Schools of Pharmacy

We have too many.
We need to police ourselves.
Pretty soon, Community Colleges will become the Caribbean of Medical Schools. (Sure, some good prescribers have come from schools there.)

When a degree takes nearly a decade to achieve, opening schools now that take years to become accredited will only help us in 10 years. Unfortunately, by most calculations, the profession will be saturated, again, as it was in the early 90's.
We need to stop opening new schools of pharmacy.
Increase enrollment at the best schools to adjust for demand. Decrease enrollment as needed to adjust for demand. Opening new schools? Without a placement system? Without a guarantee of a need?
Senseless. Reactionary. Money-grabbing.

We need quality over quantity.
We don't need to become the lawyers of the healthcare profession where we are a dime a dozen.

What is another problem we can see with too many graduates? Loss of our identity. For some time I have quit using the term "doctors" to describe those medical professionals. Why? I don't want to give credit where it is not due. There are many groups now who can prescribe. Without knowing who is and who is not an actual doctor, I believe the generic terms "practitioner" or "prescriber"are more appropriate. There was a need for more people to take care of sick people in this country. We imported as many as we could but how else could we increase that number? Give more professionals the right to prescribe. It's like the Old Catholic way of thinking about how to increase your flock: If you can't birth them, convert them.

Soon, Pharmacists will have the right to prescribe as well. However limited or broad the scope of these rights, it does not diminish the fact that we can prescribe. What then? Doctors will have to find a new way to have their egos stroked. No longer can they monopolize the "I'm a Doctor!" mantra. Patients will recognize they can go anywhere to receive a prescription.
To them I will say "welcome to being marginalized!".

Unless we do something as a group, as a unified profession to stop the greedy reach of our professional education system, we will continue hurting our beloved profession.
We have too many pharmacists. We continue to train more than we need. New pharmacists need jobs and are cheaper to employ. Older, more experienced pharmacists are at risk of losing their jobs. Eventually, and not too far away, our profession becomes the "you want fries and a flu shot with that?" minimum wage job that Corporate America is longing for it to be.

If your state is considering opening a new pharmacy school, consider petitioning them to stop it. With the number of schools having nearly doubled over the last 25 years, and the number of graduates along with it, the number of available jobs has not kept pace.

http://www.newrepublic.com/article/119634/pharmacy-school-crisis-why-good-jobs-are-drying

We are killing our own profession and no one is going to stop us.

The System

Skynet is real.
We continue to feed it information.
It's like "The Cloud".
Or "THE System"…You know "THE System", right? This is where everything in the world is located and conveniently stored so it can be plucked out of the void at a moment's notice to serve your every whim.
It's like THE Google, only more personal.
There is no arguing with someone once they invoke "THE System" argument.
It's like to trying to argue with a woman after she says "fine".

To Wit: (and yes, sometimes I continue these witty dialogues just to see how far down the rabbit hole I may be drawn.)

CP: Guten Morgen.
Frau I Can't Know Everything Now: Tag. Here is my insurance.
CP: There is no prescription information on here.
FICKEN: Just plug in the numbers.
CP: To what?
Herr FICKEN: "THE System".
CP: Oh. <wink, wink> Got it. "THE System. <pantomimes air-typing 100 wpm over the counter and blankly staring at the sky>
FICKEN: What are you doing?
CP: Shhh. I'm entering the information you provided into THE System.
FICKEN: How's that work?
CP: About as well as this useless card you just gave me. I would have had more luck if you had pulled your Diner's Club card out of your Members Only jacket from 1983 instead of this.
H-FICKEN: They said to just give you this card and tell you to put the information into "THE System".
CP: And you watched me do that and saw how successful it was. I hate to be the bearer of bad news, wait, no I don't, but there is no Skynet. There is no THE System <holds arms outstretched> anywhere for me to input and pull data using these numbers. Call your HR Dept.
H-FICKEN: I did. They're the ones who told me that.
CP: Indeed. And you believed them?
H-FICKEN: Of course.
CP: As opposed to me. The pharmacist? The almost-most trusted professional in the country, standing in front of you, telling you I know how to do my job and what pieces of information I need and how the process works and this ain't my first rodeo?
FICKEN: Right.

CP: I fixed it.
FICKEN: You put it in THE System?
CP: No. Turns out we filled something for another family member at another store.
FICKEN: We said that.
CP: No. I asked if we had filled for HER before and you said "yes". Anyway, the new insurance is Medco. The ID#, phone#, group#, BIN#, PCN and well, everything else have no relation to this card you presented. They are as unrelated as African Swallows and German Shepherds.

