"Super technicians" replacing pharmacists

[TheDude559]

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"The current model of using over-qualified pharmacy practitioners for the sole purpose of drug dispensing may be replaced by a new 2-tier paradigm involving “dispensing” and “nondispensing” pharmacists. Dispensing pharmacists would supervise a core of pharmacy technicians that provide high-volume, product-focused services. As pharmacy technician credentialing continues to increase, these “super technicians,” combined with robotic systems, might even replace the functions of the dispensing pharmacist. "

http://www.ajpe.org/doi/full/10.5688/ajpe79101

Thoughts?

 

[BenJammin]

More technician power = less pharmacist power.

 

[trailerpark]

No thoughts here. And I don't get the article posts where the poster just says "thoughts?" when not even having one of his/her own about it...

 

[PharmNerdMatt]

Seems like reading the whole article, he is advocating more for the return of the BSPharm, than for the elevation of technicians. I think that some places overseas (sweden, maybe?) have similar models. Where right drug, right bottle, etc is verified by someone with a BS while a masters/doctorate is needed for patient counseling/DUR sort of issues.

In the current model of pharmacy, I see this as only really working in pharmacies with more than one pharmacist at a time.

 

[MatCauthon]

Glanced through the references; how did he come to this conclusion when not a single article listed discusses super-techs or reducing retail pay?

This article is the neurotic fantasy of an academic PGY2 with a fellowship. The part where it talks about pay cuts to dispensing pharmacists is especially laughable. Since when have clinical pharmacists been bringing in more revenue than dispensing pharmacists? My hospital's 340b outpatient pharmacies subsidize the clinical programs.

More people can do residency, but that doesn't change the fact that the bulk of pharmacists are working in a dispensing role. Don't see the premise of this article happening anytime soon.

 

[gwarm01]

This article is the neurotic fantasy of an academic PGY2 with a fellowship.

Well put. I just read the article and it reminded me of people who ask "what if the Axis powers won WW2?!"

 

[BMBiology]

^ I am sure his preceptor pushed him to publish it. It is so funny how people are so against dispensing medications? That is the bread and butter of this profession and it is where pharmacists are making a difference. Do you know how many mistakes I caught working at a big chain as an intern?

I don't dispense anymore but I have always respect the pharmacists who do. It is not an easy job and it is where pharmacists are making a big difference. It is also a service that pharmacists are being paid to do, unlike providing "pharmaceutical care" or "patient care" or whatever they are now calling it.

 

[awval999]

^ I am sure his preceptor pushed him to publish it. It is so funny how people are so against dispensing medications? That is the bread and butter of this profession and it is where pharmacists are making a difference. Do you know how many mistakes I caught working at a big chain as an intern?

I don't dispense anymore but I have always respect the pharmacists who do. It is not an easy job and it is where pharmacists are making a big difference. It is also a service that pharmacists are being paid to do, unlike providing "pharmaceutical care" or "patient care" or whatever they are now calling it.

Spot on per usual BMBiology.

A significant salary differential, commensurate with credentialing, training expectations, and differences in clinical service expectations might develop between these 2 “classes” of pharmacists.

I got a kick out of the above.

The students that I precept at the hospital that already have offers from RAD, WAGs and CVS that start at $15k more than me, with my fancy 5 years hospital experience, fancy super duper CLINICAL nursing unit based job with a fancy BCPS. But wise ole' pharmacy journal PGY-2 fellowship man, he sees a day when his FANCY PGY-4 colleagues get paid more than our retail brethren who work in the salt mines. I just want to punch idiots like him.

Edit: I looked him up, he makes $142,731.96 at UK but he's the associate dean or whatnot. Hell WVU makes that much working nights up in Philly.
http://opendoor.ky.gov/search/Pages/SalarySearch.aspx

 

[BenJammin]

I hate the holier than thou hospital pharmacists. I feel like I make a big impact on my hospital along with the student pharmacist who rotate through and the medical residents who try to keep their head above water. But one thing that is undeniable is that dispensing the bread and butter of this profession. Some of us may think that being hospital makes us superior but there is a reason that a new grad can go to Target and make $120,000 as a community pharmacist while a hospital pharmacist has to take a 50% pay cut for a residency just for the privilege of interviewing for a job that pays less than retail.

Money talks.

 

[confettiflyer]

Won't reduced RPh salaries obliterate most of the cost savings of a "super tech?" Why hire a super tech when you can get someone for a little more money that's not subject to things like ratio?

