Lo Chi Pride

 

For the uninitiated, Rho Chi is the organization that rewards those who academically perform well in pharmacy school, and then grant them with acceptance into their prestigious organization.

When starting pharmacy school, it is presented to you as one of the crowning achievements of your academic career. It is only when you finally become buried in the life of a pharmacy student that you realize what an actual farce this is.

In my experience, those who are in Rho Chi typically don't know what the hell they're talking about in practical situations. Sure they can recite every side effect of lamotrigine and they may know proper UHF dosing guidelines in a patient with VTE or ACS... provided everything is answered on a scan-tron form.

In a real world setting, most often emulated via our case studies, these successful "methods" no longer apply. Therapeutic suggestions are aimlessly justified because of what it said in a slide. Or, even worse, they won't know what a specific agent is or does, as they merely memorized it for the exam.

These are the "elite" pharmacy students we are told we should strive to be. It is the first of many seemingly unimportant carrots that are dangled in front of us as burgeoning pharmacy students.

Yes, this is a generalization and there are several Rho Chi members who do not fit this mold, but it still does not change my belief on the illegitimacy of defining success in this manner. As practitioners, we will not see success because of our ability to remember minute details, we will see success based upon our ability to logically apply our knowledge in practical situations

So you know what, I'm damn proud to be part of Lo Chi.

I may occasionally meet the average for exams, and even more rarely exceed it, but at the end of the day I know that I will still be a damn good practitioner.. perhaps one better than those Rho Chi members.

For the rest of you exhausted pharmers, aching for the end of the semester I say raise a glass of your favorite booze/caffeinated substance and toast the recognition of the most truly glorious organization in pharmacy school.

Lo Chi Pride!

Where Is The Passion in Pharmacy?

While struggling through my undergraduate years, what stoked the fires of my soul was pharmacy. I loved every minute of being in one and would do everything I could to absorb myself in the profession. My desk was littered with trade magazines, my computer flooded with pharmacy websites and even this little site here was born out of this fit of passion.

And while time was worn on and I find myself questioning that passion at times, it nonetheless is still flickering. The new fire in my life is my family, but becoming a pharmacist is ingrained in my being after my experiences these past ten years. It is, in many way, what defines me not only for myself, but for many of the people who know me.

So why do I not see this in my classmates? Why do I not see this in my co-workers? Why do I not see this in the majority of pharmacists, 63 and counting, that I have worked with over the years?

Where is that passion in others that drives me each and every day?

It is out there, fleeting as it may be. No matter where I have found myself, I have always had a pharmacist near by who truly cared about the profession. They saw what I saw, yet felt our hands tied in numerous situations.

My classmates seemingly go through the motions of school, jumping when professors say jump and barking when they say bark. Excitement is extruded over cute little informational clinics, the next frat get together, or the idea of an exam being over. We are tested on regurgitating classes of drugs, signs of a disorder and how to dictate a therapy.

Yet there is no passion in these discussions. For many, it's just more school... a means to an ends if you will.

Again, there are those who feel this passion, who want to see change or wish to envision pharmacy as something more than it is right now. Perhaps it is not as surprising that those of us have found each other to varying degrees as we, more or less, stand out within the class.

But we need more passion.

The disillusion in the profession still astounds me. Retail pharmacy is slowly devolving into a profession of puppets, only doing what corporate lays out for them to do no matter their desires. It is almost as if we are living in a George Orwellian 1984 and information is relayed in pharmacy doublespeak.

"Give more flu shots! Push for 90 day supplies! Obtain new patients!.... But we're going to cut your hours by 20%"

"Patient's are of the utmost importance to our business!... But you're going to be understaffed, only allowing you to spend a brief moment, if at all with them."

It is as confounding as it is frustrating. And I can completely understand why those who say they came out of pharmacy school ready to change the world, only to have their hopes and dreams squashed by reality.

My question is why give up? Why let that passion die? Why must so many pharmacists and students be so apathetic?

"Time is the fire in which we burn." - Delmore Schwartz

Above is one of my favorite quotes that I use as a reminder that our time is ultimately limited and that we need not waste it with frivolous activities. Live life and have fun, but do not waste it away merely doing what corporate says.

Find that passion. Fuel it and stoke its fires. Take that extra second with your patient not only to show you care, but to show yourself that you can do what you want.

We do not have to be pawns in a corporate game. We are professionals and we deserve to be treated like so. Stand up for what you believe is right and where you're passion for pharmacy proudly. After all, they can only ignore it for so long...

The Death of Angry Pharmacy Rants

No, The Angry Pharmacist is not dead... okay well maybe his soul is dead, but his body is still kicking out little amber vials at an inhumane pace.

I started this blog over four years ago partially to centralize my interesting stories from work and partially to partake in the large amount of pharmacy bitching that was present on various websites. I'll never forget the day I first stumbled upon TAP and Drug Monkey's website. The feeling of "You mean I'm not alone?" spurred a smirk as I realized others had the same thoughts as I.

And I loved it.

Finally pharmacists, technicians, students and any one else related to pharmacy had websites where their frustrations could be viewed in colorful and often humorous tones. Many others tried to emulate the original sites, while few truly succeeded. As a profession, a proverbial bitchfest took place day after day on the internet as a means to vent.

And we all loved it.

Four years later though, where are we? The tone of this site has changed dramatically over the years, and something similar is seen on other sites. While the frustration and bitterness is still prevalent through blogs and other outlets like Twitter, it's nowhere near as resonating as it once was. The knowledge that we are not alone is no longer a source of relief, but a part of daily life.