Decide or Decide Not…Either Way

Quick! Make up your mind.

Really Unusual Situation Happening: I'm here to pick up a prescription. 

CP: Ok. 

RUSH: It's been here since 2/2. 

CP: Let me grab it. (Today is 2/12) 

RUSH: I got a bunch of phone calls about this. 

CP: What took you so long?

RUSH: Busy. They call me the working man. 

CP: Understood. Been working here too. Calling people to pick up their prescriptions. 

RUSH: What is it? 

CP: Zocor. Simvastatin. Your cholesterol medication. 

RUSH: Okay. I'll take it!

CP: That'll be $3.33. 

RUSH: <pays and grabs bag> Wait. 

CP: What? 

RUSH: I don't want it. 

CP: Why not? 

RUSH: I never had it before. 

CP: Then why did you get it? 

RUSH: I'm not sure really. 

CP: You went to the prescriber, right? 

RUSH: Yes. 

CP: With a complaint, right? 

RUSH: Yes. 

CP: Then how do you expect it to get better? 

RUSH: Not sure. 

CP: You went to the office. You were given a prescription. You brought it to us. You told us to fill it. You received 4 phone calls from us reminding you it was here. You came in to get it. You asked me what it was for. I told you. You took out your credit card. You paid for it. You pulled it off the counter and THEN you decided you didn't want it because "you'd never taken it before"? Did this really just happen? 

RUSH: Well…

CP: Look. You need to decide right now if you want this. If you choose not to decide, you still have made a choice. But I'm walking away and you're keeping this. Besides, how would you know you enjoyed ice cream if your parents hadn't given it to you? Or marijuana? Bet you never passed up a chance for a toke at a concert yet this, THIS is where you draw the line? 

RUSH: You're right. And oh, so wise. 

Out of Touch With Reality

There used to be a time, not so long ago, where life was normal. Where people had average expectations and lived average lives. There were always the outliers, but the majority of people tended to follow the same path. 

You would be born. You would go to school. You would move out of your parents' house. You would get your own place to live, your own insurance, your own job, your own responsibilities. The job of a parent is to prepare your children to become the next round of responsible adults set to inherit the planet and its issues. However, in this current era of self-entitlement, where you can be famous for being famous, people are used to having everything done for them. Battles are fought FOR them (helicopter parents, really?). 

I suppose it should come as no surprise that this was my Quote of The Week winner:

Gone Girl: This isn't fair!

CP: How's that? 

GG: "Under Obamacare they just kick you off your parents' insurance after a certain age. That's just wrong!" 

CP: Life sucks, huh? 

GG: It sure does. 

CP: I mean, you're only 28 years old, still living at home, with your boyfriend there, right?

GG: Yeah. 

CP: And mom and dad still cook for you and buy groceries?

GG: Yeah. 

CP: And I'm sure when you get home and whine to them about how unfair life is that I'll get a phone call scolding me for not caring about your plight. Mommy or Daddy will fight your battle while you snivel in the background that "the mean pharmacist said I didn't have insurance and now I can't play 'bump the uglies' with my boyfriend". 

GG: Well I never!

CP: I know. And that's your problem. All that reality TV you watch didn't prepare you for Reality Life.  Here's your dose of reality. 

GG: I'm calling my mom. 

CP: Her name wouldn't happen to be Lysa Arryn, would it? 

The Inanity of Corporate Quotas...

