New BLS reports -3%

[Judgment Dragon]

Pharmacists will be paid minimum wage in the future.

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Members don't see this ad.

 

[Xenophylia]

I still think new students signing away their lives for this nonsense profession are part of the problem. Stop feeding the machine with warm bodies. If the new grads dry up, either the profession will still die or it won't. But we just can't keep adding to the saturation year after year after year. That just allows employers to treat us like **** without giving us any recourse to fight back. We're all too easily replaceable, and unless that changes, nothing will ever get done by individuals.... And we all know our organizations have never advocated for us.

 

[Medicineman23]

NP growth is at 45% and PA growth is at 31%.

Pharmacy somehow shrinking isn’t shocking but this is starting to get beyond lopsided. Greed from all angles did this field in. I feel awful for new grads that will get lower wages and 30 hour workweeks.

 

[NorthTexasPharmacist]

Idk they certainly haven't had any success with whole foods

I dont want my groceries delivered. I want to go pick out my own apples lol. Same thing with medications.

 

[NorthTexasPharmacist]

Nope. You do realize it takes business skills and a certain personality to open up your own pharmacy right? You think any pharmacist moms, yes-men let alone 2.0 GPA diploma mill grads will want to open up pharmacies or be successful at it? I think not. Let's not overspeculate... at BEST you might have some chain retail pharmacists leave but not enough to force chains to pay up.

Thats actually is not the problem. There are so much involved in running an independent pharmacy that schools dont teach you. Also, to start a new pharmacy would mean youre gonna have to start your patient base at zero. This is probably the hardest part. The best thing to do if you want to own an independent is to buy a well established existing pharmacy.

 

[ldiot]

Well the number one problem is new schools, plus existing schools increasing class size. During my last rotation I had to interview pharmacy school applicants and people with 2.5 GPAs were getting interviews who didn't even bother to write a personal statement or get LORs, and this is at a top school in the nation. The guy in charge of recruiting students isn't a pharmacist and has no interest in pharmacy, he has one job and it's to grow the class size. My preceptor talked to the school about this and apparently admitting less students would shrink our state funding. So perhaps the way that public schools are funded is a part of the problem (it's not all about tuition dollars).

With an oversupply of pharmacists and many subpar students clinical hospital jobs are impossible to get without a 2 year residency to further weed out the idiots. Chains are lowering pay and cutting hours. It's hard to work 40 hours a week unless your are pharmacy manager. I had classmates accepting offers for $47 dollars an hour at 20 hours a week.

Additionally, we are in a low interest environment which encourages consolidation. Big chains are buying up small chains and indis, or putting them out of business, and expanding to alternate revenue streams. CVS owns a PBM, and are using it to suffocate competition. The goal is for there to be only CVS and WAGS. Once that happens they will control pharmacist pay entirely and renegotiate all their insurance contracts since there are no other options. Walmart is happy to lose money because to them pharmacy is just a side show to gain foot traffic, so they will probably just ride it out while taking a dump on their pharmacists in the process.

But no matter how powerful chains can become, they still would have to increase pay if their aren't enough pharmacists and there were jobs waiting elsewhere. That's why we should focus on closing down schools, cutting class sizes, and increasing the barrier to entry. It's the fastest, easiest, and most effective fix. PBM reform is a distraction. CVS probably uses it's PBM as a weapon, it's true. But it's a problem so far disconnected from your salary and hours that it doesn't even matter. You think if they fixed it today pharmacist salary would start going back up???

 

[Sine Cura]

Independent pharmacies are the last mom and dad’s retails that are still standing today. There is a reason why small retails went away like the dinosaurs.

Do people know what is Walmart profit margin? Just 3%. That is how small it is. Sooner or later, Amazon is going to come in and finish them off.

Amazon won't finish the #1 grocer in the U.S.

 

[mentos]

So basically over the next 10 years, 3% of 300000, 10000 jobs will be lost. Around 6000 pharmacists X 10 = 60000 pharmacists will retire or leave the workforce (counting 6000 as number of pharmacists graduating each year 35-40 years ago and now leaving workforce). 60000 - 10000 = 50000 jobs up for grabs over next 10 years (that would assume everyone is currently employed, which is not the case as we know). 14000 X 10 graduates = 140000 pharmacists will look for 50000 jobs. Of that hope some schools close, some dont pass NAPLEX so over time maybe 100000 pharmacists trying to go after 50000 jobs. Well there's the 20 hour per week jobs at 30$ an hour I guess (which translates into a 30k salary?).