 

[confettiflyer]

I hate the holier than thou hospital pharmacists. I feel like I make a big impact on my hospital along with the student pharmacist who rotate through and the medical residents who try to keep their head above water. But one thing that is undeniable is that dispensing the bread and butter of this profession. Some of us may think that being hospital makes us superior but there is a reason that a new grad can go to Target and make $120,000 as a community pharmacist while a hospital pharmacist has to take a 50% pay cut for a residency just for the privilege of interviewing for a job that pays less than retail.

Money talks.

I'm constantly tugging in the direction of operations and dispensing within my clinical role, only because a good number of clinical pharmacists forget that the #1 job of a pharmacist is to be a pharmacist...that is, to run a pharmacy.

But I think the feeling of superiority lies in the knowledge base required to function in some of the high acuity settings of a hospital. Arguably, working on patients that can decompensate and die any second is a different type of stress from dealing with the local public jerk offs that wonder why their meds aren't done in 10 mins....and wonder where the toilet paper is.

It's different, it's not better or worse, per se. I stay as far away from community as possible because that type of stress will take years off my life, while someone else on the other side is saying the same thing about my job.

This is wholly separate from financial compensation, though. Just like real life, salary is not an indicator of societal/personal value, just a purely economic function. Case in point, certain dock workers/supervisors here on the west coast make $250k year while pediatricians are some of the lowest paid health professionals anywhere.

 

[deleted544110]

To clarify, the authors of the article are Dr. Tim Tracy who is the former Dean of the College of Pharmacy at UK and now the Provost of UK and Dr. Frank Romanelli who is an Associate Dean at UK.

 

[BMBiology]

The saturation will continue to hurt the "dispensing" pharmacists and the "clinical" pharmacists.

Do you know who will compete with the "clinical" pharmacists? Nurse practionaires! That is what academia does not get. It is already too late. These nurse practitionaires do not only diagnose, write prescriptions but they are also getting paid for their services. They even work for less! In addition, with advancement in technology, the the role of a "clinical" pharmacist is even less valuable. Look at CVS. They are not looking for a "clinical" pharmacist to fill their Minute Clinic. They are looking for nurse practionaires.

In the meantime, pharmacy schools are still fighting for "provider status" while new graduates are fighting for a PGY-2 position + board certification just to find work.

These two professors do not get it. They are the ones who are hurting this professors by accepting unqualified students so they can fill their pockets with student loans. Why are they not advocating for small class size? for higher standards? for some schools to close?

 

[BenJammin]

Funny that you mention that. I'm starting a side MTM company and guess who are my troops on the ground floor? Nurse practitioners.

 

[BMBiology]

Funny that you mention that. I'm starting a side MTM company and guess who are my troops on the ground floor? Nurse practitioners.

Yes, nurses....even licensed vocational nurses (LVN) can do MTM. How are you going to distinguish the quality of care provided by a pharmacist vs. a LVN? How does the MTM pay structure differentiate it? You can easily pick up "billable" work by just entering the drugs into a computer.

Residency has become extremely competitive but not because there are more opportunities but because CVS won't hire you unless you have interned with them. Even then, not all of their interns get a position. So where do these students go? Residency. That is why it is becoming competitive. These two professors just don't get it.

 

[Digsbe]

The good would be allowing more time for pharmacists to do clinical work like counselling, giving shots, reviewing charts, etc. The bad thing is if techs are allowed to verify without supervision that pharmacist jobs will plummet in retail and likely won't have those jobs made up in clinical pharmacy. Under current payment models pharmacists typically can't make a full income on clinical or cognitive services, unless tech verification is coming due to pharmacists being paid and having time pulled away for clinical issues then it will only hurt the market.

 

[awval999]

I hate the holier than thou hospital pharmacists. I feel like I make a big impact on my hospital along with the student pharmacist who rotate through and the medical residents who try to keep their head above water. But one thing that is undeniable is that dispensing the bread and butter of this profession. Some of us may think that being hospital makes us superior but there is a reason that a new grad can go to Target and make $120,000 as a community pharmacist while a hospital pharmacist has to take a 50% pay cut for a residency just for the privilege of interviewing for a job that pays less than retail.

Money talks.

Completely agree. Anything like "super tech" or "tech check tech" threatens our profession. Those ivory tower pharmacists can jack-off all day to MTM and provider status and PGY-4s but at the end of the day, our profession's bread is buttered by dispensing. And YES, we need to have more roles, and we are doing that in the hospital, but any attempt to take away dispensing needs to have that messenger shot.

