Future of Retail Pharmacy

[1ive2die]

The more I think about it the more I feel that most pharmacists are one step away from being obsolete. That step may be a change in regulation/law, a rise in mail-order pharmacy, greater automation requiring less pharmacists, remote dispensing, or basically any method that allows more scripts to be filled with fewer pharmacists.

I'm no expert but it seems the business model of having a pharmacy on every street corner is entirely unsustainable and like many other industries and many other brick and mortar operations there will be streamlining in the future and I worry that many pharmacy jobs will be casualties of that streamlining.

Now normally I wouldn't worry about this but pharmacists are notoriously bad at demonstrating their value to the public. I feel it would be way too easy to pass a law that decreases the need for pharmacists or to have insurance companies all decide that mail order is the way to go. I really doubt the public would bat an eye at any of this if it were to happen.

What do you guys think? Do you feel the future of retail is safe or is it possible that in the future there will simply be less of a need for pharmacists?

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[PharmDstudent]

unsustainable

is what I think.

 

[Dr Wario]

I believe that people's stupidity will save retail pharmacy to some extent as well as their reliance on quick fixes to minor problems. How many times a day do you have to rescue someone with a mail order emergency and how many hospital/urgent care scripts do you fill? I don't think the government will allow tech verification any time soon so I think we still have a little longer yet (though our working conditions and salaries are sure to become less attractive).

With all of that said, I am saving about 80% of my net salary and already have other income streams that will cover my expenses should the need arise.

 

[MountainPharmD]

I don't think the government will allow tech verification any time soon so I think we still have a little longer yet (though our working conditions and salaries are sure to become less attractive).

The military has done this for years. In some states it is allowed in hospitals. It won't be long......

 

[MountainPharmD]

I'm no expert but it seems the business model of having a pharmacy on every street corner is entirely unsustainable and like many other industries and many other brick and mortar operations there will be streamlining in the future and I worry that many pharmacy jobs will be casualties of that streamlining.

Yep, pretty much sums it up.

 

[Unchained]

I'm a fairly optimistic person but I do see some very negative headwinds in the future for the profession. Automation, telepharmacy, and advanced tech training will result in less need for pharmacists. The recession and oversupply of pharmacists has advanced this decline. Our saving grace may be the healthcare bill. One thing for certain is that the future of pharmacy needs to move away from just dispensing. I am looking at establishing other streams of income during the next 5 yrs as a hedge.

 

[LazyMooch]

Yep, pretty much sums it up.

Mountain, do you ever think of going industry or residency or hospital? I sometimes wonder if retail will be worth it when I get my PharmD, but the divide in salary blows my mind.

Just curious.

 

[All4MyDaughter]

The military has done this for years. In some states it is allowed in hospitals. It won't be long......

Yet the military still employs tons of pharmacists...

Plus, allowing one certified technician to check what the other has loaded into a med cart hasn't yet eliminated hospital pharmacists in MY state. For one thing, every order still has to be evaluated by a pharmacist. Once that happens the techs do cart fill and check each other. The thought behind allowing this is that there is still another safety check or two (administering nurse and some places, BCMA system) between the drug and the patient. Plus, nothing goes INTO the cart until that order has been reviewed and approved by the pharmacist.

That system is a FAR cry from one tech filling in Walgreens, having another check tech his or her work and then handing the med to the patient to take home and self administer. I just don't see it happening...

 

[RxMTM]

I dont think pharmacists will be fired. Techs will get their hours cut. The main problem is market saturation. New schools opening and axisting schools opening satellite campuses.

 

[RxMTM]

My preceptor used to type on a typewriter and file everything away in folders. Technology and laws have changed but she still fulfills the exact same role. She verifies and counsels. That basic function wont become obsolete. If the government changed a law and made pharmacists obsolete, then all 100+ pharmacy schools would come crashing down. I can never see techs in charge of verification.

 

[rph3664]

There are some "You know you're from Town X if you remember....." boards on Facebook, and the one for my hometown is currently on viral status. There are repeated posts regarding certain pharmacies, long since closed, that had great soda fountains and lunch counters.

It was probably the only way they could stay open back then too, when it was mostly cash and carry.

 

[MountainPharmD]

Mountain, do you ever think of going industry or residency or hospital? I sometimes wonder if retail will be worth it when I get my PharmD, but the divide in salary blows my mind.

Just curious.

I made my choice for retail when I graduated. I could have got a job easily at a hospital back then. Now I am stuck. When you have a family, kids mortgage ect. it is hard to rewind and start over. It is what it is.....

