Future of our profession?

[TonyRx]

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I am not a "power of positive thinking" person (see Smile or Die: How Positive Thinking Fooled America and the World ...) but other than that I give your post a big: 👍

Haha! I hear ya man, to each their own. After I saw "What the Bleep do we know?!?" on DVD years ago (http://www.whatthebleep.com) ....my perspective changed dramatically. Quantum Physics/Mechanics has shown that our very own perception, behavior and thoughts can drastically alter the 'universe' around us. Their is a connection there that we don't fully understand or grasp, but it is rooted in consciousness. Great DVD, gets you thinking.

 

[SELDANE]

Not true. In earlier post, I specify as long as pharmacy is a part of the multidiscplinary healthcare team, profession will be fine. And retail pharmacy does and will certainly play a role. You seem to think retail pharmacy is count and pour and do it faster profession, or at least headed that way. I tend to think retail will change significantly with MTM when $ is presented when pharmacist becomes a healthcare "provider."



Your view of my view on pharmacy is completely incorrect. The profession of pharmacy will be fine. It's the oversupply of pharmacist that's going to affect new grads and incompetent practicing pharmacists who will be affected. Hence I keep saying being a pharmacist may not be ok.

I'm afraid your view of the future of retail pharmacy is overly optimistic at the expense of being realistic. Saying that the profession of pharmacy will be fine but that being a pharmacist may not is like a dentist telling you that your teeth are in great shape but the gums will have to go.

 

[owlegrad]

Haha! I hear ya man, to each their own. After I saw "What the Bleep do we know?!?" on DVD years ago (http://www.whatthebleep.com) ....my perspective changed dramatically. Quantum Physics/Mechanics has shown that our very own perception, behavior and thoughts can drastically alter the 'universe' around us. Their is a connection there that we don't fully understand or grasp, but it is rooted in consciousness. Great DVD, gets you thinking.

Thanks for the recommendation, I added it to my Netflix queue.

 

[Its Z]

I'm afraid your view of the future of retail pharmacy is overly optimistic at the expense of being realistic.

Why is it overly optimistic? Make a case instead of a statement without a justification. If my expectations of retail pharmacy keep thriving in the future, why is it unrealistic? Again, make a case and back up your statement instead of a blanket statement.

Saying that the profession of pharmacy will be fine but that being a pharmacist may not is like a dentist telling you that your teeth are in great shape but the gums will have to go.

That's the stupidest analogy and you clearly have no sense of comprehension.

How's the profession of PGA golf? How's the profession movie industry in Hollywood? How's the profession of professional football in the NFL?

The professions are fine. And if you're one of the few who can join and have a job, then you're fine. But if you're outside looking in, then it aint all that rosy. Does that make sense?

Those of us already in pharmacy and established and doing a good job, we'll be fine...and we'll keep moving the profession ahead. Those who are established in the retail sector be it in chain or independent, they'll be fine...

Now the new grads coming out $200K debt with no job... will they be fine??

Why can't you see this simple concept? Get real with the gum and teeth analogy. That's freaking stupid.

I've been in Pharmacy for 20 years... and 10 years in management. And progressive one at that.. Don't you think I have a little more sense into what's going on and where pharmacy is headed?

 

[Its Z]

Instead of bumping an old thread, why don't I link it.

Read post #30. You were talking about me. I started this thread 4 years ago.

And we used to actually have productive discussions about pharmacy.

Zpack said...

 

[Its Z]

heh... post #35.. Zpack truly was a visionary..as he was blurting this crap..only to have the new vanco guideline say the same crap in 2009... it's just that I was preaching this crap in 2007.

Zpack says..

But the true reason for the Vancomycin level monitoring is to ensure the level stays above the MIC. We use to shoot for the levels between 5 to 30 ug/ml years ago...now we shoot for the trough of 10 to 20ug/ml and the peak of 40ug/ml. We can predict the levels by a PK model...but nothing gives us a peace of mind like getting some levels.

