ASHP presidents address - Pending oversupply - get over it

[aboveliquidice]

---

Members do not see this ad.

The recently elected ASHP president assumed his position yesterday. In his address, he touched on a few subjects and his vision for our future.

One subject he touched on was the pending oversupply. A few of his thoughts, without direct quotes and in no particular order.

The oversupply is here, now. It is an opportunity to bring about competitive growth. Your dream job will not be handed to you; it will have to be worked for. If you want a residency, it isn't enough to have ecellent grades, references, extracurriculars, and leadership positions. You need to have passion and zeal for what you do. The zeal is what will separate you from your peers.

These are the thoughts of the number one guy; in what could arguably be the only pharmacy org that matters.

 

[MountainPharmD]

The recently elected ASHP president assumed his position yesterday. In his address, he touched on a few subjects and his vision for our future.

One subject he touched on was the pending oversupply. A few of his thoughts, without direct quotes and in no particular order.

The oversupply is here, now. It is an opportunity to bring about competitive growth. Your dream job will not be handed to you; it will have to be worked for. If you want a residency, it isn't enough to have ecellent grades, references, extracurriculars, and leadership positions. You need to have passion and zeal for what you do. The zeal is what will separate you from your peers.

These are the thoughts of the number one guy; in what could arguably be the only pharmacy org that matters.

ASHP is as worthless and unimportant as the rest. None of them matter. I love it. Having a passion and zeal for what you do will save you. What happens when everyone has a passion and zeal for what they do? It won't change the fact there are 20 people appling for every job.

 

[aboveliquidice]

ASHP is as worthless and unimportant as the rest. None of them matter. I love it. Having a passion and zeal for what you do will save you. What happens when everyone has a passion and zeal for what they do? It won't change the fact there are 20 people appling for every job.

You do know ASHP represents healthsystem RPhs... They don't represent you.

You absolutely missed the gist - The oversupply is recognized now (those ignorant can finally stop quoting projections). It's here, so how do you manage it now? If you want that great job, you'll have to work for it. Not interested in putting in the extra time? Here's a retail job in the middle of nowhere (that I promise you does not have 20 people applying for it).

Ive watched you whine for years about pharmacy. Someone at the top is finally speaking the truth, and you still bitch.

 

[VCU07]

You do know ASHP represents healthsystem RPhs... They don't represent you.

You absolutely missed the gist - The oversupply is recognized now (those ignorant can finally stop quoting projections). It's here, so how do you manage it now? If you want that great job, you'll have to work for it. Not interested in putting in the extra time? Here's a retail job in the middle of nowhere (that I promise you does not have 20 people applying for it).

Ive watched you whine for years about pharmacy. Someone at the top is finally speaking the truth, and you still bitch.

Have you found a position yet?

 

[BenLysta]

Someone at the top is finally speaking the truth, and you still bitch.

I don't think we need someone to tell us that.

 

[aboveliquidice]

Have you found a position yet?

I'm still a resident - unfortunately military residencies lag behind in cycle die to initial training requirements. I am slated to take over a small clinic in Germany early next year.

I don't think we need someone to tell us that.

True for some - but the kids signing up for pharmacy school and those coming up the ranks may not know this yet. They absolutely need to understand the work force they are entering. It simply isn't the wild frontier it used to be.

 

[VCU07]

I'm still a resident - unfortunately military residencies lag behind in cycle die to initial training requirements. I am slated to take over a small clinic in Germany early next year.



True for some - but the kids signing up for pharmacy school and those coming up the ranks may not know this yet. They absolutely need to understand the work force they are entering. It simply isn't the wild frontier it used to be.

That's pretty cool. Never thought about doing that in pharmacy, but I guess its a good way to make a living while serving and seeing the world.

 

[aboveliquidice]

That's pretty cool. Never thought about doing that in pharmacy, but I guess its a good way to make a living while serving and seeing the world.

It has altered my career focus. Initially, I saw myself as a clinical pharmacist. I am starting to evolve that view now. Informatics, stewardship and leadership, methods for implementing change are major issues that I am interested in right now.

I would have chosen a large MEDCEN where I could implement clinical services - we'll see what the future brings. Where are you at in training?

 

[willrocks]

Is there a link to the ashp address that you referenced?

