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Obamacare and Pharmacy

Discussion in 'Pharmacy' started by thedave, Aug 16, 2012.

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  1. thedave

    thedave

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    I don't know if this is already being discussed elsewhere but does anyone know how Obamacare will affect the field of pharmacy?

    I frequently hear about doctors left and right planning on retiring because of Obamacare, but I don't know what it will do to pharmacy. Will it mandate more prescriptions are covered? Will it mandate how much can be charged per prescription? etc.
  2. notafraid87

    notafraid87 Member

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    I remember asking this question...consensus was that it's still too early to find out what will happen, but for now, more prescriptions = maybe more job openings in the future.
  3. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    More scripts, more jobs. That simple.

    And physicians won't walk away from $300k+/year jobs. Thats just what the whiny, hyperpartisan physicians say. The regular ass ones will shrug they shoulders and do what they do.

    It should be a boon for PAs/NPs...which will also be great for us because they tend to eff up more with prescriptions...that's called job validation.
  4. ancienbon

    ancienbon

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    I agree with you. Actually, last week there was an article on the new york times where cardiologists working at hca hospital would perform uncessary cardiac surgery on patients who don't actually need them to increase profit.
  5. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Wrong.....More scripts + lower reimbursement = more work with less help than you have now. It's that simple
  6. npage148

    npage148 Senior Member

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    How about you call it by the correct name, The Afordable Care Act (ACA), instead of the fox news approved "obamacare"

    That said, it's more people getting the healthcare they need. I dont see how that's a negative for phamarcists who are actual in the field to take care of people. Even if it hurts pharmacy in some way, I doesn't bother me because it's a step in the right direction of ultimately getting universal healthcare and socialized medicine
  7. gotdrugs

    gotdrugs

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    That's your problem. You are trying to think globally and see the big picture.

    You should just think about the immediate impact on what this does to you personally. Nothing else is relevant.
  8. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    What help, I work nights.

    And, come on, 50 million more people with access and that doesn't result in more jobs? To imply otherwise is just being obtuse.

    If this reduces costs at all, it will probably lead to single payer healthcare down the line...oh, wait...that means you won't have a job all, will you...ouch...
  9. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    /not sure if serious meme picture of your choice.
  10. thedave

    thedave

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    In my defense, every major news outlet commonly uses the nickname Obamacare, as well as thinkprogress.org because it is easier to say, and more people know what you're talking about. If ThinkProgress doesn't have to call it The Patient Protection and Affordable Care Act, neither do I.

    That said, I want to thank everybody for their opinions so far. I should have realized there probably wasn't going to be a clear consensus as to how it would affect us pharmacists and future pharmacists.

    Thank you again, and if anybody happens to have sources to support their opinions, I would love to see those, as well.
  11. gotdrugs

    gotdrugs

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    /sarcasmdectormemepictureofyourchoice
  12. gopher13

    gopher13

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    In my opinion Obamacare, will accelerate the removal/devaluation of dispensing pharmacists. This is why:
    Obamacare increases the number of those with insurance (30ish million), with tighter formularies and lower reimbursement rates ==> more scripts for pharmacies to do but less profit per script ==> companies will turn to automation in order to save their profit margins, which require less pharmacists.
  13. rxblitzrx

    rxblitzrx Short-Bus Member

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    Affordable Care Act (ACA) and the American Recovery and Reinvestment Act (ARRA) have been huge for pharmacy (in my opinion). The HITECH section of the ARRA mandated Meaningful Use of an EMR, and that is why the healthcare sector is outpacing everyone else in job growth.
  14. gopher13

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    Just to be clear the reason you think there is such great growth in the healthcare field is because of mandating the use of EMRs? Not that there has been an exponential increase in knowledge in the field requiring layering of professionals, or the exponential increase in population? (Not trying to be rude, just trying to understand your opinion)
  15. awval999

    awval999 New Member

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    Meh. Maybe less technicans.

    You have to realize that there will always be an RPh at the corner Walgreens. Now yes, double RPh coverage may be zapped. But I don't think the public would stand for the pharmacy to be open without the pharmacist. And I just don't see the magical vending machine thing happening.

    Hospital pharmacists will continue to be employed because physicians (especially residents and physician extenders) are quite incompenent when it comes to order entry, renal dosing, formulary compliance.

