Jul 9, 2013
The dispute about how the prescription-providing industry will move forward is long over. It ended in a virtual deadlock. However, the issue of money has tilted the game in favor of those who defend the bits and pieces like Wait Times, Metrics and the Low-Profit (18% GP) High-Volume business model.
These are the PROCEDURE people. They say that the PROCEDURE model has proven itself, over and over. The most important thing is putting out lots of product by using the correct PROCEDURE. The PROCEDURE will guarantee that pharmacists do not deviate from a winning plan. If they resist, bully them with the dreaded write-up, below the line performance reviews, with new pharmacists (Robo-dispensers) begging for jobs put them on the list for termination. The PROCEDURE will eventually calm the ESSENCE people. They throw in MTM, BP screenings, Hemoccult programs, immunizations and they say, “See what good boys we are. We are all about professionalism, the ESSENCE. This is what you want, isn’t it?
The PROCEDURE people are not usually pharmacists. They hold powerful positions that did not even exist when pharmacists (ESSENCE) were directing the profession. The PROCEDURE people (Call them Masters of the Universe) crunched numbers and came up with some radical new business strategies, but they have neglected patient care, the ESSENCE of any medical profession. I suppose had they paid attention to the fact that pharmacy is a profession and not just another variety/grocery/big box store department they may have had something that could be worked with. Alas, they don’t get it and they never will. Not a pharmacist, never a pharmacist and unable to think in the retail box that was perfected by a dying breed..the DRUGGIST. I mean totally incapable of getting what DRUGGISTS did to satisfy the patients and make a damn good living with the moderate to high profit (40% GP) Low Volume business model.
Those who still emphasize ESSENCE, argue that the Masters of the Universe are defined by their business school beliefs. The ESSENCE people, like me, reject the idea that a pharmacist is a fucking drone, run by a productivity program at the company’s headquarters. When you turn a profession over to business school Fanatics of the Universe, you have done nothing to advance the PROFESSION. The Masters of the Universe are all about profit. The patient be damned. The major pharmacy retailers (Chains, Groceries, Big Box) have been allowed to subvert the profession and worse, the Boards of Pharmacies have sat back and watched. If your mandate is to protect the public from dangerous pharmacy practices and you do not even wink at violations of counseling laws because the PROEDURE leaves no time, are you a hypocrite or a fucking hypocrite.
The important thing is to get people like that out of power, even if it takes a program designed to OUT the BOPs to the public. The goal is to weaken the PROCEDURE, by nearly any means. Did I hear Pharmacist Bob spell U-N-I-O-N? I am still waiting for one of you to contact the Guild for Professional Pharmacists for advice on how to go about organizing.
It was all ESSENCE when I was a new pharmacist. My goal was to get a job with Horton and Converse, a real pharmacy chain in Los Angeles. Horton and Converse ran operations that would cause any ESSENCE pharmacist to over-excited, but the stores were small, with a small OTC out front and a huge pharmacy in the back. Of course, a decent size pharmacy counter with like three typewriters. One counter back was a large compounding area. They were 24 hour operations. This is a 50 year memory. I did not get a job with Horton and Converse because every new pharmacist applied. I was told, “You are new from Ohio. Frankly, we will hire California graduates first.” I went to work for Thrifty Drug Stores up in the San Francisco Bay Area. My first job in a PROCEDURE based store and the PROCEDURE in 1965 would be to die for in 2013.
The events of the last 50 years have vindicated the PROCEDURE people. Population growth. Many more drugs. In 1964, the choices for blood pressure with a diuretic and either hydralazine, reserpine or a combination. Today.. count them and count the patients who are on two or three. Third parties. With only a copay, drugs are cheap. The boomers. Every single thing says to the PROCEDURE folks that their way is the only way. The ESSENCE pharmacist, forever, will say, “Patient care is the most important thing. This is pharmacy we are talking about. Not dispensary. No pharmacy no need for the pharmacist. A dispenser in the PROCEDURE model could be a well-trained high school graduate. I have harped in the past…. The law that you be ready to go to the barricades to make sure it is sacrosanct is the one that says, A PHARMACIST MUST BE PRESENT WHEN A PRESCRIPTION IS SOLD. What do you think will happen if you let that one get away? You believe that the PROEDURE Masters of the Universe will NOT find a way to get rid of you and you are the guy who believes that the stripper will change her ways after you marry her.
PROCEDURISTS have shown that they can run effective and profitable departments as long as they keep the sword over the head of the pharmacists. “You want the job, you make the metrics sing.” You know what, they lack the mental equipment to govern a profession. They aren’t pharmacists to start. But, once they have the power, they are always going to centralize that power and undermine creative thinking in the stores. Once the PROCEDURISTS got the power, they subverted any review from the pharmacists in then stores. You think that $25.00 gift cards for a transfer would be the gold standard promotional tool if pharmacists got to sign off?
The Masters PROCEDURISTS have built a tight-knit cadre of mid-level managers that is resilient. (The also did not exist 30 years ago). The ESSENCE crowd has not a chance in hell unless someone wakes up and points “Look, the emperor has no clothes.” When I read that in the Wall Street Journal of the USA Today with statistics of probably harm due to non-counseling, I know that the PROCEDURISTS can feel their rear ends pucker up. I honestly believe that, in marketing pharmacy, that incompetence is built into the intellectual DNA of the PROCEDURISTS. Oh, there are pharmacists among the PROCEDURISTS.
The ACPE, The NABP, the APhA, the Boards of Pharmacy and the Colleges of Pharmacy have not handled this situation particularly well. They have shown disgusting deference to the money bags, the big prescription-sellers. They want good relationships with the PROCEDURE people who can write a whopping nice check for that new laboratory. Put on a nice shiny brass plaque. THE WAL-MART DISPENSING LABORATORY. The ESSENCE people cannot compete. They are much better preceptors however. They must teach these kids about what it takes to be a DRUGGIST. It is the only hope for pharmacy.
The status quo is bad. Most of you have absolutely no practical idea how to make things better. You all believe that you will end up on the float team, have your hours cut or out of a job. Small thinking. With so many ESSENCE fans still out there, what is the problem? You can overwhelm the PROCEDURISTS be numbers alone. You are not going to do it alone though. You need direction. I can hear Pharmacist Bob in the background spelling G-U-I-L-D.
PS. If the new pharmacists lose the traditions of pharmacy, and I like to call it THE WAY OF THE DRUGGIST, it is all over.
This is not rocket-science. If you keep your feet on the floor in a pharmacy department all week long, you cannot deny that all that I have outlined is the distillation of what we are facing as we enter a period of incredible growth in the number of prescriptions filled.,