Pharmacists becoming obsolete?

Not going to happen in the remainder of my career so that takes care of the next twenty years. As for you folks in school now, I think you are also safe because any technology devised will require supervision and that role will be filled by a pharmacist.

Example; WAG highly automates their busier stores and those baker units can only be serviced by a pharmacist. A colleague was telling me about a pilot project where one pharmacist would monitor the functions of licensed technicians in three stores remotely. This idea runs counter to existing ratio laws which in Florida are 2:1 and with special approval can be 3:1. Laws can be changed but change comes slow when dealing with public safety.
How long have we had fax machines now? State pharmacy laws are only just getting around to accepting the validity of a faxed prescription, and as far as systems where a physician electronically enters his order into a system unchecked? State boards haven't really touched that yet and I assure you any order entered by anyone physician or not is still checked by a pharmacist before it is dispensed. Docs get fat fingered too! Protecting the public welfare is a very stiff test to pass even for automation.

Retail demand is gonna skyrocket. Your friend is out to lunch. With this jump in scripts, greater pharmacist autonomy, required cognitive service, and IMMUNIZING which is gonna be absolutely huge whether you like giving shots or not. All of these are gonna drive demand.

Why do we keep having this discussion? I don't get it.

you are not the dingus...that is a totally valid concern. it's my concern as well. but baggywrinkle knows much more than i do so i hope and pray that he/she is right.

while i don't think pharmacists will be completely outmoded, i do feel the demand will decrease w/automation. i agree that the whole babyboomer aging thing will increase the demand. but the demand may become so much that the only way to meet it will be through automation cuz we may not be able to crank out enough pharmacists in time. and with automation, we may need fewer pharmacists to oversee. we'll still need them but not as many. but what do i know? baggywrinkle, please feel free to correct me if i'm way off.

i think i read on another thread that walmart is gonna try and institute a system whereby one pharmacist can over see prescriptions in several stores at once from a central location. so maybe they'll have this one pharmacist at the central location and each location can also have one in house to counsel, immunize, whatever. and that will cover it. still have pharmacist but fewer. that will save the chains lots of $$$ so they may be inclined to do something like this. And in fact computers and automation may yield better results (i.e. fewer errors overall). i certainly hope not but this does sound like a distinct possibility to me and i'm kinda scared.

There are of course other avenues for pharmacists besides dispensing but if the dispensing jobs decline, all these dispensing pharmacists are gonna be competing for the other jobs and then we're gonna end up w/more pharmacists than jobs overall.
i know i sound negative but actually i'm just trying to be realistic. it's always about the bottom line and if chains can save money by getting rid of us or reducing the need for us, they will.
i'm scared. 🙁

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i'm scared. 🙁 [/B][/QUOTE]

Pharmacy HAS changed since I started practice, but in the other direction. We are much much busier today than we were twenty years ago.

Let me tell you what I have seen (shaking some old fart barnacles off and getting comfy). When I graduated it was easy to find an independent to work for. A busy store did two hundred scripts a day and there would be as many as three pharmacists behind the counter to deal with that rush. There were no technicians or typists - just a cashier. The big boys were just getting into the picture with a new formula; rock bottom prices and no help.

Work was abundant - more so than today. When I got off the plane in Dallas Ft Worth to look for a job I had six solid hospital offers within five days of interviews. Talk about a sassy new graduate! Computers were only just beginning to arrive. All profiling and billing was done by hand. My biggest job as new guy was typing IV labels. Six hours out of every day was spent typing the batch. A pharmacist or pharmacist intern did the typing. Techs were not allowed. I remember how happy we were when we got an IBM memory typewriter that could repeat and even store the most common labels.

Those were good days! Only the largest hospitals had 24 hour pharmacies (Parkland - Dallas) Tiny rural hospitals closed at 9pm or even 6pm. One of my good buddies worked a corperate outfit called HCA (today Colombia) He worked hard but could count on being done after dinner and watching TV in the surgery waiting room. In the late weekend afternoons he might move into an empty private room to watch TV, eat dinner, and even grab a relaxing shower! I remember busting butt in the morning so that me and my tech could watch double shock theater on Sunday afternoon. So what happened? Where did the gravy train go?