Each car dealer may have a quota of vehicles for each of his stores or each of his salesman to hit each month. That's easy. People come to YOU looking to buy a car.
Pharmacies requiring a set number of CMRs to be completed each month is like dictating how many traumas an ER must complete each month. Do the hospital administrators tell their staff to "just make accidents happen"? Hey, on your way into work tonight, cause a chain reaction pileup on the expressway so we can make our quota.
No.
Well, hopefully not.
The same can be said of CMRs in the pharmacy. What if you call everyone on your list and no one wants to stop by for a chat?
Every Apex Top Manager's Expectations: Why are your numbers so low?
CP: No one wants to come in.
EATME: Why not?
CP: They don't think they need it.
EATME: Convince them.
CP: They're on Medicaid. They have plans.
EATME: Like what.
CP: Napping.
EATME: What about the others?
CP: They don't want to come in.
EATME: Why not?
CP: Why don't you call and ask them yourself?
EATME: Not my job.
CP: What is your job? Other than to pester me to make quotas?
EATME: They're not quotas. They're a limited or fixed number or amount of things.
CP: Thank you Mr. Webster. How do I convince people to get something they neither want nor need?
EATME: Don't care. Just do it.
CP: Is kidnapping legal?
EATME: What?
CP: I figured we could pull a Ramsay Snow and have someone kneecapped in the parking lot, drag them in the back door, counsel them with a little black hood on like Theon Greyjoy, then let them leave only to follow them out and capture them again.
EATME: What? No! That would probably only work once and you don't have the budget for that much time.
CP: Can we lock customers in the dungeon/waiting room until they agree to be MTM'd to death? Perhaps tell them we will give them "just a few to get through the weekend" if they accede to our demands?
EATME: I don't care about your tactics, just get them done.
CP: Yes, m'lord.
EATME: And I'm cutting your tech hours by 10% since it's almost summer.
CP: Of course. Hey boss?
EATME: Yes?
CP: Do you need a CMR?

If the Real World Worked the Way People Believe Pharmacy Does...

I didn't know what to do.
I had only been on the other side of the counter for these situations before.
This was new territory for me.
Fortunately, years of practice made me a skilled warrior, ready to act appropriately.
Though I felt naked without my Kitana Spatula, I knew my sharp wit would see me through this dark encounter.

Midnight, the time.
McDonald's drive thru, the place.
Drive-Thru Lady: How may I help you?
CP: I'd like 4 apple pies and a Coke.
DTL: You a Blues Brother?
CP: Nope. Need to feed a car of peckish people.
DTL: We don't have any pies now.
CP: You're out?
DTL: Yes.
CP: Do you not sell pies at night?
DTL: Yes. But we are out.
CP: Can you just nuke a few more?
DTL: No.
CP: Thanks. (drives away)
<car next in line begins to order>

Car Two: I'd like a milkshake.
DTL: No milkshake.
CT: No? Why not?
DTL: They are cleaning the shake machine.
CT: You are open another hour, yes?
DTL: Yes.

<back in line after hearing this exchange>
CP: I'd like 4 apple pies and a milkshake.
DTL: No pies. No milkshakes.
CP: <calls store phone number from drive thru> I'd like to speak to the manager please.
McD's Manager: How may I help you?
CP: I ordered pies.
MM: And then.
CP: A milkshake.
MM: And then.
CP: They told me they were out.
MM: And then.
CP: No and then. This is McDonald's, right? Your sign says Pies and Shakes. I want pies and shakes.
MM: We don't have any right now.
CP: Okay. I'll wait.
MM: What?
CP: I'll wait right here for you to finish cleaning the machine and bake me more pies, except I expect 8 pies, all for free, a gift card for breakfast tomorrow, two shakes, and a Coke.
MM: Um…
CP: I'm also calling your franchise office and complaining about the service here. I'll have your job and all your burger flippers fired. I see them in there not making my pies.
 <gesticulates wildly saying: "I see you! You can't hide from me"> How hard is it to just nuke a pie?
MM: Um…
CP: Just kidding. Guess we'll all just have to drive on with our thirsts unslaked.

<Drives off until finding the next McDonald's>
DTL: How may I help you here at your 24-hour Drive-thru?
CP: I'd like 4 fried chickens and a Coke.
DTL: Really?
CP: No. Just 4 pies, a shake, and a Coke.
DTL: Sorry. We only have 2 pies and the shake machine is broken.
CP: Hold on. Go pick up your phone.
DTL: What? It's not ringi...

(More) Stupid Expectations

Insurances change.
They send new cards…or not.
People receive them…or not.
People know they have them…or not.
People have oddly unrealistic expectations of my power. While I am not quite Aladdin's genie, or Jafar ("Phenomenal cosmic powers…itty bitty living space"- okay, that part is true), I can work some magic. However, this was not one of those days…except to make myself laugh.

