The Dumbing Down of Pharmacy Schools Produces Robo-Dispensers

Jp Enlarged

He is paid too much.  His benefits are too comprehensive.  He gets too much vacation.  He still gets a bonus even though we have eliminated bonuses.  He still works 40 hours a week.  He limps after 40 years on his feet.  He spends too much time talking with the customers.  He complained about the $12.00 an hour tech wages.  He called it a disgrace.  He told an intern that patient-centric pharmacy practice should be the goal.  He also told her to disregard the metrics when a patient was in need.  This guy is a trouble-maker.  I suggest that we trump up something out of the years of documentation we have on this guy and replace him with that kid who just graduated from Pine Leaf Veterinary School of Pharmacy.  

Those among you who read here regularly know that I have been harping about what I see is a conspiracy to “dumb down” the retail pharmacist corps to save money.  I don’t know if the schools are in collusion with the retail giants, but it looks that way when you observe the quality of the graduates from the new for-profit schools.  

 have been having their way with our profession. We cannot allow this. We cannot allow students from FOR-PROFIT SCHOOLS becoming registered with only two years in the class room.  They don’t even teach compounding.  It is not relevant, they say.  Soon, the profession’s memory of what an old-fashioned “Druggist” brings to the table will be lost… forever.  It is up to us to rattle the cage so hard that the vibrations are felt as far away as Washington, DC.

I worked for a few months with a very bright new graduate.  She got her education at the Feik School of Pharmacy, University of Incarnate Word, San Antonio, Texas.  Founded in 2006.  It looks as if she was in the first graduating class.

There were huge holes in her education.  I went on a mission to fill them.  I worked with her for about 15 hours a month.  We did compounding.  We did Rx counseling.  We did OTC counseling.  I gave her the “You da boss” talk.  When she was the pharmacist on duty, she was the Queen.  All professional issues were her call.  The Lead Tech (who is an ex floor manager believes that she runs the place).  We rattled that hard.  I drilled her with “Counseling defines what you are”.  If you do not counsel (Rx & OTC) you are just a robo-dispenser working in a dispensary.  If you can’t compound, you can’t call yourself a pharmacist.  

She was a sponge.  She sucked up everything I had to offer and I was at it from the minute I entered the pharmacy until she left for the day.  

You MUST step up you guys.  We are fighting for our existence and watching isn’t enough.  Get some steel for uour spine and DO IT.  I have plenty of astep-by-step advice as I am sure Steve and Goose do also.  Stand up.  Kick the non-pharmacist out of the pharmacy just once, if she disrupts the professional job.  Gotta go.  Victoria just said, “Are you coming or not?”
From Goose

Friends,

We haven’t talked in a while, so I thought I’d share a few things I heard yesterday. First a little background. I currently am a preceptor for 3 students, 2 of them on 6th year rotations just prior to graduation and 1 that is doing a 4 week rotation in the middle of her third year, first professional. All are from Purdue and as far as students go, they are okay, but nothing great. The younger student is in her last week and the two older ones are just starting this week, 2 days late because of the weather. I thought all 3 were kind of wimpy about the weather, but that’s another story.  Anyway, one of the older students shared her experience about the interview
process and the job she accepted with CVS and it confirms some of what JP has been hearing about hours, etc. She was hired in by CVS on a 30 hour/week base and was asked if she needed medical or could stay on her parents until she was 26. She didn’t share whether she took CVS medical or not but they did ask. That would be a reason to hire the youngsters, right? She also will be required to float indefinitely.
Another student stopped by that works park-time for us and is also ready to graduate. He was hired by Walgreens to work in South Bend, and he initially agreed to do that. Then he had a change of heart about going there and turned down that position, (unbelievable, right?) and asked for a position in Louisville. I thought that was interesting since Steve has been posting about Wags openings in L-ville. He has not been called or offered. We currently have 2 other students that I am not involved with but know, for a total of 6. Frankly, out of the 6, only one is any good and he’s not that good. Not sure what this all means long-term, but if the talent is this poor coming from a good school like Purdue, what are the others like? The students were also talking about Manchester College’s first graduating class in 2016. (the new pharmacy school in Indiana) Butler and Purdue are currently having a lot of trouble getting preceptors for their students, the Purdue kids think Manchester students will have placement problems. Maybe we’ll get paid now. Looks like more problems for the kids.Just wanted to verify some of the rumors.
Peace out,
Goose