 

[GreyFox2002]

A few years ago, there was a 20/20 special report about "Mistakes in the Pharmacy." I remember them reporting about how all those "people in white coats behind the counter" are not all pharmacists, but mostly technicians, with one pharmacist among them. I remember a rather large public outcry from the lay-public about the fact that non-pharmacist personnel was behind the counter.

If some law changed that allowed techs to verify and made pharmacists obsolete, I guarantee that there would be A: public outcry, and B: more patient harm. I don't think it would save the health care system money in the long-run.

Retail has been "threatened" to become an obsolete model since the 80s with the advent of computer technology, robots, mail-order, etc. Last time I checked, Rx counts for the district I'm in (Kroger) is up 10-15 % over the last year. Also, most retail pharmacists complain about one thing more then anything else: workload. Workload is increasing, increasing, increasing, and that is mostly because of increase in script counts. More scripts need to be filled, so this whole theory about mail order stealing retail business away really doesn't seem to be the case.

 

[StallionRx]

A few years ago, there was a 20/20 special report about "Mistakes in the Pharmacy." I remember them reporting about how all those "people in white coats behind the counter" are not all pharmacists, but mostly technicians, with one pharmacist among them. I remember a rather large public outcry from the lay-public about the fact that non-pharmacist personnel was behind the counter.

If some law changed that allowed techs to verify and made pharmacists obsolete, I guarantee that there would be A: public outcry, and B: more patient harm. I don't think it would save the health care system money in the long-run.

Retail has been "threatened" to become an obsolete model since the 80s with the advent of computer technology, robots, mail-order, etc. Last time I checked, Rx counts for the district I'm in (Kroger) is up 10-15 % over the last year. Also, most retail pharmacists complain about one thing more then anything else: workload. Workload is increasing, increasing, increasing, and that is mostly because of increase in script counts. More scripts need to be filled, so this whole theory about mail order stealing retail business away really doesn't seem to be the case.

An intelligent post appears.

Techs are not going to take your jobs and neither is mail order.

 

[joetrisman]

Yet the military still employs tons of pharmacists...

Not to the best of my knowledge. Last I check there were only around 150 active duty rphs in the army which has the largest number of pharmacists of any branch.

 

[THE MTL]

The more I think about it the more I feel that most pharmacists are one step away from being obsolete. That step may be a change in regulation/law, a rise in mail-order pharmacy, greater automation requiring less pharmacists, remote dispensing, or basically any method that allows more scripts to be filled with fewer pharmacists.

I'm no expert but it seems the business model of having a pharmacy on every street corner is entirely unsustainable and like many other industries and many other brick and mortar operations there will be streamlining in the future and I worry that many pharmacy jobs will be casualties of that streamlining.

Now normally I wouldn't worry about this but pharmacists are notoriously bad at demonstrating their value to the public. I feel it would be way too easy to pass a law that decreases the need for pharmacists or to have insurance companies all decide that mail order is the way to go. I really doubt the public would bat an eye at any of this if it were to happen.

What do you guys think? Do you feel the future of retail is safe or is it possible that in the future there will simply be less of a need for pharmacists?

I can tell you dont work at a retail store. Once you start working there, you'll realize that you can never get rid of retail pharmacy.

 

[Digsbe]

I am still pre-pharmacy, but I did work as a tech in a retail pharmacy for a year before I started working for my university doing cancer research. I don't see pharmacists in retail going obsolete anytime soon.

The state that I work in has a law that says before a new medication can be handed to the patient, a pharmacist must counsel that patient on the side affects of the drug and how to take it. A pharmacist will always be necessary to verify medication to ensure that there are no interactions and to keep doctors from killing their patients when they prescribe a lethal dose of codeine for an 80 year old woman (this happened in my store, and the pharmacist was the one who denied the treatment and contacted the physician). We would receive many phone calls from patients who had questions about their medications or wanted to report a side affect which required a pharmacist. I don't see techs ever being able to verify medications. In my store I would audit prescriptions as a double check to ensure that what was dispensed matches what was prescribed. However, never was I able to (nor should I have been able to as a tech) to verify the medication and approve of the therapy. It is illegal (at least in my state) for techs to give medical counsel. I don't see retail pharmacists going obsolete.