You're assuming pharmacists actually retire. Many of them "retire" then come back a week later to work part time or even full time cause they have nothing else to do. You're also assuming there's one job per pharmacist. Right now there's plenty of pharmacists with two or even three jobs, so that's even less jobs available for new grads.

 

[NorthTexasPharmacist]

Well the number one problem is new schools, plus existing schools increasing class size. During my last rotation I had to interview pharmacy school applicants and people with 2.5 GPAs were getting interviews who didn't even bother to write a personal statement or get LORs, and this is at a top school in the nation. The guy in charge of recruiting students isn't a pharmacist and has no interest in pharmacy, he has one job and it's to grow the class size. My preceptor talked to the school about this and apparently admitting less students would shrink our state funding. So perhaps the way that public schools are funded is a part of the problem (it's not all about tuition dollars).

With an oversupply of pharmacists and many subpar students clinical hospital jobs are impossible to get without a 2 year residency to further weed out the idiots. Chains are lowering pay and cutting hours. It's hard to work 40 hours a week unless your are pharmacy manager. I had classmates accepting offers for $47 dollars an hour at 20 hours a week.

Additionally, we are in a low interest environment which encourages consolidation. Big chains are buying up small chains and indis, or putting them out of business, and expanding to alternate revenue streams. CVS owns a PBM, and are using it to suffocate competition. The goal is for there to be only CVS and WAGS. Once that happens they will control pharmacist pay entirely and renegotiate all their insurance contracts since there are no other options. Walmart is happy to lose money because to them pharmacy is just a side show to gain foot traffic, so they will probably just ride it out while taking a dump on their pharmacists in the process.

But no matter how powerful chains can become, they still would have to increase pay if their aren't enough pharmacists and there were jobs waiting elsewhere. That's why we should focus on closing down schools, cutting class sizes, and increasing the barrier to entry. It's the fastest, easiest, and most effective fix. PBM reform is a distraction. CVS probably uses it's PBM as a weapon, it's true. But it's a problem so far disconnected from your salary and hours that it doesn't even matter. You think if they fixed it today pharmacist salary would start going back up???

In my opinion, yes. The reason is simply that we are in a free market. The way PBMs have exploited the loopholes caused so much loss in revenue for all pharmacies. Why do you think Omnicare is in trouble with the feds. Caremark billed patients for meds they werent even on. Or continue to fill prescriptions even after patients passed away. Medicare is losing billions each year because of PBMs and those billions are going straight into PBMs pockets. Oklahoma and Texas have fought hard to expose PBMs. Arkansas is a very pharmacy profession friendly state which is why one of the biggest lawsuits in medical history is happening. But aside from these states, others have suffered so much such as Ohio and California. Since they do little to control these big insurance companies, they can reimburse and clawback how ever they want.

Its a simple math. You get less money, you spend less money.

 

[WVUPharm2007]

There will be less jobs cause pharmacies close and hours get cut every year.

Right now there's plenty of pharmacists with two or even three jobs, so that's even less jobs available for new grads.

Fewer.

 

[Marzapan]

I actually think a major oversupply of pharmacists is a good thing. It causes maximum pain and therefore, it causes pharmacy schools to shut down.

Not sure how oversupply will cause maximum pain and therefore pharmacy schools will shut down. If anything academia is the most insulated career from saturation because only one thing affects academia which is the number of seats filled per year, and they have many levers they can pull to keep fill those seats in spite of saturation such as false advertising, dropping admissions standards, recruiting in BFE etc.

In contrast, if you are a pharmacist trying to find work in the real world (in any other setting), saturation will cause you maximum pain due to increased competition (thousands of applicants for every job posting) and lower wages (threat of firing you and replacing you with a desperate new grad with $200k+ loans for half the price) etc.

 

[PharmtoCS]

I actually think a major oversupply of pharmacists is a good thing. It causes maximum pain and therefore, it causes pharmacy schools to shut down.

