The future of community pharmacy

Truman Lastinger recently posed the question “Is community pharmacy a dying profession?” [DT Blog, December 2014]. Here is how I would answer him.

As a profession we worry too much about that elusive provider status. Charlie Brown kept trying to kick the football, to no avail. In the pharmacy profession, we are not that much different. We have been talking about clinical pharmacy and pharmacist services for 20-25 years now. Maybe more.

Definition and value

The primary problem for the pharmacy profession is not that some insurance company is not giving us money. It is much simpler than that. As a profession, we fail to effectively define what we do, and we fail to demonstrate it.

 I’m not saying that there aren’t thousands of incredible pharmacists out there doing great work. I’m just saying that collectively we have failed as a profession to define and demonstrate what we do.

Secondly, we have failed to establish value for it. Out of the thousands of pharmacists mentioned above, only a few hundred or so actually assign value and ask for it. We can get paid for our services; we just don’t believe we should - not enough to charge for it, anyway!

See also: Is fee for service dead?

Chiropractor and optometrist services were not covered for years, but that didn’t stop chiropractors and optometrists from charging for them. Come to think of it, for many years dental services weren’t covered either. Even now, in 2015, there is limited coverage for many services delivered by dentists. But we still pay for them.

I consult with pharmacies all over the United States. In many instances I hear, “He/She’s in a room with a patient right now,” and I think - wonderful! Then, when I ask whether they charge for such services, the answer is a resounding “no.”

Many years ago, I worked for a retail chain. In my experience, patients were willing to pay me and did pay me for some of my services.

If we plan on sitting around and waiting, or lobbying our senators and legislators for provider status, we might just be trying to kick the football for another 20-25 years!

Simple answer

To my way of thinking, the answer to our problem is relatively simple:

• Define what you do. Be able to recite it in an elevator speech (30 seconds or less). Then truncate your message to just 9 seconds, because that’s about as long as anyone will remember.

• Now talk about and demonstrate what you do with fervor - first with your staff; then with your patients and their nurses, PAs, NPs, and doctors. Be consistent with your patients. Tell them what you are going to do for them. Then do it. Then show them what you did for them. You may need to write it down for them. Ask them to follow up and see you in a few days, if necessary. Mail-order-pharmacy threat? Poof!

• Develop a business plan. It does not need to be elaborate - just have one!

The response I heard most commonly when I met with patients was “How much do you charge for this?” What will you say when they ask you? If your answer is, “Aw, shucks … nothing!” then as a profession, we have a major problem.

It’s up to us

When the senators and legislators we lobby hear about what we do, they may have a hard time conceptualizing it, because every time they go to a pharmacy, all they get is a sack. To return to the football analogy - we get sacked a lot! When Charlie Brown tries to kick the football for a measly three-point field goal, what does Lucy do?

The problem is not that we cannot charge for our professional services. Our problem lies within ourselves. We are required to provide basic consultation on proper use and side effects of prescription medication. Beyond that, there is nothing stopping us from charging patients for advanced services.

We have so many tools available to us. Just look at the APhA website.

Truman is right. As a profession, we must pursue change from product to service. I believe we can achieve that goal.

Mark Jacobs is a past chair of APhA's Pharmacy Work Life Issues Committee. He has published a book titled "101 Ways to Improve Your Pharmacy Work Life" and has lectured all over the country on methods for advancing pharmacy practice.