Billing changed and DRGS happened. This is a flat rate pay structure for a given dis-ease. $1500 dollars for treating an acute asthma episode for example. You do the job for $500, the hospital makes money. If it takes two grand, the hospital loses their shirt. The gravy days were gone forever and the great consolodation began and continues to this day. I've had two hospitals and an independent go out of business underneath me.
There are fewer jobs because there are fewer pharmacies owned by even fewer deep pockets. HCA swallowed Humana and was in turn swallowed by Colombia. Fewer larger pharmacies with much larger staffs are the rule. Independents are hard to find unless they have found a niche like durable medical supplies or compounding.

Against this pressure to cut costs demand has skyrocketed. The 300 scrpt a day Eckerds of the early eighties might be filling 600 today. More is expected of a pharmacist. Prospective drug screening, patient counseling. Perusing the current Texas state board newsletter I see pharmacists fined $1500 dollars for failure to counsel, pharmacists put on probation for missing a drug/drug interaction. A job ad I looked at in Seattle required BCLS certification because the pharmacist is expected to answer a code - I wonder if there is more than one RPH on duty during the evening or at night and who does the regular work while he is out playing ER? Expanded clinical roles are great but who is minding the store?

In the future this trend will continue. Demand will continue to increase and pressure to cut costs will also. In the future there will be a place for the pharmacist - the question is - in this fast paced high pressure environment will anyone want the job? Women now outnumber men and tend to be part timers while they raise their families. Men are staying away in droves preferring sexy lucarative fields like IT and nanotechnology. By the time you guys retire you may well not be doing anything like classic lick stick and pour. You might even have to go back to school to build on the foundation you already have. But your position is assured if you stay loose and go with the flow. This is bad how?

thanks baggy. i'm always looking for some reassurance.

Originally posted by lilmk
thanks baggy. i'm always looking for some reassurance.

Click to expand...

It is a good thing to get into the job market periodically.
I just saw a hospital in Syracuse New York offering a $25,000
dollar sign on bonus for a warm licensed body. Now I don't know what is wrong that their bonus is so high. Is Syracuse the armpit of the world? Does the pharmacy director bite his employees?

In contrast, when I was looking in 1998 El Paso was offering a $5,000 dollar sign on bonus and they really **ARE** the armpit of the world unless you were born there. I just thought that figure was some kind of hot but it pales compared to this by any scale.

No bonuses offered at all in Vail Colorado, or Seattle Washington {sigh}

After listening to a lecturer talk about the recent UAW plan of mandating mail order provision of maintenance drugs, I started to sweat. After doing my readings for Health Care Delivery, I have to say that I am a little less optimistic about job opportunties for pharmacists in the future. Things like the increasing number of exclusive contracts PBMs are negotiating with mail order pharmacies and the increasing technician to pharm ratio are just a few that are worrying me. While others would argue that this is a step to improving the pharmacy profession by pushing pharmacists into more non-traditional clinical streams and realizing that hazy 'Pharmaceutical Care' goal, I don't know. It seems like things can really change with the blink of an eye in corporate America.
I don't feel as though pharmacists have a whole lot of power when faced with the corporate bullies. Who does? I thought for a momnent that with such a shortage of pharmacists NOW, that pharmers had some power. But will the big guys figure a way around this?
I am very much interested in Independent pharmacy practice and I felt very saddened to see that in the USA, it's pretty difficult for independents to survive when those predatory corps take a big bite out of the market share.
Will pharmacists one day be as disappointed as the IT folks are today?
Perhaps only the creative and innovative pharmacists will able able to survive and conquer?

Just ramblin'

chunkyb, my sentiments exactly. that's why i'm so freaked. and while others on this thread are trying to be reassuring (i appreciate that 🙂 ) i still don't feel that they are addressing the issues you mentioned. i feel these are real issues and real threats. chunkyb, you said exactly what i was trying to say in my post only you said it much better.

i politely do not share your pessimism in regards to this issue. The pharmaceutical frontier is not something that can be replaced by machinery or a corporate business model, as much as physicians could not be replaced by a robot that did a work-up and spit out a diagnosis.

Hey Jason!! Don't you have an opinion on this da#*it!!!??