The issue is that government policy has been propping up the pharmacy schools artifically by handing out $200k+ in student loans to anyone with a pulse. Now there is a huge push for the government to shield borrowers from said pain via loan deferral and forgivess programs.

Students will continue borrowing to the hilt as long as the consequences for not paying back the loans are minimized.

 

[AP191]

Physical therapy. They went through our issues a decade ago. When I started, they were paid more than we were.

I'm curious whey you mention PT?

They have issues for sure, for example low reimbursement rates pushing salaries even lower and the ever mounting student debt needed to get a DPT. But apart from COVID, the job market is pretty good even in big cities. Can't say the same with pharmacy .

 

[BenJammin]

Oral arguments in U.S. Supreme Court PBM case get a new date

The case was filed by Arkansas Attorney General (AG) Leslie Rutledge. PCMA is the professional association that represents PBMs. “This case is one of the most impactful health care cases at the Supreme Court in a decade. That’s why the U.S. Solicitor General encouraged the Court to take this...

www.pharmacist.com

You realize that's never going to happen, right? PBM laws across the country are null and void because of ERISA. Arkansas, Oklahoma, Texas, you name it. They can't regulate their activities due to federal law. SCOTUS isn't going to be our friend so your only recourse is amending ERISA. Republicans aren't going to do it because of the PBM lobby and Democrats aren't going to do it because they want Medicare For All.

 

[WVUPharm2007]

I wonder what running an independent would look like under M4A.

 

[NorthTexasPharmacist]

You realize that's never going to happen, right? PBM laws across the country are null and void because of ERISA. Arkansas, Oklahoma, Texas, you name it. They can't regulate their activities due to federal law. SCOTUS isn't going to be our friend so your only recourse is amending ERISA. Republicans aren't going to do it because of the PBM lobby and Democrats aren't going to do it because they want Medicare For All.

We shall see how things turn out after the hearing in October. The whole point is to look into PBMs books. No one at this point aside from PBMs knows why DIRs fees the way they are or the reasoning behind inconsistent reimbursements. We don't know why CVS is being paid $1000 compared to another pharmacy at $100 for the exact same prescription. ERISA isn't the reason why PBMs are being stupid. PBMs serves as TPA for ERISA but ERISA does not dictate how much pharmacy gets reimbursed especially when it comes to reimbursements way below acquisition cost.

 

[NorthTexasPharmacist]

I wonder what running an independent would look like under M4A.

Supposedly medicare for all would help all pharmacies? That would be true looking at South Korea but we know medicare for all would not happen here in US.

 

[Marzapan]

No one at this point aside from PBMs knows why DIRs fees the way they are or the reasoning behind inconsistent reimbursements.

The concept of DIR fees is to act as a price control mechanism against drug companies jacking their costs up and a mechanism to keep pharmacies accountable to their contract terms, and it is very much interrelated with network rates, MAC pricing and performance guarantees.

I don't know the specifics but this is needed as a form of bookkeeping on a periodic basis (usually monthly or quarterly before a check is actually cut to the pharmacy) because transactions at the pharmacy happen in real time so you're unable to capture longitudinal trends or measure outcomes if you looked at data on a daily basis, let alone have the administrative capability to even have daily reporting done. These are (I would imagine) some scenarios that impact DIR fees:

1) If there is a contracted rate of reimbursement for a drug but the drug manufacturer starts marking up their drug irregularly and at different rates (3% in month one, 6% in month 2 , 15% in month 3 etc.) then some kind of adjustment needs to be made

2) If there are price concessions made based on patient volume. For example let's say if the contract was such that if a pharmacy had 10,000 patients fill scripts each month then they'd get a "10% overall discount," if they had 20,000 patients they get a "15% overall discount" etc. You won't know what the final discount is until month's end.

3) If there is fraud, waste or abuse activity detected when auditing rx claim payments throughout the cycle - compounded medications are a big one. Bill insurance for ingredients not covered? Well they'll take it back from you in the form of DIR fees.