 

[30Percent]

Do you really need excellent grades and ECs if so many people mention networking is key to finding a job? You can have average grades and EC, but if you know the right people and suck up to them you'll still land the job over the Rho Chi candidate with no contacts in the company.

 

[konkan]

The recently elected ASHP president assumed his position yesterday. In his address, he touched on a few subjects and his vision for our future.

One subject he touched on was the pending oversupply. A few of his thoughts, without direct quotes and in no particular order.

The oversupply is here, now. It is an opportunity to bring about competitive growth. Your dream job will not be handed to you; it will have to be worked for. If you want a residency, it isn't enough to have ecellent grades, references, extracurriculars, and leadership positions. You need to have passion and zeal for what you do. The zeal is what will separate you from your peers.

These are the thoughts of the number one guy; in what could arguably be the only pharmacy org that matters.

Again with that residency...As if it is the most important thing in the world of pharmacy...

 

[lorain]

i think if you are in the field or finishing up soon, you'll be fine

but if you are starting to go in this field, you really need to have second thoughts and see if its worth it considering costs, time, and the jobs availability

 

[BrightLight]

For someone who has already got where that guy is already, it sure is easy for him to say.

 

[R2pharmD2]

i think if you are in the field or finishing up soon, you'll be fine

but if you are starting to go in this field, you really need to have second thoughts and see if its worth it considering costs, time, and the jobs availability

Anyone considering any field should consider those things. Why would pharmacy be any different?

 

[lorain]

Anyone considering any field should consider those things. Why would pharmacy be any different?

b/c pharmacy b4 was the golden field, put 6 yrs and get 100k automatic jobs, no questions asked

now that is not so much the case and people need to consider if its worth the 6 yrs, 150K in costs, etc

 

[R2pharmD2]

b/c pharmacy b4 was the golden field, put 6 yrs and get 100k automatic jobs, no questions asked

now that is not so much the case and people need to consider if its worth the 6 yrs, 150K in costs, etc

So you would commit to 6 years of school and 150K in loans, no questions asked, simply because you would be guaranteed a good paying job in the end? That's silly, and that was my point. Everyone considering pharmacy has to consider all of the same factors now that they always did, even though the job market has clearly changed.

 

[PumpkinSmasher]

So you would commit to 6 years of school and 150K in loans, no questions asked, simply because you would be guaranteed a good paying job in the end? That's silly, and that was my point. Everyone considering pharmacy has to consider all of the same factors now that they always did, even though the job market has clearly changed.

Now and going forward that 6yrs and 150k will put you in the running for a retail(LTC, community, mail order) position, that is about it. Anything else will require further training and deferment of loans.

Like above poster said, know what you are getting into, if you love it, then go for it! Realize the market is tough, prepare and go forward with passion in all you do.

 

[lorain]

So you would commit to 6 years of school and 150K in loans, no questions asked, simply because you would be guaranteed a good paying job in the end? That's silly, and that was my point. Everyone considering pharmacy has to consider all of the same factors now that they always did, even though the job market has clearly changed.

i would be more than comfortable stating that is a very big reason as to why so many people go into pharmacy

 

[lorain]

Now and going forward that 6yrs and 150k will put you in the running for a retail(LTC, community, mail order) position, that is about it. Anything else will require further training and deferment of loans.

Like above poster said, know what you are getting into, if you love it, then go for it! Realize the market is tough, prepare and go forward with passion in all you do.

even those positions are going away each year

mail order is yuck, but the only offers i get in my inbox now are temporary assignments

retail is still ok for the next couple years, but I am seeing that even the rural places, floaters who live in the large city are driving the 1-2 hours to covering those shifts

thats why i said, if you are close to graduating, you'll be fine....but if you are just starting to go into this field, imo you need to reconsider

 

[PumpkinSmasher]

even those positions are going away each year

mail order is yuck, but the only offers i get in my inbox now are temporary assignments

retail is still ok for the next couple years, but I am seeing that even the rural places, floaters who live in the large city are driving the 1-2 hours to covering those shifts

thats why i said, if you are close to graduating, you'll be fine....but if you are just starting to go into this field, imo you need to reconsider

I agree, mail order and dispensing LTC positions are mind numbing. The majority of my classmates staying in the metro area are floating, like you said up to 1-2hr distance. It is definitely getting tight, underclassmen are having a tough time finding any sort of paying internship.

