- Email: [email protected]
Looking Back, Looking Ahead
Looking Back, Looking Ahead An interview with John F. Schlegel, PharmD his spring John Schlegel resigned as chief executive officer and president ofAPhA (see T April issue, p. His leadership during the F.
248). past 5 years has seen the revitalization and reorganization of the Association, and increasing recognition of the trend toward and the need for reorientation of pharmacy from dispensing to counseling and monitoring. As we look ahead to new leadership, it is appropriate to look back at what has been accomplished and what is yet to be done. In this interview with American Pharmacy, Jack Schlegel reviews his years at the helm, discusses why he is changing career direction, and shares his views about the future for the pharmacist and the association.
Your announced resignation came as a shock to many. Why are you stepping down? This was not an easy decision, and I tried to explain this in an open letter to my colleagues [see opposite page]. Also, it is one of those decisions that is hard for anyone to understand unless they have actually walked in my shoes. We have taken APhA through enormous change in recent years, and I believe that most will agree that the organization is better for it. The turnaround in a IO-year decline in membership is just one indicator, albeit a strong one, that we are on the right track. When an organization goes through such dramatic change, quite frankly, it causes a fair amount of stress - stress for the organization and stress for the leadership. For nearly 5 years, my wife, Priscilla, and I have lived and breathed APhA 24 hours a day, 365 days a year. Sure, there have been stressful moments, but even so we have been proud to serve what we considered to be the ultimate calling in pharmacy. Now the time seems right to let someone else take up the baton and carry 34
American Pharmacy, Vol. NS29, No.5 May 1989/342
An Open Letter to My Colleagues from John F. Schlegel, PharmD, President Dear Colleagues: On March 4, I submitted to the APhA Board ofTrnstees my resignation as President and CEO of the American Pharmaceutical Association, effective March 31, 1989. It was not an easy decision - such decisions never are. Being your CEO has been ever exciting and immensely satisfying. I truly love this Association - it literally has been my life for the past 5 years - so to serve it in this capacity has been a rare privilege. One of the greatest pleasures has been the many fine people I have had the opportunity to work with - our exceptionally qualified members, our dedicated volunteer leadership, and our talented and devoted staff. Nevertheless, in every career there must be points when one assesses what has been accomplished and decides whether it is time to move on. For me, that time has come. Ilook back with a great deal of pride in what we have accomplished together over the past 5 years. Our Association is in excellent health. We undertook a major strategic planning exercise that resulted in a new and dynamic direction for the Association. We established major outreach programs to pharmacy students, women pharmacists, employed pharmacists, and young pharmacists. There has been strong financial growth, with annual income increasing 34%, and membership is on the rise for the first time in 10 years. The Association's physical capacities have been significantly expanded. We have built a staff unequaled in the nation's capital, we have equipped them with the modern tools they need to do their jobs, and we have renovated our exceptional headquarters building so that it is recognized as one of the jewels on the Washington landscape. APhA has reestablished its presence in the Washington legislative and regulatory community to an unprecedented level. In the process we have become highly respected for the quality of our advocacy for the profession and our proactive and problem-solving approach to government affairs- to a level worthy of receiving an award of excellence from our colleagues in the American Society of Association Executives. Pharmacy has participated in the development of more federal legislation during this period than ever before in recent memory - including pharmacy crime legislation, the Prescription Drug Marketing Act, the Veterans Benefits and Services Act, the Employee Polygraph Protection Act, and the Medicare Catastrophic Coverage Act. We have been equally active on the political front, with the APhA Political Action Committee being formed and becoming one of the top 15% of all national PACs. We have refocused our scientific activities, so that APhA's scientist members are beginning to nerican Phannacy, Vol. NS29, No. 5 May 1989/343
have a significant impact on the national scientific policy scene. Never have so many members directly participated in the affairs of the Association. Our new organizational structure has dramatically increased member input into our policy making, educational programming, publications, and awards activities. APhA has reached out anew to other pharmacy organizations by rejoining the National Drug Trade Conference, becoming a member of the Joint Commission of Pharmacy Practitioners, and exercising leadership in the building of coalitions on a number of government-affairs issues. Our Annual Meeting has become a showcase, both within the profession and as an example that other professions are emulating. It has gained a widespread reputation for its consistently excellent educational, exhibit, and social programs. Our participation and reputation in the international pharmacy community have been revitalized. Our professional-affairs activities have resulted in major initiatives on issues such as third-party payment programs and physician dispensing, and major new training programs have been established like the community-pharmacy residency program, the executive residency in association management, and the Apple Pharmacy Management Program. We have significantly strengthened our stateoutreach efforts, including the launching of an intensive state pharmacy association visitation program and the establishment of a State Affairs Department. Our publications efforts have been upgraded, with several new publications on the market and many others in the pipeline. In public relations, we have added a full-time staff position with the result that the profession's and the Association's visibility in the professional and public media have reached unprecedented heights, resulting in our winning the Silver Anvil Award - the public-relations profession's "Oscar." I think most must agree, APhA truly is poised for greatness. I extend to my successor both my best wishes and my continuing support as APhA takes the next steps that will bring this Association and the profession to the heights to which we are destined. To all of you who helped in bringing us to where we are today, I thank you. It has been an experience I will never forget. Sincerely,
