Pharmacy Takes Another Haircut

There’s a lot going on in the wacky world of pharmacy these days, and as usual a great deal of it doesn’t make any sense; some of it is contradictory.

First, in Ontario, the MOHLTC has decided it needs to save even more money as the government is running a deficit of over 7 billion, all due to the previous Liberal government of course. So, it needs pharmacy to make a generous contribution of 436 M over five years, thank you very much.  This is in addition to several other bites taken out of pharmacy over the last several years.  Death by a thousand cuts is the expression.

It could have been a whole lot worse according to the Ontario Pharmacists Association/Neighbourhood Pharmacy Association of Canada’s (OPA/NPAC) self congratulatory announcement.  The government apparently wanted 791 M, but as a result of ‘astute negotiations’ by the OPA/NPAC alliance, that amount was “reduced by 45%”. Talk about taking a negative and turning it into a positive.

Also, Medscheck has been saved, but who cares? …this one has been milked to death already.  The important achievement apparently is that the OPA/NPAC alliance and the government are now friends and the future is surely going to get better.  Not sure where this rosy prediction comes from, but it sounds optimistically hopeful at best.

The reality is this.  This unholy alliance between the OPA/NPAC is seen by government as another business lobby group representing Big Pharmacy Retail (BPR) mainly, and to some lesser degree small businesses called independent pharmacies who are often seen in the news ripping off the government somehow through unauthorized rebates, or other nefarious or sneaky deeds.  Maybe not totally fair, but those are the optics.  So, not much sympathy from government.

The unfortunate critical element is that the government does not see itself as negotiating with pharmacists.  The government has no compensation framework with pharmacists, and it likes it this way.  Much better to hack away at big business who has lots of money, and as big retailers have ample opportunity to make up any shrinkage in prescription drug profits by selling higher margin stuff like OTCs, Halloween candy, pizzas, lawn chairs, pop & chips.

The fact that unrepresented employee retail pharmacists will suffer the consequences through even more reduced compensation (already down at least 30%), even less technical support, and even more quotas, is not government’s concern.  These consequences are indirect and not in the government’s eye.

Too bad the Canadian Press and other media outlets continue to use the word ‘pharmacists’ when what is really meant is ‘pharmacies.’  Pharmacists are real people, while pharmacies are things.  Pharmacists have no negotiating power and government knows this.   Pharmacy students should be given a five by eight-inch card with this reality written in red ink & in large print on it on the first day they enter pharmacy school.  It would save a lot of tears and anguish six years and $150,000 down the line.

And in the face of all this, the holy grail for pharmacy now appears to be even more increased scope of practice ‘privileges’ i.e. do more stuff for a level of compensation which is yet to be determined.  And what is this extra stuff?  Mostly prescribing for a predetermined number of so-called minor ailments eventually, and extending prescriptions up to a year over the short term.  In other words, do more for less to help the government with its fiscal problems.

The OPA/NPAC alliance likes this.  Why not?  A chance to generate more revenues with no extra costs.  Think any of these yet to be determined fees will trickle down to employee pharmacists?  Join the line to sit on Santa’s lap.

Let alone that after six years of university education, today’s pharmacy graduates have little or no training in diagnoses nor ordering nor interpreting lab results.  The Ontario College of Pharmacists (OCP) knows this.  Imagine what the OCP will put its members through before they are allowed to enter this new arena.

Up to now, these activities were the purview of Medicine, not Pharmacy.  As one physician recently stated: “There is a big difference between medicine and medicines.”  So, a huge assumption of liability (more insurance costs), more courses to take (a few thousand dollars at least) and mostly to increase the bottom line of non-pharmacist owned pharmacies.  The Ontario Medical Association (OMA) doesn’t like the idea, and the Canadian & Ontario Nurses Associations have serious reservations as they see a direct conflict of interest between prescribing and selling medication.  This observation goes back a thousand years and was the basis/rationale for separating medicine & pharmacy in the first place.

There may not be a great deal that individual pharmacists may be able to do to avert this juggernaut, but at least they should not add delusion and a surreal sense of self-importance to the list of their travails.  A lot has already been written about all this, and more will surely come down the pipe, but pharmacists must maintain a critical perspective and separate the wheat from the chaff.  The truth is often the last thing people want to talk about.

The Post Office Pharmacist …Part 2

By now most of us are familiar with the case of the “Post Office Pharmacist” and the fate that befell upon him at the hands of the Ontario College of Pharmacists (OCP)

If this injustice was not enough, the OCP went on to publish this decision in its recent publication Pharmacy Connection.

The assumption must be that, because so many pharmacists reacted negatively to this decision, the OCP felt the necessity to reinforce the reasoning behind the decision.

I wrote a blog about this incident a few months ago.

The pharmacist involved went on to appeal the decision of the Inquiries Complaints and Review Committee (ICRC) of the OCP to the Health Professions Appeal & Review Board (HPARB).  This did him no good, and even though he had counsel present, HPARB ruled in favour of the ICRC/OCP.

Consequences?  This pharmacist lost his job, suffers from anxiety, and basically has had his life turned upside down.  And what for?

This altercation with this irate post office customer (not a patient) may be subject to further scrutiny, but the essence is that, unable to deal with this individual effectively, he went looking for help from the physician at the clinic next door.  He probably should have just called the police and let them handle what could be described as harassment and a potential threat.  The recommendation to call police was what Canada Post gave when contacted about this incident for advice.

In its zeal to make an example of this unfortunate pharmacist, the OCP hinged its decision on the fact that the pharmacist “left the pharmacy unattended” while he went out seeking help in a desperate situation.  One wonders what the consequences would be for a pharmacist who ran out of his store during an armed robbery.

This pharmacist, concerned about his safety, stepped out the front door two feet and went right next door looking for help.  This is a fact, but what happens in a Super Colossal Big Pharmacy Retail Store (BPR) when the attending pharmacist needs to use the washroom, which is located hundreds of yards away from the actual pharmacy department?  (This assumes the pharmacist is allowed to go to the washroom)

In this case, which is highly frequent, now that many pharmacies are just departments in huge mega food drug combos, the pharmacist is much further physically from the pharmacy, and for a much longer period of time.

Why does the OCP not intervene in these physical circumstances and hold the non-pharmacist pharmacy owners accountable?  There’s a very simple solution.  Every one of these pharmacy departments should have self-contained handicap accessible male and female washrooms right in the pharmacy department.

Of course, these washrooms would then take up more square footage than the actual pharmacy and would cost a ton, not to mention take up highly valuable retail space.

Conclusion.  To make a point, it is much easier for the OCP to take action against a single pharmacist with little leverage or power, than to take on BPR and the big-name law firms BPR employs.

This is both a hypocrisy and a gross injustice.