From Steve

    I am hearing other “seasoned” RPH’s talking about the kids coming out of Sullivan U.. here in Louisville.. I hear the phrase that they are being “taught to pass the test” .. and few are very impressive.  From a business standpoint.. it makes sense to have 30 hr RPH’s.. If you have a 90 hr/wk store.. most likely you will have some non-overtime hrs.. when sick days, vacations come around… and since most of the chains have standardized their Rx dept layout… in the larger cities.. you just move bodies around from store to store and/or need a smaller float pool… to cover shifts and avoid overtime.

    I know, that I have a cousin that has a store in Scottsburg… and he was a preceptor .. for only one year.. and that was enough for him… he is no longer doing it.  I still say that we will see – as the surplus grows – PDM’s coming into stores and telling RPH’s .. I have a new RPH’s willing to do your job for xx,xxx.xx/yr and you have 24 hrs – or less – to make up your mind.. if you want to keep your job..  you will have to work for what they agree to work for and take a cut in benefits to match what a new hire would be entitled to. If corporate health insurance premiums are aged based – like everyone else – might have to pick up the cost of insurance over what the new hire
would cost.

    I still think that there is a possibility that we may have to “bid” to get a job… the chain does interviews… and selects half-dozen or so that they feel are good candidates … then get them to bid on how little they will take to get the job. As Obamacare kicks in… and tries to cut costs and the PBM’s & the chains fight over what is left… while trying to increase their profits annually… labor is normally the highest per-cent of a store’s overhead.. and since we are the highest paid… it could get real nasty..  on the positive side… the chains might increase the number of stores that a DM/PDM have to manage – shrink that labor pool cost – so more stores.. the less you have to personally see the asshole :-)

 

18 Comments

18 Comments

  1. pharmacyslave2000  •  Jan 11, 2014 @3:23 pm

    Pharmacy, retail in particular, has become a victim of it’s own success. When I first started in the profession 13 years ago, the demand was almost at it’s peak. The chains couldn’t give you enough. It was a literal bidding war, but in a good way. Obviously, this “gold rush” lead to more interest from students and also schools. Now we see the flip side. Supply outweighs demand and we are fighting to keep our positions and salary. Personally, I haven’t seen it hit my area as of yet as it pertains to the older pharmacists. No salary decreases, no hours cut…yet. However, I have spoken with some new hires who have very similar stories to the one’s discussed here. 60 hrs./pay period guaranteed. $14 less per hr. than what I currently make. Extreme travel for additional hours. Many are thankful for the job as there are classmates of these new grads who don’t currently have ANY opportunities. This is simply the direction of the profession. It took time to get to this point and it will probably take twice as long to return to that period between 2002-2004 when life was good. I really don’t believe we have much we can do. We can be as “professional” as we like but we don’t make the decisions. Those are made by the upper management MBA’s and when those decisions are made, they never benefit the peons at store level.

  2. broncofan7  •  Jan 11, 2014 @9:33 pm

    Our profession will not be going back to the glory days of 2000-2005 anytime soon. Not with the increase in number of Pharmacy schools coupled with the economic salary realities of oversupply as pharmacyslave2000 mentioned. As employees, our circumstances will continue to be dictated by corporate bean counters; meanwhile those with the desire, discipline and guts to move forward into ownership will be rewarded handsomely by being able to practice pharmacy with the respect of the patients that they serve and more importantly, they will be able to have the satisfaction of practicing pharmacy in a manner consistent with their professional beliefs and not being micromanaged by a non Pharmacist MBA……

  3. broncofan7  •  Jan 11, 2014 @9:36 pm

    http://www.bizjournals.com/philadelphia/blog/health-care/2013/08/the-rise-of-independent-pharmacies.html

    Here’s a video on an increase in the Philadelphia market of independent Pharmacies….