~l~'PhannD 35
the Association forward. I feel as though I have done the job that I was asked to do - that of revitalizing APhA, bringing a growth in members and stature within the profession and the national legislative arena. But why step down now, especially just before an Annual Meeting? Our staff meetings for the past couple of months have been at least as intensive in planning the 1990 Annual Meeting as they have been for executing the 1989 Annual Meeting. APhA's Annual Meeting has become one of the most complex in the health field. When it's a month before an Annual Meeting, everything has been set in place and very little can be done to influence its outcome. A goal of mine was to build an organization with highly competent staff and decentralized authority and responsibility so that the organization would have the ability to function effectively and efficiently without the need for one hand on the wheel all the time. This approach results in a better-run organization and allows the CEO to spend time more effectively where his or her expertise and unique perspective are most needed. My departure before the Annual Meeting will take advantage of the fact that leadership and members can actively discuss what type of executive officer they wish to have lead the Association for the next few years. I would hope that the Board of Trustees will listen very carefully to what they hear from the members at the meeting. Earlier you spoke of the fact that you believe you accomplished much of what you were asked to do when you were selected to be president 5 years ago. Can you shed some light on the agenda you brought with you to APhA? I just reviewed once again the statement I presented when I interviewed with the APhA Board of Trustees on April 6, 1984. I spoke of social-political, technological, and economic trends that gave insight to a very different future for providers of health care. I predicted increased competition and a shifting away from a regulatory and planning approach to containing costs to an unfettered medical-care marketplace. I also suggested that there would be changes in the structure of health services with a likely decline in the independent, free-standing delivery of health services. Also, I indicated that we should anticipate a continuing shift from a fee-for-service payment to prepaid comprehensive health plans, noting the need for predictability of costs and hope of lowering costs as driving forces. Finally, I suggested that 36
there would be a greater demand for an emphasis on ambulatory home health care. To meet these societal changes, I argued that pharmacy must become more patient-centered and information-based, rather than being primarily a skill-based profession. Practiced to its fullest potential, pharmacy can keep more people out of acute-care settings, can reduce institutional stays of the acutely ill, and can playa primary role in disease prevention and health promotion. I urged that APhA must bring together the best minds of the profession to look into the future and lay a strategy for preparing current and future practitioners for change. APhA, as the foundation organization for the profession, must be a preeminent example of national leadership. It is unrealistic for the Association to believe that it has a special mission to lead all other organizations, for there are other significant state and national organizations with the capacity to serve elements ofthe profession as well. Thus, APhA must increasingly work through coalitions. And APhA must be an active force in these coalitions, and gain respect through its desire to cooperate in discussions, debates, and programs. The Association cannot stand outside these discussions and pursue its own agenda, for the bulk of members belong to these other state and national organizations as well. I did not take the job with an agenda directed at changing APhA in any particular way, other than to revitalize the organization so that it could better achieve results in the areas I have outlined on behalf of the profession. Much of what I predicted unfolded over the ensuing years, and the pride I feel upon leaving office is that the Association has been a major player in many of these broad health-policy discussions. Today, the Association is better prepared than ever before to weigh in on behalf of the profession on discussions at the highest level dealing with the delivery of health care in the United States. You have spoken in broad terms about changes in pharmacy and in health care, but what about the changes that have occurred within APhA itself? When I became President on June 1, 1984, the APhA House of Delegates had just adopted a resolution that called for the Board of Trustees to immediately undertake a strategic planning effort. Although some maintained that such strategic planning should be conducted on behalf of the profession, it was clear that APhA first needed to get its own house in order. APhA had bee~ losing members since 1978, had reAmerican Pharmacy, Vol. NS29, No. 5 May 1989/344
