Anyone can count to 30

[gadlo]

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"At the end of day . . . NEXIUM is NEXIUM, LIPITOR is LIPITOR, drugs are drugs and it shouldn't matter that much whose counting to 30."
Georg Paz-CEO of Express Scripts

here is the full transcript of his comments from the Express Scripts Fourth Quarter 2011 Earnings Conference Call

Discuss.

 

[KARM12]

While I hate PBMs and think they are scum...Make sure you read the whole comment because he also said:
"So we are absolutely focused on that and we believe that the community pharmacists severe a very important role in healthcare, that they do a tremendous amount. But we just don't see that 1 pharmacist does it that much better than another pharmacist, at least not by change. And so we're just not going to pay those premiums."

That above comment was taken out of context - his point was that it doesn't matter if the pharmacist is a Walgreens pharmacist or a CVS pharmacist, they provide the same level of service.

 

[gadlo]

While I hate PBMs and think they are scum...Make sure you read the whole comment because he also said:
"So we are absolutely focused on that and we believe that the community pharmacists severe a very important role in healthcare, that they do a tremendous amount. But we just don't see that 1 pharmacist does it that much better than another pharmacist, at least not by change. And so we're just not going to pay those premiums."

That above comment was taken out of context - his point was that it doesn't matter if the pharmacist is a Walgreens pharmacist or a CVS pharmacist, they provide the same level of service.

I did read that portion, and I still find it misleading and offensive in that or any context. His implication is that community pharmacists are like interchangeable widgets who simply need basic counting skills. This makes his brief comment about the important role of the pharmacist in healthcare appear to be empty lip-service. Given the sheer size of Express Scripts and potential mergers, comments like this are important to the profession.

 

[MountainPharmD]

I did read that portion, and I still find it misleading and offensive in that or any context. His implication is that community pharmacists are like interchangeable widgets who simply need basic counting skills. This makes his brief comment about the important role of the pharmacist in healthcare appear to be empty lip-service. Given the sheer size of Express Scripts and potential mergers, comments like this are important to the profession.

This is the problem. No one places any value on the services we provide. To pin heads like this prescription drugs are just another commodity that is to be sold as cheaply and efficiently as possible. We are screwed because high level leaders like this think a pharmacist does the same job with a product that warehouse worker does. We just move it on down the line.

Does this asshat also think patients do not care what Doctor they see. I asure you they do. There are many that alsomwant to know the pharmacist who is filling thier medication.

 

[sfwusc]

ESI has to sell their service too and make a profit. If they piss off enough chains, then business owners/HR departments will change to another insurer. Most business value health insurance as this or that replacement. If one starts only letting you go to one pharmacy or mail order, then that will change. HR departments don't want to hear their employees fussing about it, and business owners use health insurance to woo employees. Their is some balance and forces to limit ESI.

That said, ESI is right. Overall, you aren't getting better pharmacist at Walgreens, so it is stupid to pay them more than CVS.


FYI, I am a CPA and current pharmacy student (P2). I worked for some big hospitals (in my area), one small insurance company, some real estate developers, and a large manufacturer (who has a segment in healthcare) when I was in public accounting. I worked for a small outsourcing HR firm as well.

Pharmacist make good money. You read this board and you forget that fact. You make $120k coming out of school, and get raises after that. You don't have to work any OT for that...just your 40-45 hours a week. Go look at what a MD works and you find you are making a fair wage. Other professional aren't making what you are making. I made half of what a pharmacist made as a CPA and worked 60% more hours.

 

[clockwork247]

ESI has to sell their service too and make a profit. If they piss off enough chains, then business owners/HR departments will change to another insurer. Most business value health insurance as this or that replacement. If one starts only letting you go to one pharmacy or mail order, then that will change. HR departments don't want to hear their employees fussing about it, and business owners use health insurance to woo employees. Their is some balance and forces to limit ESI.

That said, ESI is right. Overall, you aren't getting better pharmacist at Walgreens, so it is stupid to pay them more than CVS.


FYI, I am a CPA and current pharmacy student (P2). I worked for some big hospitals (in my area), one small insurance company, some real estate developers, and a large manufacturer (who has a segment in healthcare) when I was in public accounting. I worked for a small outsourcing HR firm as well.

Pharmacist make good money. You read this board and you forget that fact. You make $120k coming out of school, and get raises after that. You don't have to work any OT for that...just your 40-45 hours a week. Go look at what a MD works and you find you are making a fair wage. Other professional aren't making what you are making. I made half of what a pharmacist made as a CPA and worked 60% more hours.

i can understand 60k for a CPA but 60% more hours? isn't that a bit too much?

