LONG RANT BUT worth a read if you’re in the community pharmacy sector.

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rxstudent297

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Hi everyone I’m a Graduating pharmacy student with second thoughts about going towards community. I play a huge role in NCPA and my state board pharmacy association but now a little bit unsure where to go.

Ever since I was little; I had a passion for pharmacy due to it having the right combination of business and health and I can open up my own practice. I honestly think pharmacists can play an important role in helping the community as we are the most accessible healthcare professionals. Recently as I get surrounded by more community pharmacy owners and pharmacists, I’m having second thoughts about the pursuit of ownership and was hoping to get your opinions and advice esp with the topics below.

  • The profession: No one cares. All day in group chats pharmacists just complain and do nothing about It. No one does anything for advocacy for their profession even the simple things such as sending an email or writing a letter esp in the community sector. Like think about it we are the most accessible health care providers, patients see us 4x more than their prescribers yet we never ask for their support.

  • Respect: this is going to push some buttons but why are we needed? I’m in NYC where pharmacy owners call pharmacist “bodies.” All the pharmacist does is fill without checking any interactions, they don’t care if it’s controlled as long as it's an e-script and the correct medication written got dispensed. their main reason is it’s not their fault. It’s the providers. LIKE BE HONEST HOW MANY PATIENTS IN A DAY DO YOU EDUCATE OR EVEN TALK ABOUT THE MED ABOUT? 80% of the meds I see ppl just verify and the patients get it through delivery JUST LIKE a MAIL ORDER!! People use the excuse mail order cost the government money due to filling unwanted meds but so do you guys, if the patient has Medicaid or Medicare you keep refilling rescue inhalers and other medications and send an ELECTRONIC REFILL REQUEST FOR EVERY MEDICATION and then these pharmacists publicly complain about DIR fee’s or even getting paid $40 an hour. (Also please don’t say PA’s or even obvious mistakes on sigs because even a tech can figure those out)
  • I even see pharmacist compete with each other in the wrong way where they are paying their patients 25% of their medications but don’t dispense it or even giving them bounty/soap/toilet paper/pots/pans and we all know who these pharmacies are yet no one wants to report them to OPD.
  • One personal experience is the doctor sends a patient’s metformin with 5 refills to the wrong pharmacy and we do blister packs for a patient. For the last 3 months, we can’t fill the patient’s metformin in the blister pack because every time we ask them to reverse the claim the pharmacy said they sent it out by delivery
  • When NYS was announcing fee for service all these pop-up scamming pharmacies began trying to open


  • Sustainability: Has anyone seen the NCPA financials about 25% of pharmacists are operating at a loss. It’ a high revenue business but low profit I know there is CPESN which I believe strongly in but be honest how many owners are members of it or even NCPA or let alone their state board pharmacy association. The DIR fees are killing the business and not to mention in NYS we were promised Fee for service which got delayed for a month and now for two years. Even with the flu vaccines being a 40$ profit margin all the vaccine doses are going to the chains.
I don’t know if I’m getting exposed to the wrong different sector of community pharmacy but I’m passionate about this industry. I created business plans but I wanted you’re thoughts and opinions on my observations to see if I should continue this path



P.S I’m just a pharmacy student that needs some guidance and wanted to see what people had to say about my thoughts. I don’t mean to belittle anyone in any shape or form because this is my profession as well. Also, I’m not drowned in loans.

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Like think about it we are the most accessible health care providers, patients see us 4x more than their prescribers yet we never ask for their support.

What kind of support do you expect to get? Retail pharmacy, like mass merchandising or grocery, is highly commodified and transactional. You compete on price and convenience, not "quality of care." It's a race to the bottom

Definitely have seen the "fee-for-service" effect in California with pharmacies popping up left and right to cash in.
 
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Once upon a time, pharmacists needed to know different compounds and inactive ingredients to compound a medication. They needed some level of diagnostic skills to identify causes of symptoms, and knowledge of pharmacotherapeutics to compound the appropriate medication. They also needed some business skills by virtue of running a pharmacy business, or managing one on behalf of the owner.

Let's consider how things have changed, and continues to change. The most obvious is automation. Formulations and packaging are becoming more available all the time for the ease of patients. There will still be some compounding to do, but I think it's much less than in the past. References are more readily available electronically, and AI is going to be advancing rapidly - AI and machine learning will be able to replace much of the "thinking" aspect of pharmacist responsibilities in the future. Remaining responsibilities are becoming more redundant to technicians, telemedicine, other HCPs, and references that are becoming more readily available.

Maybe the roles of pharmacist associated with dispensing, consultation, identifying drug interactions, providing limited recommendations, resolving insurance issues, managing a business have to be re-thought (and maybe re-invented) in perspective of this age of advancing automation, AI, information sharing. A pharmacist used to manage more people instead of machines.
 
