Pharmacy. Jim Plagakis. Pharmacist

Those of you who have followed my thoughts here and at Drug Topics, JP at Large, know that I have commented frequently on the highly educated professional Hib Visa holders.

They often have accents that my 1960s rock ‘n roll tone compromised ears do not get. Then (some of them, certainly not even a majority) will talk so fast that I get nothing useful. I have to ask them to slow down. I even have to ask them to spell the names and drugs. I say, “Please”.

Of course, this is when getting transfers. When they call to get a transfer from me, they miraculously speak slowly and distinctly.

Take a look at these figures.

Every one of you have scratched your head in dismay when you get a foreign pharmacist on the line at CVS.

Between 2001 and 2008

CVS applied to sponsor 3,590 H1b pharmacists. 15 were denied.

Rite-Aid 3,448 33 denied

Walgreens 1,477 13 denied

Kroger 295 7 denied

Safeway 359 6 denied

You can visit www.myvisajobs.com and spend a whole evening entertaining yourself. If you are a foreign pharmacist, you can see what is out there. This site has the wages that each company pays an H1b Visa pharmacist. Check out www.h1bvisa.com and www.h1bvisa.org It is absolutely amazing. It is a remarkable subculture.

Look hard and you will find a discussion board where H1b applicants discuss their chances. A girl from the Philippines tells of her excitement about landing a California job with CVS.

Doing this research, I see that the United States of America is screwing the goose educating our kids. There are millions of highly skilled foreigners holding H1b Visas. Dell computers sponsored 2,481 in the 2001-2008 period. Probably all engineers. We must do better. It could be your nephew who can’t do better than the night shift at Circle K because he was more interested in beer, babes and on-line games than doing what it takes to get marketable skills in the global economy. Globalization is systemic. It does not go in a straight line. You have noticed that it is all over the place. Dr. Reddy’s is in Mumbai. The genie is out of the bottle.

One question for any H1b Pharmacist to answer. When CVS sponsors are you essentially an indentured servant? You are not free to quit and go to Wal-Mart if you want. If Rite-Aid puts you in Dry Hut, Desert State where the provincial people don’t like the way you talk and mumble the word “terrorist” while you are picking out spices for the curry you plan for your two new friends (both Technicians) on Saturday night, can you quit if they do not honor your demand to be transferred?

Perhaps, H1b arrangements are in violation of USA labor laws if CVS actually gives preferential hiring treatment to H1b RPhs.

In the end, I believe that we need the H1b pharmacists to fill in the holes. However, if the shortage is over, as some of you have suggested, they go first. Is that unfair of me?

PS: I do not believe that the shortage is over. Far from it, but that is for another time.

Jay Pee

look at RxJoe’s comments. Do any of you actually believe that a new Rx can get scanned at your local CVS and then the typing of the Rx is out-sourced to a cheap Pharmacy Technician in Bangalore? If Joe’s $8000.00 per applicant is accurate, these five employers spent
almost $74 million.

I have written for Drug Topics magazine for twenty-one years. I am a company man and not a disinterested observer. That being said, I’m going to comment on David Stanley’s current essay about pharmacists and APhA (When Pharmacists Speak, Who Listens?). It is brilliantly written and oh so true. Please take the time to visit the Drug Topics site. You can look down to the right and click on the link Click on E-News and read the best, edgiest comments on the organization that has the name, but has never delivered anything for working pharmacists. Our working condition entreaties have been ignored.

I have observed Drug Topics since the 1950s. Since January, 1989, it has been MY magazine. It was OUR magazine, with news and commentary that we wanted to read. Pharmacists actually took the magazine home. Drug Topics was published twice a month, 23 issues a year. The staff took December off. It was a news magazine for pharmacists and it was a really fun magazine to read.

Then, there was what felt like a never-gonna-end period when a pharmacist was the Publisher and it looked to me like he was leading the magazine to being just a me-too 100% clinical rag. Of course, we do read clinical pieces if they fit our interest, but this was ridiculous. Drug Topics had become a very boring, into the round file publication. They ended twice a month issues after more than a century. It was a very low period for Jay Pee and the magazine. The story is long, but the magazine is back. Drug Topics is published every month FOR YOU.

I think that David Stanley’s essay on the APhA is a statement by the publisher of Drug Topics. You need to read it. If you agree, you need to communicate your thoughts to the magazine because the “posers” who promote APhA are gonna whine.

Send your thoughts to the managing editor. Julianne Stein jstein@advanstar.com

Please pass this on.

Update. 1/22/2010. I have received a few strong comments to my messages on obesity. A few pharmacists have accused me of being insensitive and mean. One woman RPh called me a dick. Linda Bacon, who I quoted, sent a long letter denying the statistics I used. My source is impeccable, by the way. What I wrote was threatening and that is good. A woman who is five foot two and 300 pounds is in a dismal situation no matter how much propaganda is out there. They may smile at the pharmacy counter, but there are gallons of tears on pillows every night.

My most recent JP at Large column in Drug Topics was on the growing menace that obesity presents to our country. The CEO of The Cleveland Clinic will not hire smokers and would not hire obese people if he could get away with it. 67% of Americans are overweight or obese. Women are 20 pounds heavier than they were in 1978. Diseases associated with obesity drain $150,000,000,000.00 a year. That is $50 billion more than cancer.

Of course, I had fun. You wouldn’t read it if it was just statistics. I referred to Fried Twinkies. I accused fat pride promoters of revisionist propaganda. I said that obesity could be a death sentence.

I also suggested the idea that some pharmacists might see an increase in Rx business once the coming health care changes insure everyone, including fat people who are uninsurable right now.

