In this country, the practice of pharmacy is valued in two markedly different ways. Consequently, two different responses are necessary.
Robert L. MabeePharmacists are primary care providers. Through the years they have often been the first healthcare professionals consulted by patients. When it is appropriate, pharmacists can guide patients to seek care from their physicians. For many routine matters, pharmacists themselves can give patients the help they need.
As various third-party payers have expanded their MTM requirements, the role of pharmacists as providers of primary care has grown, to the point that many insurers and government healthcare programs now support provider status for pharmacists. Pharmacists in some states are being paid to evaluate patient profiles and review medications, because their doing so will improve care and reduce cost.
In this country, the practice of pharmacy is valued in two markedly different ways.
Retail chain drugstores consider pharmacists merely expensive employees. The business model of those organizations is to sell more prescriptions in larger quantities, with the goal of increasing gross sales. To maximize total sales, retail chains demand that pharmacists verify and dispense as many prescriptions as possible each day, a process that requires pharmacists to spend as little time as possible with each patient.
This model is unsustainable and has nearly run its course. With more expensive drugs regularly added to the healthcare arsenal, selling those prescriptions with margins below the cost of capital is unsustainable. These operations will be forced to restructure with new financial and practice models.
In retail chains where this model prevails, nonpharmacist managers with little understanding of the profession are frequently hostile toward pharmacists who strive to practice responsible, patient-centered pharmacy. Experienced pharmacists committed to a higher form of professional practice - particularly those who are over 50 and relatively well compensated - have been hounded out of retail chain positions so often that this is now a recognized occupational trend.
Increasingly, medical practices, clinics, and health systems now take quite a different view. Organizations that view pharmacists as essential to the primary care team encourage them to take time with each patient, knowing that this will ensure compliance and eliminate problems. Managers nurture the pharmacists’ practice, regarding them as among the operation’s most productive assets.
When it comes to maintaining a productive work environment, these contrasting attitudes call for radically different responses.
On the east coast, the Teamsters Union is organizing Osco Drug pharmacists and will represent them, a move that foreshadows many to come. On the west coast, various states and assorted carriers are pushing for provider status for pharmacists. Pharmacists need to expand both approaches. This is not a zero-sum game.
Pharmacists working for large corporate chains need protection from potentially predatory management practices. Although resisted by many as somehow unprofessional, collective bargaining may be the only way to combat much of the abuse that passes for management strategies in those organizations.
With the primary care team, integration of pharmacists as providers is based on a business model that puts the patient first. This model recognizes the fact that the most efficient and preferable care for patients is not necessarily the most expensive.
As more of the cost of healthcare is shifted to patients covered by private plans, these patient-consumers will be motivated to save money. The pharmacist provider will not be pushed to increase sales but will strive to optimize outcomes. This will lead to a rational approach to the allocation of healthcare spending.
Corporate pharmacies’ strategy of increasing stock price by encouraging overutilization is unacceptable. It is neither economically nor therapeutically rational. And in the case of government agencies, wasteful spending is not generosity; it is a recipe for economic collapse. The solution is value-based healthcare delivery, and pharmacists constitute a crucial component.
As essential participants in the movement to reduce healthcare costs, pharmacists will help shape the new healthcare economy. The preservation of pharmacists, vital assets to the healthcare team, will require a two-pronged approach.
Pharmacists can be providers. Pharmacists can be union members. There is room for both. And there is need of both.
Robert L. Mabee is a pharmacist and an attorney practicing in Sioux Falls, S.D. He also holds an MBA. E-mail him at firstname.lastname@example.org.