    Fancy clincial RPhs could be axed though. To this day I really don't know what they do. Especially hospitals that have so many of them.
  16. npage148

    npage148 Senior Member

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    I'd be happy if we could get rid of techs. Honestly, they are the cause of most of my day to day headaches.


    They run residency programs to make more fancy clinical RPhs so they have people to hang out with and act important
  17. gopher13

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  18. npage148

    npage148 Senior Member

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    The problem with techs is exactly what you claims makes them so great, their insulting salary

    you can't expect good tech help when most places pay a wage on par with mcdonalds. I've been a long time proponent of cutting Rph wages, getting rid of excess techs and using the money to get good tech help. You'd get better people as pharm techs which in tern would allow you to be more productive with less help. In the long run you'd run leaner with less payroll but it's not possible to convince pharmacist to give up a penny or to convince corporate to fire all 6 of your techs and hire 3-4 competent people at 2x the wage
  19. gopher13

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    I would agree with you on that. I don't believe dispensing pharmacists should get $50+ an hour (unless they do MTM, and clinical things in the retail setting), and techs get just around $10-15/hour. No way that you can build a talent pool of techs then unless they are all pre-pharmacy students ;)
  20. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    I'd be willing to cut my salary down to like $115k a year to give a tech an extra $10 an hour, no doubt. Imagine the level of competence we could hire.
  21. gopher13

    gopher13

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    You make over $115k in a retail pharmacy?
  22. npage148

    npage148 Senior Member

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    I'd be willing to bump down more to like 100-105K. If we paid techs 20$/hour we'd probably end up with amazing help with degrees in related fields and good problem solving skills. I'd probably never have to help with an insurance claim again or explain how to calculate day supply for a liquid.

    The good techs runs run ASAP to their "real jobs" and leave the bad ones behind to drive me up the wall
  23. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member Administrator SDN Senior Moderator

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    This cracked me up.

    And I agree that techs should be paid more. Good techs are a joy to work with, though few and far between. And this is just from an intern's perspective!
  24. rph3664

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    "60 Minutes" did a story about 10 years ago about a hospital in California that was doing this too! Father John Corapi, who has (had?) a program on EWTN was almost a victim of this doctor, who also had a very high rate of surgical complications. There's also a book about it, which I tried to read but it was in desperate need of an editor so I didn't finish it. It was called "Condition Critical" or something like that.

    He practiced at a Tenet facility, which is a for-profit chain and this was part of the reason why they weren't asking too many questions until the other cardiologists in town starting hearing stories. Example: One of the interviewees was told by that surgeon that he needed open heart surgery TODAY, and in the prep room, one of the nurses said, "If I get caught, I'd be fired and possibly lose my license, but you need a second opinion. Please sign out AMA." He did, and went to another doctor in town who said, "You're the third person I've seen this week from that hospital who told me the same thing."

    My old hospital had a heart surgeon who was incompetent, but since his patients almost always had such long stays and were bringing lots of $$$$$ into the facility, once again, TPTB looked the other way until word got out in the community that there was a doctor at our facility who was killing people and patients were driving 100 miles to the nearest similar facility rather than have it done there. He left, although AFAIK he never lost his license or anything, and is now practicing in another rural area. :eek: This is especially despicable because this town already had one medical serial killer; we sure didn't need another.
  25. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Really? What happens if there isn't a corner Walgreens? What happens when the law that mandates a pharmacist be in the pharmacy is changed to let "super" techs count the pills and read the patient counseling sheet off the label to the patient?

    Boy you don't see much do you? The public could give a rats ass who fills thier prescription. You know what the public cares about? Getting thier Vicodin filled as fast as possible. As long as it is done thier way right away prisoners on work relese could fill the prescriptions and they could care less.

    This proves you have no clue what you are talking about......
  26. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Costco pays thier techs over $20 a hour and thier pharmacists the market wage. Its short sighted companies run by MBA idiots who are shooting themselves in the foot by low balling tech salaries.
  27. npage148

    npage148 Senior Member

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    Costco and Walmart and the like can allow they pharmacies to be loss-leaders so what they do doesn't relate to how the rest of the industry functions
  28. awval999

    awval999 New Member

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    1. Just because the patients like fast service doesn't mean they wouldn't bitch if only a high-schooler was there to count their pills and verify the Rx. And laws don't get changed so easily. You have to realize that if push came to shove and a State legislature was considering such a law--ie: removal of pharmacist verification the cheap ass RPh's would be donating lots of bucks to make sure it wouldn't happen. You also have to realize that the State Board of Pharmacy is composed of Pharmacists. When push comes to shove they aren't going to cut the throat of their own profession, even if most of them are corporate hacks.

