There is a lot of noise about working conditions, but is the hollering just a few malcontents or is the issue pervasive, cutting across all levels, in every corner of our country?

Let’s do a significantly unimpressive little study.  Just people who hang out at Jay Pee’s.  You can be anonymous, so tell the truth.  Please tell us what company you are talking about and, at least, the state where you work.  Answer these questions and feel free to editorialize all you want.

1.  Do you work 12 to 14 hour shifts on a regularly scheduled basis?

2.  Do you work more than one long shift each week?

3.  Do non-pharmacist management people interfere with the pharmacy, micromanage the pharmacy or otherwise assert their authority in pharmacy business matters?

4.  Do non-pharmacist managers interfere in PROFESSIONAL matters?

5.  Do you comply with all pharmacy laws?  If not, which ones do you neglect and why.

6.  Have non-pharmacist managers ever told you that you counsel too much, that you take too much time or have they told you to modify your counseling behavior?

7.  Do you get an uninterrupted meal/rest break of at least 30 minutes for each 8 hour shift?

8.  Do you have to eat “On the run”?

9.  Do you eat good, healthy food or do you grab what is quick and tasty from the snack aisle?

10. Have you ever had an “accident” on the way to the bathroom because you waited too long?

11. You are a well-educated medical professional.  Does your employer value you as such?

12. Does your employer treat you as if you are not valued and tell you that you are expendable?

13. Does management side with the pt.. no matter if the patient is wrong, rude, threatening?

14. Does your employer have “timer icons ” on the pharmacy computer?  Do metrics interfere with patient care?

15. Do you consider your Rx dept “under-staffed” the majority of the time?

16. Does management side with the pt.. no matter if the patient is wrong, rude, threatening

17. Does your employer have “timer icons ” on the pharmacy computer

18. Do you consider your Rx dept “under-staffed” the majority of the time

Give me your suggestions for further questions.

The state boards have their heads in the sand.  This e-mail is self-explanatory.  We have a chance in this state. The writer/pharmacist has filed an official complaint that the board is obliged to take some action on.

The nature of the RRRRRRR program’, one of XXXXXXXs business practices that is an automatic refill service, created numerous instances of unintended polypharmacy.  I do not have records of these instances, because when I noticed them, I corrected them.  The ones I didn’t notice were not corrected, because the system has no set way to make a pharmacist aware of them.  We simply must catch them as they appear, and use our best judgment at the time.  This can be very difficult due to the horrendous pressure the pharmacist is under to do things quickly.  Every action is timed, how quickly you get prescriptions done, how fast you answer the phone, how quickly you get drive through customers handled and move to the next one.  Failing to meet these targets results in discipline or even termination.  This pressure puts the pharmacist in an untenable position: Do I satisfy company demands even if I feel in my professional judgment this may do harm, or do I take the legal and ethical path and possibly lose my job?  Can a pharmacist comply with the mandates of counseling as defined by 21NCAC 46.2504, if they only have 2 minutes 30 seconds to do it in at the drive through?  Why is there a ‘target’ number of automatic refills we must achieve every week, if the pharmacist honestly feels that a patient would not benefit, or possibly be harmed by this service, do we not have the ethical and professional obligation to act in the way that defends the patients interests, and not the company bottom line, no matter how that ‘shakes out’ on our weekly RRRRRRR report?

This constant pressure creates an unnecessary distraction that is a breeding ground for errors.  I do not have records of actual patient harm, but the assumption that a harried pharmacist is more prone to make errors is a logical one.  I do know that XXXXXX has a policy that any misfills are to be reported online via the company channels.  I obviously cannot acquire these now, but I would imagine that should the Board inquire these records would be turned over.  Then one could backtrack to see if XXXXXX policies led to these errors.  Several pharmacists and store managers in the district may have other information as well.

I am curious, however, how this relates to my original complaint?  I had initially stated that XXXXXXX’s involvement of a non-pharmacist manager – who is not even registered as a tech on the NCBOP website – in countermanding my authority in the filling and dispensing of prescription orders constituted an unlawful violation of 21 NCAC 46.1804 ( a ):

“The pharmacist-manager of the pharmacy shall be ultimately responsible for the safe, lawful and secure receipt of prescription orders and delivery of prescription drugs.” – to be responsible for something, yet unable to exert authority, cannot be the intent of the law.  Such would be ludicrous. and ( b ):

“In filling or refilling prescription orders, the pharmacist shall not be required to deal with parties, including managed care companies and insurance providers, outside the practitioner-pharmacist-patient relationship.” – I can’t imagine that the store manager or district manager, both non-pharmacists, as agents of the permit holder, are included in the practitioner-pharmacist-patient relationship.

