Why pharmacy continues to fail

By | February 2, 2012

I’ve been a pharmacist since 1997. The profession of pharmacy, and therefore the basic principals of the practice, haven’t changed in that time. During my career I’ve worked in six different hospitals (1 in operations, 2 as a clinician, 2 general practice, 1 informatics), one long-term care pharmacy, once as a consultant pharmacist in long term care, in retail for two different retail chains, one community pharmacy and as a relief pharmacist for about a year. Looks pretty bad when I put it in writing. What can I say, I get bored.

I’ve recently been following a thread on one of the ASHP Forums about tech-check-tech (TCT). For those of you that may not know, I’m in favor of it. Why? It’s a tool. A tool to get pharmacists more of what they want, and that is less time spent in direct distribution functions and more time spent working with other healthcare professionals on patient care. I see it as a no-brainer, but there are many that are fearful of such a simple practice change. Of course everyone has their reason for not wanting to use TCT – too difficult, regulatory requirements, “risk”, liability, and so on – but that’s not really the issue. To me the failure to universally accept and use such a powerful tool represents the professions inability to make adjustments to age old practices that will ultimately lead to the failure of the profession. I hope I’m wrong, but unless things change drastically over the next couple of decades, pharmacy will simply vanish under a sea of massive changes in the healthcare environment. There will come a time when a pharmacist, in their current practice model, will be obsolete. Most people don’t like to admit it, but we’re on the edge of such a catastrophic failure right now. Pharmacists are beginning to look for alternate career paths in alarming numbers. I know several bright pharmacists that have moved, or are contemplating a move away from traditional pharmacy practice. Why? It’s hard to say. All I can tell you is that I left pharmacy because it became clear that what I was doing would never make a difference in the overall scheme of things. The practice was so deeply rooted in tradition and fear that alternate theories and concepts were looked upon as blasphemy or akin to voodoo. And, I was bored.

With that said, I have hope for pharmacy. My hope is fading quickly, but it’s there in the back of my mind. Things like ASHP’s Pharmacy Practice Model Initiative (PPMI) are encouraging, although the enthusiasm for the initiative seems to be fading just as quickly as it rose. The PPMI Summit, which was held in November of 2010, pulled together some of the brightest minds in pharmacy to ponder the need for changes to the profession. The result of the Summit was a long list of recommendations designed to help transform pharmacy practice. You can read all about it in the June 15, 2011 issue of AJHP if you’re interested.

More than a year has passed and I still run into pharmacists across the country that have no idea what the PPMI is or that an initiative for practice change even exists. How is that possible? Some blame ASHP, but I hardly think that’s fair. It’s not their responsibility to change our practice environment. It’s yours and my responsibility to do that. Change has to come from the trenches. If you don’t like your situation, then change it. If you’re expecting pharmacy organizations to take you by the nose and drag you into the future, then you’ve got it all wrong. You have to create the pharmacy practice you want. For the record, I do believe that pharmacy organizations can help. They have resources to make changes to laws and regulatory processes that will go a long way in improving the profession’s chances of changing how we practice, but ultimately it’s not up to them to force a change.

My words may lead some to believe that I don’t like pharmacy, but that’s not the case. I love the profession and I like being a pharmacist. I just don’t like the practice of pharmacy. There is a difference. Sometimes I jokingly tell my daughter that I love her, but I don’t love her behavior. It’s an important distinction. Pharmacy is like that for me. And even though I complain about pharmacists, I have great respect for them. There are some really smart people in pharmacy. I often feel quite small when gathered with some of the big names in the profession; they cast a big shadow.

People don’t become pharmacists because they can’t do anything else. They become pharmacists because they want to be pharmacists. What that means is different for everyone, but the pharmacists in the audience understand what I mean. Even though I no longer practice traditional pharmacy, I’m proud of the fact that I went to pharmacy school and have a license to practice in the state of California.

Regardless of my opinion, pharmacy has ultimately defined an endpoint, which is “to significantly advance the health and well being of patients by developing and disseminating a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers.” Unfortunately it’s clear to me that we’ve failed to create an infrastructure strong enough to reach that endpoint. Pharmacists have been talking about what they want for years, and this new round of “change” appears to be little more than talk as well. To paraphase Theodore Roosevelt, “Rhetoric is a poor substitute for action, and we have trusted only to rhetoric. If we are really to be a great [profession], we must not merely talk; we must act big.”