A good friend, from my childhood, is a school psychologist. I shared this column with him. He suggested that I was insensitive and that I should not be dealing with such subjects. He said that I should not be treading where I did not belong.

I had a huge problem with that. I wrote back and told him that I have been a well-educated, qualified and competent health professional for over four decades. I told him that this is exactly what I should be doing with my bully pulpit.

I told him that I was insulted that he apparently saw my lifelong professional job as one of a pill pusher. He was showing enormous ignorance. The pharmacist, I argued, is in the best spot to deal with this national problem. We are at the bottom of the funnel. We often have friendly relationships with patients. We can casually break the ice. Talk about it. Most pharmacists know exactly what an obese person needs to do to save her life.

The doctor will give the rote message, “You could lose weight, Brenda.” At the same time that he is writing 8 prescriptions to treat the symptoms of the comorbidities of obesity. That’s it. Brenda is left twisting in the wind.

Back to my friend. I told him that I would never, ever presume to even comment on his professional choices when he tested a child and found the kid to be ADHD.
That is not my job. Not in my bailiwick. I am a casual observer of what he does and would never criticize his choices. I expected that same courtesy from him even though it was very clear to me that he had marginal respect for me, what I do and the profession of pharmacy. I have heard from him many times since, but not one word on this.

Now, whose fault is it that my friend, and probably the majority, look at us as modern Mister Gowers? It is not my fault. I tell anyone who will listen what pharmacy is really about. When medical care is 90% Rxs written at the end of the office visit, why do we have such a back seat position?

I say that it is the APhA’s fault. They have the name, grandfathered from when they really did work for us. I say that it is the APhA that needs to get its ass in gear before all of us lose ours.

The pharmacy where I work every Friday evening is right close to UTMB.  It is a major medical center and is the original medical school in Texas.  It is also the provider of medical services to the poor of Texas. 

 

UTMB was mandated, in the 19^th Century, to welcome any Texan, regardless of ability to pay.

  

 That is no longer a viable situation with the costs of modern medicine, but it is a fact of life for UTMB and the source of lots of hand-wringing by the administration. 

 

Patients are discharged on Friday evenings and many of them end up at my counter.  Recently, a woman begged me to fill her son’s prescriptions.  It was 3 minutes to ten and the manager on duty had just announced that the store was closing.

 

She had a dark, stricken look on her face.

 

“My son had a table saw accident.  He has to have these medicines.  Please fill them.  His hand is still numb, but they said that he was going to be in real pain when the shot wears off.”

 

I took a look.  Clindamycin, oxycodone/APAP, Betadine Solution, back up Vicodin, diazepam and prescriptions for sterile pads, gauze, tape and Neosporin.   I explained to her that she could not remain in the store, but that I would stay as long as it took to get the orders ready and we could transact business at the drive-through.

 

The manager on duty did not like it, but shrugged when I told him why I had chosen to stay.

 I fought my way through an insurance that I was unfamiliar with and finally left the store around 10:30 PM.  I felt like a winner.   I was glad that I could help.

 

Last night I was a loser.  I could not win no matter what I did or said.  The girl still had her wrist band on.  She had left the hospital 20 minutes before.  With her was a second teen age girl and a middle age woman. 

 

I asked the girl if we had filled prescriptions for her previously.  

 

She answered, “I don’t know.”  She wouldn’t look at me.  This was big time guilt that I was looking at.  “I just had my baby.” 

 

I asked her if she had insurance.  She said that she had Medicaid, but did not have the card.  The older woman had her arms angrily crossed.  Her eyes were practically bugging out.  “She didn’t need a card at the hospital.”

 

“Well, this is not the hospital.”  I didn’t tell her that UTMB had to take her for free.  That is not what pharmacies do.  I wanted to lighten it up, so I smiled at the patient and asked her, “What did you have?”

 

She did not look at me, but she said, “I had a girl.”  No smile.  No emotion. Nothing.

 

“Congratulations,” I said, “That is wonderful.  A little girl.  I raised two little girls and it was a joy.  A baby girl is a wonderful thing.  You should be smiling.”    

 

The older woman piped up.  “Wonderful?  The daddy won’t have nothin’ to do with it.

She can’t stay with her crack head momma, so she come to my house with her problem.  She is just a stupid n*****r bitch.  I have a half a mind to throw her and that bastard n*****r baby right out the door.”  She gave me a look that lingers on the front of my brain.  “So, you don’t be tellin’ her how wonderful a new baby girl is.”  She grumbled.  “A joy?  Ain’t no joy in this baby.  None.”

 

I grimaced.  “Well, it better be wonderful because it’ll be many years of misery if she can’t make it wonderful.”

The other teen age girl stepped up.  “He is right, momma.  This is Yolanda’s baby and it has to be good.”

 

I explained to Yolanda that she would have to pay for the prescriptions if she did not have her insurance card. 

 

The aunt chimed in, “She ain’t got no money and I ain’t paying.”  I don’t think that this woman was as mean as she sounded.  This seemed like a no win situation for her.

 

“All three are for over-the-counter medicines”, I said, “I’ll get them for you and I’ll pay for them.”

 

“No you won’t” said the aunt.  Her eyes asked, why are you saying you’ll pay, white man?

 

“I have an agreement to do this,” I said.  “Two weeks ago, a nurse from the women’s crisis center bought her patient a fleece jacket and I told her that I would pass it on.”

 

That was that.  Less than $10.00 with my discount.  Ferrous Sulfate, docusate and APAP.  I could so I did.   The aunt hated me.  Yolanda just seemed dead.  The cousin tried to smile and failed, but did say, “Thanks”.

 

Try to make a difference, try again.  Fail.  Try harder.