 

[SELDANE]

Why is it overly optimistic? Make a case instead of a statement without a justification. If my expectations of retail pharmacy keep thriving in the future, why is it unrealistic? Again, make a case and back up your statement instead of a blanket statement.



That's the stupidest analogy and you clearly have no sense of comprehension.

How's the profession of PGA golf? How's the profession movie industry in Hollywood? How's the profession of professional football in the NFL?

The professions are fine. And if you're one of the few who can join and have a job, then you're fine. But if you're outside looking in, then it aint all that rosy. Does that make sense?

Those of us already in pharmacy and established and doing a good job, we'll be fine...and we'll keep moving the profession ahead. Those who are established in the retail sector be it in chain or independent, they'll be fine...

Now the new grads coming out $200K debt with no job... will they be fine??

Why can't you see this simple concept? Get real with the gum and teeth analogy. That's freaking stupid.

I've been in Pharmacy for 20 years... and 10 years in management. And progressive one at that.. Don't you think I have a little more sense into what's going on and where pharmacy is headed?

In the past 20 years chain pharmacies have done whatever they can to minimize any proactive laws advanced by the profession of pharmacy. Take mandatory counseling. I don't think I need to list examples of how corporate chains have underminded this law (one only need to pick up a new prescription at CVS). Because of fines that have been levied by the states board of pharmacy against chains for infraction of this law, employers have designed ways to shift the culpability from the chain to the pharmacist (ie., Rph acknowledgement of counseling at the point of sale via bar codes or touch pads, etc..) We can look at the change of ratio between pharmacists and technicians pushed through by the chain pharmacies (surely they didn't advocate this so as to help society receive their meds in a more timely manner). Regardless of the example, in light of such behavior I just don't see the chains endorsing the changes you've been advocating in the past couple of posts. Not that what you've advocated is wrong. I think everyone on this forum would love to see wide acceptance of your proposals. But in all fairness, when a pharmacist steps behind the counter at a Walgreens I seriously doubt he or she sees a KPI which measures MTM or the number of counsels on new prescriptions that have occurred. The point of my disagreement with your view regarding retail pharmacy is that your proposals (worthy as they may be) still have to through a CEO's board room first. Despite the chain's board room, if you were graduating today with over 120k of debt would your priority be advancing a proactive future for pharmacy and possibly incurring the ire of your employer or picking up as many extra hours as possible so as to pay off that debt?
As for the analogy, I am simply trying to point out that the state of the profession of pharmacy goes hand in hand with the state of pharmacists. Especially if we take into consideration that the majority of pharmacists (maybe 70%) work within retail. I'm sorry for any misconception.

 

[SELDANE]

Instead of bumping an old thread, why don't I link it.

Read post #30. You were talking about me. I started this thread 4 years ago.

And we used to actually have productive discussions about pharmacy.

Zpack said...

Just because we don't agree dosen't mean the discussion isn't productive.

 

[MountainPharmD]

heh... post #35.. Zpack truly was a visionary..as he was blurting this crap..only to have the new vanco guideline say the same crap in 2009... it's just that I was preaching this crap in 2007.

Zpack says..

Z-Pack was a punk! Man I am glad that guy left! He drove off a wonderful poster named Slaver. Now Slaver, that guy was a visonary.

 

[MountainPharmD]

SDN...the Doom and Gloom Forum.

Let's all quit our jobs, put aside our dreams and aspirations, stock up on; guns, water, food and gasoline and move to Montana to join the Militia's. Heck, December 21, 2012 is coming!!

FINALLY!!!! Someone making some sense on here! Bravo!

 

[MountainPharmD]

As for the analogy, I am simply trying to point out that the state of the profession of pharmacy goes hand in hand with the state of pharmacists. Especially if we take into consideration that the majority of pharmacists (maybe 70%) work within retail. I'm sorry for any misconception.

