Mark Burger owns Health First! Pharmacy and Compounding Center in Windsor, California. He welcomes your questions and comments at Mark@healthfirstpharmacy.net.

Mark T. Burger, PharmD

The New Pharmacy: Revenue streams, Part 1

," we outlined some of the steps you can take to research the New Pharmacy approach to professional practice. In 

, we examined a different way to elicit patient information and analyze physical states. Now let’s go right through the pharmacy door and take a look at some of the nuts and bolts of your daily routine.

	Here’s the first rule: Set yourself up to succeed. Pick your patients carefully. Not everyone is your patient. Not everyone wants to participate in their own healing. Not everyone is going to listen. Not everyone can afford your fees - and some won't do anything that isn't paid for by insurance.  

	Some patients “inhabit their illness.” Some patients have been thoroughly brainwashed. Some patients are too complicated for you to help. Usually these are patients who aren’t honest or are in some type of denial, or are playing a game of “I need attention.” Google “Munchausen Syndrome.” Learn to recognize it. Avoid patients who have it.

	This is called triage, and sometimes newly minted, high-minded young pharmacists, eager to serve humankind, find it difficult to carry out. But you can't help everyone.

	Spend your time with the motivated patients. Explain that you are not a doctor, so you can't give them a diagnosis, but you are pretty sure you can improve their health. Don't try to be the doctor ... be the pharmacist - the New Pharmacist!

See also: The New Pharmacy: Revenue streams, Part 2

	The following pointers are in daily use at our pharmacy, Health First! Pharmacy:

 from involved questions at the register. They should know what your limits are for answering questions at no charge and when those questions suggest a consult. Teach them to recognize the long storyteller and to ask nicely, "What is your question?"

	Your employees are your shield. Without them, you will never get your work done. If you don't give them tools for handling patients, they will never get 

, or subscribe to a cloud-based service that has one, with access points for your clients to log in, answer the web-based questionnaire, post their answers where you can evaluate them, and print out teaching docs, graphs, symptom burden lists, etc. [If you want the names of a few applications, e-mail me and I'll send you the links.]

 on your consultation fees. This guarantees that patients won't cancel on you, wasting your time. The same practice applies to seminars: Collect in advance. No refunds.

 (e.g., the maximum number of consults/day and the time of day for consults that 

 prefer). Post your fees. Offer patients the option of going 15 minutes, 30 minutes, etc. Ask them what 

 want to do. If they are only willing to give you 15 minutes, do the best you can. At 15 minutes, wrap it up as best you can, or ask them whether they want to go another 15 minutes.

	If you've done an honest job of educating them, captured their interest with solutions, shown them that you know what you're talking about, and sold yourself as a caring pharmacist (which you 

!), then they are likely to buy enough time to get to the answers with you.

5. Make sure that patients send you their completed questionnaires

 at least 24 hours before the scheduled appointment.

 the day before the appointment to remind them. â¨

9. Consciously develop a skill for "knowing"

 whether your clients want to hear the â¨explanations or just the solutions (i.e., you tell them what to do and they do it). Using the right approach with patients will save them money and frustration. Also tell them, realistically, what you think you can accomplish in the time allotted to the consultation.

10. Always ask for and document the names

 of each patient’s primary care physician and medical specialists.

 that can be easily uploaded and shared with patient and physician. We use the Smart Pen (aka Echo Pen) by 

	A colleague of mine in Columbus, Ohio, uses a free medical charting system developed by The Ohio State University that lives on the Cloud. He sold his compounding pharmacy, by the way. Many physicians refer patients to him every day, and he spends 8+ hours each day on consults. This will happen to you.

 Learn how to SOAP (Subjective, Objective, Assessment, and Plan) and use the POMR system (Problem Oriented Medical Record system). It will help you to problem-solve.