And we all became used to it.

The question becomes, what now? Witty and spiteful posts are often been replaced by more demonstrative and action-oriented posts as shown by Eric, Pharmacist and The Readheaded Pharmacist. One could say that substance is slowly replacing style and it seems as if there are the beginning flickers of a collective voice for the profession. Something APhA, which has been covered numerous times, lacks the ability to do so.

And we all want more.

Perhaps the next step is providing substance towards are frustrations. To focus it into something productive and produce actual change. Many pharmacy bloggers are attempting to do just that and, if the conversations I have had from APhA are accurate, they are beginning to be heard. The time for angry pharmacy rants is ending, being replaced by something which may ultimately be even more fruitful.

And we all will love it.

It is a scary thought how a few late night, profanity laced tirades could propel a, perhaps, legitimate push to change our profession. Evolution often takes a winding and unpredictable path, yet usually leads to a superior result. My hope is that our current trend continues because it holds the promise of yielding true change in our profession, albeit in small amounts at first.

And we will all finally be happy.

A guy can dream after all can't he?

Does APhA Really Represent Pharmacists?

Tonight I was playing with my son with the TV on in the background when a commercial splashed across the screen. Immediately I stopped what I was doing and watched, jaw slightly agape, at what was on the screen.

What was it you may ask? Take a look for yourself:


Beautiful is it not? Even more so when you go to the actual YouTube page and read the purpose of the advertisement. It truly is great to see a professional organization be assertive and stand up for their profession. Clearly the AMA will not sit idly by and wait for change to come to them.

Bravo for that.

Now wouldn't it be great if APhA did the same? Between the health professional organization trifecta of the AMA, APhA and ADA, the APhA is often the silent partner. Whereas the AMA and ADA are very active outside of their practitioners and have a very broad public awareness, few outside of our immediate profession even know what APhA is.

It's one of the topics I have pushed several times on this site in the past and will continue to do so until someone actually listens. Recently I discussed the distressing notion that a business oriented enterprise is, in effect, leading our profession to change for their own selfish reasons.

It is something which has even been brought up in publications like the Wall Street Journal. Interesting how those even within the profession see the massive amount of benefit of the idea I laid out, yet APhA does not seem interested in actually following through with it.

It is this which is the most distressing aspect of pharmacy as a whole. In school and by APhA we are repeatedly told about the "future" of pharmacy, but in reality there does not appear to be a realistic path towards this future. Progress by APhA can be measured by the speed of a sloth, and we run the risk of being bypassed by other health care profession as the system evolves.

For instance let's look over the Strategic Issues on the AMA website which describes who they are and what they are fighting for. It is rather all encompassing while being concise and plotting for the future, wouldn't you agree? It's something even the lay person could read and instantly understand what AMA, and physicians as a whole, stand for.

Now let's look over what APhA has listed as their Advocacy Issues. One of the first things you notice is a lack of an adequate summary to the overall goal of the organization. Line by line and link by link they list specific issues, but there is no connection between the issues and what they mean for pharmacy. The AMA does a spectacular job of presenting their main goals and then diving into the specifics. Here, the APhA merely presents the specifics without any cross-linking to form a cohesive idea. In the end, the problem lies not so much with the issues themselves, but more with how they are presented.

Clearly the AMA's website is focused towards both their providers and their patients whereas APhA's website is tailored to its providers. There is already a disconnect of perception between pharmacists and their patients, and this does nothing but further that divide. If anything, the APhA website continues to make it's self inaccessible to the patients they so often tout as the focus of their work.

Why is this? Why is it the organization, which is financed partially through the dues of pharmacists, seems to ignore this crucial ingredient to the long term success of the profession? Why is it that pharmacists across the country feel like they have no voice?

There was no immediate response to the disparaging remarks by the CEO of Medco from APhA. For those unfamiliar with the situation, this link provides a good summary. How is it that our so-called voice of the profession remains eerily silent while one of the most powerful individuals in health care obtusely insults our profession?

What are those dues good for then? Several times it has been reaffirmed that the APhA can only reflect the views of those members who participate, and pay, through their membership. Granted I see the logic in this, by why is membership required to represent pharmacists as a whole? Why is it that none of the 70+ pharmacists I have worked with over the last ten years are active with APhA? Why is it that rarely do you find a community pharmacist, who just happen to make up the largest constituents of the profession, that considers the APhA worthwhile?

Because they have no faith in it. APhA is viewed as a lion with no teeth and no roar. Why devote time to something which is ultimately fruitless? As pharmacists are pushed around year after year with little light at the end of the tunnel, of course they become disillusioned. Who wouldn't?

So why doesn't APhA throw up a hail mary and start to regain the trust of the pharmacists it represents? Why doesn't APhA consider educating patients on who they are to overcome the biggest obstacle the profession faces, a lack of understanding of who and what a pharmacist is. Why doesn't APhA maintain a daily, strong active voice for the profession which can readily respond to comments from individuals such as David Snow?

Why doesn't APhA model itself after the AMA and actually represent the profession?

Give me a reason to want to be a member of APhA. Give me a reason to want to be extraordinary proactive within the profession. Give me a reason to stand up for what pharmacy stands for. Give me a reason to have faith in APhA.

Is that too much to ask?

No iPhone For You!

"I was wondering if you could possibly spot me enough of my meds for a week cause I won't have the money for my co-pays until I get paid next week."

An innocuous question, no?

I'm sure most of you are thinking that it is a completely unreasonable request and, as pharmacists, we should see no issue with heeding her request.

Which would be true... unless you had a bit more information.