My problem with retail is how it is changing and it's largely due to chain stores changing how a pharmacy is viewed and what is to be expected. There is a very disturbing trend that has patients viewing pharmacies less and less like a healthcare facility operated by doctors of pharmacy, and more and more as a dispensary that needs to be on par with fast food. Certain chain stores are starting to promise that scripts will be filled in 15min or less. They decrease tech hours and demand more from the pharmacists. I think they are warping the public image of retail pharmacy and it will impact the profession negatively. This is due to the businessmen and marketing teams that want to try and erase the healthcare facility aspect and enforce some "fast food model" for pharmacy practice while at the same time cutting tech hours and demanding more from the pharmacists. This is my problem with retail and the disturbing trends that I saw as a technician.

This said, I don't see the demand for pharmacists going down or becoming obsolete in retail pharmacy. I don't see techs being able to verify and approve of therapies, nor do I see techs being able to provide medical counsel to patients or to discuss therapy management with physicians and nurses.

 

[MountainPharmD]

I can tell you dont work at a retail store. Once you start working there, you'll realize that you can never get rid of retail pharmacy.

Retail pharmacy will always be around that is not what is being argued. What is being debated is whether a Pharmacist will be there. Read up on Walgreens POWER program and Walgreens Project One. The retail chains want to continue to crank out as many scripts as they can while reducing costs as much as they can. Pharmacists are expensive, technicians are not. Hence programs like POWER and Project One.

Trust me when I say this, what I spend 90% of my time on everyday does not require a PharmD or any education beyond high school for that matter.

 

[RxMTM]

Retail pharmacy will always be around that is not what is being argued. What is being debated is whether a Pharmacist will be there. Read up on Walgreens POWER program and Walgreens Project One. The retail chains want to continue to crank out as many scripts as they can while reducing costs as much as they can. Pharmacists are expensive, technicians are not. Hence programs like POWER and Project One.

Trust me when I say this, what I spend 90% of my time on everyday does not require a PharmD or any education beyond high school for that matter.

It used to require a bachelors of pharmacy. Then they tacked on another year of school and it's called a PharmD now.

 

[Pharmizzle]

Not to the best of my knowledge. Last I check there were only around 150 active duty rphs in the army which has the largest number of pharmacists of any branch.

Only looking at the number of active duty pharmacists is not an accurate representation of how many pharmacists are employed in military or government pharmacies. In my experience, the vast majority of pharmacists that I worked with in the military weren't active duty; they were either contract or GS employees. As an example, my last base had two active duty pharmacists and five civilian pharmacists. Usually the active duty pharmacists function more as pharmacy managers, and the civilian pharmacists are the ones doing the majority of the verification, doctor call, patient counseling, etc.

The military does allow tech-check-tech for certain things, but there are limitations (for example, techs could check refills, but could not check new, handwritten prescriptions), and a pharmacist had to be consulted any time professional judgment was required (basically if you had a question about *anything* on any prescription or refill). At one base, we tried doing our refill dispensing without any pharmacists, but too many patients complained that there was no pharmacist around to answer their questions. There was certainly never any shortage of work for the pharmacists to do at any of the bases I worked at, despite techs being allowed to do much, much more than they are permitted to in the civilian sector.

 

[joetrisman]

Only looking at the number of active duty pharmacists is not an accurate representation of how many pharmacists are employed in military or government pharmacies.

I was saying in response to military employment for rphs. But yeah I forgot about the civilian contracting that goes on

Did you like working in military pharmacy?

 

[Tired farmer]

Retail pharmacy will always be around that is not what is being argued. What is being debated is whether a Pharmacist will be there. Read up on Walgreens POWER program and Walgreens Project One. The retail chains want to continue to crank out as many scripts as they can while reducing costs as much as they can. Pharmacists are expensive, technicians are not. Hence programs like POWER and Project One.

Trust me when I say this, what I spend 90% of my time on everyday does not require a PharmD or any education beyond high school for that matter.

This^^^ As much as I'd like to think there would be a huge public outcry as pharmacist's start to get phased out, I look at mail order, the $4 prescription list, drive thru's.... the majority of the public does not seem to associate much a a "value" in the services pharmacists can and do provide.

People want their medication, and they want it cheap, and they want it immediately.

I believe that if walgreens or CVS or any of the big chains could eliminate pharmacists as much as possible and have techs and "advanced techs" take on more responsibility they will do it in a heartbeat without thinking twice to make their profit margins larger.

The reimbursement rates from insurance companies isn't helping the matter, and with the Medco/Express Scripts merger looming in the future, I do not see things getting better any time soon.

 

[RxMTM]

New pharmacy schools are still going to open and fill ALL of their seats. Existing pharmacy schools are still going to open satellite campuses and fill all theirs seats even if they have to get the dumbest applicants. Graduates are still going to do retail because it is the easiest option.