 

[NorthTexasPharmacist]

The concept of DIR fees is to act as a price control mechanism against drug companies jacking their costs up and a mechanism to keep pharmacies accountable to their contract terms, and it is very much interrelated with network rates, MAC pricing and performance guarantees.

I don't know the specifics but this is needed as a form of bookkeeping on a periodic basis (usually monthly or quarterly before a check is actually cut to the pharmacy) because transactions at the pharmacy happen in real time so you're unable to capture longitudinal trends or measure outcomes if you looked at data on a daily basis, let alone have the administrative capability to even have daily reporting done. These are (I would imagine) some scenarios that impact DIR fees:

1) If there is a contracted rate of reimbursement for a drug but the drug manufacturer starts marking up their drug irregularly and at different rates (3% in month one, 6% in month 2 , 15% in month 3 etc.) then some kind of adjustment needs to be made

2) If there are price concessions made based on patient volume. For example let's say if the contract was such that if a pharmacy had 10,000 patients fill scripts each month then they'd get a "10% overall discount," if they had 20,000 patients they get a "15% overall discount" etc. You won't know what the final discount is until month's end.

3) If there is fraud, waste or abuse activity detected when auditing rx claim payments throughout the cycle - compounded medications are a big one. Bill insurance for ingredients not covered? Well they'll take it back from you in the form of DIR fees.

Why should that matter to PBMs? oh, that's right, because they're greedy scum. That is not how DIR fees work. If you're claiming that they're taking away money from pharmacies because they filled more scripts, how is that even legal in free market? Unless you actually had to pay DIR fees and looked at how or why they're charging you DIR fees and had to deal with PBMs directly, you would know what you stated above makes no sense haha.

 

[NorthTexasPharmacist]

Your reading comprehension level is that of a third grader, it's no wonder you're bitter at life. Nobody is saying you get paid less for more scripts filled - that's the complete opposite of what a volume discount is. But go on living in whatever world you're living in.

Interesting... self hate is strong with this one.

 

[Marzapan]

Interesting... self hate is strong with this one.

Self-hate? Please use words that you actually know. Maybe then people will take the words of a pharmacist from BFE Texas more seriously. LoL

 

[NorthTexasPharmacist]

Self-hate? Please use words that you actually know. Maybe then people will take the words of a pharmacist from BFE Texas more seriously. LoL

Didn't know Dallas was BFE. Eh, I suppose I can understand your hatred and anger considering you're probably miserable in your current job. Good luck.

 

[Marzapan]

Didn't know Dallas was BFE. Eh, I suppose I can understand your hatred and anger considering you're probably miserable in your current job. Good luck.

Love how you're trying to flip the script when you're the one posting about how miserable your life is due to failing PBM reimbursements. LoL

 

[gyngyn]

We expect professionals to disagree with civility.

 

[NorthTexasPharmacist]

Love how you're trying to flip the script when you're the one posting about how miserable your life is due to failing PBM reimbursements. LoL

I thought you were insulting my reading comprehension... which means yours is higher than my 3rd grade level? At what point did I say anything about my life being miserable? I'm having the best time of my life actually. Love working at an indie. Love my patients and my coworkers. I've worked at several different pharmacies including hospital and long term care and this has been the best so far. I was making a point that PBMs are hurting our profession in general not just indies. Even with PBM abuse, most indies that I know of are still doing really well.

 

[deleted562805]

Can't wait to see how the pharmacy school deans spin this one. The UC Irvine dean explained away the 0% growth update as "negative retail growth balanced out by positive growth in clinical positions, and we're training our students to be clinical pharmacists"... The grand irony is that I researched this person and turns out she was a pharmacoeconomics professor so she should know numbers... shame on her...

Well, residents are finding it hard to get clinical jobs, so... I guess they will avoid the job market

 

[Dred Pirate]

I wonder what running an independent would look like under M4A.

it all depends on if we set a reasonable reimbursement rate - unfortunately looking how medicare reimburses hospitals - I am not optimistic.

 

[BenJammin]

I wonder what running an independent would look like under M4A.

It would be really wonderful. One payor, fair reimbursement, and people would actually get prescription drug coverage. Pharmacists will get paid $45k/yr and techs will make closer to the minimum wage of $7.25/hr. It's a win-win for everyone but it will never happen.