 

[extra07extra]

I don't understand what's the big deal... He's right, anyone can count to 30. I intern at a community pharmacy chain and that's basically what pharmacists do all day.

 

[NAPLEXON]

Pharmacists key interventions in patients' therapy are important, but because those interventions are not routine for every patient, the pharmacist's role can be unnoticed. The pharmacist role can never be reduced to counting pills and insurance troubleshooting. Who can counsel on the administration of medications, main side effects, and intervene in pharmacotherapy when necessary? I know that all of you can enumerate many times when his/her interventions were very important and, sometimes, lifesaving. It is so sad that our work is underestimated by both the general public and even our fellow healthcare providers. If they think it is safe to replace pharmacists by techs or nurses, let them do it now, only if they will be responsible for every damage that may happen to someone's health.

I can also claim that I can do the work of a physician. I can have the same shallow view of a physician's job. It does not take much intelligence to follow a protocol for treating asthma, epilepsy or hypertension. It is not hard to diagnose anxiety or depression and then throwing prescriptions of benzos and SSRIs at the right persons. I think I also can write more legible prescriptions with no mistakes and I promise I will not have a ready prescription format containing valium, soma, and lortab for every patient.

 

[sfwusc]

Nope. I worked about 85 hours a week for the first 4 months of the year. Around 70 hours a week the last 4 months of the year. The middle four weren't so bad around 45-50.

There is a reason public accounting has around 25% turn over rate. It is hell.

 

[sfwusc]

Pharmacists key interventions in patients' therapy are important, but because those interventions are not routine for every patient, the pharmacist's role can be unnoticed. The pharmacist role can never be reduced to counting pills and insurance troubleshooting. Who can counsel on the administration of medications, main side effects, and intervene in pharmacotherapy when necessary? I know that all of you can enumerate many times when his/her interventions were very important and, sometimes, lifesaving. It is so sad that our work is underestimated by both the general public and even our fellow healthcare providers. If they think it is safe to replace pharmacists by techs or nurses, let them do it now, only if they will be responsible for every damage that may happen to someone's health.

I can also claim that I can do the work of a physician. I can have the same shallow view of a physician's job. It does not take much intelligence to follow a protocol for treating asthma, epilepsy or hypertension. It is not hard to diagnose anxiety or depression and then throwing prescriptions of benzos and SSRIs at the right persons. I think I also can write more legible prescriptions with no mistakes and I promise I will not have a ready prescription format containing valium, soma, and lortab for every patient.

Exactly, we provide a service. We provide a valuable service. We are being well paid for it. ESI is willing to pay for it, but they aren't willing to pay more for Walgreen's version vs. everyone else's.

 

[gadlo]

I posted the comment because I thought that it was offensive and poorly phrased. I linked the entire transcript to give access to its context and because his main point is not unreasonable (I'm not saying that I agree, just that it is reasonable).

Considering the source, I feel that the comment portends scary things. When the president gets people together to give advice about healthcare, people like George Paz are sitting at that table. When the CEO of one of the largest PBMs will describe what a pharmacist does as "counting to 30", this tremedously devalues the profession-the type of devaluation that is in prestige and ultimately in everyone's paychecks.

 

[ancienbon]

Pharmacists key interventions in patients' therapy are important, but because those interventions are not routine for every patient, the pharmacist's role can be unnoticed. The pharmacist role can never be reduced to counting pills and insurance troubleshooting. Who can counsel on the administration of medications, main side effects, and intervene in pharmacotherapy when necessary? I know that all of you can enumerate many times when his/her interventions were very important and, sometimes, lifesaving. It is so sad that our work is underestimated by both the general public and even our fellow healthcare providers. If they think it is safe to replace pharmacists by techs or nurses, let them do it now, only if they will be responsible for every damage that may happen to someone's health.

I can also claim that I can do the work of a physician. I can have the same shallow view of a physician's job. It does not take much intelligence to follow a protocol for treating asthma, epilepsy or hypertension. It is not hard to diagnose anxiety or depression and then throwing prescriptions of benzos and SSRIs at the right persons. I think I also can write more legible prescriptions with no mistakes and I promise I will not have a ready prescription format containing valium, soma, and lortab for every patient.

I agree. You forgot to add- perhaps we would not precribe nasonex instead of fluticasone or crestor instead of pravastatin or other statins for someone who does not have insurance

 

[MountainPharmD]

Pharmacists key interventions in patients' therapy are important, but because those interventions are not routine for every patient, the pharmacist's role can be unnoticed. The pharmacist role can never be reduced to counting pills and insurance troubleshooting. .