  4. broncofan7  •  Jan 11, 2014 @9:43 pm

    And note this Philadelphia reporters concern about the increase in the number of independent pharmacies could lead to an increase in errors “as they may not check the Rx’s as accurately” according to this business blog reporter.

    We as a profession need to do a much better job about explaining how the busiest chain stores, CVS, WAGs, Walmart , Rite Aid, etc. are higher risks for prescription filling errors due to the lack of auxillary help that these chain corporate bean counters provide for their employee Pharmacists.

    This reporter’s belief expressed in this video is actually directly contrary to the reality that any practicing Pharmacist has experienced. We as a profession obviously need to do a better job of letting the public in on the high risk working conditions that the MBA’s create with our chain stores throughout this nation.

  5. broncofan7  •  Jan 11, 2014 @9:57 pm

    Just a quick overview of the average gross xr margin nationwide: $12.50

    Do 100rxs a day x $12.50 x 5 days a week x only 50 weeks ( figure days lost due to being closed on holidays — a perk that you can enjoy as an owner) is $312,000 of gross margin ( that’s your profit over your drug cost).

    That $312k is what you use to pay your overhead…. It’s a rather simplistic view but with some personal curiosity and a will to learn, one can make independent pharmacy a viable business model.

  6. broncofan7  •  Jan 12, 2014 @2:55 pm

    on 100 rxs per day:

    $312k/12 months= $26,000 per month gross profit

    -RPH: $10K
    -Tech 1= $2600
    -Tech 2/clerk= $2100
    =$14,700 in monthly salary

    other monthly expenses:
    - Rent: $2000
    - Rx processing system: $600
    - Electric: $600
    - Phone: $250
    - IVR/telemanager: $45
    - Alarm: $50
    - Insurance check reconciliation service: $200
    - Water: $50
    - Advertising: $250
    - Supplie: $250

    TOTAL: $4295

    so: $4295+ $14,700= $18,995 in total overhead expenses per month

    GROSS PROFIT PER MONTH $26,000- overhead expenses per month $18,995= $7005 NET PROFIT per month

    $7005/ month x 12 months= $84,060 as the owner

    so you’d make $120K as the working RPh and another ~ $80K as the owner for $200K per year—that’s on only 100 rxs per day.

    Ask yourself this question: HOW MANY RXS ARE YOU FILLING PER SHIFT AT WALGREENS, WALMART, CVS, ETC.? AND HOW MANY TIMES DOES MANAGEMENT TELL YOU THAT YOU NEED TO CUT YOUR STAFFING? It’s not for economic reasons, that’s for sure.

    Above you see the economic TRUTH of community Pharmacy. Empowering yourself is empowering our profession.

  7. Barto  •  Jan 13, 2014 @5:06 pm

    BF7
    You missed a few things that really add up, workmans compensation and liabelity insurance. In my area rent is above $3000 SF/mo. The most important thing is to have available cash you need about 650K to get a store open. I did not make that number up that is the number that my wholesaler told be that they feel is the minimum for opening a store. But if you have good customer service and approachable it is like shooting fisn in a barrel. When I opened my last store in 2008 there was one day that we transfered over 50 scripts from CVS.

  8. Barto  •  Jan 13, 2014 @5:07 pm

    Thats $3.00/SF

  9. broncofan7  •  Jan 13, 2014 @8:47 pm

    Thank you for the response Barto,

    -Workmans comp and Liability insurance cost me literally under $3500 PER YEAR. It’s minimal in the grand scheme of things

    - Cost barriers to different markets are VERY real. Rents typically range in the $12-15 per sq foot (you take the dollars( for example $15), then multiply by the square footage being leased, (say 2000), and then divide by 12 months to get your square monthly lease rate; so $15 x 2000sq ft/ 12 months= $2500/month).