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Hi everyone I’m a Graduating pharmacy student with second thoughts about going towards community. I play a huge role in NCPA and my state board pharmacy association but now a little bit unsure where to go.

Ever since I was little; I had a passion for pharmacy due to it having the right combination of business and health and I can open up my own practice. I honestly think pharmacists can play an important role in helping the community as we are the most accessible healthcare professionals. Recently as I get surrounded by more community pharmacy owners and pharmacists, I’m having second thoughts about the pursuit of ownership and was hoping to get your opinions and advice esp with the topics below.

  • The profession: No one cares. All day in group chats pharmacists just complain and do nothing about It. No one does anything for advocacy for their profession even the simple things such as sending an email or writing a letter esp in the community sector. Like think about it we are the most accessible health care providers, patients see us 4x more than their prescribers yet we never ask for their support.

  • Respect: this is going to push some buttons but why are we needed? I’m in NYC where pharmacy owners call pharmacist “bodies.” All the pharmacist does is fill without checking any interactions, they don’t care if it’s controlled as long as it's an e-script and the correct medication written got dispensed. their main reason is it’s not their fault. It’s the providers. LIKE BE HONEST HOW MANY PATIENTS IN A DAY DO YOU EDUCATE OR EVEN TALK ABOUT THE MED ABOUT? 80% of the meds I see ppl just verify and the patients get it through delivery JUST LIKE a MAIL ORDER!! People use the excuse mail order cost the government money due to filling unwanted meds but so do you guys, if the patient has Medicaid or Medicare you keep refilling rescue inhalers and other medications and send an ELECTRONIC REFILL REQUEST FOR EVERY MEDICATION and then these pharmacists publicly complain about DIR fee’s or even getting paid $40 an hour. (Also please don’t say PA’s or even obvious mistakes on sigs because even a tech can figure those out)
  • I even see pharmacist compete with each other in the wrong way where they are paying their patients 25% of their medications but don’t dispense it or even giving them bounty/soap/toilet paper/pots/pans and we all know who these pharmacies are yet no one wants to report them to OPD.
  • One personal experience is the doctor sends a patient’s metformin with 5 refills to the wrong pharmacy and we do blister packs for a patient. For the last 3 months, we can’t fill the patient’s metformin in the blister pack because every time we ask them to reverse the claim the pharmacy said they sent it out by delivery
  • When NYS was announcing fee for service all these pop-up scamming pharmacies began trying to open


  • Sustainability: Has anyone seen the NCPA financials about 25% of pharmacists are operating at a loss. It’ a high revenue business but low profit I know there is CPESN which I believe strongly in but be honest how many owners are members of it or even NCPA or let alone their state board pharmacy association. The DIR fees are killing the business and not to mention in NYS we were promised Fee for service which got delayed for a month and now for two years. Even with the flu vaccines being a 40$ profit margin all the vaccine doses are going to the chains.
I don’t know if I’m getting exposed to the wrong different sector of community pharmacy but I’m passionate about this industry. I created business plans but I wanted you’re thoughts and opinions on my observations to see if I should continue this path



P.S I’m just a pharmacy student that needs some guidance and wanted to see what people had to say about my thoughts. I don’t mean to belittle anyone in any shape or form because this is my profession as well. Also, I’m not drowned in loans.
I just want to know if there is anything i'm not seeing because i still see all these pharmacies open up that do operate legitimately and i wanna know with the three major reasons i listed why would they still continue this sector of pharmacy
 
Or for fraud edge cases, of course. Independents have a bad reputation for that too.

Compounding is not a niche anymore either. You buy the package, go to classes that should have been school ones, and go compete with everyone else.

The two niches are language niches (Polish in Chicago, Spanish in Phoenix) and other non pharmacy services (we don’t use your real name for any transactions, just aliases which a DC pharmacy uses).
 
What I’ve learned since graduating and interacting with people in many different careers is...

there are opportunists everywhere. People in their respective line of work that aren’t in things for the “right” reasons and people trying to jockey to look better than their peers. People solely motivated by financial gain rather than the extrinsic value they provide.

Pharmacy is not immune to this. There is politicking, posturing, slander of different groups in the industry all trying to out position the other. But again as this may begin to reveal itself to you about pharmacy it is not unique about real life work.

Each line of practice in pharmacy is going to have something like this. I’d say pharmacists that work for chains generally don’t have motivation to do some of the more fraudulent activities, but I can’t say that they don’t and they have their own problems.

I think what you need to do is understand what your goals and purpose is going to be and don’t be distracted by those that don’t always fall in line.
 