This makes me laugh. Its worse than you think. Pharmacy technicians count the pills and trouble shoot insurance. The pharmacist is there because the law says he has to be. The pharmacist proof reads the data entry technicians work and then makes sure the product dispensing tech has put the right pill in the bottle. The pharmacist clicks the enter button as fast as possible to keep the prescription mill running at top speed because there isn't time for anything els or you will get behind in you metrics.

Who can counsel on the administration of medications, main side effects, and intervene in pharmacotherapy when necessary? I know that all of you can enumerate many times when his/her interventions were very important and, sometimes, lifesaving. It is so sad that our work is underestimated by both the general public and even our fellow healthcare providers. If they think it is safe to replace pharmacists by techs or nurses, let them do it now, only if they will be responsible for every damage that may happen to someone's health. .

Does it take a PharmD to turn the label over and read the counseling points printed on it? Because thats what 99% of all pharmacists do. Really? 130K a year and a PharmD? I don't think so.

Go ahead and document every single time you call the doctors office to make one of your "life saving" calls. Do it for one week ....no do it for one month because you won't get enough in a week. Hell you probably won't get any in a year. Point is it doesn't happen very ofter.

I appreciate you trying to defend our noble profession. It's to little to late. We've lost and all that's left is to pick up the pieces when it all finally comes crumbling down.

 

[MountainPharmD]

Exactly, we provide a service. We provide a valuable service. We are being well paid for it. ESI is willing to pay for it, but they aren't willing to pay more for Walgreen's version vs. everyone else's.

We may provide a valuable service but that is not why we are getting paid. We are getting paid to distribute a product. As long as our reimbursement is tied to product distribution we are screwed.

 

[NAPLEXON]

The pharmacist is there because the law says he has to be. The pharmacist proof reads the data entry technicians work and then makes sure the product dispensing tech has put the right pill in the bottle. The pharmacist clicks the enter button as fast as possible to keep the prescription mill running at top speed because there isn't time for anything els or you will get behind in you metrics.
Does it take a PharmD to turn the label over and read the counseling points printed on it? Because thats what 99% of all pharmacists do. Really? 130K a year and a PharmD? I don't think so."


And the doctor is there only because the law says he has to be. So what is the point?
Does it really need a doctor to approve 95% of the prescriptions that you dispense daily? Can not a nurse just follow a a treatment protocol for hypertension or asthma? So can we replace doctors by nurses, or by pharmacists when necessary? Do you trust your technician to do your work? I catch techs mistakes on a daily basis. I really do not know what is the point that you are trying to prove here.

 

[MountainPharmD]

The pharmacist is there because the law says he has to be. The pharmacist proof reads the data entry technicians work and then makes sure the product dispensing tech has put the right pill in the bottle. The pharmacist clicks the enter button as fast as possible to keep the prescription mill running at top speed because there isn't time for anything els or you will get behind in you metrics.
Does it take a PharmD to turn the label over and read the counseling points printed on it? Because thats what 99% of all pharmacists do. Really? 130K a year and a PharmD? I don't think so."


And the doctor is there only because the law says he has to be. So what is the point?
Does it really need a doctor to approve 95% of the prescriptions that you dispense daily? Can not a nurse just follow a a treatment protocol for hypertension or asthma? So can we replace doctors by
nurses, or by pharmacists when necessary? Do you trust your technician to do your work? I catch techs mistakes on a daily basis. I really do not know what is the
point that you are trying to prove here.

You proved my point for me. No, it doesnt take a doctor to write prescriptions. Ever heard of nurse practitoners and physician assistants? A nurse with some additional training can do some of what a physician can do in the same way a technician with some additional training can do what a pharmacist does. I would say a tech with additional training could do 99% of what retail pharmacist does.

You are making a very simplistic comparison between doctors and pharmacists. If medicine were as easy as following established protocols then high school graduates could do it. Before you can use a treatment protocol you must diagnose a patient which is some what complicated. Going from a patient who says some times I have trouble breathing to a diagnosis of asthma is a bit more complicated than proof reading your technicians work and reading the drug interactions the computer flags.

You catch technician mistakes all day? Did you take advance classes in pharmacy school covering paying attention and proof reading? What part of your PharmD education makes you better at catching other peoples mistake verse a technician. I hate to break this to you but your technicians could proof read and double check others work just as well as you can.

 

[WVUPharm2007]

I can count to 60.

Take THAT.

 

[Its Z]

Anyone may count to 30 except some months have 31 days.

 

[Ackj]

Anyone may count to 30 except some months have 31 days.

This was a rough year with that Feb 29 business.

 

[sfwusc]

Crap...with extra training we could all do someone else's job. No one is born being able to perform surgery. What the heck is your point?