First, the total amount on her seven medication was $1. I'm pretty sure there is enough change in my couch to total a buck.

Second, she asked this while her blinged-out iPhone 4 sat on our counter. A quick glance at said phone showed numerous pages of apps and, from what I could see on the page showing, numerous paid apps.

Knowing this, does your answer change?

Apparently this person, and many others, can fork over money for a pointless app which makes a farting nose for their phone, but they don't have the dollar for the medications which help keep them alive?

Does anyone else see the issue with this?

Look, I know what it's like not to have money, I live with it every day. I put off buying new shoes for over year until I could not glue or tape them anymore. Why? Because we needed that money for bills, diapers and other necessities.

It was not absolutely required to live, so I did not purchase it. Being able to provide basic needs should supersede any other frivolous spending at all times.

I don't care if someone splurges on themselves every once in a while and, in fact, it can be a good thing. But when you do so at the expense of your basic needs which may harm you, or others, what the hell is the point?

The better question is how we can let low-income individuals, whom for various reasons the public is supporting, be allowed to sign expensive phone contracts or fill said phones of paid apps? How is that fiscally responsible? They can't pay more than a dollar for their medications, but they can pay over $100/month for their iPhone.

Too often in today we rely on others to fix our own problems. We "pass the buck" far far too often and do not take responsibility for our actions.

And it's sad to see.

Ultimately the pharmacist decided not to spot her any of her medications partially for the reasons I mentioned and partially because this is a regular occurrence with said patient. There is only so much charity and hand holding we can do before the patient needs to stand up for themselves.

Cruel? Perhaps. Unprofessional? Maybe. Except for when she came back an hour later and paid with a crisp $20 bill.

Funny how that works.

Realistic Professionalism in Health Care Practice

Inspired by the following post over at 33 charts

Barely an hour into the first day of orientation for pharmacy school we were given the first, of what would be many, lectures on professionalism. We were told how our daily actions, both during and after work/school, would reflect both the image of the school and of the profession. Due to this, we were to maintain professional decorum at all times.

There was also some insinuation that our actions outside of school could be used as a reason for dismissal.

Think about it though, how realistic is it to expect an individual to maintain professional standards at every waking moment? Am I not allowed to see movies with an R-rating in case a patient sees that I may be viewing something inappropriate? Am I not allowed to consume a beer at a restaurant for fear of a patient judging me?

Where precisely is the line?

For whatever reason, too many people today expect perfection. In the mind of the public, there can be absolutely no errors in dispensing or prescribing or diagnosing without an immense amount of retribution. Life is, of course, immensely precious and people feel wronged when something goes wrong. So-called 'News' shows such as Dateline NBC feed off this fact and help propagate the incessant need for perfection.

However as Alexander Pope once said, "To Err is to be human." We are not machines designed for perfection, we are human beings. We have faults, we make mistakes even though we may strive to mitigate them as much as possible. It's one of the reasons why I repeatedly say here that failure is our greatest strength. Perfection is a wondrous illusion, namely because of the impracticality of it.

Humans, well most humans, cannot restrain their emotions every hour of every day behind a professional facade. In fact, it has been shown in numerous studies that bottling up one's emotions has negative consequences. Health care professionals have one of the most mentally taxing daily jobs, yet we are all expected to maintain professional composure at all times.

Due to this, many choose to vent their frustrations not only for their own mental sanity, but to be able to continue to effectively practice. We all have to let that facade crumble at some point or another, and the majority choose to do so outside of the public realm. Whether it is through a blog, Twitter or even a friend, it is where we are able to let our guard down and shed our concerns, fears and worries.

The evolution of devices like blogs and Twitter may prove to be one of the most beneficial outlets for health professionals in their history. It now only spurs new and creative ideas, but let's professionals bond across state and even national boundaries if only to reassure all that they are not alone in your frustrations. Pharmacy blogs like Your Pharmacist May Hate You and The Angry Pharmacist have quite literally helped to relieve the immense amount of stress felt in pharmacies across the country.

For those of us who may be shy when discussing our most personal problems, professional or otherwise, the fact these devices exist is a godsend.

While those popular blogs exist as a source of venting for the profession, it has lead to the creation of other blogs with slightly different focuses such as Eric, RPh and The Redheaded Pharmacist that exist to help better the profession. And this example is just describing the pharmacy blogosphere, not even considering the countless medical blogs in existence.

Yes, some of these blogs and Twitter accounts are crass, using language that would never be used in an actual professional setting. Yet they speak more truth than any professional document you may see coming out of organizations like APhA or AMA.

Why is this?

Because professionalism is self-limiting in that we are all expected to maintain the same methodologies and persona to standardize patient care. In itself, there is nothing wrong with this, but outside of a professional setting how else are we to spur innovation? How are we to explore the good, and bad, of our profession? How else are we to relieve the stress we all feel and actually enjoy life?

We all carefully consider federal and state laws, often artfully crafting responses to ensure the innocent are protected. Every work place has similar gossip-style discussions, and yet similar health care professional discussions are draped in anonymity in comparison. This is a fact even more impressive when considering the amount of venting we all do.

And venting is just that, an outpouring of frustration. What is said during this time should not be construed as a representative of who they are as a person and a professional. The majority of the time if someone stubs their big toe, their first reaction is to spout off a slew of words that would make a sailor blush. Does this mean that we should judge their response and formulate that they are crass and unprofessional?

Of course not.

Expectations are a wonderful device when used properly, but only when they are based in reality. Today the expectations for not only health care professionals, but for individuals as a whole are unrealistically high. Before you decry what and how they say something, consider the benefits they earn from doing so.