I have kept up my network throughout school and been active with faculty, I was able to find a clinical inpatient position in metro area as a new grad. I do not see this happening in the coming years, I feel blessed and lucky.

 

[R2pharmD2]

i would be more than comfortable stating that is a very big reason as to why so many people go into pharmacy

I would be more than comfortable saying that many people are idiots

 

[pfaction]

There are many ways to "network"...but I feel dirty doing it. Don't get me wrong, I love to talk to teachers and learn something extra. But I always wanted to get a position as a clinical pharmacist because of my knowledge...not by knowing people. I worked hard to prove that I was semi-intelligent. Even the 2.5 GPA's that don't know basic pharmacology or drug interactions can network but they may not get employed.

 

[PharmD1988]

I agree, mail order and dispensing LTC positions are mind numbing. The majority of my classmates staying in the metro area are floating, like you said up to 1-2hr distance. It is definitely getting tight, underclassmen are having a tough time finding any sort of paying internship.

I have kept up my network throughout school and been active with faculty, I was able to find a clinical inpatient position in metro area as a new grad. I do not see this happening in the coming years, I feel blessed and lucky.

what metro area you got your position in? congrats on that too. might have to follow your route tho I might not be as lucky

 

[lorain]

I agree, mail order and dispensing LTC positions are mind numbing. The majority of my classmates staying in the metro area are floating, like you said up to 1-2hr distance. It is definitely getting tight, underclassmen are having a tough time finding any sort of paying internship.

I have kept up my network throughout school and been active with faculty, I was able to find a clinical inpatient position in metro area as a new grad. I do not see this happening in the coming years, I feel blessed and lucky.

congrats, how did you pull that off? lol

 

[PumpkinSmasher]

There are many ways to "network"...but I feel dirty doing it. Don't get me wrong, I love to talk to teachers and learn something extra. But I always wanted to get a position as a clinical pharmacist because of my knowledge...not by knowing people. I worked hard to prove that I was semi-intelligent. Even the 2.5 GPA's that don't know basic pharmacology or drug interactions can network but they may not get employed.

I do not think you understand what networking is....🙄 By having references...they are part of your network. Professionals who will speak to your knowledge base, the research you have done, the quality of your work, extra hours you have put in, etc. Employers can read your CV but speaking with others who have worked on research projects with you, presented at national meetings with you, accepted award with you, witnessed your lectures, inducted you into Rho Chi, etc can offer the employer further insight. It is valuable to have people who can vouch for your quality and work ethic. Employers also want to work with people they like and want to know your a good man/woman to work with...some people are toolbags that ruin the harmony of the dept.

You feel dirty because you do not understand what networking is, hopefully the light clicks... Booyah!

 

[joetrisman]

I'm still a resident - unfortunately military residencies lag behind in cycle die to initial training requirements. I am slated to take over a small clinic in Germany early next year.

Could you elaborate more on how the residency thing works with the military or check your pm? Thanks! 👍

 

[confettiflyer]

I'll admit, one of the things that attracted me to pharmacy was the fact that it was a 4 year degree (vs. 4 years of med school AND years of residency) and a six figure job with relative job security and great work-life balance potential.

Now that most of that is out the window...I've moved on and diversified my options as well.

Oh well, seemed fun while it lasted..all you older folks are lucky.

 

[VCU07]

It has altered my career focus. Initially, I saw myself as a clinical pharmacist. I am starting to evolve that view now. Informatics, stewardship and leadership, methods for implementing change are major issues that I am interested in right now.

I would have chosen a large MEDCEN where I could implement clinical services - we'll see what the future brings. Where are you at in training?

I have been in a variety of settings after graduation. Retail, Staff hospital, Med/Surg, Rehab, ICU, Cards, and now EM. I also had a stint in med school during that time. Yeah, I know lol...