    Again, mine was a quick and simple overview but the numbers I gave can be manipulated to meet any prospective buyers situation to evaluate if the business may be a viable opportunity or not.

    BF7

  10. broncofan7  •  Jan 13, 2014 @9:24 pm

    and finally, you don’t need $650K for a start up pharmacy. :)

    -store build out is typically $75-80K

    - Pharmacy system can be had for $3000 down and leased for $600/mo

    - initial drug inventory can be negotiated to be paid for over a 6-9 month period.

    - phone system install typically $4000

    - security cameras installed typically $5000

    Realistically, to do a start up you’ll need around $120,000–or what amounts to a year’s RPh salary. If you have 20% to put towards it($24,000) and a solid business plan that accounts for your expenses to present to a bank, you are more likely to get approved.

    Liveoak bank funds many Pharmacy start ups and acquisitions.

    $650,000??? That’s an incredibly off base, inaccurate and ridiculous number.

  11. broncofan7  •  Jan 13, 2014 @9:29 pm

    Barto, if your wholesaler really told you that you need $650K to start a pharmacy you really need to go talk to another wholesaler :)

  12. Peter  •  Jan 14, 2014 @10:10 am

    In Canada, very similar to what Broncofan described. Rent, depending on location is between 2000-3000 per month. More if you’re next to doctors or in a medical building.

    Start up costs and build-out about the same.

    Inventory – our brand name drugs cost less here, so even $150K gets you a very well-stocked pharmacy. Most wholesalers will give you 6 months before a bill is due. Any inventory you don’t use in the first 3-4 months can be returned without penalty (except injectables).

    So, assuming you are very slow in terms numbers, you could build out for 75K, needs salaries for 1 RPh and 1 tech ($140K), and operating costs for the first year ($5000/month = 60K) and inventory ($150 K), you could be fully funded for an entire year for $425K. But most of us will not have enough capital to fully fund operating costs ($5000/month) and salaries (12K/month). By month 6, you should be doing enough Rx’s to cover operating costs, month 9 technician salary. So, quite doable for about 350K. If as a pharmacist-owner, you’ve saved enough money, you could get through the first year for only a 250K start-up cost if you don’t pay yourself for the first year. Not a bad sacrifice for freedom from bullying from head office and hating your job. If, as Broncofan says, average GP per Rx is $12.50 in the US, it is so worth doing.

  13. broncofan7  •  Jan 14, 2014 @10:31 am

    Great information Peter. As someone who has started a store from the ground up, Peter is a very good reference for those who are reading this blog.

    Here’s some additional info on the average gross margin per RX.

    http://www.drugchannels.net/2012/12/surprise-cms-computes-and-publishes.html

    on a personal note, I am friends with 2 other Pharmacy owners and their average gross profit per Rx is between $14-$15. Just some additional food for thought…..

  14. Barto  •  Jan 16, 2014 @1:22 pm

    You are all correct in that it depends on the market and how you wish to position yourself. In the mid 80s I oppened a store your under 80K.The last store that I opened in 2008 over all cost to open was 275K. Don’t let the wholesales talk you into putting in a big inventory because they are going to give you 6-9 months dating. If you get daily deliveries don’t order any expensive meds untill you get the script. 99% of the patients are very understanding when you tell them that you are a new business and you can have that for them in tomorrow.

    The key to success today is cash flow management and buying prudently.