duced its staff to an alarmingly low level, and had cut back substantially on activities, programs, and services for members. As a result, the Association had diminished influence within the profession. Consequently, strategic planning was directed early on at rebuilding the Association so that it would be in a better position to serve both its members and the profession as a whole. The details of our strategic planning work have been reported on several occasions and so I will not go into them now. Suffice it to say that no stone was unturned in our early stages of planning to gather information about APhA and how it was perceived by leaders, members, nonmembers, colleague associations, and the community at large. The strategic thrusts of renewal, growth, and efficiency were identified, and it was recognized that growth could not be achieved until the other two thrusts were addressed. The reorganization of the Association, the building of staff, and the modernizing of technology and management systems were addressed first. By mid-March 1987, the Board approved an Action Plan that would roll out nearly 20 programs over the next 3 years, targeted at employee pharmacists, young pharmacists, women pharmacists, and pharmacy students - the four segments of the profession with the highest potential for increasing membership in APhA. Over the next 18 months, the Action Plan was able to stay pretty much on target. As a result, we closed 1988 with the first annual increase in APhA membership in 10 years, thus satisfying the strategic thrust of growth. It has been only since the Association has had its own house in order that we have been in a position to most effectively address the needs of the profession. Are you saying that it has taken 5 years for the Association to reach the point
Act, which restricted the' distribution of samples. That year we also worked for successful enactment of the Veterans Benefit and Services Act that increased benefits to pharmacists working in the Veterans Administration; ensured fair treatment for pharmacists and pharmacy students under the Employee Polygraph Protection Act; and were key players in obtaining a drug-benefit provision in the Medicare Catastrophic Coverage Act. I would not presume to claim that APhA was solely responsible for all of this activity; however, there is no doubt that we were central players.
where it can only now begin to address the needs of the profession?
Do I take it that the major accomplishments of the Association during your tenure then have been in government affairs?
Not at all. Throughout these years, we have been working on behalf of the profession, but if you take a look at our accomplishments, they have increased exponentially over the past couple of years. As an example, take a look at our achievements in government affairs. In 1984 we successfully lobbied for the passage of pharmacycrime legislation. In 1987 we worked for the introduction of federal legislation to restrict physician dispensing for profit, and although the legislation was never passed, it did serve as a useful strategy in helping some states develop such legislation. In 1988 we were instrumental in successful enactment of the Prescription Drug Marketing
Definitely not. I am proud of our accomplishments in that area, but I am equally proud of what we have done in many other areas of the Association. We have a 12-page document that details by department the accomplishments of APhA over the past 5 years. For instance, we either revitalized or started several new entities under the umbrella of APhA, such as the political-action committee. In terms of money contributed, it is already among the top 15% of all national PACs. The APhA Foundation was revitalized and in the past 3 years has funded such activities as the Pharmacy Commission on Third Party Programs, the founding and implementing of the Residency in Community Pharmacy pro-
American Pharmacy, Vol. NS29, No.5 May 1989/345
37
gram, and the founding of the American Pharmaceutical Institute. The Foundation also has supported a consortium of pharmacy schools developing curricular materials for external PharmD programs, supported original research in the recovering pharmacists' program, and supported a study on the impact of pharmacists' prescribing. The Pharmacists Insurance Trust was given new life and today offers a broad mix of new insurance programs, which are serving increasing numbers of our members. The activities of the Board of Pharmaceutical Specialties, although independent of APhA, depend on financial and staffing support by APhA, and BPS has been increasingly active to support new petitions for specialties that have been recognized in nutrition support pharmacy and pharmacotherapy. The Association has reentered the international arena by rejoining the Federation Internationale Pharmaceutique, supported the activities of the Pan American Federation of Pharmacy and Biochemistry, and co-organized and executed a major scientific symposium in conjunction with the Pharmaceutical Society of Japan. In the policy arena, the Association has increased its activities to the point where we are submitting formal testimony or comment letters to the federal government on an average of nearly one every 2 weeks. We have a long list of achievements in the professional-affairs area, including holding regional hearings and issuing a major report on third-party payment programs, holding regional hearings and issuing a major report on reimbursement under Medicaid, initiating a number of committee activities jointly with industry and medicine dealing with the issue of therapeutic interchange, initiating planning for a major national forum on the employee pharmacist to be held in 1990, and establishing a cognitiveservices working group. Our public-relations and public-affairs program has launched several new programs that have increased the frequency with which pharmacy is referenced in national and local press, and we have participated in the development or released on our own several public-affairs programs that deal with the role ofthe pharmacist in patient education, medication usage by older Americans,and a range of public-health programs such as AIDS, cholesterol education, high blood pressure, smoking, and immunization. In scientific affairs, the Association has substantially contributed to discussions within FDA of bioequivalence, the cost-effectiveness of pharmaceutical products and pharmacy services, postmarketing surveillance, and treatment INns, and also by participating in 38
international scientific symposia and initiat· ing an annual End-of-SUIllIller Science Sym. posium.