Would you rather have a practitioner who is constantly uptight, concerned with ensuring that they abide by all expectations and standards while they treat you? Or would you rather have the practitioner who is able to release their frustrations outside of work and remains relaxed and clear headed?

Before you judge and before you point fingers remember that you are not speaking about a device spouting off medical advice, but a person with a personality and emotions. They have the same needs and desires as anyone else in the world.

If anything it's a good thing others can see these frustrations under the premise that they realize we are not as infallible as they assume us to be. Because of they see that we are not infallible perhaps, just perhaps, they will no longer operate under the guise of perfection.

One can dream, can they not?

When False Facts Are Factually False

As I walked into the pharmacy school building on the first day of classes, I was keenly aware that the next four years would be difficult. I knew that it would test every ounce of mental and emotional fortitude that I housed in my geeky little body. In the end, I would be challenged to grow beyond myself into something, hopefully, resembling a health care professional.
Heading to the first day of pharmacy school, I knew that the next four years would be difficult.

What I did not expect was for this road to be made so astonishingly difficult, almost in a sadistic manner.

You see, no one had informed us that professors routinely trick students in lectures and/or exams. That they'll present something as fact, but carefully phrase it in a way that means it is actually false.

Kind of like using a triple-negative to explain something.

When you use said fact and are told you are incorrect, they reply back that we must be acutely aware of how and what it is they say. Phrasing this way is to help develop a higher sense of thinking on our part.

Now how in the hell is that supposed to work? I busted my ass for six years only to be forced to endure another four years of deceptive learning? Leading up to a recent exam, our professor routinely exclaimed that we were over-analyzing material and that, "it will be incredibly straightforward, not requiring overly analytical techniques."

I'll let you guess what the exam was truly like.

And I don't get it. How are we supposed to adequately learn for patients if some of the professors derive some sort of sick pleasure from tricking us? Granted not all of the material is presented in this manner, but enough of it is to make you wonder how we can be taught in such an environment.

Now maybe I feel this way because I am an ardent believer in equality or maybe because I'm still young and relatively un-jaded about the world

Or maybe it's just because it's a steaming pile of bullshit.

I think I like that explanation better.

Roads... Where We're Going We Won't Need Roads... But We Will Need a Prior Auth

Is there any other rejection phrase I dread more than:

DRUG NOT COVERED; STEP-THERAPY/PA REQUIRED. CALL 1-800-JACKOFF

Seriously, that simple string of words is enough for this normally calm little pharmacy student to erupt in a fury of rage reminiscent of taking a cake away from a fat kid.

What makes it worse is that it happens when you least expect it, eerily similar to a herpes outbreak. Kind of like when someone brought in a new prescription today for loratadine.

"But Phathead," you're saying, "The smidgen of glue that holds the label on the bottle costs more than the number of tablets in the bottle. Never in a million years would a PBM require a PA on it."

Well that would be true... if PBMs were run by human beings with a lick of logic.

This particular plan, cough Medco cough, decided that cetirizine needed to be first line and that, for some god forsaken reason, loratadine would only be paid for after a PA and step-therapy.

Way to go Medco, you just saved yourself a whopping two cents by denying the initial fill. Glory be to you for such a wise financial decision which will ultimately bring troves of riches to your CEO. And by troves, I mean one or two extra Tootise Rolls after lunch.

Long time readers may remember that I have a particular hatred for the sadists that call themselves Medco. If anyone deserves to have bamboo shoots shoved up their urethrae and then forced to watch Glee for 24 hours straight, these guys are the unanimous winners.

After the pharmacist stopped laughing at the ridiculousness of the rejection, we kindly pointed her to the allergy aisle and told her it would only be a few dollars more to bypass this lunacy and receive the same treatment. She agreed, the gray skies parted and for a brief while peace and tranquility returned to the pharmacy.

Until the next PA rejection. About two minutes later.

Damnit.

Rite Aid: Cheapening the Profession $5 at a Time

The majority of us are aware of Rite Aid's guarantee to patients that their prescription will be ready in 15 minutes. For the most part, I don't have a problem with that. I give our guarantee to our patients that if you fill your Norco on time, a Spanish speaking Monkey will fly out of my ass and make you a denver omelet.

See, I can promise things too.

Apparently, this wasn't enough. Oh no, in an age where a Dateline special lurks around the corner for a worn down, exhausted pharmacist to make a mistake, Rite Aid decided to kick it up a notch. They decided to offer a $5 gift card if that 15 minute guarantee is not met.

Bravo Rite Aid, bravo. Way to aim yet another shotgun blast to the image of pharmacy.

We live in a world where pharmacy is viewed as a product based business rather than the service it truly is. That's how PBMs reimburse us, that's how the public views us and that's how we are treated on a daily basis. If we are to truly reach the goals laid out by APhA and other organizations, we must truly remedy this fallacy.

But then there is Rite Aid, making sure that for every step forward that we are shoved back another five.

A few weeks ago I questioned why national organization such as APhA did not denounce WAG's creation of Wal-beer. Again, I ask, how can APhA allow such a cheap attempt to attain customers without disparage?

It doesn't so much matter that the 15 minute guarantee is a game of Russian Roulette as it is. Rite Aid just made sure that the barrel is loaded with five bullets instead of just one.

Rarely are we complemented for the work we do in fixing errors by doctors, solving various insurance issues, keep track of interactions or offering simple advice. We are chastised when their doctor takes one day too long to fax back a refill authorization or when the four different C-IIs they drop off take a bit too long to fill.