Some healthcare systems have taken the plunge and started the process of investing in the future and changing how they practice. As a result they have become examples for the rest of us. But those examples are few and far between. The ideas necessary to make wide-sweeping changes to our profession have failed to take hold. It’s difficult to say exactly why, but some of the barriers are evident.

The profession is segmented
Pharmacy is a segmented profession. All you have to do is look at the different practice settings to know that I speak the truth. Retail practice seems to focus more on the business, i.e. the money of pharmacy. Acute care, i.e. hospital pharmacy tends to over focus on the clinical side of things. And long-term care pharmacies tend to focus on operations, i.e. how can I make this more efficient. Of course the focus of long-term care is designed to squeeze money out of the process, but nonetheless the result is a highly effective distribution process. There really is very little common ground among the practice settings.

By itself, the difference between practice settings matters little, but when it spills over into everything we do it creates dissension between pharmacists. In fact, I would go as far as to say that most pharmacists stick to “their own kind”. I was taught early on in my professional education to look down on retail pharmacists (not to be mistaken with community or outpatient services). I find myself doing it today even though I make a conscious effort not to. I have friends in the retail world and I find it difficult to feel compassion for them when they talk about their working conditions, the lack of help, the lack of time to consult with patients and all the troubleshooting they have to do with insurance companies. I don’t understand why they do what they do. I’ve tried working in retail a couple of times during my career and each time I’ve quickly discovered that I hate it. That’s why a vast majority of my career has been spent in the hospital setting.

With that said, hospital pharmacist have their own issues. Hospital pharmacists are so focused on being “clinical” that they often forget about everything else. “Clinicians” don’t want to be bothered with operations. “Clinicians” don’t want to be troubled with regulatory affairs. “Clinicians” don’t want to have to deal with billing and business practices because they’re nothing more than a nuisance. Unfortunately the result is an incomplete practice environment. I’m as guilty as the next pharmacist of contributing to this failure. Until quite recently my beliefs were as described above. Even as an informatics pharmacists I always felt inferior to the clinicians. After all, clinicians are the jocks of pharmacy practice, and who doesn’t love jocks.

And what about long-term care pharmacists? There are two types of “long-term care pharmacists”: those that work in operations and those that act as consultants to the care facilities. I won’t talk about the consultants as it’s a fairly unique niche. I did the whole “consultant thing” for a while and quickly became bored by the redundant nature of the job. The consultants could probably be lumped in with the “clinicians” in terms of desires and personalities, but I won’t go there.

Long-term care pharmacy is all about distribution; getting as much product out the door as quickly as possible. And let me tell you something, it ain’t no joke. I spent a year working in a large long-term care pharmacy and it was amazing to witness the efficiency of the distribution process. It would make any retail or hospital pharmacy green with envy. And why are they so good at distribution? It’s really quite simple. They operate on razor thin margins so they have to be as efficient as possible. They make good use of technology and great use of their pharmacy technicians. Hospital pharmacy could learn a lot from a long-term care operations model. As a pharmacist, however, the job is terrible. I spent hours simply standing in one place verifying the contents of punch cards using bar code scanning. Beep-beep. Beep-beep. Beep-beeeeeep! Oops, that one doesn’t match. Send it back through. Beep-beep. Beep-beep, Beep-beeeeeep! Oops, that one doesn’t match. Send it back through. And so on, ad infinitum….. Hours felt like days.

Ultimately if you combined the three different practice environments you would probably end up with a complete “pharmacy model”; clinical, operations, business. I doubt that will ever happen, but integration across the continuum, changes in laws and the automation of many processes are ultimately what’s needed to bring pharmacy together into a global practice model.

Regardless of how things look in the future everyone has to decide on the practice setting that best suits their interests and needs, and that has to be acceptable within the profession.

Lack of strong leadership
Pharmacists are, by their very nature, introverts. I don’t know if the profession attracts them or creates them; chicken and egg argument. Pharmacists tend to work better alone, standing in the corner with a calculator and a pencil working on one difficult problem after another. It’s not simple shyness, but rather the desire to stay away from the masses in healthcare. Like many other pharmacists I prefer to work alone. I don’t like relying on other people to get things done because they will ultimately come up short and let you down. Don’t look at me like that. It is what it is. I didn’t create human nature.