 

[Mad Jack]

Pharmacists replacing primary care physicians, nurses replacing physicians, physician assistants replacing physicians, techs replacing pharmacists, medical assistants replacing nurses, CNAs replacing nurses... It's really a race to the cheapest possible provider, and the people that make the most are going to be pushed out of the system first in the name of cost savings, something which the public will suffer for.

 

[confettiflyer]

NP's really own it in terms of niche, they have prescriber laws and economics on their side.

Of course everyone will rush the NP doors now and they'll be where we are in 5-7 years.

And for the record I love love love tech check tech. Pharmacist still has to audit. Makes my work day much more enjoyable vs. checking the same pills and vials all day long.

 

[BidingMyTime]

Sounds like an article that doesn't really say anything. Checking for accuracy is important, but so is checking for logic. I have been amazed at some of the stuff techs, even certified techs, have blindly filled and given to me to check Some stuff is obviously wrong (say 100meq KCL in a 100ml bag, if you have to draw out half the bag to add the KCL, one would think common sense would say there is an error somewhere.) A lot of stuff is not that obviously, but the checking pharmacist will realize the dose or frequency is extremely unusual if not out and out wrong, and know to check the order entry (say Fosamax 35mg QD.) Catching this stuff is the value the dispensing pharmacist adds over a super tech (whether a corporation will consider that financially worthwhile, is a separate issue.)

I don't see there being 2 levels of pharmacists, that would be backwards and not going to happen (1 because colleges make money from having a 6 - 8 yr degree, they aren't going to go back and offer a 5 - 7 yr degree.) And it really does provide no benefit to the profession (which is why more and more places say, only want RN's, not LPN's. Would a "super technician" ever take over many of the pharmacist duties? That is possible, in the same way NP's are taking over physician duties, dental therapists are taking over dentists duties, etc. I don't think this is a good thing, but it does seem to be the direction the country is moving in.

 

[gwarm01]

Checking for accuracy is important, but so is checking for logic.

This is a facet of our job that many people overlook or simply ignore. It seems every description of a pharmacist throws out "checking for drug interactions" as one of the largest components of our jobs, when I rare come across anything that requires action. Meanwhile, changing the dose, frequency, or drug altogether is a daily aspect of my job. No supertech is going to have the knowledge to ask themselves "what are we trying to accomplish?", "why are we choosing this path?", "how can I make this better?". No supertech is going to speak to a physician and make an argument for how and why therapy should be changed.

I'm speaking from the perspective of a hospital pharmacist, which the fevered dream that is this article doesn't really address, but I imagine similar situations occur in the retail setting.

 

[BeLikeBueller]

Those ivory tower pharmacists can jack-off all day to MTM and provider status and PGY-4s but at the end of the day, our profession's bread is buttered by dispensing.

First of all, 😆🤣😆 to the above. Well played, sir. Well played.

Secondly, a "two-tier" system in pharmacy is laughably absurd.

But...

I'm not sure that I 100% disagree with the assessment of the increasing role of technicians beginning to eat away at the role of dispensing pharmacists. The wrench that has been thrown into the middle of the pharmacy profession is technology. Heck, Watson (IBM) is trying to replace physicians. We can't be too naive to think that technology will refrain from knocking on our door too.

I've heard rumors (yes, just rumors), that WAGS is testing a system where the pharmacist is outside the pharmacy at a desk or in a small "office." Technicians take care of all of the goings-on inside the pharmacy, and the pharmacist remotely verifies the medications (using a picture that is taken by the techs inside the pharmacy) and counsels every patient at the point of sale. Sounds great, right? Maybe, but what happens when you take the pharmacist completely out of the pharmacy and drop him/her into a cubicle in a corporate office doing nothing but verifying prescriptions all day and placing an occasional video call to "telecounsel" a patient. Under a model like this, how many prescriptions could one pharmacist verify on a daily basis? Could one pharmacist manage the equivalent of two...three...maybe four stores?

That's the dystopian future that I worry about. I don't find anything wrong or less valuable with the pharmacists that work in dispensing roles. But with the rapid pace of technological development, aI do think it's unrealistic to think that this role will continue to require the same level of pharmacist involvement.

I don't think the public will ever be comfortable with no pharmacist involvement, but I think the corporate powers that be are going to continue to try to find ways to squeeze every bit they can out of the profession. Then again, the general public routinely asks techs at my store if they're the pharmacist, so who knows...they might not miss us after all.

I think the point of it all is that we, as a profession, have to make ourselves apparent. No more hiding behind counters, hunching over computers with glazed eyes. Forget CMS and provider status. We have to work to make sure that patients are aware of what we can do for them. I look forward to the day that I overhear someone in conversation saying, "oh, you should go to your pharmacist and see if they can do ___insert service here___ for you!" That is the day that I will know that the profession is safe.

