Pharmacy is a calling.

A lot of people begin pharmacy school to make a lot of money once they are
out of school. However once they experience the retail world experience a
lot of them decide that this is not for them.

Pharmacy has certainly gone downhill in the past 25 years.  When I was doing
my internship there were hardly any 3rd party payers.  Patients submitted
their receipts to the insurance company and they were reimbursed.  It meant
some extra work on the pharmacists' parts because we had to help them
complete their forms (i.e. NDC numbers... name of manufacturer... price paid
etc).

We actually loved 3rd party cards because in the end there was a lot less
work for us.  We could set the paper claims aside and fill them in during
"downtimes" .  Usually all the medications were covered.  Reimbursement
rates were profitable. The problem was that there was no way of telling if
the patient really had coverage.  We got stuck on a lot of those.

When the"black box" version of pharmacy billing came into effected (late
80's early 90s) that risk was removed.  You filled the prescription... the
insurance information went into a "black box"  (usually a phone line) ...
the patients' coverage was verified and a copay popped out.  Wow... what a
improvement.  Our job suddenly got easier.

Then one day the insurance companies started to play doctor.  Formularies,
tier level copays, and prior authorizations took hold and suddenly we were
begging some little high school graduate employee for permission for a
patient to get a script filled multiple times daily.

Additionally competition heated up amongst the chains and the insurance
companies took advantage of this.  They reduced our reimbursement rates to
levels which cut profit margins and in fact sometimes caused a net loss per
prescription.  The chains faced the possibility of not getting patients in
the door if they did not accept the contracts.

Now chain stores know how much money a person walking around the store
spends per minute of walking around.  They  accepted the lower payments in
the hope that the patients would come into the store and buy impulse items.
Of course they still wanted to maximize profit. The chain stores handled
this by decreasing the fixed cost of filling prescriptions... mainly cutting
staff hours (especially technicians).

The net result pharmacists are much busier... with less help.  Stress levels
are intense.  We cannot do our jobs up to our own professional standards
because you cannot talk to doctors about changing medications to formulary
products and counsel patients at the same time.

I see this and I still feel the calling.  I'm still here.. however my
respect for my employers has certainly lessened and my feelings toward  3rd
party payers cannot be expressed in a public forum.  However a lot of people
considering pharmacy as a career see it and change their majors... or work
for a few years and then get out it all together.

And Pharmacy times wants to know why there is a shortage?

Viva la shortage. I prefer to think of it as a healthy market.

I suppose there are not enough pharmacists for the chains to build a
pharmacy on every block. Oh well, too bad for the chains.

At my employer, a ~400 bed hospital, since the start of the year, at
least 7 pharmacists have been hired, (including me :-) but only about 3
have left. (The imbalance was to fill a need left by an expansion of RPh
duties.) Anyway if we could hire a net of 4 RPh, maybe the shortage is
not too severe.

I first became interested in pharmacy ~1992, and since than salaries
have increased >100%. Nice.
I was in retail, and couldn't handle it. I took several months off, and
had no trouble finding employment when I was ready, and I'm 48. Nice.
The next guy we hired had an identical story. Nice. Give me a shortage
anyday.

There is one thing that worries me. My brother faced a larger shortage
in his line of work in the late 90s. He was a main frame programmer.
There was a mass influx of labor from overseas, and now, it's difficult
at best for an "American" to find work in that field. But of course,
that could never happen to us . . .

Shortages come and go. Say a prayer tonight to thank God for the
shortage.

I am a retail pharmacist. It allows me to get full-time hours in the space
of 3 days, so I can spent the majority of time home with my 2 kids (and
wishing I were at work). I have a clinical degree and can easily slip into a
position at the husband's place of work (big East Coast manufacturer). As
tempting as it would be to have a pretty desk job with a huge salary
and --get this-- a LUNCH BREAK! SICK DAYS!! (gasp!)... I love retail.

I love my customers. I love being right there when they need me for all
their big and bitty questions and concerns. I get to see bellies grow big
with new babies, and I get to see age erased from faces when a patient
finally gets pain relief, and I get to hold hands with my customers when all
that's needed to brighten someone's day is a simple human touch. I am
fulfilled by my role as a retail pharmacist. I try hard to be a good person,
and this is the place I get my best practice. I can see why some people
don't last in retail-- if your heart isn't in it, if you aren't a people
person, if you just don't give a rat's a.s for a stranger's problem, then
you are going to be annoyed when customers come to you for compassionate
care.

Ok, so it's not glamorous. The stuff I actually get paid to do-- repetitive
counting, regulations out the wahzoo, calling petty third parties,
explaining copays to pissy people, trying to explain that "Yes, there is an
Aisle 6, it's right next to Aisle 5 but there is no sign"...the real work
stinks sometimes. We are horribly understaffed-- I guess they budget their
tech hours to the point when there are none on duty at some point every day
and from 3-9 on Saturdays because it MAKES SENSE to some dope who probably
has never even been in my store...ah, the Corporation Mentality...and
sometimes I can't get to the other phone in time.  But I have a great
partner (still don't know how I got so lucky to work with her) and I like
the front store staff and I have great customers. The mall has pretty good
food and when I actually have a tech working with me, I get to eat. I go
home some nights dog tired, and some hours are so busy that I pray out loud
not to screw up something. But I love my job because the good outweighs the
bad and that's why I am in retail for life.

Aimee

A brief item in the latest issue of "Pharmacy Times" said that the
pharmacist shortage continues unabated. The article estimated that, for
example, the US chain drug industry is short 5500 pharmacists. The cause, it
was suggested, is the lenghtening of the pharmacy program by one academic
year to make the Pharm.D. degree.

What else is contributing to the shortage, and to what degree do you think
it is? Lack of secondary school training, interest, and/or ability in
science? Tuition costs? I know that there was a Congressional study on the
issue in the late 1990s, but I'd like to hear from the field. What do you
think?

Paul Trusten, R.Ph.
3609 Caldera Boulevard Apartment 122
Midland TX 79707-2872 USA
432-694-6208
ptrusten@cox.net

"There are two cardinal sins, from which
all the others spring: impatience and laziness."

                                         ---Franz Kafka