The public already treats us like we're the bitch of the health care system, there's no need to give them another whip to play with.

People need to start realizing that in pharmacy the customer is not always right. In fact, they are not a customer at all, they are a patient and we are a health care provider. This is not a Jiffy Lube where we'll top off the washer fluid just for the hell of it.

And with ridiculous programs like the one Rite Aid is employing, we'll have a damn hard time trying to convince anyone otherwise.

It's just too bad they can't use their $5 to buy a six pack of Wal-Beer. Oh wait, I think I just gave someone an idea...

To Speak or Not To Speak

This may not surprise most of you, but I apparently already have a reputation among the other classes at my school.

Shocking, I know.

Through the grapevine I have discovered that I have been referred to as the "guy who doesn't take shit from the professors" or "the guy who brings the real world into class."

Kinda cool, wouldn't you think? Except I've noticed a slightly perplexing side effect to this. It seems, almost, as if I'm being blackballed by certain professors.

That big multi-year research project I had mentioned a few months ago? It's suddenly vanished, along with the regular emails from the related professors. In one of my classes, management class, I am regularly ignored when my hand is raised.

It's frustrating.

Which leads me to this question, should I continue to speak up? Should I continue to push the envelope in our classes in order to ensure my fellow classmates, and future pharmacists, have a truthful view of the pharmacy world?

The me of 2-3 years ago would keep at it. Now that I have a wife, a child and a burgeoning career, I wonder if this is the best course of action. This isn't a small, unknown little school and I certainly do not want to create a negative perception of myself as I enter the pharmacy world as a pharmacist.

And since my plans have changed in the hopes of attaining a particular residency, I really do not want to shoot myself in the foot anymore than I have to.

So do I speak up at every inane situation presented, at every fairy-tale story told, at the incorrect information we're fed? Or do I pick and choose my battles and straddle the line of appeasing both sides.

Truly, I do not know. It's part of the reason why I have been "freakishly silent", as someone told me, the last few weeks.

What good is having a voice if it only spouts negativity?

I suppose that is the ultimate question I have been asking myself. And honestly, I do not have an answer.

Improving the Pharmacy Profession… One Wal-Beer At a Time

Walgreen’s bills itself as “The Pharmacy America Trusts.” With that trust comes the responsibility of an honest and ethical management of their patient’s health care. If America trusts them as they suggest, and honestly it’s probably hard to argue otherwise, due to their size they are the public face of pharmacy.

It’s not preferable that one, generic entity represents the varied world of pharmacy, but alas that is what we have to live with.

Imagine the shock pharmacists across the nation had when a little nugget of news appeared, even as it was clearly attempted to be brushed under the rug. That nugget? The creation of Wal-Beer.

We live in a massively evolving health care system in which pharmacists are fighting to rightfully assert themselves as a respected and educated member in modern collaborative practice. For too long we have been either dismissed or ignored, but in the last two decades have seen the profession begin to shred itself of those shackles and become an integral part in the management of a patient’s health.

And it is something to be applauded.

The bigger issue, something which I have touched on in the past, is that while those within the medical profession now readily acknowledge our presence, the public has a complete lack of understanding of our abilities. It is a fact that, at some point, will need to be addressed if we are to reach our full potential.

Now, the public will have Wal-Beer.

How morally and ethically responsible is it for the largest pharmacy chain in this country to create a beer label, with a low-ball price point, in the midst of this change? Pharmacy’s across the nation are refusing to sell cigarettes and alcohol in their pharmacy, yet Walgreen’s has decided to not only ignore this but to instead take it a step farther.

And don’t tell me that it’s okay to sell cigarettes in a pharmacy as the pharmacist can consul a patient on the negative aspects of smoking. The day that truly happens is the day the cigarettes are kept behind the pharmacy counter.

Fat chance of that.

Instead, “The Pharmacy America Trusts” is undermining everything we have fought for these past decades. In class we are preached “Patient Care, Patient Care, Patient Care,” and that our generation of pharmacists will be focused on this for our entire career in new and novel ways.

So how does Wal-Beer fit into that? How is what Walgreen’s doing an attempt to not only further the profession but increase the health of their patient population?

I realize that chain pharmacies are more profit driven than others, but this is a deplorable step even by those standards. Every day we deal with shrinking reimbursements and the lack of an ability to bill for basic services. This is what Walgreen’s should be focusing on and standing up against, not creating its own line of cheap beer.

The better question is, what will organizations like APhA say about it? Will they ignore it? Or will they stand up and denounce the creation Wal-Beer and what it means for the profession? A dare not to be overly dramatic and overstate the importance of doing so… but I’m not sure that would be overly dramatic.

Surely Walgreen’s isn’t the first pharmacy to attempt something of this nature, but as the face of the profession they should be held to a higher standard. If not by the public, then by their employees and the profession itself.

There are bigger fights on the horizon and many will dismiss this as something trivial. It is far, far from trivial however, and represents a dangerous tipping point for the profession. If we wish pharmacy to be properly understood and respected among not only our peers, but the public, we cannot condone this.

Until then, Walgreen’s shouldn’t be the pharmacy America trusts. Hell, they shouldn’t be the pharmacy pharmacists trust. Should they?

Because God Said So

I'm man enough to admit not only do I not know everything, but that I continually learn new things almost every day. About a week ago there was a note on a patient's prescription asking if she had new insurance coverage for her birth control prescription.

Her response was that since she worked for a 'really religious' organization they had decided that certain medical treatments defied the will of God and that they would not pay for these items. In this case, one of these 'treatments' was birth control. There were also other 'treatments' that were not allowed, but she didn't really wish to discus them.