In and of itself being introverted isn’t a bad thing, but it ultimately keeps the profession from progressing; out of sight, out of mind. I don’t like to admit it, but nurses and physicians are much better at cultivating leaders capable of making change inside a healthcare organization. This is evident when looking at the hierarchical structure in a large healthcare system. It’s not uncommon to see physicians and nurses in positions of power, while it is rare to see pharmacists in similar positions. Do pharmacists fear the responsibility of making decisions? Certainly not. Pharmacists make countless decisions every day that directly impact patient care. They take on great responsibility. Nonetheless, it is uncommon to see pharmacists striving for leadership roles, which creates a conundrum because the most effective place to implement change is from a position of power. Pharmacy needs a pulpit from which to preach the message. Without it, pharmacy change will likely not occur in my lifetime, nor will it likely change in the direction of our choosing.

Pharmacy Education
Let’s face it, people that chose to attend pharmacy school aren’t typically looking for a career in finance, business or administration. By in large, people attending pharmacy school want to be healthcare providers. At least that’s what I wanted. Unfortunately pharmacy schools fall short of giving students a realistic view of pharmacy practice. Everything in pharmacy school is sunshine and butterflies. Transitioning form the role of pharmacy student to full-fledged pharmacist is difficult. The reality check brought on by real-life pharmacy practice can leave freshly minted pharmacists bitter and frustrated with a job that is clearly not what they expected. There are ideal practice settings to be sure, but they are rare and do not accurately represent the majority of pharmacy work environments.

So how do we fix the pharmacy education issue? That’s a very good question, and I don’t have the answer. It certainly won’t be an easy fix as one wouldn’t want to give up the current crop of didactic courses and clinical focus in exchange for something else. It will take years to make the necessary changes. Do we have years? Only time will tell.

Failure to understand the business of pharmacy
Ultimately pharmacy is a business. Pharmacists provide two products: information and medications. Unfortunately pharmacy doesn’t get paid to provide information, and thanks to a poor job by retail pharmacies and healthcare systems, pharmacies don’t earn much from the distribution of medications. And that leads to a fundamental problem: pharmacists cost healthcare systems a lot, but they don’t make a lot of money for the healthcare system in return. In other words, our profession has failed to provide a ROI, which makes it difficult to justify potentially costly changes.

As much as I hate to say it, money is power. Pharmacy doesn’t make enough money, and therefore has little power inside the structure of a healthcare system. How many times during your career have you, as a pharmacist, had a problem with a department inside your hospital only to be told nothing could be done “because they make a lot of money for the hospital”? There are people reading this right now nodding in agreement with a smirk on their face because they’ve been there.

Fortunately all is not lost. We have opportunities, but until recently have missed the mark. Pharmacists aren’t trained or educated in the way of the busy savvy executive. Quite the contrary. Most pharmacists I know, including myself, are quite ignorant about business practices. I’ve gone out of my way to avoid the business side of pharmacy. Why? Because I’m a pharmacist. I didn’t get a degree in finance or business, I got a degree in pharmacy. I’m not alone, and that has ultimately resulted in pharmacy leaders that don’t have a clue.

It’s time for pharmacists to embrace the business side of pharmacy. As silly as that sounds it must happen for us to be successful. Without it the profession is likely to end up with “business men” making decisions for pharmacists instead of pharmacists making business decisions for the profession.

Complacency
The mantra of pharmacy should be “if it ain’t broke, don’t fix it“, and that’s not a good thing. The process of making an IV admixture hasn’t changed since we began mixing IV’s. Pharmacy distribution, whether it be in retail or acute care hasn’t changed since its inception. And so on. Sure, we use better technology and have managed to make slight improvements here and there, but ultimately the nuts and bolts of the process remain relatively unchanged over the past 20 years; possibly longer.

We should be asking ourselves what we want the practice to look like and work backward toward a solution. I guarantee you that solution won’t be what we have today.