    2. Yes, I know what I'm talking about. I am a hospital pharmacist. Yes the 1st year medical residents attempt to kill our patients, on a nightly basis. This is why I feel that hospital pharmacy will always be safe. Two, who knows what a staff of clinical RPh's do. Mostly they do busy work and document bull****. The truth hurts.
  29. gotdrugs

    gotdrugs

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    Regarding the bolded part, the "cheap ***** Rph's" donating bucks would pale to the money the corporations would donate to make it happen.

    Regarding State Board of Pharmacies "protecting" the profession:

    1) They are there to protect the public, not us. And there is already data out there showing that "tech-check-tech" is just as (if not more) accurate than pharmacist check teck. Granted there are reasons behind this, but the people who want to make this happen won't go into that part, they will just show the final results.

    2) You don't think Boards of Pharmacy will cut their own profession? Why do you think there aren't regulations limiting # of scripts per pharmacist per shift. Why do you think over the last 15 years many Boards increased the tech-to-pharmacist ratio or did away with it all together? This wasn't to "help" pharmacists. This was a movement initiatied by big box chain. After these ratio's were increased or removed years ago that's when many Walgreens districts started to remove the 10-6 midshift pharmacist. Why did they approve "central fill" operations? Why did they approve the vending machines? I could go on................but hopefully you start to see the point. They will cut it, don't kid yourself.

    3) Why do you think the chains have made a push that Managers sit on boards of pharmacies? Heard of the term "puppet?"

    4) One final note regarding Boards of Pharmacy. For this doomsday scenario would happen, it would require to change the law. Keep in mind the Boards only make the regulations for the profession. It's state legislators (i.e. non-pharmacists) who would be the decision makers. Yes, they would ask the board for "input," but there could be a lot more influential entities (and $$$) giving "input" that this is a good idea.

    If you think hospital pharmacy will always be safe even if retail goes down in flames you are sorely mistaken. It's symbiotic. Do you think the hospital you work for really wants to pay you the salary you are making (or even think you are worth that)? NO, they don't. But when the pseudo-shortage hit late-90's/early-00's they HAD to to keep up with the retail market.

    If retail pharmacists get obliterated, how long before the CNO's, CFO's, COO's get together and come up with a plan that "tech-check-tech" has as good or better accuracy, the nurses are more than qualified to "save the patient from the incompetent residents/attendings" (which the CNO happily attests to), and they can save money by eliminating the position of pharmacist.

    BTW, you contradict yourself, you fully admit in one breath that you have no idea what the "clinical" pharmacists do at your instituation, then proceed proclaim you know all they do is document crap and do busy work. My guess is you truly have no ****ing idea what they do and are a bit envious. BTW, it's that line of thinking (that if you aren't dispensing you aren't working) is what could kill the profession as we have tools like you cutting the throats of people who might be trying to change the profession to more service-based than product-based.

    One last note, if you don't like what I post, keep in mind what you stated:

    The. Truth. Hurts.
    Last edited: Aug 18, 2012
  30. pezdispenser

    pezdispenser

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    I'm not so sure about that... See this article on Kiplinger 10 Best College Majors for a Lucrative Career and yep, pharmacy made #1. But what's most entertaining is when you go down the bottom and read the public comments, a lot of people have no clue we get paid six-figures and honestly thought we just go to one of those vocational colleges you hear advertising on the radio...
  31. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Costco and Wal-Mart are not running the pharmacies as loss leaders I assurue you. Do you go to Wal-Mart or Costco just becasue they have a pharmacy? They fully intend and expect to make money on the pharmacy.
  32. joetrisman

    joetrisman

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    Tell me how you really feel :smuggrin:
  33. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Think about this? Does the average patient have a clue you are in the hospital? Do you think they would care if you were not there?

    Can the average patient go to their local community pharmacy and pick out the pharmacist? Especially at CVS now that everyone incuding the pimple faced highschool cashier wears white lab coats?

    Your lack of understanding is scary...especially since you are a pharmacist. If I had to guess I would say you are someone who has never worked in the field before.

