Adaptation Is the Key to Success
Farmers and welders have adapted to work with the current times. Pharmacists should consider adapting their profession as well.
Close to our new home in West Virginia is Rich Farms, a business that appears to do little traditional farming. Instead, the owners have turned to landscaping—growing bushes and shrubs and tending a very expansive greenhouse. They had to adapt to the changing times; there are no more rows of corn, oats, and soybeans. They have made it a destination spot for weddings and large parties. They have a spectacular Kids Day at the farm, where kids do everything from visit the pumpkin patch to climb over bales of hay. At Halloween they have a haunted house that draws people from Morgantown and Pittsburgh, Pennsylvania.
Peter A. Kreckel, RPh
The best half hour of my day is taking our 7-year-old grandson to school. Luke, a first grader, frequently asks me to tell him a story about my family. Last week, we discussed how my dad was the best welder at the paper mill where he worked. Dad was certified on high-pressure steam welding and was an expert on stainless steel and aluminum welding. I was recently talking to my brother Don, who followed in my dad’s footsteps with his career choice. Don, who is now retired, brought me up to date: “They don’t weld much anymore; they crimp pipes together, which holds better than most welds,” he said. Don went on to explain that they can crimp 20-foot sections of pipe together in a fraction of the time that it takes to weld. Crimping is faster and cheaper and takes a lot less skill.
According to Don, welders are headed the same direction as blacksmiths. Our Grandpa Joe was one of the town’s most excellent blacksmiths in the 1930s; he had an amazing skill for sharpening chisels and making horseshoes and chains. The only blacksmiths we see today are those at old-time demonstrations, ornamental blacksmiths, and a few farriers who continue the tradition of shoeing horses.
Our profession is seeing the same challenges as farmers, welders, and blacksmiths. Pharmacists, in the eyes of big corporations, are too expensive. The big chains continue to pile workloads on the pharmacists to squeeze out as much profit as they can over the course of the day. Things have changed since I dispensed my first prescription in 1981: Pharmacists are expected to immunize; to do comprehensive medication reviews; to contact physicians; and to have their patients with diabetes prescribed statins, angiotensin-converting enzyme inhibitors, and aspirin. All of these additional tasks have provided no renumeration.
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Pharmacists are leaving traditional community pharmacy practice in droves. Enrollment in pharmacy schools has significantly decreased, leaving community pharmacy practice in shambles. Even independent community pharmacies are struggling with staffing, although not to the extent that the big chains are. I think it is time for a reality check among pharmacists, schools of pharmacy, pharmacy benefit managers, and the major chains.
As most community pharmacists practice, is it necessary to have a 6-year degree to do the mechanics of dumping pills “from the big bottle to the little bottle”? I believe we should follow the example of our German pharmacy colleagues: Every drug is blister packed and identified. There is no counting of loose pills, no stock bottles; everything is tracked with lot number and expiration date. Everything is barcoded, and there is no constant aggravation with insurance companies. Everything is patient centric—not insurance company centric. Most community pharmacists in the United States spend more time discussing the costs of medications than the important information relating to medication adherence, adverse effects, and treatment benefits.
Even health systems are getting in on the act. Some health systems are implementing meds-to-beds programs, where prescriptions are filled and delivered to the patients before they are discharged from the hospital. Some of these systems are doing their own mail-order prescriptions as well. One health system was 60,000 prescriptions behind and began vigorous recruitment of community pharmacists. With no insurance challenges and no COVID-19, flu, respiratory syncytial virus, or shingles vaccines to give, this sounds like utopia for community pharmacists.
Chain pharmacies need to think about what they have done to create this mess, and what they need to do to solve the numerous problems in the community setting. Farmers, welders, and blacksmiths have adapted. Health care needs to adapt as well, probably starting with community pharmacies.