No players at the table
I’ve been part of several pharmacy projects. Nothing strange about that. However, in a majority of those projects the person in charge wasn’t a pharmacist; that’s a little strange. Why would a non-pharmacist be in charge of a pharmacy project? The only thing that makes sense is that pharmacy has little to no power inside a healthcare system. The reasons are basically what I’ve outlined above, i.e. lack of strong leadership, incomplete educational structure, failure to understand the business of pharmacy and complacency. When pharmacists aren’t making decisions that impact their practice environment there’s a problem.

Lack of communication
There are basically three ways that pharmacists communicate: 1) conferences, 2) through literature, and 3) directly with one another through email or other electronic means (texting, social media, etc).

Conferences are great for gaining new practice insights, but they fail to muster the right atmosphere to talk about change. When pharmacists attend the ASHP Midyear Meeting, for example, they are there to learn. They go to see what’s new to the practice; most commonly clinical practice. To drive change organizations like ASHP would have to create something like an annual PPMI Summitt and make it open to anyone that would like to attend. I’m not sure that would actually do much good, but it might be worth a try.

Literature is quite possibly the most poorly designed method for communication in the digital age. Journal articles are often out of date by the time the information is published. The process is too slow to be an effective means of communication. In this day and age I find it incomprehensible that journals can’t push out information more quickly. In addition to the glacial pace of journal publications a subscription is typically required for access. This creates yet another barrier to the information. Information should be readily available for free (we need an open source pharmacy information movement – discussion for another time). Plenty of information can be found online, but you have to be willing to dig, and most people aren’t.

And finally, pharmacists communicate directly with each other…on occasion. There are two problems with such a strategy. First, your information is only as good as the smartest friend you have. Don’t get me wrong. Some of my pharmacy friends are brilliant, but there’s always someone smarter and odds are I don’t know them. And second, you tend to befriend people that have like opinions and thoughts, which ultimately limits the scope of one’s search for enlightenment. Introverts, remember?

Unwillingness to be bold
The theme throughout much of the PPMI Summit was to “be bold”. Unfortunately the profession has not only failed to be bold, but they’ve crawled under a rock since the initial flutter of activity following the PPMI Summit. I hear things about the PPMI occasionally, but it’s less and less often as time goes by. We don’t have to constantly talk about the PPMI, but it would be nice to hear a lot more about change.

I follow a lot of pharmacy discussion on various forums, websites and social media platforms and I don’t hear much about radical changes. It is increasingly rare when I see real thought provoking discussion about expanding the practice and moving toward the future. A majority of pharmacists are simply trying to find better ways to do the jobs they have. I certainly can’t blame them because that’s all most people want. But then again we’re a profession in search of significant change.

And there you have it. All we need to do is develop strong, well spoken, charismatic, highly educated, business savvy, well-rounded, bold pharmacists. Sounds simple enough.

30 thoughts on “Why pharmacy continues to fail

  1. The Cynical Pharmacist

    Wow, I thought I was the only one who has these thoughts. Sometimes I wonder if it has something to do with age since I don’t hear many other pharmacists willing to “yell it like it is”, or if they haven’t yet figured it out.

    BTW, while some people might think working in so many different places “looks” bad in writing, but that variety give one tremendous insight into what’s happening throughout the profession, and helps one to be a better pharmacist, and see things in a better light.

    Here’s my opinions –

    I agree with you that pharmacy is on a precipice of massive change, and like everything else in this world, it’s all about money and power.

    Subtle clues convinced me that it was headed this way long ago. If one reads the various medical, nursing, and pharmacy journal articles, it’s easy to notice. The medical and nursing journal articles NEVER have authors telling them what their roles should be, or how they should practice their profession. Almost every other pharmacy journal article has the phrase “the role of the pharmacist” somewhere in it’s description. It seems to me that we’ve always been desperately looking to find and describe a role for us since 3rd parties came into the picture. Now, it’s supposedly MMT.

    These articles also point out a reason why pharmacy is so fragmented and why we haven’t fully been able to communicate with each other and work together. These same authors are often “telling” pharmacists “how” they need to practice their profession, as if we are beneath them instead of being their equals, or like we aren’t capable of doing it right. It sends a negative subconscious message to other pharmacists.

