen. Don't wait for someone else to save you. Challenge your leaders and the status quo. In a nutshell, get off your rear end and make things change. Based on the stories he told me, I think he knows what he's talking about. 

We are at a watershed moment in pharmacy. We have given up control of our destiny to bean-counting, nonprofessional MBAs. We did it willingly, too. Just show me the money and I'll work 14-hour days, fill hundreds of prescriptions in a shift, do vaccinations on demand, or even run a drive-up window. There is more than enough blame to go around. National organizations, state boards, schools of pharmacy, PBMs, chains, hospitals, and even politicians have all contributed to the problem. We all are responsible for this mess we are in and it is time to get serious about a solution. 

If what we do is important to us, it should be up to us to save it. It will not be easy, and some of us may lose greatly in the process. Like most revolutions, youth will have to lead us. However, with massive student loans in most cases, they also have much to lose.  

Let's keep sight of the fact that we are well-trained and educated professionals that can wear many hats. We are in a good position to affect change and should move forward with confidence.  

I think it's time for some '60s-style protest for our profession. How about sit-ins with locked arms or marching on company headquarters? Active protest that educates people about what they get if we are no longer in the picture. We could encourage some solidarity about working hours and conditions. What do you think? I'd like to hear from you. 

To paraphrase a popular protest sign from the '60s: "They can't fire us all."   

is a senior pharmacist at a hospital in central Indiana. He can be reached at 

Maybe the best way to change the environment in pharmacy is to have an old-fashioned '60s-style protest