That was my point a few posts ago. You cannot separate the heath system pharmacists and the retail pharmacits from the profession. We are all part of the same thing. What happens to the pharmacists who make up the majority of the profession will affect the minority that doesn't. To think otherwise is foolish.

 

[Its Z]

In the past 20 years chain pharmacies have done whatever they can to minimize any proactive laws advanced by the profession of pharmacy. Take mandatory counseling. I don't think I need to list examples of how corporate chains have underminded this law (one only need to pick up a new prescription at CVS). Because of fines that have been levied by the states board of pharmacy against chains for infraction of this law, employers have designed ways to shift the culpability from the chain to the pharmacist (ie., Rph acknowledgement of counseling at the point of sale via bar codes or touch pads, etc..) We can look at the change of ratio between pharmacists and technicians pushed through by the chain pharmacies (surely they didn't advocate this so as to help society receive their meds in a more timely manner). Regardless of the example, in light of such behavior I just don't see the chains endorsing the changes you've been advocating in the past couple of posts. Not that what you've advocated is wrong. I think everyone on this forum would love to see wide acceptance of your proposals. But in all fairness, when a pharmacist steps behind the counter at a Walgreens I seriously doubt he or she sees a KPI which measures MTM or the number of counsels on new prescriptions that have occurred. The point of my disagreement with your view regarding retail pharmacy is that your proposals (worthy as they may be) still have to through a CEO's board room first. Despite the chain's board room, if you were graduating today with over 120k of debt would your priority be advancing a proactive future for pharmacy and possibly incurring the ire of your employer or picking up as many extra hours as possible so as to pay off that debt?
As for the analogy, I am simply trying to point out that the state of the profession of pharmacy goes hand in hand with the state of pharmacists. Especially if we take into consideration that the majority of pharmacists (maybe 70%) work within retail. I'm sorry for any misconception.

You have not said anything new. Your points are:

1. Retail pharmacy will keep driving volume efficiency to increase profit.
2. 70% of pharmacists are retail.
3. Retail pharmacy will worsen?
4. MTM is unrealistic

Well, you do know there are 2 bills, 1 in senate and 1 in house to allow MTM reimbursement program under Medicare B to include pharmacist as a provider?

The "Outcomes" pilot currently pays $50 for comprehensive review and $20 per interventions such as duplicate therapy or brand to generic under Medicare B.

Perhaps you missed the thread on this topic.

If there's a profit to be made through MTM, do you really believe CEOs will turn it down? The difference between OBRA 90 and MTM? MTM gets paid...OBRA 90 doesn't.

I will give you another example:

Vaccination. Some pharmacists see it as extra work. Some see it as an opportunity. Chains forced pharmacists to provide vaccination...why? Reimbursement. Therefore, to say Chain CEO's vote against every change except for more volume is false. They want more profit. Pharmacy just needs to find synergistic program that drives more profit while enhancing pharmacy practice. And I firmly believe MTM is the key.

Once CMS reimburses MTM, other 3rd party payors will follow. That's the typical pattern.

Again, kids heavily strapped to student loans will suffer and the majority of pharmacists will reactively follow whatever is handed to them. But it will be the few trend setters who will shift and shape the future of pharmacy. You're either a follower or a leader. And you better hope your leader leads you the right way.

 

[Its Z]

That was my point a few posts ago. You cannot separate the heath system pharmacists and the retail pharmacits from the profession. We are all part of the same thing. What happens to the pharmacists who make up the majority of the profession will affect the minority that doesn't. To think otherwise is foolish.

dood,

Aint nothing gonna happen to retailers. Yeah..work condition will get worse...then again what industry isn't driving efficiency??

What boils down to is the oversupply of pharmacists driving leverage towards employers. That's not going to kill the profession.

What you're seeing is a leverage shift... When I graduated, I was at a mercy of the employers..hell, Walmart never even acknowledged my application. What ensued during the real estate boom and retail expansion was probably an exception, not the rule where young punk pharmd had all the leverage in the world. I bet you were one of them. Now it's the pay back time for the CVS of the world to whip y'all into shape. Now people moan and groan how unfair everything is..