The doctor's in your area must be just amazing, but around here they would kill people without a pharmacist. You want a tech to figure out what drug the dr. meant when they screw up the script? At least once a day...I input the script, go grab the drug off the shelf, and ask my pharmacist make sure that is what the doctor meant...since they misspelled the drug so badly, wrong dosage form of the drug, and so on. Some dr screws up and some tech just counts the wrong drug and throws it out the windows at the patient...patient dies and pharmacist will be back into demand real quick. Hell just let the doctors hand the drugs out from their offices why even pay techs...they have some office worker that can count to 30.

Not to mention all the times they write for the new brand name drug because some drug rep told them it was amazing. Doesn't matter that you never tried the dirt cheap generic in the same class. The doctor says I wanted to avoid side effects, but the patient never tried the other drug...they might not have those side effects. You are going to make the pay 20 times more a month because they could develop whatever? Give me a break!

If you could be replaced by a tech, then you aren't a very good pharmacist. Could a tech do a lot of your job most of the time? Sure, they demand a pharmacist do the job for the times a tech couldn't do it. I could do a Dr. job a lot of the time...but I couldn't do it all the time...the patients over all would suffer. For that reason, I can't practice medicine. What I can do doesn't matter...it is what I can't do that matters.

 

[SoylentGreen]

Yes, anyone can count to 30. That's why we let the techs do it.

 

[PharmDstudent]

I don't understand what's the big deal... He's right, anyone can count to 30. I intern at a community pharmacy chain and that's basically what pharmacists do all day.

 

[amox]

I don't understand what's the big deal... He's right, anyone can count to 30. I intern at a community pharmacy chain and that's basically what pharmacists do all day.

Since you are pre-pharm, go ahead and put that in your letter via pharmcas... Let me know if you get in!

I seriously hope this isn't your perception of the profession... Your ignorance reminds me of the general public.

Remember retail isn't the only career path, yes pharmacists may count to 30 in retail. HOWEVER they also do more, which you most likely aren’t seeing.

 

[PharmaTope]

Since you are pre-pharm, go ahead and put that in your letter via pharmcas... Let me know if you get in!

I seriously hope this isn't your perception of the profession... Your ignorance reminds me of the general public.

Remember retail isn't the only career path, yes pharmacists may count to 30 in retail. HOWEVER they also do more, which you most likely aren’t seeing.

it is way more than counting to 30. you need to run a business and deal with major insurance problems that can make or break the pharmacy. they are stressed to compete with the big chains that are undercutting their business and profits. it is a lot more than counting to 30.

 

[sfwusc]

You can't remove pharmacist from the equation. There has to be someone at the end of the line to verify everything is right (even if machines are doing the actually production work). There is no way to know a machine wasn't load with the wrong drug. There has to be someone to take responsible for everything leaving the door.

Can thing don't to increase the number of scripts a pharmacist does in an hour...sure/maybe. You can't take them out of the equation.

You need someone in the pharmacy to answer questions, and operate one in my state (if the pharmacist leaves the pharmacist... everyone should leave the pharmacy and the code should be place on the pharmacy...this might not happen, but that is what should happen in theory.) If the pharmacy is open 84 hours a week, then that is 84 pharmacist hours required period.

The people getting screwed out of hours are techs. They are easy to cut...they aren't required unless the work is there. Pharmacist are required if you are going to keep the store open.

 

[clockwork247]

Nope. I worked about 85 hours a week for the first 4 months of the year. Around 70 hours a week the last 4 months of the year. The middle four weren't so bad around 45-50.

There is a reason public accounting has around 25% turn over rate. It is hell.

wow, if you put it like that, CPA are like minimum wage lol, 60k and you're working like 2 full time jobs, doesn't that come out to be like 30k annually? for some reason I can't seems to piece that together, all that studying and taking the test and you're looking at 30k? I might as well go chop trees or something.

 

[PharmDstudent]

I was thinking at work last night that it's very difficult to gauge someone's worth in a knowledge-based career like pharmacy, and that if pharmacists are considered drug experts, then their worth should be implied like any other expert's, because their wisdom is what counts.

The workplace is not a tv show like Jeopardy or a casino where doubling your bet on a question will get you any further... if you get it right. All questions and consults need to be answered correctly and only a qualified person has the potential to do that.

So the fact that pharmacists are counting to 30 everyday is an under-utilization of talent by an expert. It's like a physician counting and then handing out catheter tubing instead of seeing patients.



If only the real world was set up like Jeopardy or Who Wants to be a Millionare. That angioedema reaction question would get you more money than the Zyrtec for pet allergies question. 😛