Understaffed and overwhelmed

February 15, 2010

Patient counseling and medication management therapy: You do the math.

If you are accused of a crime in this country, you have a right to a speedy and public trial. You will probably not get one.

Sound familiar? If not, substitute the words "have a prescription filled" for "accused of a crime," "be counseled by a pharmacist" for "a speedy and public trial," and "healthcare" for "criminal justice" and reread that first paragraph. We have more in common with lawyers than we might like to think.

Run the numbers and you'll see that if you freed the pharmacist from all the lick, stick, and pour tasks of the profession, and if somehow you were able to exempt the pharmacist from taking telephoned prescriptions and getting transfers from other pharmacies, and if the whole day went by without a patient asking a question over the phone, and if you chained the pharmacist to the pickup window to do nothing but counsel, you would need 50 pharmacist hours in that store every day. And that assumes the customers came in at a nice steady rate over the course of 24 hours.

Fifty pharmacist hours will easily cost a company over $3,000, including benefits. Which means that a pharmacy filling a thousand prescriptions a day has to make three dollars a prescription just to pay for a pharmacist's counseling duty. Most insurance companies pay a dispensing fee of around $1.50 per prescription, meaning that we will never come close to being able to give our patients a scant three minutes of our time. The numbers simply don't allow it.

So we don't do it. We do "counseling triage," pulling customers aside to talk to them when we must, making sure they were expecting a painkiller when a doctor's handwriting makes "Celebrex" look a little too much like "Celexa," checking that the endocrinologist knew his patient was taking warfarin when he wrote that Synthroid prescription.

For the rest, we cross our fingers and hope that most customers can be talked out of the time with us to which they are legally entitled. Because if the Bill of Rights of this country's Constitution can't ensure that a nonprofit legal system will provide the rights to which our citizens are entitled, what are the chances that a budget reconciliation act will compel compliance from a corporation that has to show earnings growth from quarter to quarter?

Remember that, the next time your boss tries to get you excited about some new technology or reorganization that will "free the pharmacist to counsel." Show your boss the numbers I just laid out here and announce that you're looking forward to the new pharmacist labor budget of three minutes per prescription. Then watch your boss turn pale and pass out.

I've been hearing about changes that will "free me to counsel" since the day I entered pharmacy, but somehow I had far more time for my patients the day OBRA passed in 1990 than I ever do today. Perhaps it will take a constitutional amendment to get that time back. Or an increase in insurance reimbursement rates. You decide which is more likely.

I'll let you get back to work now. Don't forget to keep saying those magic words, "Did you need me to go over your medicine with you?"

Remember though, you have a doctor holding on line one.

David Stanley is a practicing community pharmacist in California. He can be reached at drugmonkeyrph@gmail.com
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