    In my experiences, pharmacists also waste inordinate amounts of time competing with each other contemptuously in order to prove to themselves that they are smarter, richer, or somehow “better” than the “other” pharmacists. It seems that way since I’ve been a pharmacist, and I first experienced it in school. While we were foolishly fighting with each other about what pharmacists should be doing, how to do it, and who’s better, the profession’s enemies did away with us.

    Like they say.. divide and conquer.

    Also, while we were bullshitted by our leaders years ago that technology will “help” the pharmacist, I believe it will eventually replace us. If you ever visit or work for a PBM, you’ll see that robotics has already replaced pharmacists, and the BOPs give them special preferences because of their robotics are more accurate. Think about this too – how many hospital pharmacists do you know whom carry smart phones or other hand-held devices that they automatically pull out when asked a question by a doctor or nurse? Everyone, right? So, what’s to stop those other healthcare providers from doing the same thing? Why try to find, and consult with, the pharmacist, especially one they don’t like, when they can use the same devices the pharmacist does, but quicker and with less effort?

    The same goes with community pharmacy. It’s “been” a given that third parties, and some of our chain “colleagues” have already, and will finally, make it so that no individual pharmacist can make a living through “legally” operating an independent pharmacy. Even the chains are finding it difficult now.

    In chain pharmacy, everything has become automated and computerized, with improving capabilities being discovered daily. Corporate powers concerned with the bottom line, again with help from some of our “colleagues”, have enabled technicians to take over our traditional roles altogether, and have almost fully pushed us out of the pharmacy. So, where are we to go?

    Of course, our “colleagues” in higher education, probably fearful of losing their jobs, or of having to work front line positions that they may consider “beneath them”, try to find ways where the system can use pharmacists. Again, we don’t have a defined role anymore. It’s always changed throughout the years, and like I said before, now it’s MTM.. or what I like to call “babysitting”.

    But, of course, we are not “smart enough” or “capable enough” to handle that job. In order to teach us to be almost as equal to our journal colleagues, we must pay higher tuition rates, enlist in residencies and become certified. Instead of 6-years of college education we have, we’re now “unofficially” required to have 8-years or more of education in order to considered “good enough” to provide the same services we’ve been already providing for years.

    So, now that would give us the same amount of education required to becoming a physician – someone considered a “provider” by Medicare, someone who can bill insurances for their services, a decision-maker, someone who is able to make their own treatment decisions and prescribe, or even someone who can command an equally-educated pharmacist to be his/her handmaiden.

    If you ask me, why spend the time and money becoming a pharmacist instead of a physician, or why not even spend less time and money becoming a nurse, whose roles are already defined, and who seemingly have the ability to bring their profession together as a whole?

  2. Jerry Fahrni Post author

    Thanks for the thoughtful comment, TCP. You make some great points, including a couple that are obvious to me now that you point them out. I find it interesting that MTM has become a popular battle cry for pharmacists when, in theory, front line pharmacists should be doing medication management with their patients each and every time they see them. Of course that assumes that the retail model is completely different than it is in reality.

    I do believe that technology will eventually replace much of what we do. If it wasn’t for laws requiring pharmacists to be present, retail pharmacies would have rid themselves of the expense long ago.

    Pharmacy is a conundrum to be sure.

  3. The Cynical Pharmacist

    Legislators and our “colleagues” who are “appointed” to the various BOPs will soon make sure that those laws are changed to benefit the corporations.

  4. Recent Graduate

    I just happened upon your blog Mr. Farhni and I am simultaneously elated and saddened; elated because you’ve expressed my opinions of pharmacy so clear and saddened because I’m a recent graduate of pharmacy school and I’ve already determined that I will be returning to school within the next year (or two) to peruse a different career path. I’m considering obtaining formal training in the tech world and, hopefully, mending such training with pharmacy. We’ll see.