And no, the organization was not a church or anything similar to that.

In my mind there is no point to delve into a debate on personal beliefs because we each have our own. Mine is no more superior to yours than yours is to mine. We believe what we believe and leave it at that.

This, however, I do have a problem with. How can you deprive someone, specifically an employee, medical coverage for something because of someone else's belief? How is that fair to others?

Furthermore, how is that deemed acceptable in modern health care? What's to keep the CEO of company from deciding, "Ya know what, I don't believe in warfarin therapy because of my God the Flying Spaghetti Monster and I don't want our health insurance to cover it anymore."

Ridiculous? Sure it is, but the scary thing is that that instance really isn't terribly far from what has happened to this poor woman. She seemed like a well educated and well adjusted married adult woman who simply does not want to have children at this time. And yet she is being punished, in a way, for being responsible.

Sure she could just leave her job, but who is really willing to do that in this economy?

I'm all for expecting and honoring every one's beliefs. But when your beliefs deprive an innocent person medical coverage, then I have a bone to pick with you. Push your beliefs through pamphlets, mass emails, televisions ads, whatever pleases you.

But for the love of God, don't deprive people of their right to health care.

Pun most definately intended.

Taking On Walmart: Lawsuit Style

Over the top post title? Perhaps, but hear me out.

Every one within the pharmacy world agrees that Walmart pharmacies are the cancer of the profession. They are mostly detrimental to the profession, to the point that something needs to be done about it.

In the Walmart I recently worked at, my store manager told me the pharmacy is responsible for 4% of the yearly revenue of the store. Think about that, just 4% of the entire store. In the great scheme of things, the total profit brought in by the pharmacy does not have a high priority. What a pharmacy does accomplish, though, is to drive more people into the store. And that's where the problems arise.

It's not difficult to imagine that twenty years from now we will see the final death blow for true small town, rural, independent pharmacies as the four dollar generic program that Walmart began a few years ago. The effects from this program will begin to become more evident as the years wear on (I personally believe it will, or maybe already has, trickle over to the reimbursement side of things). It's a program which is great for consumers, but utterly terrible for pharmacies and pharmacists.

Previously I have covered how we are routinely underpaid by insurers for the services we provide. Here is how Walmart, in its revenue based mindset, gouges the profession using poor, and unethical, business practices.

In the state I am in at the moment, the average cost of a prescription, prior to the addition of the cost of drug, was $10.28 as of 2006. This is the most recent data we have and does not take into effect the legal changes since then which have significantly increased overhead labor costs. If you consider that the most of the drugs listed under the $4 generic program actually cost roughly $1 per 30-day refill, we're looking at a total cost (in this state) of $11.28 per 30-day supply.

Using a bit of simple math, we can see that Walmart is selling these $4 generics at 64.6% below true cost. Sure they're making a "300%" return on the cost of the drug, but we're a service based profession and you cannot quantify cost in that manner.

Here is where the lawsuit would come into effect; there are laws in place to prevent businesses from undercutting competition by ensuring that they cannot price their products and/or services below a price floor, namely the cost of the product/service. It a byproduct of the monopolistic tendencies of big business at the turn of the 20th century and the anti-trust laws that followed.

This is called predatory pricing, and it is usually intended to drive competition out of business. In Walmart's case, they are doing so to drive more consumers into their store and not so much to rid them of competition.

However, one of the key components of predatory pricing is a high market entry barrier. By pricing their prescriptions so low, and under cost, they are in effect presenting a high market entry barrier. It is one thing for a new, or small, pharmacy to be unable to offer all of the insurance plans offered. It is a completely different problem when they cannot come close matching the cash-pricing policy of Walmart.

Under the Sherman Antitrust Act, this is considered monopolistic business practices and is unhealthy for both the market and the consumer. And, at least legally, you could file a class action lawsuit claiming as such.

The thing is, you would lose the lawsuit. Walmart is far too big, far too powerful and with far too many attorneys. Also, it has proven difficult to adequately argue for monopolistic business practices, although I concede we could develop at least a moderately successful argument.

But here's the best part... we wouldn't have to win the lawsuit.

Really what we need is consumer awareness of what is happening within our profession. It's been shown time and time again, especially when it comes to Walmart, that when the public is presented with an injustice they will move on their own to attempt to right it. People like a good deal, but only to a point.

We have the data, we have the facts, we have the manpower, so why not? What's stopping a group of us from standing up and actually doing this? It isn't about increasing pharmacy profits, about maintaining the integrity of one of the most important health care professions in existence. We an argue convincingly that we have been put on a dangerous path and, if it is not righted, in a few years we will be presented with a very serious problem.

Cost/revenue cannot be the sole driving force for the profession, yet Walmart, and to a lesser extent the other large corporations, have decided to take that route. It will continue to harm us, the market and, ultimately, the patients. The last part of that statement is what we have to proclaim most loudly.

Let's rile up the consumers, let them see how big business is harming one of the essential health care services in this country. It can only go up from here, right?

Walgreen's, Sucking the 'Phun' Out of Pharmacy

I am coming near to my three month anniversary with the empire that is Walgreen's. During this time I have moved around to a couple different stores now which has helped me gather a more rounded view of their day to day operations. Recently, I have come to a singular conclusion.

Walgreen's has sucked the fun out of pharmacy.

In the past, I have worked in stores that were a blast to work in to the point that when you saw you were scheduled there, you smiled. The co-workers were great, the pharmacists were great, the patient population was great... it made for an awesome daily work experience.