Well, I kinda like what I'm seeing with the new grads...they're level headed and appreciate opportunity to work. Dood, you know it and I know it... those young pharmds came out with a chip on their shoulder wanting $30K sign on and a BMW lease. Those days are gone!!

Many older pharmers like me appreciated and enjoyed the massive pharmacist shortage. We capitalized on it. But now, the wisdom says be thankful we have a job and we were able to enjoy something we'll never see anymore.

Younger pharmacists who came out during the shortage better be thankful they got to taste the once in a lifetime employment aberration instead of bitching about the changing working environment.

Now...I feel for current students and new grads... the pot' o gold at the end of the rainbow was nothing but a mirage.

I went into pharmacy because my goal was to set up a pharmacy in a medical building. I envisioned I would own multiple locations.. well, I ended at the other end of the spectrum but flirted with DME & closed door pharmacy ownership. And I'm not done with retail pharmacy.

And from what I've seen, pharmacy is a healthy profession with many opportunities.

 

[Its Z]

This thread diverged with the "typist" picture.

We all know the profession of VCR repair is obsolete.

Trust me when I say this, Pharmacy will not become an obsolete profession anytime soon.

Drug therapy is too important.

 

[Its Z]

Z-Pack was a punk! Man I am glad that guy left! He drove off a wonderful poster named Slaver. Now Slaver, that guy was a visonary.

You know... Slaver was the ultimate Gloom and Doomsayer of pharmacy. One time, he faked his death..it's classic. He came on the forum pretending to be his wife to announce his death and during that time, he was posting on other forums as a slaver...so some of us caught him on it... That was classic. If you're nice, I'll go find that thread on that forum.

 

[MountainPharmD]

dood,

Aint nothing gonna happen to retailers. Yeah..work condition will get worse...then again what industry isn't driving efficiency??

What boils down to is the oversupply of pharmacists driving leverage towards employers. That's not going to kill the profession.

No, it is not going to kill the profession. It will kill any chance of having some job satisfaction or pleasure especially on the retail side. Woo hoo!!!! MTM, immunizations, whatever all sounds great except when you working 12 hour shifts with inadequate staffing and no breaks.

What you're seeing is a leverage shift... When I graduated, I was at a mercy of the employers..hell, Walmart never even acknowledged my application. What ensued during the real estate boom and retail expansion was probably an exception, not the rule where young punk pharmd had all the leverage in the world. I bet you were one of them. Now it's the pay back time for the CVS of the world to whip y'all into shape. Now people moan and groan how unfair everything is.

Yep, I was one of them. And I am ticked, at myself and my fellow colleagues for not using our leverage to improve the profession. Instead we took the money and laughed all the way to the bank. You are correct. The leverage has shifted back to the employers and payback is a bitch! I moan and groan not because things are unfair. Hell life isn't fair and big corporations are not fair. I moan and groan because I see the potential of retail pharmacy being trashed everyday by the corporate chains.

 

[MountainPharmD]

You know... Slaver was the ultimate Gloom and Doomsayer of pharmacy. One time, he faked his death..it's classic. He came on the forum pretending to be his wife to announce his death and during that time, he was posting on other forums as a slaver...so some of us caught him on it... That was classic. If you're nice, I'll go find that thread on that forum.

Nope, leave that in the archives. It was a classic though! You have to give the guy some credit. The things he was saying five years ago pretty much have come true. He was doom and gloom when it wasn't cool to be doom and gloom. Hell everyone is doom and gloom now.

 

[Its Z]

Nope, leave that in the archives. It was a classic though! You have to give the guy some credit. The things he was saying five years ago pretty much have come true. He was doom and gloom when it wasn't cool to be doom and gloom. Hell everyone is doom and gloom now.

He and I didn't disagree about hospital practice though he loathed me because he thought I was one of those condescending academia type who looked down upon BSpharms. He never realized that wasn't the case.