 

[Kansas Pharmer]

Only looking at the number of active duty pharmacists is not an accurate representation of how many pharmacists are employed in military or government pharmacies.

Good quote as most people do not realize the number of civs working on or around military in a wide variety of jobs nowadays.

Pharmizzle, if you are currently working in a base pharmacy, what do you see as the need for uniformed pharmDs in the future? I only ask because I have thought about rejoining guard/reserve once I get accepted to school. I would like to finish out a retirement with a shiny rank insignia instead of the subdued one.

 

[Pharmizzle]

@joetrismanhttp://forums.studentdoctor.net/member.php?u=252392 I did like working military pharmacy. The patient population tends to skew a lot more polite than the general population, and you don't have to deal with insurance. I would love to go back and work in a military/government pharmacy again after I graduate.

@Kansas Pharmer I left the military for pharmacy school so I'm not currently working at a base pharmacy, but as far as I know (in my experience, I don't know official stats or anything) the armed services don't tend to recruit a large number of pharmacists and it can be pretty competitive. As I mentioned, the military relies heavily on civilian/contract pharmacists for staffing (obviously cheaper, since they're not paying out benefits and giving free medical care and retirement after 20 years like they are for active duty pharmacists), but if you can get a spot, it seems like a really sweet place to work as a pharmacist.

The lower-ranking active duty pharmacists always got to do a lot of clinical stuff - coumadin clinics, diabetes clinics, cold/allergy clinics, etc. The only reason I don't think I personally would like it is that once you start to move up in rank you almost inevitably end up as an officer-in-charge, which is basically just a managerial position. A lot of sitting in your office doing paperwork and going to meetings, and not a whole lot of actually practicing pharmacy. But if you want to get leadership experience like that, the military is an awesome place to do it IMO.

 

[kvl1027]

An intelligent post appears.

Techs are not going to take your jobs and neither is mail order.

I agree that Pharmacists are not going to be replaced anytime soon, mail order pharmacy is certainly turning the world of retail pharmacy up-side down. It is killing small business, especially when patients don't have the option to fill their scripts in whatever pharmacy they want.
Mail-order pharmacies still need pharmacists, so the jobs will be there, but I don't think mail-order is good for pharmacy.

"Mail order is the devil!"

 

[rxlea]

One of my issues with mail order is drug stability. In a scorching place like Arizona, drugs being left in the mailbox or at the door can be a problem. I haven't seen mail order places address this issue on a wide scale; at least not in my state.

 

[MountainPharmD]

One of my issues with mail order is drug stability. In a scorching place like Arizona, drugs being left in the mailbox or at the door can be a problem. I haven't seen mail order places address this issue on a wide scale; at least not in my state.

I had a lady call me yesterday and ask me if her mail order medications would be safe to take after sitting in her mail box. One of my biggest pet peeves is people callling up and asking me questions about thier mail order scripts because it is to hard to get ahold of anyone at the mail order place. I told her that would be a good question to ask the mail order place that sent her the drugs.

 

[PharmDstudent]

If the government will soon foot the bill for prescriptions, why will it pay more? Isn't mail order "a given" because of the potential cost savings?

 

[Tinkerbell22]

I think patients would refuse to fill their prescriptions where I work if a pharmacist was not present.

They always want to talk to the pharmacist... I couldn't see them replacing pharmacists any time soon, at least not within the foreseeable future, especially not at a chain that doesn't compete based off prices. Mr. George just might roll over in his grave...

But I agree... I think mail order is stupid, and we have a few patients who can't fill with us anymore because of it.

 

[LazyMooch]

I think patients would refuse to fill their prescriptions where I work if a pharmacist was not present.

They always want to talk to the pharmacist...

Hahahaha really? At the pharmacy I work at, I would venture that 1 out of 10 people ask to talk to the pharmacist and those that recieve first fill counseling bitch about it quite a bit.

 

[Tinkerbell22]

Hahahaha really? At the pharmacy I work at, I would venture that 1 out of 10 people ask to talk to the pharmacist and those that recieve first fill counseling bitch about it quite a bit.

We offer counseling on all prescriptions, but patients are able to decline and most of them do.

I'm mostly referring to OTC questions, first aide, or non Rx fill questions.

 

[naus]

I believe that people's stupidity will save retail pharmacy to some extent as well as their reliance on quick fixes to minor problems. How many times a day do you have to rescue someone with a mail order emergency and how many hospital/urgent care scripts do you fill?

You don't need a drug store on every other block to do that though.