With Walgreen's you still have that, yet you do not have the same experience. I'm not saying that work should always be fun, but more that you should be able to enjoy it at some point. After three months, I have yet to find a day that comes even remotely close to that.

Part of it, as I alluded to when I started working there, deals with their work flow. It's one of those ideas that looks beautiful on paper, but doesn't work as well as it should. The better stores I have worked in have just a straight pharmacy (to me, the sexiest pharmacies have a straight counter about six miles long), but the pharmacies based in the corner of a store are just terrible.

To top it off, there is virtually no patient interaction. I miss the days of an open pharmacy. When my favorite customers would come up to the counter, wave me over and ask me if "I got lucky on Saturday night." Or the customers who would randomly bring treats or show pictures of their grandson at his most recent soccer game.

When I started, the manager told me I would fit in really well because this store had a really close knit community. From what I have seen this far, it does not meet my past experience of a close knit community.

Working in a Walgreen's is very cold and methodical. Each worker is only really well versed in their specific tasks and the pharmacists, no offense to them, are very one dimensional. That, of course, is a byproduct of the Walgreen's system, but I still would put up a pharmacist from one of the indie stores I worked with up against a Walgreen's pharmacist any day.

Have I mentioned I despise their robots and the lack of record keeping/information they hold?

I'm not trying to be a negative Nancy, but I miss enjoying going to work. Moving around to different stores the last few weeks, I have learned that this is probably not going to change any time soon. How depressing of a thought is that?

No wonder so many of you are so bitter.

Anal Raping with a side of Tequila

Hi everyone. How are you? Pretty good I'm sure.

How am I you ask? Why what an interesting question. There is a mental countdown in my head right now as in four hours the skies will open and the tequila will rain down.

And I cannot wait.

School for the first month had been peddling along in first gear. They weren't shoving information in our face and all of the professors appeared to be kind, understanding and non-threatening.

It was a false sense of security.

Today will be my third test in seven days. Normally not too tall of an order... except for the nature of the tests. The week has steadily grown worse and in two short hours I will take my final exam of this retched stretch.

You see, they lulled us into thinking the exams themselves were not to be too bad. The practice questions were easy. The lectures were easy. The study guide was easy. The exams.... not so much.

It was like being in a prison cell with a lonely guy named Bubba and not an ounce of KY present.

In the last week I have studied more than my entire undergrad career combined. It became quite apparent that our profs were not as easy-going as they made themselves out to be. These exams have been the most demented, head-throbbing exams I have ever experienced. And the worst is yet to come.

For the first time in my life, I truly felt utterly and completely stupid.

And really I cannot blame the profs for this. I underestimated, along with the majority of my classmates, what would be required for each exam. Obviously that little tangent in biochem may ultimately be related to a problem worth 10% of your score on the exam.

As I sit here, bruised and bleeding, a new plan of attack for the rest of the semester has been formulated. These SOBs aren't gonna keep me down, and I'm going guns blazing for the rest of the semester.

First thing is first however... where the hell is that tequila?

The First Annual Angry Medical Professional Conference

Today there exists conferences for medical professionals on seemingly any topic. Yet there exists a void in the conference spectrum which could be of greater benefit than any other conference one would attend.

A conference in which medical professionals could bitch about their daily lives in their profession.

The sheer amount of booze consumed over this multiple day event, and yes it would be multiple days, would be astounding. The times we would have.... now those would be priceless.

If I have learned one thing over the last few months via conversations on Twitter, it's that we all enjoy sharing asinine stories about patients. It is a way we manage our frustration of our profession during a day.

Obviously, for HIPPA reasons, the names of the inane are never released, but the experiences can be retold in detail.

We could even have an awards ceremony for meeting various requirements of ineptitude.

"To the doctor who dealt with the foulest shit stench while in an exam room... BurbDoc!"
"To the creation of the best patient greeting card slogan... The Angry Pharmacist!"

Then we could all high five each other and take a shot of Tequlia.

We would share tears, laughter, and the occasional group singing of a Journey song. Really, this could be the greatest thing we ever contribute to the profession.

Now who's with me?

Stick Assectomy

Why is it every person I see in a pharmacy down here, at least those that are my age, seems to have a stick shoved so far up their ass it's branches are poking out their nose?

No one says hi, few smile, yet they imagine to project an aura of superiority. It's impressive in almost a sad way.

Am I that unusual in that I have a sense of humor and actually find joy in something other than being serious? Yes, sometimes shit sucks, but suck it up and carry on. I pray to Buddha that my classmates are not like that.

I'm fun, and damnit I won't have people rain on my parade.

Perhaps it has something to do with this area in general because I don't remember this many pharmacy folk being unapproachable in any of my other travels. Maybe there is a Paxil-deficiency in this region of the country.

Or maybe they just need some Fuckitol.

Followed by a Stick Assectomy.

Yep, that's it....

What Type of Industry is Pharmacy?

Is pharmacy a product based industry or a service based industry?

Surprisingly there are many pharmacists that I have talked to that state we are a product based industry. Even more perplexing, they state that we need to become MORE product based and that programs like MTMs are worthless and will never do anything for the profession.

To me, that seems like a massively ill-conceived idea.

Part of the problem that what a pharmacist does is not accurately portrayed to the non-pharmacy public. I cannot even say the non-medical public because there are many medical professionals who do not know what a pharmacist can do. I covered this fact alone in a few months back.

If anything, we need to do more to be seen as a service based industry.

Sure we dispense a product that is sold and the surrounding areas of the store do the same. But that is not what a pharmacy is.