    I was going to comment more on this magnificent post. But you can read my two pharmacy opinions here:

    (1) http://baheyeldin.com/khalid/why-retail-pharmacist-is-a-bad-career-choice.html?page=14

    Scroll down to “You Have Given Me Hope! Part II”

    (2) http://forums.studentdoctor.net/showthread.php?t=940386

  5. bigdinthed

    Our timidness and complaining like you said will get us nowhere. Yes boldness and we need to have and maintain self respect. Doctors are by nature arrogant and cocky and egocentrical and if not, those around them cow tow to them. But they also have one of the most poweful rganizations and lobbyists out there with the AMA. Ours fails in comparison. And even the jocks(our surgeons of pharmacy) the clinical pharmacists hold nocandle to a snot nosed physician internor soon taught to look down on us, when they should be intelligent enough to know we are experts in our focus. At least we can forgive the public patient who is more uninformed about their comsumers issues placed on the retail pharmacist such as pbms insurance mfg. physician choices and errors- which made the once trusted and respected pharmacists the messenger to shoot. We need to start being cocky and emphasize our superiority in our knowledge not amongst ourselves or amongst our fragmented pharmacy practice but to the rest of the healthcare industry. Dont worry our hardest attempt at adpting that attidude at best would still end up being on the lower arrogant scale of doctors and nurses. As you well put, we need to direct change to our own profession so we need to first internally then as a group respect ourselfs fully inorder for others to begin respecting us and seeing us as leaders demanding and empowering change.

  6. Jerry Fahrni Post author

    Well, I can’t disagree with anything you said. You make a valid point in regards to the power of the AMA, and in turn the lack of our power through various pharmacy organizations. The emphasis on our knowledgebase should begin in pharmacy school and continue as we enter the workforce. Unfortunately it will take years (decades?) to reverse the damage that has been done; if it can be reveresed at all. Thanks for taking the time to comment. – Jerry

  7. Dan Gardner

    Sir,

    I just stumbled across this post. I have been practicing pharmacy for just over twenty years. In that time I have seldom seen a more thorough and cogent synthesis of the challenges facing the profession. I am relieved to finally hear from someone who sees the necessity of pharmacists understanding and embracing ALL aspects of the profession – business, clinical, distribution/operations. I would add technology and IT to that list. My generation of pharmacists was largely taught a distributive role and the early stages of clinical practice (1991 graduate). Most real pharmacy was learned after graduation through hard experience. Clinical skills were largely learned through direct experience. Today I am concerned about pharmacy education. A surplus of new schools and all the long standing schools have entirely invested in the “medical model” for the profession emphasizing “clinical” practice over everything else. The clinical training is very good, but has some of the baby been thrown out with the bath water? Should the new bath water include substantive (not cursory) training in pharmacy business, information technology, pharmacy operations. The reality is, and will continue to be, that most pharmacy jobs (I have largely a hospital background) will require several such skill sets. I want to hire, and work with pharmacists who can and will do what is required to provide care and services. Experienced pharmacists who have not embraced at least some clinical skills, newer pharmacists who refuse to learn operations, and all of us who like to pretend that pharmacy/healthcare is a calling and not a business all severely limit our own futures. We must all be willing to learn some new tricks and embrace new technology. We are a small profession compared to our medical and nursing colleagues and thus not as politically powerful. Still we have an important role which we must emphasize. I still see a future for the profession, but it will not likely be quite the one expected. It will not be purely clinical, or purely distributive, or purely a profit driven business. It will be all three, leveraged by rapidly advancing technology. There will be demand for fewer pharmacists, but they will have to be better trained and more adaptable to new challenges.

  8. Jerry Fahrni Post author

    Thanks, Dan. I appreciate the feedback and your thoughts. – Jerry

  9. RightNextDoor

    I was a retail pharmacist for almost ten years, always regretting my chance to work in a hospital. Then my chance came; it was a lower paying job at a dying hospital. They needed someone quick and a friend of mine called me if I was interested. I took the plunge and never looked back. I enrolled in NTPharmD program. The hospital that I worked was small and the clinicians that worked there were mediocre at best. The ICU doc and I would always team up. This is how I made my bones. Six years later, I am now BCPS and work at a very large hospital as a senior clinical pharmacist.I do not let any doctor belittle me or question my science– ever. Yes, I have embarrassed physicians in front of their colleagues when they start to be cocky and stupid. I have them trained to never do therapy battles with a clinical pharmacist. On the same token, I never give an answer in a subject that I don’t know. The problem that I have now is that they go out of their way to seek me out for answers, even if they are not in my department. The moral of the story is that, you will never be seen as an equal unless you behave like one.

  10. Jerry Fahrni Post author

    Congratulations on your transition from retail to hospital practice. I appreciate you telling me your story. It’s not often that I hear of someone doing what you did, especially making the transition and being successful. Here’s to your continued success.