What do you say to the criticism that it has taken the Association too long to turn around? Two things. First, I remind the critic of the basic laws of physics. Any time there is significant momentum, a great deal of energy is expended in slowing that momentum before a new direction can be set. In the late 1970s and early 1980s, the Association began to experience substantial decline. Organizations go through natural cycles and we must remember that as one of the oldest -national associations in the United States, APhA has gone through several cycles of growth and decline or steady state. Having said that, we must be honest in our .recognition that the Association began a period of decline starting about 1978. The decline' had gained a fair amount of momentum when I joined the staff. A great deal of our human and financial resources and organizational energy was spent attempting to stem that tide. By late 1986 and early 1987, we saw the negative slope begin .to level off and indicators of growth begin to appear. Unfortunately, I believe we became overly optimistic and prematurely implemented a dues increase in 1987. It is generally accepted that there will be a 10% drop in membership any time there is a substantial dues increase. Our membership drop in 1987 came at a time when we were not prepared psychologically and programmatically for it. However, we recovered by 1988 and, as I have said before, closed the year with the first annual increase in membership in over 10 years. I have focused on membership figures because a .great many people view them as a barometer for the health of an organization. Let me remind you that membership is only one indicator and that other indicators, such as new programs, activities, member participation in the affairs ofthe Association, and attendance at meetings are other important indio cators. A second point I would like to make here is what I will call information lag. There is a substantial lag - perhaps up to .2 or 3 years - between what happens in a national organization and the perceptions of what is happening by individuals at the grass-roots level. This is not at all surprising, because most people spend the greatest'amount of their energy dealing ·with issues that are the closest to home for them. ' Every organization has a core of individuals who are politically very active in that .organization, but the vast majority of members are American Pharmacy, Vol. NS29, No.5 May 1989/346
not active participants and simply want a strong organization that provides them good leadership, good information, and good products and services. If the organization has been going through a period of decline, there are a number of individuals who have taken themselves out of the information loop by resigning or not joining the organization. Thus, it takes longer for them. to find out that things have indeed changed within that organization. So it is not surprising to me that perceptions at the grass-roots level about APhA, or any other national organization, may lag substantially behind the realities that exist within that organization. This will occur with organizations in periods of growth as well as in periods of decline.
Are you concerned about the deficit spending the Association has .been engaged in?
Certainly. There needs to be close attention paid to the finances of an organization, especially when income is not keeping pace with expenditures. But as with any business, APhA has to plan its business cycles to span at least 2 to 3 years. There will be times in an organization when the situation is right for that organization to contribute to reserves. But reserves should not be amassed simply for the sake of amassing reserves. Reserves should be amassed so that when the time is right to make investments the Association is in a position to do so. The purpose of those investments is to create an opportunity for the Association to have greater income potential down the road. As I say, APhA should be run just like any other business. When I started in 1984, the Association had about $7 million in reserves. In 1984 and 1985, we added an additional $700,000 to reserves, and then in 1986 and 1987 we drew that $700,000 back out of reserves. We projected drawing about $1 million more out of reserves in 1988 and 1989 and anticipated a break-even budget by 1990. Recall that the Action Plan that resulted from strategic planning and was unveiled in mid-1987 was introduced as the "million-dollar action agenda," which anticipated that at the end of the 3-year period the Association would have returned that amount of money as a result of new programs and growth. When I resigned, we were pretty much on schedule with this financial planning. Let me reiterate that the Association is in strong financial health. We have financial reserves that equal 1 year's operation, which is about double that recommended for associations.