 

[p-rog]

I was looking for the ASHP President's address and couldn't find anything but I did see this on the UConn COP website:

http://pharmacy.uconn.edu/index.php?option=com_content&task=view&id=509

Dear Friends:

Although I generally use this space to share the accomplishments of our students, faculty & staff (which I do below), I'd like to share my perspective of the crisis facing pharmacy education, unquestionably the most significant challenge we have ever been confronted with. Those of you of my vintage can recall the oversupply of pharmacists we faced in the late 1970s and early 1980s; over the last number of decades, the demand for pharmacists has waxed and waned. What was different about the shortage of a decade ago was the response by a number of institutions who, frankly, saw a financial advantage to pharmacy education and decided to start a program. From our long steady-state of about 72 schools in 2000, we have now added more than 50 schools many of whom are not of the caliber we have come to expect in the academy. Our accrediting body, ACPE, in my view, has not been rigorous enough in enforcing its own standards. It certainly seems that ACPE will eventually accredit any program that applies if the institution remains persistent. What is the result? An oversupply of pharmacists, a shortage of experiential sites, and the graduation into the pharmacy workforce individuals who do not all meet the high standards of competency we expect of a 21st century pharmacist. We have a shortage of deans and faculty, leading to the appointment of individuals without the requisite background, experience, and credentials; can you imagine a medical school appointing a pharmacist as dean as we have appointed physicians to our schools? Some have argued that once we recover from the financial crisis (that has lead to the delayed retirement of some pharmacists) and MTM is in full bloom, we will have the need for all of these individuals; I strongly disagree. In my view, between the unbridled growth of new schools and the overexpansion of existing programs, we will be faced with an oversupply, I fear, for some time to come. What's the answer? First, ACPE must rigorously enforce its accreditation standards in new and historical schools alike. Second, we in the academy and in practice must make clear to institutions that pharmacy is not a "cash cow." Third, those of us in the academy must become introspective; these schools would not be able to open without deans and faculty to staff them. Some might recall the 1990s report of the Pew Commission that suggested the closure of one-third of the then 72 schools of pharmacy; clearly they were wrong, but so is the current expansion. Many of us have spent our careers working to raise the quality of American pharmacy education; for us, it's a sad day.

Now, let me share some happier news about our students and faculty

 

[p-rog]

Altough I understand the frustration, I really have no reason to be surprised. I applied to pharmacy school mostly because of the cushy job prospects. The only class I thought I would even be interested in was Med Chem, and I figured worse case scenario I'd get a PhD in med chem and still have my RPh license as a backup. Turns out med chem is a joke in pharmacy school, but I still ended up really enjoying what I learned in the other classes.

Anyways my point is there are still plenty of students applying to pharmacy school despite what everyone knows about the job market. We all want to blame the schools, but they are just trying to make a buck afterall. Some responsibility does have to fall on the consumers in the end... It's just amazing how quick the whole thing is collapsing.

 

[steveysmith54]

this man is a ***** and should resign if he truly feels that way. Oversupply of pharmacist will lead to poor working conditions for pharmacists in chains, which will lead to medication errors. People will pay for this with their lives. I've already witnessed this... Oversupply of pharmacists will make our profession seem like a joke to the public because a pharmd will be completely meaningless. I can't believe this guy.

 

[Its Z]

ASHP is as worthless and unimportant as the rest. None of them matter. I love it. Having a passion and zeal for what you do will save you. What happens when everyone has a passion and zeal for what they do? It won't change the fact there are 20 people appling for every job.

dude, ASHP is not worthless. Their medical journal is not a throw away and once in a while provide very useful literature. President of ASHP is absolutely correct in his speech that it's the ones with a passion and zeal who will go out of the way to pave opportunities for themselves through more education and training while advancing the Healthcare system pharmacy practice.

Now...APHA on the other hand....

See... the fallacy in your statement is that not everyone will have a passion and zeal... perhaps he should have added a passion and zeal and "willingness to proactively seek advanced training and experience."

When most pharmacists were hopping around retail for higher salaries and signon bonuses in the US News and World Reports's "Most Desirable Cities to Live in the US" during the hayday, I took a crappy DOP position in a severely understaffed rural CA hospital because I needed and wanted the experience.

Be honest with yourself. Many pharmacists made a wrong decision during the shortage. Many pharmacist friends questioned why I was working so hard in a harsh environment when they were enjoying the retail haven. Opportunities were there to choose the pharmacy career path but many chose wrong.

 

[confettiflyer]

dude, ASHP is not worthless.

Now...APHA on the other hand....

👍

 

[MountainPharmD]

You do know ASHP represents healthsystem RPhs... They don't represent you..

Last I checked we were all Pharmacists *******. The point is there isn't one organization who represents us that is actually doing something to help the profession. There is a lot you don't know because you are still running around with your preceptor wiping your ass.