13. Don't be afraid to recommend products

 that you sell or lab tests that you stock. Remember that when a pharmacist suggests a lab or a supplement, it means a lot to the patients. They have a lot of trust for and confidence in your advice. Don't abuse it.

 in 8-12 weeks. State what you want to accomplish with it and suggest a time.

15. When you get too busy, raise your prices

. You will lose patients, work less, and make more money. This is called "market pricing."

	You should hear the complaint "Your prices are too high!" or "Will my insurance pay for this?" at least once a week. That is how you know your worth - and know that you are not leaving any money on the table.

	Remember: You are "too busy" because you are getting results and the world is beating a path to your consult room.

Next month: “The 80/20 solution ... a case study.”

owns Health First! Pharmacy and Compounding Center in Windsor, California. He welcomes your questions and comments at

Articles

In Part 3 of "The New Pharmacy," Mark Burger takes you through the daily checklist of a successful practice.

15 keys to the New Pharmacy

 arrived in my mailbox. The title that caught my eye was: “The Evolution of Alternative Medicine.” I wasn't hopeful. As a pharmacist who practices compounding and functional medicine, I was ready for the usual slam: "It's not science!" "It's snake oil." “There is no 'proof.'” "It's just Big Supplements making $$$$ off unsuspecting people," etc.

	Except it wasn't. The subtitle read: "When it comes to treating pain and chronic disease, many doctors are turning to treatments like acupuncture and meditation - but using them as part of a larger, integrative approach to health."

	A perfect lead-in for what I propose to offer as Part I in a series that I hope will inspire pharmacists who are:

	A. Beginning their careers and seeking an alternative to chain-store pharmacy;

	B. Older pharmacists who are on the other side of that career choice and looking for alternatives; or

	C. Members of Choice A who want to partner with members of Choice B and really do some damage as a Choice C Team.

See also: Drugs or lifestyle changes? Are pharmacists pill-happy?

	Why me? Well, I have a relatively rare type of practice that melds independent/compounding/functional pharmacy into one practice site. We compound. We teach. We sell professional-grade supplements, vitamins, herbs, nutrition, homeopathy (no OTCs). We schedule and charge for consultations in 15-minute chunks.

	We have weekly health seminars that draw 20-50 people, and we charge admission. We sponsor and promote prescribers when they want to give a seminar, and we often give them together: Pharmacist + Prescriber. We act as a clearinghouse, of sorts, for the functional medicine practitioners in our area.

	I hope to awaken in you some interest in this type of practice, so that together we may salvage this noble profession of ours. Really.

) to get a sense of the paradigm shift that is going on - especially if you think this is NOT happening.

 They didn't cover this in pharmacy school or medical school. You probably need some refreshers on normal physiology (à la Guyton), biochemistry, microbiology, epigenomics, and normal GI physiology.

 columns you read in your pharmacy mags ... ditto, if you read medical journals.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It

. (Random House, 2004, ISBN 9780375508462; Marcia Angell was the first woman to serve as editor-in-chief of the 

 I’m serious. You don't necessarily need a pharmacy, but if you must have one, a compounding, cash-only, independent pharmacy would be ideal. If you need the “traffic,” ask an independent if you can rent/use space in his/her pharmacy. The indie might welcome you as an added benefit for patients.

Subscribe to some functional medicine newsletters,

Natural Standard: The Authority on Integrative Medicine

. It's inexpensive, considering the solid information it provides. You won't be sorry.

 and have paid off your pharmacy school debt and you want to get an advanced degree, you have several options (including a two-year online master’s degree in natural products, offered by a prominent school of pharmacy), but I don't recommend it. I don't think you need two or three more years of school and $20,000 more in debt to practice the way I am proposing. You've paid your dues! You’ve 

	Still listening? Interested? Send me your comments and I'll elaborate further. (Rule One: Don't give them 

 the answers the first time out. This goes for 

 future seminars too. You want them to come into the pharmacy to complete the transaction). Stay tuned!

If you're a pharmacist looking for another route to success, satisfaction, and reward, start here.