    Don't be so sure about the difficulty getting State laws changed. The State Boards are full of retail coroporate stooges. It is only a matter of time before CVS and Walgreens get a State to remove the requirement a pharmacists has to be in the pharmacy. CVS has been trying for years.
  34. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Exactly!
  35. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Bingo! We have a winner! Nice post.
  36. joetrisman

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    Agreed.
  37. 5minutes

    5minutes

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    Not trying to piss you off, but what do you suggest us to do with all of these information you are giving?
  38. gotdrugs

    gotdrugs

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    I'll admit I don't know all the answers, thought I have a decent understanding of the problems.

    My post was designed to

    1) vent, I'll admit it.

    2) Try to get people's heads out of the sand. If I don't know all the answers, maybe making others aware of what are the possibilities will motivate someone(s) smarter than I to help change. Part of the issue, IMO, is that so many pharmacists have sat back and thought things would work themselves out or somebody (e.g. the Boards) would look out for us.

    3) Try to get people in our profession not to be so damn fragmented and against the other fragments (i.e. hospital vs. retail - the thought that retail could die but hospital could live on; the thought that since "clinical" rph's don't do much/any dispensing then they must be worthless and not do any work). It won't work unless we realize we are all in this together and need to work together to resolve global issues or to support other sects initiatives even if it doesn't directly benefit them (as long as it doesn't harm them of course). Unfortunately, I have seen that last sentence bite the profession in that ***** at the state level because one of the state organizations took their ball and went home.

    4) Become proactive - change your practice, expand, try to grow the profession. I have and I'm not that good nor smart so it can be done if you really try.

    5) Get into advocacy. If you don't do it, who will? Non-pharmacists are NOT going to advocate for pharmacists. Period. This is where we have dropped the ball.

    6) #2 and #3 are two of the biggest problems with our professions. It's why #5 has been struggling (failing?). Too many people interested only in themselves or their sect of pharmacy and not looking at things from the "big picture" level.

    7) when you change your practice, or be innovative or expand services, get more FTE's etc. Share your accomplishments with others so hopefully they can repeat your success, expand on your success, or use that as a springboard to new opportunites. But it doesn't happen often enough as at the moment, too many pharmacists are just in it for the next paycheck, the chains - in general - don't care, too many hospital DOPs are too set in the "old ways" of pharmacy and unforunately think like others that if you are a pharmacist who isn't dispensing, then you are worthless, academia members - as much as they piss me off - sometimes have done the above. Unfortunately though, too many of them are too interested in making a name for themselves (or completely don't understand the real world) than actually promoting the profession.

    Sorry for the long rant.

    EDIT: Many other potential things you can do. Be a board of pharmacy member. But if you are, and work for a chain, do what's best for the patients and the profession, not what will make the most money for the chain you work for.
    Last edited: Aug 18, 2012
  39. awval999

    awval999 New Member

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    Damn that was a thorough asskicking.

    Upon reflection of my comments I agree that somethings I said were embelished. And I do agree with many of your counter-points.

    But honestly you can play the same game with any of the medical professions.
    1. Nurses just wipe asses and give medications, why can't the $10 STNA's do it.
    2. NP's and PA's can replace the MDs save lots of bucks there.
    3. Fancy nurses like CRNA's, etc can replace some medical specialists.

    Pretty soon we'll just have surgeons, PA's and STNA's.

    I really just think that salaries won't keep up with inflation. They will constantly remove 'slower' pharmacists via metrics and have the new grads replace them. If RPh's made ~$60-70K a year we wouldn't have to have this conversation.
  40. pezdispenser

    pezdispenser

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    Bravo gotdrugs! I agree with all of your points including the previous post and especially #2 and #3 above.

    I'm afraid most students and a lot of pharmacists still have their heads stuck in the sand. I am a retail pharmacist so I know some insider information about what's going on at the bleeding edge. I can't say it in public, but I can warn you guys that the **** is going to hit the fan. And frankly, I'm too busy trying to get my own sorry ass out of the way that I can't help the profession :(
  41. gotdrugs

    gotdrugs

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    You definetly make good points (in this post ;) )

    I'm not for sure if the "doomsday" scenario will happen, but I do think IF it happens to retail, it will happen to hospital as well.