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Possible future scenario:
Pharmacists are specialized in making Frontline recommendations for OTC therapy or escalate to a physician through the use of MedDRA and WHO coding dictionaries.
Patients come in to the pharmacy and list their symptoms, pharmacist codes appropriate terms and spits back likely issue and options for therapeutic OTC agents or escalation to PCP.
If its a list of OTC options, pharmacists selects whatever...if escalation the coded terms can be electronically forwarded to the patient's PCP.
The part where pharmacist skill is still utilized is in interpreting the patient's verbatim description into the best coded terms -pharm schools include this skill as part of standard curriculum and it would become a topic on the NAPLEX.

At the end of the day, jobs where rules/parameters/standards/procedures are rigidly followed as defined will become more replaceable. The professional value is in identifying the pharmacy scenarios where rules have to be circumvented, where planned deviations have to occur or can't apply, and where risks of current rules have to be continuously assessed. The dilemma is pharmacy practice has been going the reverse - where practice is being deconstructed into an increasingly growing number of defined rules...and it's being done by business managers rather than pharmacists.
 
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Hi everyone I’m a Graduating pharmacy student with second thoughts about going towards community. I play a huge role in NCPA and my state board pharmacy association but now a little bit unsure where to go.

Ever since I was little; I had a passion for pharmacy due to it having the right combination of business and health and I can open up my own practice. I honestly think pharmacists can play an important role in helping the community as we are the most accessible healthcare professionals. Recently as I get surrounded by more community pharmacy owners and pharmacists, I’m having second thoughts about the pursuit of ownership and was hoping to get your opinions and advice esp with the topics below.

  • The profession: No one cares. All day in group chats pharmacists just complain and do nothing about It. No one does anything for advocacy for their profession even the simple things such as sending an email or writing a letter esp in the community sector. Like think about it we are the most accessible health care providers, patients see us 4x more than their prescribers yet we never ask for their support.

  • Respect: this is going to push some buttons but why are we needed? I’m in NYC where pharmacy owners call pharmacist “bodies.” All the pharmacist does is fill without checking any interactions, they don’t care if it’s controlled as long as it's an e-script and the correct medication written got dispensed. their main reason is it’s not their fault. It’s the providers. LIKE BE HONEST HOW MANY PATIENTS IN A DAY DO YOU EDUCATE OR EVEN TALK ABOUT THE MED ABOUT? 80% of the meds I see ppl just verify and the patients get it through delivery JUST LIKE a MAIL ORDER!! People use the excuse mail order cost the government money due to filling unwanted meds but so do you guys, if the patient has Medicaid or Medicare you keep refilling rescue inhalers and other medications and send an ELECTRONIC REFILL REQUEST FOR EVERY MEDICATION and then these pharmacists publicly complain about DIR fee’s or even getting paid $40 an hour. (Also please don’t say PA’s or even obvious mistakes on sigs because even a tech can figure those out)
  • I even see pharmacist compete with each other in the wrong way where they are paying their patients 25% of their medications but don’t dispense it or even giving them bounty/soap/toilet paper/pots/pans and we all know who these pharmacies are yet no one wants to report them to OPD.
  • One personal experience is the doctor sends a patient’s metformin with 5 refills to the wrong pharmacy and we do blister packs for a patient. For the last 3 months, we can’t fill the patient’s metformin in the blister pack because every time we ask them to reverse the claim the pharmacy said they sent it out by delivery
  • When NYS was announcing fee for service all these pop-up scamming pharmacies began trying to open


  • Sustainability: Has anyone seen the NCPA financials about 25% of pharmacists are operating at a loss. It’ a high revenue business but low profit I know there is CPESN which I believe strongly in but be honest how many owners are members of it or even NCPA or let alone their state board pharmacy association. The DIR fees are killing the business and not to mention in NYS we were promised Fee for service which got delayed for a month and now for two years. Even with the flu vaccines being a 40$ profit margin all the vaccine doses are going to the chains.
I don’t know if I’m getting exposed to the wrong different sector of community pharmacy but I’m passionate about this industry. I created business plans but I wanted you’re thoughts and opinions on my observations to see if I should continue this path



P.S I’m just a pharmacy student that needs some guidance and wanted to see what people had to say about my thoughts. I don’t mean to belittle anyone in any shape or form because this is my profession as well. Also, I’m not drowned in loans.
1. Lesson 1 people go into business to make money not make a difference
2 Respect have self respect practice the way you feel comfortable who cares about everybody else
3 independent pharmacy is a tough business but can still be profitable have a drive thru
4 immunizations from flu to COVID are widely available for pharmacies to purchase
 
I feel ripped off - thread title is misleading. Certainly not “worth the read”
 
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I thought this way for a little while..but banging out vials of pills for shift after shift kicked me into reality..I had kiddies and bills and another much more interesting and challenging sideline that I floundered into..that gave me interest..challenge and a lot of fun. (usually) I have essentially no experience in a hospital operation.........maybe it's your only chance because retail pharmacy will never change from "bang 'em out and pray to avoid a mistake". You have a choice to make and fairly soon 'cause retail ain't gonna get better...
 
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