I would also point out that this behavior was incongruent with the “Practice of Pharmacy” as defined by 90-85.3-( r ):

“the responsibility for: interpreting and evaluating drug orders, including prescription orders; compounding, dispensing and labeling prescription drugs and devices; properly and safely storing drugs and devices; maintaining proper records; and controlling pharmacy goods and services.”

These are clear violations of the law.  The fact that I left the pharmacy in protest of being forced to work in an environment I had repeatedly announced to management and staff was unsafe is irrelevant.  Whether I stayed or left, a non-pharmacist usurped my authority as provided by the law.  This action created a magnified potential for patient harm as the pharmacist in charge was no longer able to control the delivery of pharmacy goods and services to best benefit the public.  To say otherwise, would be to admit that the public the Board is charged to protect is at the mercy of non-medical management who do not have the training to practice pharmacy, and whose loyalties will be to the good of corporate profits and not the patient.

To my mind, this is a cut and dried situation.  Either a pharmacist manager is in charge, as the law would seem to imply, or they are not, in which case the law needs clearer language.  I must admit that as a pharmacist of 12 years, over half of which has been as managing pharmacies, I find the notion of a non-pharmacist manager walking into a pharmacy and telling the pharmacist manager what she/he will or will not do in regards to any aspect of the pharmacy appalling.  The fact that the legality of it seems to be up for debate is unconscionable.

But.. fuhgedaboudit, Sucka, if it is cheap.  Case in point.  Colchicine/Colcrys.

When I think about mathematics, I am usually sound asleep. I did not like it when I was in school and held the long unexamined belief that I didn’t really learn much worthwhile. Then, last week there was an Rx with a complicated dosage issue. The doctor was clueless, as can be the case. I took about 20 seconds and handed it back to the Tech. I had written the correct dosage on the face of the prescription.

The Tech gave me a look. “How did you figure that so fast?”

I didn’t know. I examined what I did and then told the Tech, “Algebra.” I guess I did learn something.

Using my meager knowledge of mathematics, let’s pose a question.

Who runs the ship of pharmacy?

In math, there are knowns, unknowns and variables. Does that sound right? Well, for this essay, that is a known.

Here are some knowns.

The pharmacist is perfectly capable of practicing pharmacy without the help, guidance or rules of the company.

Running the Prescription Mill is not practicing pharmacy.

The pharmacist does not need the assistance of any non-pharmacist, other than the technician doing the technician’s job.

Company rules, Timers, Metrics and guarantees are artificial overlays that, at worst, interfere with the practice of pharmacy and are irritations at best.

Counseling is not a quantifiable event. Counseling is arbitrary and discretionary. The middle managers who believe they can write a “Counseling Guidebook” are idiots. Your counseling is not the same as my counseling.

What most of us call “Work” is simply the place where we have brought our practice of pharmacy.

Long days at the pharmacy, no breaks and not enough help is something we willingly tolerate. We, in effect, by our behavior, agree to live by these rules.

Here are some variables.

The non-pharmacist store manager can be either a micro-managing megalomaniac or he/she can be non-involved and supportive.

The company can be invested in running a business that is invested in patient care first and profit second or the reverse.

The company can be totally supportive of the pharmacist or they can view the pharmacist as expendable chattel.

The PBMs will continue to profiteer at our expense of they will be brought to heel.

The Unknowns

In the end, the pharmacists hold all of the trump cards. Will we lose our spot simply by not playing our cards?

Will the staggering indifference of pharmacists relegate us to the role of glorified technician?

There is one simple route to taking hold and regaining our profession. It is so simple that most of us do not even notice it. Do you know what it is?

9/26/2011. I just read through the comments and, you guys, I am purposely provocative. I am not an idiot. I know the realities of retail pharmacy, but I also know the value of being AN OBSERVER of my life at work rather than always, in every depressing case, an immersed participant. It is so much more healthy to say with a smile, “Oh, Jay Pee, the drive through is crazy today” rather than whine, “The drive through is going to kill me today.” Nothing is black and white.

Most of the members of “The 1960s Pharmacists Club” are men.  I can attest that even us older guys would hire Patsy.

I know.  That is sexist, but I’m just being honest.  I’d love to hire Patsy, but I would have doubts about her ability to do the job seamlessly.  I would say, “Patsy, I dearly love you, Baby.  You are a terrific pharmacist, but your attire is distracting.  Will you please dress in a more professional manner.”