    Regarding your 2 points (I'll lump #2 and #3 together as they are both geared towards replacing physicians with mid-level practicioners/nurses):

    Nursing is more protected than us because

    1) they have a very strong voice both publicly and legislatively. Not all nurses practice in the same setting, but when it came to growing the profession (via NP and now DNP) they circled the wagons and fought together to push this through (and did so with the NP and expanding the NP roles despite grumblings from the medical community)

    2) The public as whole has more respect for nurses than us. One reason is because they are more visible and the other is because they do a very good job of promoting themselves. They also embellish their accomlpishments on both a "in the trenches" level and on a national level - I"m not condoning that, but it has helped them as a profession.

    3) They are seen as providing a service.

    Physicians are more protected than us because

    1) They have a strong voice both publicly and legislatively. Not as strong as nursing when it comes to MD/DO vs. RN/NP/DNP always, but definetly stronger than pharmacists.

    2) The public as a whole has more respect for physicians than us.

    3) They are absolutely seen as providing a service and for intellectual thoughts.

    EDIT to ADD: BTW, PA's are zero threat to physicians as the Boards of Medicine are the ones who license and regulate PA's. The PA's are dependent upon the physicians and always will be. In fact, the PA profession was created by physicians in the 60's in order to combat the growing NP/mid-level nurses such as midwives that started in the 40's/50's.

    Pharmacists are at greater risk because

    1) We don't have a strong voice. I spoke to some of the reasons behind this issue already.

    2) We are seen a bit too often as providing a product. We are seen this way to some extent by the public, by decision-makers both legislatively and business decision-makers, by other health care professionals, and even by other pharmacists (hence my tongue-lashing about your 'clinical' rph comments)

    When your role is perceived as only, or mostly, providing a product, the business decision makers are going to find ways to make that delivery process as cheap as possible as you are just a means to an end. So they will find the cheapest means possible. And then the doomsday scenario hits if they can convince the legislative decision makers to see things the same way.
  42. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    I have been telling you all for awhile. If you are a retail pharmacist now is the time to get out. The best time to get off a sinking ship is before anyone else knows it is sinking. A lot of pharmacists are starting to figure out retail is sinking. Jump off the ship now while there are still lifeboats.
  43. joetrisman

    joetrisman

    Joined:
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    Developing rickets
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    Pharmacist SDN 5+ Year Member
    Inquiring minds want to know...
  44. thedave

    thedave

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    Apr 4, 2010
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    SDN 2+ Year Member
    When I first started looking at pharmacy schools 6 years ago, I went to an open house for one in California and they flat out told everyone (6 years ago, before Obamacare was a twinkle in anybody's eye) that if all you do is count pills, your job will become obsolete, and you need to specialize. It kind of sounds like people on the front lines are seeing it, too.
  45. thedave

    thedave

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    I recently read about a (compounding) pharmacist who charges $200/hr for one-on-one private consultations. How does everyone else feel about a business model like that?
  46. Ava999

    Ava999

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    Feb 15, 2009
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    Pharmacy Student
    SDN 5+ Year Member
    Theres hope for c/o 2016! :smuggrin:
  47. pharmasaur

    pharmasaur

    Joined:
    Mar 17, 2012
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    Pharmacy Student
    SDN 2+ Year Member
    sooo if retail pharmacies become obsolete (likely to happen, kind of like all the corner bookstores dissappeared and now everyone shops on amazon)...


    where are pharmacists going to work? or is the WHOLE CAREER going to dissappear?
  48. clachan3

    clachan3 Member

    Joined:
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    Messages:
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    Status:
    Pharmacist
    SDN 10+ Year Member
    I've thought about this, until people turn into robots we should still be okay. I think most people still like to have some human interactions. We may not be just filling prescriptions, we may become more like healthcare educators.
  49. sisson329

    sisson329

    Joined:
    Aug 5, 2010
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    Pharmacy Student
    SDN 2+ Year Member
    Make sure that if you're really going to look at the big picture, look at the BIG picture. Not just the ACA. There are many things going on aside from the ACA that the ACA has incited. Look into transparency right now with PBMs, look further into "third class of drugs", look into CCO changes, etc.
  50. sisson329

    sisson329

    Joined:
    Aug 5, 2010
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    48
    Status:
    Pharmacy Student
    SDN 2+ Year Member
    I don't know how other states have been, or are, handling pharmacy with or without these changes but Oregon sure as hell has it's head on it's shoulders. The pharmacists here really push for quality changes where they can, so I feel in Oregon, this is going to be nothing but positive for us.

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