CP: Allo? This is the United States calling. Are we reaching?
Needs To Lower Expectations: Yes?
CP: I was calling because it appears you have a new insurance.
NTLE: I do?
CP: You do. Would you happen to have the information with you?
NTLE: Perhaps.
CP: Could you bring the card with you when you return?
NTLE: "Can't I just give it to you over the phone?" (not an unreasonable request.)
CP: Sure. I just need the numbers.
NTLE: Which numbers?
CP: ID#, BIN#, PCN#, Group# would all be most helpful.
NTLE: "I don't have any numbers." (now it's unreasonable.)
CP: Seriously?
NTLE: No.
CP: Then what exactly do you wish me to take over the phone?
NTLE: The information?
CP: Ah. Yes. "THE Information." And what information might that be? See, the information I need, the information to which you are referring, is located on the card. It is made up of numbers. Occasionally a few letters may appear, but numbers rule the world. Without any numbers, you are without insurance information.
NTLE: Really?
CP: Yes. To put this another way. You asking me to "take the information over the phone" without ANY information in hand is like me calling and asking a hooker to just provide services over the phone…without getting in the car…without anything in hand…(places phone over crotch for maximum emphasis of point-realises patient on phone can't see this.) You follow?

Help! I Need Somebody…Help!

The easiest costs to control in any business are payroll. Everyone everywhere is told to control their payroll dollars. New bosses come in and they first thing they do is order everyone to rein in payroll expenses. New bosses also want to stimulate business growth so they launch new programs. Wonderful. The only problem is, they are asking the same people to continue to do their original work, add in the new work, and do it all with less help. This is easy to see in the pharmacy world where we have quotas (oops, corporate calls them targets or goals) for flu shots, shingles shots, other vaccines, MTMs, CMRs, new patient calls, prescriber office visitation/meet-and-greets, and customer service calls. They expect us to add all this to our daily dose of filling prescriptions accurately AND quickly.

How would this translate in your doctor's office? Let's try this example:

You walk into your prescriber's office and are met by your doctor who is standing at the check-in window. She checks you in, ushers you to the back, gets your weight, checks your blood pressure, grabs the rest of your vitals and your current med list, then walks out saying she'll be right back. She then goes out front to collect her next patient and repeats the process. After filling all of her rooms, she puts up a sign that says "back soon", then makes the procession through each room to listen to the patients' complaints, diagnose them, prescribe medications for them, determine which pharmacy they use, send an electronic prescription from the room, then walk the patients up to the checkout counter where she herself will collect the copay after checking the computer to determine the patients' coverage.  If needed, she will also schedule the patients' followup visit and any procedures deemed necessary during the visit. In between these rounds, she will swing by the fax machine to authorise any refill requests that may have been sent by any pharmacies, check her e-scribing queue for the same, and listen to her voicemail for messages. She will also carve out time to return any of these calls should she have committed an error while hastily urging a patient out of the room because she has a schedule to keep because corporate dictates she has to send so many e-rxs per hour, see so many patients per hour, collect so many copays per hour, and check in so many patients at the front desk per hour or her STAR rating will fall and she will be at risk of losing the ability to accept Medicare plans at her practice. On top of this, she will have to answer any calls she receives from other offices that need patient information transferred to them so they may conduct tests or sign them up as new patients. At this point, she already has a waiting room full of the next round of people banging on the doors, ready for the next cycle to begin. Despite her standing in full view of the waiting room, all the while briskly walking around from fax machine to computer, to drawers of charts to the cashbox, with a phone strapped to her head, the waiting room patients look like extras from The Walking Dead, constantly banging on the doors, hurling questions at her about "How much longer?" and "Why does it take so long to just put me in a room?" and "I just need a Z-Pak", or "I'm just here for my refills". No one sees that she is on hold attempting to get a patient's prior authorization to go through. No one sees the other patient in the shot room waiting for his second Hep B shot. No one sees the other lines on hold. No one wonders where the help is. No one wonders why things could be taking so long. They only know it shouldn't be like this. What happens? They call corporate and complain about the wait times. They call corporate and complain about how the prescriber seemed rushed and didn't smile long enough, pumped the blood pressure cuff too many times, sent the e-rx to the wrong pharmacy even though it was the one on file, forgot to ask for the new insurance card, tried to charge them too much because the patient left his new insurance card at home and she should have known it changed and offered to call the insurance for her.

Consequence? Practice closes and the patients have to find another prescriber. They move to another office associated with the same general company. This practice now has to deal with all of their own patients AND those of the other practice except the old prescriber does not move there. They do not add staff. They maintain the status quo. Wait times go up. Customer satisfaction goes down. Stress levels go up. Errors are made and people are outraged.

If this really happened at your doctor's office, do you think it would get this bad?
No. Then why is it totally acceptable at pharmacies across North America (need to include my Canadian brethren here as well)?