Patsy might say, “This is sexual harassment.  It is unwanted.  I will document this transaction and any more that follow.  I will send a formal complaint up the ladder to corporate using the company’s published procedures.”

About this being sexual harassment.  Go to the EEOC website.  Yes, it can be construed as harassment.  Maybe it would be better to just not hire Patsy in the first place.

There are two members of “The 1960s Pharmacist Club”.  Jay Pee (1964) and Ken Burrows (1962) Kermit, Texas.   I have some thoughts.

The best old-fashioned drug store merchants are members of “The 1960s Pharmacist Club.”   Here is a list of what they do best.

Customer service is king.

The 1960s pharmacists are terrific at schmoozing and patting fannies.  ”Brenda, you look fabulous today.  That color really works.”  Now, it is not important if Brenda looks good or not.  If it is clear that she went to some trouble putting herself together, you gotta acknowledge it.   She will be back and will keep coming back unless.. a member of “The 2000s Pharmacist Club” insults her, neglects her or otherwise loses her.

The 1960s pharmacists do not like losing money.  It ruins their days when prescriptions that cost $25.00 are sent out for $14.99.  Where is the sense?   The PBM contracts are ridiculous.  Why spend $200.00 to make $215.00?  You can’t even  pay for overhead.

The 1960s pharmacists know that OTC medicines are real drugs and that their insistence that they go out front to help a customer make an OTC choice is real pharmacy.   Many of “The 2000s Pharmacist Club” seem to believe that their job is prescriptions and Rx Only drugs and nothing else.

Pharmacists in the 1960s Club counsel. Period.

The 1960s pharmacist is positioned to be the last man standing for triage for poor patients.   The mother will come in with a sick child, clutching a $20 bill that she took out of the grocery money.  She is desperate for some help and you, the pharmacist, are accessible.  You are free and your reputation as a medical professional can make or break your store.  1960s pharmacists know that this is a big part of the job.  What did they teach you at the new, FOR PROFIT boutique pharmacy school in Grenada? I mean Pennsylvania?  I have watched a guy in a management position who simply was never taught about compounding.   Compounding is the essential, quintessential art, function of a pharmacist.

It is triage of last resort.  Your position as a medical professional with a lot of knowledge makes you the last expert.  It is simple.  Give your little girl 10 ml of this, at bedtime.  OR  You better get this child to a doctor. OR Head for the ER.

No matter how much we hate it, members of “The 1960s Pharmacist Club” are very clear that it is all about the money.  The metrics will never get in the way of practicing pharmacy, but they have to be respected.

“The 1960s Pharmacist Club” is an exclusive club.  However, membership is open to any pharmacist of any age.  All you have to do live up to the standards I have listed here.   Just write a couple compelling sentences in the comments and if I feel that you are not shitting me, you are in.  People over fifty are in no matter what.

My wife, Victoria, is a long-tie Tech.  She has not worked in a pharmacy for 8 years, but how can you forget.  I just read this ti her.  This is what she says:

“Older pharmacists are much calmer and they don’t take things as personally as the young pharmacists.   The young ones think that they are personally being attacked.  All it is is that the patient is sick and crabby.   There will be assholes who are just looking for an argument, but that is rare.  Older pharmacists back up the Techs.  If my older male pharmacists heard the “F” word, they would be over to the counter and take charge in an instant.   Not so the female pharmacists.  The younger female pharmacists are easily bullied.  The younger males look down the counter at the offender (“F” word) and their eyes get wide, but they never came to my rescue.   A big guy, six foot three and about 215 pounds was scared of a confrontation.  I loved my older pharmacists.  They were fun to work with, the held high standards, including counseling.”

I am nominating my man Davey, if he is willing to take the pledge.

During President Bush’s first term, when Part D was being formed by a committee of drug company shills and insurance industry lobbyists, the president said:

“People talked about how the decision to reform Medicaid was immoral.  Well it’s not immoral to make sure that prescription pharmacists don’t overcharge the system.”

This kind of ignorance is why we are in such a frikkin deep hole.  Why the PBMs are running the concentration camp and why  we are following a line of our colleagues, head down, into the gas chamber.

Am I an idiot for believing that the APhA is the outfit that should be educating the politicians?

America is the land of the free and the home of the brave.  The place for opportunity and possibilities.  My Macedonian daughter-in-law called the USA “The Promised Land”.   The popular notion that you can be a success if you get an education and work hard is still true.