What he predicted was the typical prediction of retail chain corporation squeezing it out of pharmacists. What he and I didn't see was the new schools opening. That snuck up. And that alone is driving the demise of retail work environment.

 

[MountainPharmD]

Well, you do know there are 2 bills, 1 in senate and 1 in house to allow MTM reimbursement program under Medicare B to include pharmacist as a provider?

Oh boy where do I start here. "To INCLUDE pharmacists as a provider" is a key statement here. Notice it does not say include pharmacists as the SOLE provider of MTM services. There is a hugh difference. Medicare Part D has an MTM provision in it. Well here we are 6 years later and there is not alot of MTM going on by pharmacists is there? You know why? Because the law said MTM services could be performed by any qualified healthcare professional. There are many qualified healthcare professionals that can provide MTM services a whole lot cheaper than pharmacists can.

I am not at all excited about the "new" legislation for MTM services because I saw what happened to the last MTM legislation. Here is what I forsee happening. Physicians we see this as a golden opportunity to make mony since the government is cutting their reimbursemnet too. They will have nurses performing MTM services at the office. Hell if I were a Doctor I would be all over this. I set up a little office with an LPN in it. Have every patient see the LPN for MTM services after every appointment. Pay her about 30k a year and make a ton of money. Just like the current Medicare part D MTM provision Pharmacists will be left out in the cold.

I am not being a doom and gloomer here I am just being realistic. The Obama adminisatation has stated many times they will save x billions of Dollars a year becaus of increased efficiency. I have seen first hand the ****ty reimbursemnet from Medicare part D and what a distater that has been for retail pharmacy. Basically fill 4 scripts to make the same profit you make on one script from a non-Medicare insured.

 

[Its Z]

Oh boy where do I start here. "To INCLUDE pharmacists as a provider" is a key statement here. Notice it does not say include pharmacists as the SOLE provider of MTM services. There is a hugh difference. Medicare Part D has an MTM provision in it. Well here we are 6 years later and there is not alot of MTM going on by pharmacists is there? You know why? Because the law said MTM services could be performed by any qualified healthcare professional. There are many qualified healthcare professionals that can provide MTM services a whole lot cheaper than pharmacists can.

The key here is Pharmacist as a provider. Do you have an NPI# and can you get paid if you bill today? It's like this. You know the story about the shoe salesman who goes to a country.. and sees no one is wearing shoes..so he sez I'll never make any money..no one wears shoes here... so another salesman goes to the same country and yells..."no one wears shoes here, I'm going to sell shoes up the wazoo!!!"

Who can do MTM a lot cheaper?

I am not at all excited about the "new" legislation for MTM services because I saw what happened to the last MTM legislation. Here is what I forsee happening. Physicians we see this as a golden opportunity to make mony since the government is cutting their reimbursemnet too. They will have nurses performing MTM services at the office. Hell if I were a Doctor I would be all over this. I set up a little office with an LPN in it. Have every patient see the LPN for MTM services after every appointment. Pay her about 30k a year and make a ton of money. Just like the current Medicare part D MTM provision Pharmacists will be left out in the cold.

mmmm... you know primary care physicians reimbursement wasn't the one that got cut...right? It's the specialists... of course if you have PCP who has to do MTM to make money..perhaps that doctor aint worth seeing.. we all feared physician dispensing to kill pharmacy...well it didn't.

I am not being a doom and gloomer here I am just being realistic. The Obama adminisatation has stated many times they will save x billions of Dollars a year becaus of increased efficiency. I have seen first hand the ****ty reimbursemnet from Medicare part D and what a distater that has been for retail pharmacy. Basically fill 4 scripts to make the same profit you make on one script from a non-Medicare insured.

You only fill Medicare scripts?

Just take a look at Dr. M. Look around dood...there are tons of retail indys doing just fine.

 

[MountainPharmD]

You only fill Medicare scripts?

Just take a look at Dr. M. Look around dood...there are tons of retail indys doing just fine.