The classical definition of pharmacy is 'the art of preparing and dispensing medication'. I think a more accurate definition would be, 'the study and understanding of how medications react and treat disorders in the body.'

Or something of that nature.

The PBMs can justify the fact they pay us as a product based industry because that's how everyone else views us. No one cries wolf because no one sees anything wrong.

What would happen if doctors were reimbursed solely for the materials they use in an office visit? What would happen if a dentist was paid only for the cost of the filling used during a procedure?

There would be a nationwide outrage, would there not be?

Yet this is precisely what happens on a daily basis in a pharmacy and we are supposed to take it in stride.

What's more, it's not even PBMs that are shooting us in the foot. The four dollar generic program instituted by Walmart a few years ago was the biggest punch in the crotch the profession has endured. As if that wasn't bad enough, other organizations are resorting to giving away meds for free to 'compete'.


Low prices. Always.

Right.

So not only are we already viewed by the public just as someone who puts pills in a bottle, we also do so for free.

How can we function like this?

In truth, we can't. Simple economics state that we cannot continue to devalue our product without devaluing ourselves. We're already dangerously close to a point where the public views us on the same level as the cashier at McDonald's.

And then where we be? Everyone is trying to take the next step in the evolution of the profession, but no one is acknowledging the problems we currently have. Instead, most put on a happy face, throw around terms like 'MTMs' and 'Revolutionary Clinics' and assume all is well.

All is not well, and all will not be well until we start to resolve these problems.

The first step could be as simple as reaffirming to our patients that we provide a service to them. Obviously you can't say that point blank, but you can certainly start presenting yourself in ways that will lend credence to that idea.

Of course the first step is a baby one, as it's the next step that'll be the big one.

Until the majority of pharmacists in this country began to stand up for themselves and take a stand, we won't see this happen. No longer can we afford to sit idly by and be the quiet profession in the medical community.

We have been the whipping boy for far too long, and it's time to assert who we are and what we do.

What type of industry is pharmacy? An irreplaceable service that is being squandered by people ignorant of what the profession actually is.

And that is damned sad.

I'm Tired of the Whining

If there is one thing my generation knows how to do, it's how to whine. I've often been told by those older and more wise than I that once upon a time, people took things in stride. My generation, so they say, likes to nitpick and complain whenever given the opportunity.

To a certain extent, I believe this to be true. We live in an instantaneous satisfaction society now and that is one of the byproducts.

But good god am I getting sick of the whining.

If I see one more person discussing what they're fall back options will be when they finish pharmacy school and can't find a job, I may smack them upside the head with a 2x4. God forbid you actually have to distinguish yourself in a way other than having a Pharm.D. and perhaps look outside your comfort zone for a job.

It annoys me. Really, really annoys me. I am about to start a job as a cashier for Walmart. Does it suck? You bet your ass it does, but I'm not bitching about it. It's a small hiccup in an otherwise long road.

The doom and gloom about the future job market seems to be saturating my peers. Sweeping generalizations are applied simply because someone cannot find a job in a particular area.

Again, it's fucking annoying.

Am I going to have to put up with this for the next four years? Am I going to need to invest in several cases of Johnnie Walker?

Or am I completely missing something here?

Notice to Pharmacists: The Sky is Falling Down

Here's a fun fact, did you know that by 2013 the number of pharmacy schools in this country will have doubled in the past fifteen years?

Now I realize there was a pretty severe shortage several years ago. I also realize that as the Baby Boomer generation ages, there will be an increasing demand for medical professionals and that it is best to be prepared for this situation.

Yet one must also remember that it is not always wise to admit just anyone to a program and there there must be some level of high standards maintained.

Often you hear x number of students applied for y number of spots and how terrible there is such a discrepancy in the numbers. Those two numbers don't tell the whole story however. I'll use an example one of the AdCom members of a school I applied to explained to me when I asked how viable applicants usually are.

In 2008 this school had about 1,300 applicants for 145 spots. That looks like one helluva gap, no?

There is more to it than that. Of those 1,300, only about 850 actually fully completed the application. Of those 850, only about 500 actually met the requirements for the school. And of those 500, only 350 had grades and PCAT scores which really made them competitive. Thus, you only had 350 individuals fighting for 145 spots.

Boy, that sure makes a helluva difference doesn't it?

A few weeks back I was informed that the University of South Florida will be starting a pharmacy school for the 2011 school year. Nothing to out of the ordinary, except within six years they plan to have 400 students... per class.

One of the ways this is being justified is with 'facts' like this:

UF receives some 2,000 applications a year for a program that accepts only 300. Florida A&M receives 1,200 applications and accepts only 150 annually. Source: TBO.com

What they neglect to mention is how many of those applications are actually worthy of being admitted to the program. Sure, a school may have 10,000 applicants, but 9,500 of them couldn't tell the difference between a Diels-Alder reaction and a potato chip.

The odd thing is when you take a stats class you are taught repeatedly that numbers mean nothing unless you know the full story behind them. Often numbers are routinely thrown out but with no indication of where they were derived and what they truly mean. This is a prime example of this.

In today's media, and to certain extent our government, no one considers this. Right now it's More! More! MORE! It's not that USF opening a school is bad in itself, but it is that the whole idea behind it is poorly thought out.

I do not wish to see this profession watered down for the sake of having more bodies for jobs. This isn't like pumping out a cashier to run more registers, there has to be high standards involved to ensure that there are quality pharmacists out there.

Then again I'm using logic... and we all know most people don't use logic. Where's Spock when you need him...