Originally posted by Triangulation
i politely do not share your pessimism in regards to this issue. The pharmaceutical frontier is not something that can be replaced by machinery or a corporate business model, as much as physicians could not be replaced by a robot that did a work-up and spit out a diagnosis.

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well, like i said before, i don't feel that pharmacists will be replaced completely but i do feel that down the road, automation will make it so that fewer are needed. so then, many pharmDs may end up out of work and will be competing for the limited number of non-traditional jobs. i know i sound all negative but this is actually something i've been worrying about since i started pharm school 2 yrs ago. if someone can allievate my concerns with valid arguements i'll gladly lap it up as comfort food. but chunkyb made a lot of good points. it's really always about the bottom line. pharmacists are expensive and if the walmarts and sav-ons can cut costs, they will. if they can have fewer pharmacists on staff and get by...they will.

My worrying over the future of pharmacy has nothing to do with robots and vending machines dispensing synthroid. I just think that pharmacists have a lot of hurdles to leap in terms of garnering more power for themselves. Although I am resentful to the many corporate giants like Walmart and chain drug stores for destroying the dreams of independent pharmacists, I already forsee some problems that these pharmacies will face themselves.
Third parties are not generally pharmacy-friendly and the movement towards cost cuts at the expense of pharmacies makes me feel as though pharmacists will be the pawns in the corportate health care game. The new bullies on the block are the HMOs and they are in alliance with the pharmaceutical industry crips.

All you can do is keep your powder dry, and your options open. There are no guarantees in life. I will soon be licensed in four states. Colleagues have said I am crazy for wasting the money on the renewals. Options man, options. One of my co-workers is only licensed in Florida which cannot reciprocate. He is too old to take NABPLEX again. From where I stand he is screwed. Where can he go - Miami? Talk about an armpit!

It pays to test the job market periodically with a job search so you can see which way the wind is blowing.
The environment IS changing. In my earlier posting I talked about the ease with which I got a hat full of job offers in 1984. When I job searched in Florida in 1998 there were still no worries but I noticed the attitude of the interviewers had gotten ugly. One interviewer offered me a tentative position on a temporary basis. She would bring me onboard for eight weeks and decide if she liked me then make an offer of a permanent position. It was my own fault. I went to that interview through a head hunter (Cameron) Problem was, to accept her offer I needed to move my family and household from Colorado to West Palm Beach. I thanked the nice woman and gave her offer all the attention it deserved accepting a position elswhere.

That is the **POWER** of a pharmacist. You are not obliged to accept crumbs thrown in your direction.

Yes, we might be selling buggywhips. But it isn't going to happen overnight, in a month, or in five years. You will see it coming and have time to do something about it. There will be ample time and money to go back to school and join the next parade. Even if the big boys walk in the day after purchasing your place of business and tell you bye bye you are not going to starve. This happened to me btw. That is the worst case scenario.

Whatever you do try not to be like my pharmacy manager. WAG is the only company he has ever worked for (thirty years) and he has no clue what the market is like. He would be a babe in the woods if he had to work in a new environment like a hospital. Such a transition would be very painful for him. I am at the other extreme changing jobs every 1-4 years or so. I have more job history than I can get on one resume and it hurts me now in an interview. They think I am trouble (I am).

Just stay aware and you will be fine.

yes, i was referring to your post...thank you for your response. 🙂

Sorry, my control V isn't working.

No offense to triangulation as I enjoy your posts, but I don't see the big draw for immunizations by pharmacists since health departments do this for free for the indigent and many doctor's offices charge less for immunizations than what I have seen pharmacies advertising the same for.

It's actually huge. A lot of pediatricians were initially sweating the idea bc so much of what they do is child immunization. Supposedly pediatrics didn't really exist before vaccinations took off less than 50 yrs ago.

To address some of your comments. A lot of pts are more willing to come to their pharmacy to get their shots than going to their health care facility. As far as coverage, flu shots aren't generally covered by most plans. Kaiser performed a study where they cost-effectiveness of immunization vs. expenditure taking care of the sick wasn't economically feasible. Most pts are going to have to pay (i've yet to have mine covered.) As far as community facilities that do it for low cost or no cost, they are few and far between. The one facility i know of in all of LA is the Orange County Community Care clinic. The hours are extremely limited and it's not accessible. This is a general trend with free clinics.