Ive watched you whine for years about pharmacy. Someone at the top is finally speaking the truth, and you still bitch.

Big f-ing deal! Who! ****ing Hoo! His sage advice was to deal with. Thats great incitefull advice. Really talking the problems head on and coming up with real world workable solutions.

 

[MountainPharmD]

When most pharmacists were hopping around retail for higher salaries and signon bonuses in the US News and World Reports's "Most Desirable Cities to Live in the US" during the hayday, I took a crappy DOP position in a severely understaffed rural CA hospital because I needed and wanted the experience. .

Yeah right! I do not know anyone who did that....oh wait....

Be honest with yourself. Many pharmacists made a wrong decision during the shortage. Many pharmacist friends questioned why I was working so hard in a harsh environment when they were enjoying the retail haven. Opportunities were there to choose the pharmacy career path but many chose wrong.

I know many hospital pharmacists who are very unhappy. Probably because they never worked retail and do not know what unhappiness is! The bottomline is what happens to one group of us effects all of us. I believe retail has the biggest effect on the profession since the majority of pharmacists work retail. If I chose wrong and retail goes away then the whole profession essentially goes away.

 

[steveysmith54]

Yeah right! I do not know anyone who did that....oh wait....



I know many hospital pharmacists who are very unhappy. Probably because they never worked retail and do not know what unhappiness is! The bottomline is what happens to one group of us effects all of us. I believe retail has the biggest effect on the profession since the majority of pharmacists work retail. If I chose wrong and retail goes away then the whole profession essentially goes away.

👍

This guy is essentially approving the collapse of the pharmacy profession. He is okay with seeing pharmacists unemployed or dispensing 400 rx with one tech and a clerk, which i have witnessed..... The more pharmacists there, the less respect we will have from chains, public, everyone.. If pharmacists will not protect the profession like MD, DDS, other health professions, we don't deserve respect from the society and should be making 15 dollars an hr like technicians.

 

[WVUPharm2007]

Yeah right! I do not know anyone who did that....oh wait....



I know many hospital pharmacists who are very unhappy. Probably because they never worked retail and do not know what unhappiness is!

I'm way happier now that I was being slaved in a hospital. I chuckle every time a retail pharm complains when I think back to being left all alone in a hospital with 6 techs to look after. A entire ream of paper's worth of order sitting there to be done. And my hospital wasn't even the worst one in the area for pharmacists' workloads.

---

Also, good for whatshisface up above for publicly making statements that everyone else realized like 3 years ago.

I think at the next ASHP meeting, they should break the news that the Japanese bombed Pearl Harbor.

---

 

[Its Z]

The bottomline is what happens to one group of us effects all of us. I believe retail has the biggest effect on the profession since the majority of pharmacists work retail.

How does the downfall in retail affect hospital pharmacy practice?

 

[Its Z]

I'm way happier now that I was being slaved in a hospital. I chuckle every time a retail pharm complains when I think back to being left all alone in a hospital with 6 techs to look after. A entire ream of paper's worth of order sitting there to be done. And my hospital wasn't even the worst one in the area for pharmacists' workloads.

---

I'm not going to dig up old posts but you were pretty happy with your hospital pharmacy job.

 

[Its Z]

👍

This guy is essentially approving the collapse of the pharmacy profession. He is okay with seeing pharmacists unemployed or dispensing 400 rx with one tech and a clerk, which i have witnessed.....

How do you figure?

The more pharmacists there, the less respect we will have from chains, public, everyone.. If pharmacists will not protect the profession like MD, DDS, other health professions, we don't deserve respect from the society and should be making 15 dollars an hr like technicians.

What's this have anything to do with the speech?

 

[Its Z]

Also, good for whatshisface up above for publicly making statements that everyone else realized like 3 years ago.

I think at the next ASHP meeting, they should break the news that the Japanese bombed Pearl Harbor.

---

I didn't read the speech as "we have a surplus." I read it as "who will survive the surplus."

 

[WVUPharm2007]

I'm not going to dig up old posts but you were pretty happy with your hospital pharmacy job.

At first. Because it was summer. And it was new.

----

And then they started cutting hours...and entire shifts...

----

And then I found myself all alone in a hospital with 180 people on a Saturday afternoon.

 

[Praziquantel86]

Last I checked we were all Pharmacists *******. The point is there isn't one organization who represents us that is actually doing something to help the profession. There is a lot you don't know because you are still running around with your preceptor wiping your ass.