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  15. Mary Moore

    Great opinion article.

    I have practiced pharmacy for 24 years…and it has always been like that.

    My most recent position is with a big company associating with another big company and we were bench marked to other long term care pharmacies.The sad truth, however, is that we had a 40 year old COBAL-based pharmacy program that is constantly being patched together. Our department was closed because we couldn’t compete.
    Currently, I am actually looking at different careers…and I’ve worked as a clinical, consultant, customer service for PBM, hospital, retail, etc. But, I, too have become bored and frustrated.
    Still, wish me luck. Being 48 and looking for a new job isn’t that fun!

  16. Jerry Fahrni Post author

    I appreciate the feedback, Mary. Good luck on your search. It sounds like you have enough variety in your career to land on your feet doing something interesting. – Jerry

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  19. Brian

    Very well presented opinion piece. Cogent and a concise treatise on the state of modern pharmacy. I’m not an American pharmacists but most of what you describe is equally applicable to my locale. Nicely done.

  20. Pharmy

    I stumbled upon your blog looking for career advice on gaining informatics experience and felt real comfort in finding another pharmacist with similar career experience as myself.

    First off, I have been a PharmD for 14 years. My CV is similar to you in that I have worked in several niches of pharmacy. I have been a hospital staff pharmacist, home health, clinical, nuclear, LTC, etc. Like you, there was an element of boredom in going from job-to-job. Truthfully, there was also an element of unreasonable expectations for these past jobs (thankfully I have grown up) and I do regret leaving one or two of the jobs.

    I agree with you that working in multiple aspects of pharmacy gives a pharmacist a “global” perspective of pharmacy. As health changes and evolves (e.g. Obamacare), pharmacy needs to meet the challenge to survive. It is my opinion that the nature of some pharmacists (e.g. introverts and complacent)really makes progress difficult. In general, some people are really fearful of any change that requires work. I have a hard time understanding management or colleagues who are unwilling to entertain new ideas for doing something when the process is not “broken!” People often forget (myself included) that the initial struggle and effort has the potential to change workflow for the better. Do not get me started on the technophobic pharmacists I work with who refuse to use e-mail or learn our information systems LOL!

    I am not knocking the field of pharmacy, but I think we could do better. Personally, I find the IT aspect of pharmacy more engaging and am currently in a masters certificate program to hopefully help me transition into the field.

    Thank you for a great opinion piece!

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  25. Brian Bagyenda

    Hullo dear colleagues.

    Interesting comments here! To my American colleagues, let us dive into the genesis of pharmacy in USA.

    William Proctor, the father of pharmacy in USA made a great strive for our pharmacy profession when he together with pharmacists at Philadelphia College of Pharmacy ACTED and defied the notion of pharmacists being taught by physicians. they won the battle and the college of pharmacy became independent of medicine. that was in 1821.

    what we need in pharmacy is such ‘father of pharmacy’ figures in positions of responsibility in our pharmacy professional bodies.

    To add on the concerns raised, it is imminent that pharmacists are becoming strayed to middlemen entities in the pharmaceutical value chain. How? While the apothecaries from whom pharmacists took over, made herbal extractions right from the fields, pharmacists of today simply stand to receive herbal materials and process these. In addition, there is a false acceptance in the community of so-called herbalists. Surely, we see that drugs are made from herbs but we are looking on as people misuse the word herbalists/herbal drugs to refer to supplementary medicines. Nutriceuticals/supplements are made mostly from herbs but because of no ACTION from pharmacists’ representative bodies, these are emerging as a seperate practice from pharmacy. Look at the example of genetic modifications/bioengineered health solutions. What niche do we as pharmacists seek to be recognised by? It is definitely the niche of providing healing for maladies.

    Simply put: our ideology as a mass needs ‘father of pharmacy’ figures to be directed advantageously.

    We are not in cheap rhetoric here, we want action. let us join our efforts together and we shall salvage our profession.

    WE ARE ENGINEERING CHANGE FOR THE BETTER OF PHARMACY TAKING FORWARD THE MISSION TO BANISH MALADIES.

    Regards to you all.

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  30. Pharmacy student

    Another one think like I do, hope I can change my proffesion

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