I have no problems with immigrants.  All four of my grandparents came from someplace else.  Greece, Finland, Switzerland and Mexico.  They worked hard and they made a life for their kids.

H1b Visa holders are another story.  They are educated people from abroad who are here because of a perceived shortage.  Computer engineers, doctors, pharmacists.  They are not on the immigration track.  The Visa is for a predetermined time.  Is it 3 years?  They are here to make money to send back home.  A pharmacist’s money in the USA is huge money in places like Bangalore.  Ten, twenty years worth of pharmacist’s income at home.

Even though the new, boutique pharmacy schools do not teach their students what the traditional schools do, their students can pass the boards and they work right beside the rest of us.  Parenthetically, have you noticed that some of these kids who graduated from one of the boutique schools don’t know how to compound?  What the….?

Anyway, we have enough American-trained pharmacists. We do not need H1b pharmacists who know very little about our pharmacy culture and protocols.   Their English skills are poor and they are very cocky.

Here are some figures:  H1b Applications for the big three. First figure is for decade 2000-2010.  Second figure is just for 2010.

CVS-              5489     488

Rite-Aid-        4440     245

Walgreen-s    1649       27

The Royal Pharmaceutical Society

The Pharmaceutical Journal

Law and Ethics Bulletin

This organization, I believe, is the United Kingdom’s equivalent of the APhA.

Since the powers at our APhA would never dirty their hands or soil their reputations

with such a mundane, and non-important issue, where do we look for an organization that will?

This may be like a national board.  Who wants to find out?  Regardless, we need statements

like this from official organizations that carry weight.  Is that APhA?

Jay Pee 9-15-2011

Making adequate provisions for pharmacists to have appropriate rest breaks

Pharmacists’ prime concern must be for the safety and well being of patients and the public.  Working for extended hours without taking appropriate rest breaks can adversely affect a pharmacist’s ability to practice safely and may compromise patient care.  Pharmacists, pharmacy owners and pharmacy managers should therefore ensure that provisions are in place to allow pharmacists to have appropriate rest breaks.

The Code of Ethics supports this requirement by stating that pharmacists should ensure that they do not work in conditions that they do not work in conditions that do not enable them to comply with the key responsibilities of a pharmacist.  Similarly, there is a professional requirement for pharmacy owners, pharmacists and pharmacy managers to ensure that they do not seek to impose conditions on pharmacists that may adversely affect their ability to comply with their professional and legal duties.  It is essential to encourage pharmacists to take appropriate breaks, and requiring an employee pharmacist to work for extended periods without adequate provision for rest breaks could constitute a breach of the Code of Ethics.

A pharmacist’s capacity to undertake his or her professional duties safely for specified periods, without a break, will differ between individuals.  It will also depend on various factors such as the tasks being undertaken, the complexity of patients’ needs, the level of trained support staff on duty, prescription volume and the level of over-the-counter business.  Pharmacists and their employers should give particular consideration to the provision of appropriate rest breaks for pharmacist who work extended hours pharmacies, provide on call services or travel long distances to their place of work.

When agreeing working hours and breaks be taken during the working day, employers and employees should take note of the Working Time Regulations 1998. These state that if an employee is required to work for more than six hours at a time, he or she is entitled to a rest break of 20 minutes.  The break should be taken during the six-hour period rather than at the beginning or the end, but the exact time at which breaks are taken is left to the discretion of the employer.  Employees are entitled to have a minimum 11 hours rest between working days and cannot be forced to work more than 48 hours a week on average.

While the Working Time Regulations can provide a useful benchmark, more frequent breaks may be required, for example, where high volumes of prescriptions are being dispensed.  Employers are responsible for making sure that their employees can take a rest break, but they are not required to make sure that the break is taken.

The right to rest breaks does not apply where a job requires round-the-clock staffing, such as in hospitals, and exceptions can be made for emergencies or busy periods.

The above principles and guidelines also apply to Registered Pharmacy Technicians.

While a pharmacist is taking a break, robust standard operating procedures should be in place to ensure that no activities take place that require the pharmacist’s personal involvement or oversight.  All pharmacy support staff should be aware of these procedures and patients should be advised of when a pharmacist is not available and when he or she is due to return.

Two years ago we had a lengthy discussion here about Jerome Ersland, RPh.   Was it murder or self-defense?

Those of you who have given up and intend to take the company’s money for standing behind a computer all day and deftly, with talent, follow the game plan and run the Prescription Mill. DO NOT WATCH THIS.