Group practices for pharmacists: An idea whose time has come

January 1, 2009

Group practice can be a fulfilling alternative to corporate drudgery. Each participant brings skills that strengthen the whole. Retail, long-term-care, and institutional pharmacists can combine forces and succeed.

Key Points

If we work in a hospital, long-term care, or home-infusion pharmacy, we may worry about what shift we work, whether our position will be sent back to the basement (central pharmacy), and whether there will be enough pharmacists available to help with the afternoon avalanche of medication orders funneling into the pharmacy at the beginning of the second shift or late Friday afternoon. Again, this may be fine for some pharmacists, but it is not fine for others.

If we don't like an unvarying environment, we can always work for an agency and work somewhere different every day, if we wish. Show up for work, get paid, find a place we like, leave the agency for our favored contracted workplace ... and then ... see above.

I have had experience with three successful examples of group practice. The first was a combination format with four pharmacists providing home infusion, durable medical equipment, and outpatient pharmacy services. The second, a long-term-care group, was devoted to nursing-home chart review and consultant services to nursing homes, assisted-living facilities, and medical practices/surgical centers. The third was an integrated pharmacy practice within a large medical practice providing chemotherapy, institutional, and outpatient services.

Though very different practices, all are in essence groups. All leveraged the different talents of the pharmacists in the group. Each pharmacist had a specialty and was able to cover at least one other specialty as the need arose. Because these organizations were multidimensional in the provision of services, multiple revenue streams limited the financial risk. Two of these organizations still exist and are expanding their practice; the other was bought by a larger company.

Suppose 10 pharmacists form an "S" corporation. Each provides $10,000 in startup capital, ie, 10 percent of the business, whether it is a group practice owning an independent retail pharmacy or a group of pharmacists contracting out verifying orders for a small rural hospital. Each "owner" could buy a larger stake in the company or sell shares to others either in the company or wanting to join. As the practice grows, equity grows. Business opportunities can be addressed as they come up, using the pooled talent and resources provided by the owner-pharmacists.

Practice models could include retail, long-term-care, and institutional pharmacists in any combination. Models exist in law and medicine - even in pharmacy. To limit financial risk, group members can work part-time while working part-time with a chain or local hospital. As the company grows, those members who wish can devote more time to the group practice. In time, all within the group might find a niche that is professionally and personally rewarding. If not, there are always other alternatives ... see above.

What happens if the venture is unsuccessful? First of all, increasing medication use and changing demographics should be obvious to all pharmacists; there is a demand for our services. How many new pharmacy schools have recently been created to help satisfy the demand for pharmacists? Second, risk is inherent in everything we do. With ownership of a pharmacy practice, at least the possibility exists that the investment can grow. It also gives one some control over one's profession and work environment.

Smaller groups, though at a capital disadvantage compared to large organizations, are more nimble and can exploit gaps in the market the big entities either miss or are ill-equipped to take on. Every successful group I have been associated with or have observed has been able exploit these gaps by fulfilling unrecognized demand for pharmacy services.

With increasing patient-care responsibilities and armed with CPT (Current Procedural Terminology) codes, practice models are limited only by our own imaginations.

Michael J. Schuh is an ambulatory pharmacist at the Mayo Clinic Department of Pharmacy, Jacksonville, Fla.