Why should there be one organization representing all of us? The day-to-day concerns of a hospital pharmacist are quite different than those of a retail pharmacist. ACCP and ASHP do a great job representing hospital folks, but most of what they do has no bearing on the retail world. It's a shame that APhA can't do the same for retail.

Instead of complaining, why don't you do something about it? Join your local pharmacy organization and start making a stink. Find people who agree with you and start working your way up the ladder. It won't be easy or quick, but it's better than endlessly complaining on an Internet forum.

 

[Fatpharm]

I disagree. If all pharmacy orgs were merged there would be a lot more power and lobbying power to protect pharmacists interests. Right now, they can't effectively battle with other health orgs perceptions or definitions of pharmacy practice. No single national pharmacy organization has effectively expanded the role of a pharmacist (no matter what type of environment) because of their lack of power. Without expanding roles, such as obtaining provider status, we are doomed to compete in the status quo.

 

[Praziquantel86]

I disagree. If all pharmacy orgs were merged there would be a lot more power and lobbying power to protect pharmacists interests. Right now, they can't effectively battle with other health orgs perceptions or definitions of pharmacy practice. No single national pharmacy organization has effectively expanded the role of a pharmacist (no matter what type of environment) because of their lack of power. Without expanding roles, such as obtaining provider status, we are doomed to compete in the status quo.

The problem is, they have very different interests on a day-to-day scale. The organizations have released joint statements in the past when it is something that concerns all pharmacists. Each medical specialty has its own organization because of their very different interests.

Combining the organizations at this point would lead to in-fighting and one-upmanship. Absolutely nothing would get done. Keep in mind that up until the mid-70s, there was only one organization. There's a reason why it split.

 

[gotdrugs]

The problem is, they have very different interests on a day-to-day scale. The organizations have released joint statements in the past when it is something that concerns all pharmacists. Each medical specialty has its own organization because of their very different interests.

Combining the organizations at this point would lead to in-fighting and one-upmanship. Absolutely nothing would get done. Keep in mind that up until the mid-70s, there was only one organization. There's a reason why it split.

The other posters have a valid point. And this is from someone where ASHP represents me way more than the others.

In regards to the bolded part: That's true, but the AMA is the one for the medical profession as a whole and goes to bat for them legislatively.

You're making a bad comparison.

 

[Praziquantel86]

The other posters have a valid point. And this is from someone where ASHP represents me way more than the others.

In regards to the bolded part: That's true, but the AMA is the one for the medical profession as a whole and goes to bat for them legislatively.

You're making a bad comparison.

Really? Look at membership statistics in the AMA - they don't even represent a quarter of physicians. Ask any physician what they think about their representation by the AMA and they'll tell you it sucks.

It's the same as the APhA in that they theoretically stand for everyone, but hardly do anything for anyone.

 

[owlegrad]

I'm way happier now that I was being slaved in a hospital. I chuckle every time a retail pharm complains when I think back to being left all alone in a hospital with 6 techs to look after. A entire ream of paper's worth of order sitting there to be done. And my hospital wasn't even the worst one in the area for pharmacists' workloads.

My DOP told me at the last hospital that she worked at, they posted a curve showing how fast all the RPhs entered orders. Those in the bottom whatever percent were coached on how to improve. The top whatever percent were praises. I can only imagine the outcry if CVS tried that s***.

 

[confettiflyer]

Really? Look at membership statistics in the AMA - they don't even represent a quarter of physicians. Ask any physician what they think about their representation by the AMA and they'll tell you it sucks.

It's the same as the APhA in that they theoretically stand for everyone, but hardly do anything for anyone.

I agree the AMA is losing relevance, but do recall that they had the power to kill health care reform in the 90's and their stamp of approval was viewed as "crucial" to the current debate.

I disagree with the last part, but the fact is perceptions remain that it's a legislatively relevant/important organization. I don't think any pharmacy organization has ever had that distinction at any point in time.

 

[MountainPharmD]

How does the downfall in retail affect hospital pharmacy practice?

Do you not agree that the salaries of hospital pharmacist are as high as they are because of retail pharmacy? If it weren't for the retail expansin in the last few years you would have hospital pharmacists making 60k a year working in the dungeon basement of the hospital.