  15. ml142009  •  Jan 22, 2014 @1:54 pm

    I’ll be starting my second semester of my P1 year next Monday. So I still retain my hopes of what the profession has to offer and what I can contribute to it. I also know that comment sections are a poor venue for discussion, however, as I hear the way experienced pharmacists talk about new graduates I am saddened and frustrated.
    There are too many schools, and too many graduates. Not all of them will be high quality, that is true. However, it also would be prudent to remember that your preceptors back in the day (depending on your age) probably thought the same thing about you. So it needs to be kept in mind that older cohorts tend to see their younger counterparts as inadequate. Of course, there are unintelligent graduates, yet I think there is reason to have hope that a portion of current graduates will be effective in patient care, legislative regulations, and issues in academia. I am for one soaking up as much information and experience as I can.
    Secondly, it is my opinion and perception, which may be incorrect, that many of the complaints about the industry of pharmacy are deflected away from those that played a part in causing the problems. There are few who can stand up against the march of large corporations to own and profit from all they can. However, there was a time when independent pharmacies were more numerous than chains, and an effective group of pharmacists with a bit of insight may have seen what was to come and create barriers to the overwhelming dominance of retail chains that we see today. So as a student training in the profession, I have to balk at the sentiments of some of the more experience pharmacists that they had nothing to do with the current state of affairs and are both victims and bystanders in an unfolding drama. Many in my cohort were not yet born when independent pharmacies were selling out, or when members of pharmacy associations were ineffectually lobbying legislators.
    Of course, I was not there. Perhaps it didn’t happen that way. Yet, the overall sentiment I understand from online blogs, journals, and experienced pharmacists is that of having no responsibility. Perhaps the march of the retail giants was just too powerful to stop, perhaps there really was no way to keep independents afloat, or to sell them to new graduates. Perhaps the pharmacy lobby and experts were just no match for the vested interests of other industries.
    I will admit my naiveté in regards to a wide portion of the profession, and I would appreciate your thoughts and corrections. I am just disheartened to hear more often than not, and in much more persuasive terms, that the profession is doomed.
    Either way I will do what I can to improve the profession for myself and for those that follow. And as with any pseudo-rant that is posted on the web, please don’t take it too seriously or personally. You may reach me at mdl142009@gmail.com with questions of comments.

    Respectfully,
    Michael

  16. Michael A. Harris  •  Jan 25, 2014 @11:52 am

    Great Discussion ! I have been there and done that, also bought the T-Shirt. I operated a successful independent pharmacy for 10 years and sold out profitably. For the next 20 years, I worked for Walgreens and for 18 of those 20 years, it was better than owning my own store. If you made your numbers, hit your targets, and bought into the company strategy, you were in good shape. Then the micromanagement trend set in around 2009, as so well discussed above, and 2 years later I retired. If I were 10 years younger, I would open another independent pharmacy-no question about it. The greatest risk of being independent (not mentioned above) is if you fall ill, become injured, or in any way physically compromised. All the good will in the place is attached to you (usually a good thing), but if you go down, your family is left to try to sell something that might not be marketable. That being said, if you are willing to accept that risk, then go for it !! I agree that it might be the only thing that saves our profession as we know it.

  17. Michael A. Harris  •  Jan 25, 2014 @12:08 pm

    Just a further comment to my post above. With regard to pharmacist MBA’s, be careful not to generalize. I have an MBA from a very good business school and it was an excellent tool for me, both as a independent pharmacy owner and as a pharmacy manager for a major chain. The key word here is “tool”. It helped me understand the language of business and the greater business climate around me. It is also a great credential when negotiating with banks, lessors, etc. Having that behind your name, clears out all the BS and levels the playing field. For me it was a useful tool. It did not compromise my pharmacy care and clinical practice, in fact, it enhanced it. I could always stand up to management with hard numbers to justify my pharmacy decisions. Unfortunately, as so well stated in the above posts, the MBA has recently become a fast track up the corporate ladder, more often than not, with clinical and health care quality issues left on the side of the road.

  18. Stevo  •  May 18, 2014 @5:02 pm

    I just spoke with the pharmacists that I work with and onegot her PharmD out of H.S. 5 YRS. AND the avg. ones got their PharmD within 6 yrs. after H.S. Although I
    ve gone to school 8 yrs. and have no PharmD they think I’m worthless and I leave all the drug interactions, etc. to them.

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