 

[BidingMyTime]

. We have to work to make sure that patients are aware of what we can do for them. I look forward to the day that I overhear someone in conversation saying, "oh, you should go to your pharmacist and see if they can do ___insert service here___ for you!" That is the day that I will know that the profession is safe.

Oh, patients already know what pharmacists can do for them, the problem is they don't want to actually pay a pharmacist for those services. Patients love to go to pharmacists with all sorts of melodies when they should be going to the doctor (I used to joke about the day someone would come in with an appendage cut off and want me to fix it for them......and then one day a wife came in and asked me what she could get to reattach her husband's finger that he cut off!!!!) As you see, many patients actually overstate the pharmacists ability to help them with their problems. Pharmacists have always given free advice, so patients expect it to continue to be free. I would wager you can charge as small amount as $1.00 for a consultation, and no patients will be interested. People just won't pay for something they have always gotten for free.

 

[SClENCE]

I don't see how this would be more profitable for chains like CVS, thus I don't see it happening. They currently have 3-4 techs $8-10 and hour with 1 pharmacist filling both the roles of "dispensing" and "non-dispensing" pharmacist. How would employing two pharmacists (or a pharmacist and a "super tech") to take the spot of one pharmacist save money? It won't.

And when it comes to counseling... the questions that patients ask are a joke anyways. At least 90% of the time it's a patient asking for free recommendations on OTC products as opposed to actually trying to figure out what each of their 5 medications are called and are for. It's funny how many people ask for an OTC antibiotic or OTC muscle relaxer. Trying to get free advise and avoid going to the doctor both at once!

 

[baronzb]

"The current model of using over-qualified pharmacy practitioners for the sole purpose of drug dispensing may be replaced by a new 2-tier paradigm involving “dispensing” and “nondispensing” pharmacists. Dispensing pharmacists would supervise a core of pharmacy technicians that provide high-volume, product-focused services. As pharmacy technician credentialing continues to increase, these “super technicians,” combined with robotic systems, might even replace the functions of the dispensing pharmacist. "
http://www.ajpe.org/doi/full/10.5688/ajpe79101
http://www.ajpe.org/doi/full/10.5688/ajpe79101

Thoughts?

My dean without any sense of irony said he sat on a board and was pushing for this. even made fun of retail people just verifying. academia really does see pharmacy as as a cow to be milked...

 

[baronzb]

Spot on per usual BMBiology.

A significant salary differential, commensurate with credentialing, training expectations, and differences in clinical service expectations might develop between these 2 “classes” of pharmacists.

I got a kick out of the above.

The students that I precept at the hospital that already have offers from RAD, WAGs and CVS that start at $15k more than me, with my fancy 5 years hospital experience, fancy super duper CLINICAL nursing unit based job with a fancy BCPS. But wise ole' pharmacy journal PGY-2 fellowship man, he sees a day when his FANCY PGY-4 colleagues get paid more than our retail brethren who work in the salt mines. I just want to punch idiots like him.

Edit: I looked him up, he makes $142,731.96 at UK but he's the associate dean or whatnot. Hell WVU makes that much working nights up in Philly.
http://opendoor.ky.gov/search/Pages/SalarySearch.aspx

If clinical people, and he is only referring to the full time folks, not the hybrid staffers, want pay, they need a billing model. As devasted as dispensing billing fees have become, that brings in revenue.

 

[Dred Pirate]

agues get paid more than our retail brethren who work in the salt mines. I just want to punch idiots like him.

Edit: I looked him up, he makes $142,731.96 at UK but he's the associate dean or whatnot. Hell WVU makes that much working nights up in Philly.
http://opendoor.ky.gov/search/Pages/SalarySearch.aspx

ya - I made that much working nights in the retail world 8 years ago

 

[panasoniku]

Lol super techs.

I can't survive without my techs when I work retail, but how much more can you burden the tech with. Besides, the law sets the limit to be 3:1 ratio anyways.

 

[Deja]

lol if techs started to check meds, nothing will be caught... pharmacy will turn in to chaos...

 

[BenJammin]

Super technician = super disaster. "Tech check tech" needs to die.

 

[confettiflyer]

Super technician = super disaster. "Tech check tech" needs to die.

With the right barcoding technology (scanned on delivery, restock, and pull) w/ final RN check and appropriate RPh oversight & audit, TCT has been a godsend for workflow. Error rates similar to that of traditional RPh mass sign-off on product.

If the evidence proves otherwise, we'll be glad to kill it, but so far so good.