Moreover, coverage by Third Parties will increase as it becomes the norm for pharmacies to provide immunization. This is only it's embryonic stage.

I'm not saying it's gonna be glamorous. But, I really like shooting pts and it's a critical portion of health care that you're making more readily available and the statistics are phenomenal.

Flu where 90% of death is in >65 yo
Vaccination provides 80% effectiveness in preventing death in nursing home pts.

Polio >16,000 cases 1950
eradicated from western hemisphere in 1994

Hib
Formerly leading cause of bacterial meningitis among children <5 yrs of age
Now, Strep pneumo has supplanted due to vaccination.

Tetanus 500 cases per yr 1950
To less than 50 cases 2001

Diptheria >18,000 cases 1948
virtually 0 2001

tri,

you bring out some good points about the immunization issue. I just wonder if the large chains are going to be willing to take this on before reimbursement is worked out, and will they take on the extra liability ( i.e. the chance of someone anaphylacting in the store post "shot") that is possible.

Also, the more folks that would be willing to go to Wags as opposed to the health dept or their doctor's office for immunizations (and, as you say, I'm sure most would rather go to Wags) , the busier the pharmacists would be, especially during the fall wheezer season , and it seems like the idea, from a cost standpoint, might backfire. (mother of all run-on sentences-sorry) Seems like the pharmacies would be better off financially to contract out another licensed professional (rn or lpn) to give the immunizations, instead of possibly having to have extra pharmacists on duty just for the immunizations. I don't know--- maybe I'm missing something here???

carpe

I don't understand why pharmacists would give immunizations either, unless it's an underserved area. Even if the store had the clinic, wouldn't it just be a better idea to pay an RN to come do it?

That's heresy, jdpharmd....And unless the law changed in this state, pharmacy is specifically prohibited from giving immunizations.

Realistically, an LPN would be an even better hire...

here in california, pharmacists are allowed to get certified and give out immunizations. ralph's grocery stores all over are doing immunizations through their pharmacies and the pharmacists are the ones giving the shots. actually, at SC, all the students are now getting certified. so a lot of those shots are being done by pharmacy students. before they used to train and certify us in second year but from what triangulation is saying, i guess they are now doing it in first year. the profs here actually give out extra credit to students who go volunteer at ralphs and give out shots. extra credit for each shot given, up to 10 shots. weird huh?

I don't have a specific objection to giving immunizations, but I have a philosophical qualm about labeling this clinical pharmacy/pharmaceutical care rather than just a public health concern. This requires knowledge not specific to pharmacy at all. It also isn't a profit generation center for a pharmacy. I really dislike the reasons why the pharmacy leadership is pushing this, because it does not make us unique or adds value to our profession. We just join about upteenth different professions and some do it cheaper.

I just want to make sure for myself that pharmacists are pharmacists. There are responsibilities that are bona fide pharmacy concerns. I really have a problemI don't believe in spreading ourselves so thinly that we no longer have a set professional identity and are liable for everything.

BTW, this is coming from someone who participated and chaired the Operation Immunization for my school. We found that we had real issues (think HIPPA) with getting immunization records from doctors. Secondly, as you know, certain immunizations should not be boostered unless it comes due to prevent anaphalaxis issues. Because of this, we pretty much restricted ourselves to saying like a broken record, "you need to get your shots updated."

No training or value-added service necessary...

RN: $25-30 per h (but ANA is willing to do their version of OpImmune for free)
LPN: $16-$21 (see above)
Rph: $42.50-50/Intern $12-25 (and we don't do it for free)

Originally posted by jdpharmd?
I don't understand why pharmacists would give immunizations either, unless it's an underserved area. Even if the store had the clinic, wouldn't it just be a better idea to pay an RN to come do it?

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I agree that nurses would do a better job, but they would need an order from a doctor. Pharmacists are not req'd to receive authorization from a physician to perform the immunization.

I think it's just another cost containment mechanism. Why pay added funds to another health care giver when you could just throw it on the other list of duties for the pharmacist? I'm actually a staunch defender of pharmacist immunization, but it will certainly add challenges.