I happen to have some unique insight into this. I worked at a pharmacy here in Dallas that had 85% of the patients on Medicare part D. My GROSS profit margin was 9%. Mind you I said gross profit margin. That doesn't leave much CTO after you've paid all the bills.

I now work at a pharmacy in a new, younger town that does 99% private insurance. My gross profit margin is 25%. That allows for a decent CTO.

Dr. M will be the first to tell you, in fact he has said it on here, you will not make it as an independent by selling $4 generics and primarily patients on Medicare and Medicaid.

You want me to get excited about MTM? Show me legislation that recognises pharmacists as the drug experts and the sole providers of MTM, then I will get excited.

 

[Its Z]

I happen to have some unique insight into this. I worked at a pharmacy here in Dallas that had 85% of the patients on Medicare part D. My GROSS profit margin was 9%. Mind you I said gross profit margin. That doesn't leave much CTO after you've paid all the bills.

I now work at a pharmacy in a new, younger town that does 99% private insurance. My gross profit margin is 25%. That allows for a decent CTO.

Dr. M will be the first to tell you, in fact he has said it on here, you will not make it as an independent by selling $4 generics and primarily patients on Medicare and Medicaid.

You want me to get excited about MTM? Show me legislation that recognises pharmacists as the drug experts and the sole providers of MTM, then I will get excited.

Then there is the 340B and Patient Assistance Program... and DME/Pharm none of the retailers are even touching...

Man..there's so much opportunities in retail right now.

 

[MountainPharmD]

Then there is the 340B and Patient Assistance Program... and DME/Pharm none of the retailers are even touching...

Man..there's so much opportunities in retail right now.

Retail chains are into DME. We sell walkers, wheel chairs, diabetic testing supplies and the like. Some stores are certified to do diabetic shoes and fitting. If there is money to be made the retail chains are trying to exploit it.

I believe there are opportunities for independant pharmacies. In fact I believe independant pharmacy is the only hope for our profession. We must break away from the control the retail chains have. Dr. M is proof it can be done.

 

[genesis09]

Retail chains are into DME. We sell walkers, wheel chairs, diabetic testing supplies and the like. Some stores are certified to do diabetic shoes and fitting. If there is money to be made the retail chains are trying to exploit it.

I believe there are opportunities for independant pharmacies. In fact I believe independant pharmacy is the only hope for our profession. We must break away from the control the retail chains have. Dr. M is proof it can be done.

At the store level, Walgreens in my area can bill for nebulizers. We do a couple a month.

 

[Coastie]

It seems like pharmacy as a profession has been rapidly changing over the last couple of decades. There are definite increases in clinical responsibilities, and it seems obvious that pharmacy is no longer a purely dispensing/compounding career.

Some things to consider:
1. Mandatory Pharm.D - Higher required level of education and increased complexity of course work makes for more knowledgeable and comprehensive pharmacists.
2. Residencies / Fellowships becoming more and more commonplace - More potential for experience and specialization in a specific fields of medicine.
3. VA prescribing and increasing number of collaborative practice opportunities in other settings which give pharmacists greater autonomy as practitioners.
4. Immunization training - Going further from the traditional dispensing role of the pharmacist and becoming more involved in direct patient care.
5. MTM reimbursement - Increased recognition of the money that could be saved through proper drug utilization (not to mention the benefit of reducing unnecessary/improper drug therapy) may offer opportunites for pharmacists to use knowledge of kinetics/dynamics in light of more and more complex medication options.
6. Shortage of physicians and potential for a 30 million spike in number of insured individuals may offer further expansion of the pharmacist scope of practice.

Yeah the job market isnt ideal right now. And yes there could be a potential surplus. But that doesnt mean our field isnt expanding and beginning to offer new and interesting opportunites for the future pharmacists. The amount of drug information that healthcare professionals have to consider is expanding at an exponential rate. And we stand in the best position to teach and utilize this information. So forget all of this doom and glood and lets talk about the future, where things might not be so bad.