Some have criticized you for having a high rate of staff turnover. First, it should be remembered that full-time equivalent staffing grew from about 55 to about 75 during my 5 years at APhA. Many of the new faces were filling new positions. But we have had our share of staff turnover, I must admit. Some of that has been the result of management decisions, and some of that has been the result of mistakes in hiring. However, a good deal of it, especially at the support-staff level, is the result of the Washington employment environment. The unemployment rate for support personnel in Washington, D.C., is almost zero; so competition to retain staff at the clerical, secretarial, and administrative level is intense. Our turnover at that level is no more than that of similar organizations, although this is a phenomenon th~t is hard for people to understand in most parts of the country. I did make a couple of hiring mistakes. I have been in association management for 14 years, and I don't believe it's possible to manage as many people as I have over the years without occasionally not getting a good fit between employee and employer. The higher these indi-
viduals are on the organization chart, the more disruptive these unfortunate decisions are to the organization. APhA has gone through dramatic change over the past 5 years. Some employees cope with such change much better than others. Also, some employees who were hired and seemed right for the organization at one phase of development no longer fit as comfortably when the organization moved to another phase. If you take a look at staffing recently - over the past couple of years or so - I think you will find stability. Even so, as long as management is hiring bright and aggressive people and then allowing those people to gain national stature, some of these individuals will be lured away by other organizations. And there is really nothing wrong with that - it's actually a compliment to APhA.
'Over the past 5 years, there have been more coalitions formed around a wide variety of legislative and regulatory issues than I have ever seen before. I have seen more progress on the development of joint strategies for lobbying than ever before. We must continue in this vein or we will lose to the highly competitive forces that now exist in the health-care arena.'
If you were to pick one accomplishment of which you are most proud, what would that be? I simply cannot pick one. But if you will allow me three, I would say, first, a dramatically increased number of members participating in all aspects of the Association. Today there are over 50 meetings of various Association committees in anyone year - that's one meeting per week, on average. If you total up all the people who currently participate on APhA's committees, its 400-member House of Delegates, and its 400 members ofthe Congressional Contact Network, we have over 1,000 members actively participating in service to the Association. In January of this year, we held a leadership weekend for all the elected leaders of the Board of Trustees, the three 40
academies, and all the sections of the academies. There were more than 60 individuals in attendance. That kind of participation is what is revitalizing APhA and allowing the organization to be responsive to the needs of members. My second major accomplishment would be the increased presence and stature in the Washington legislative, regulatory, and health-policy community. And in this I must include the founding of the American Pharmaceutical Institute. The dramatic change I have seen in the Association moving from a passive observer to an active participant in these discussions has been most rewarding. And third, great progress toward the ''building bridges" theme unveiled at the 1984 APhA Annual Meeting. For most of my career, I have seen national pharmacy organizations working at cross purposes, refusing to cooperate on too many issues of great importance to the profession. Over the past 5 years, there have been more coalitions formed around a wide variety of legislative and regulatory issues than I have ever seen before. And although we still have a ways to go, I have seen more progress on the development of joint strategies for lobbying than ever before in my career. And we must continue in this vein or we will lose to the highly competitive forces that now exist in the health-care arena. And your greatest disappointment? In my address to the 1985 APhA Annual Meeting, I said that "we must see that we are not diverted by individuals or incidents that would cause the Association to consume its limited resources by infighting and divisiveness. This requires confidence and mutual respect." I have deep concerns that because people are facing so much change in the practice of our profession today, the dog they kick when they go home at night will be their local, state, or national organizations. There is a saying that "the more complex a problem, the more people seek simple solutions." We face a highly complex situation in the provision and financing of health care today, and this will only increase in the future. To the extent that our professionals become too deeply divided and too strongly opinionated as to their own views in response to the threats they face every day, the Association could suffer badly. APhA needs to be a forum where all points of view are openly debated and discussed, and then the Association must attempt to move toward a consensus. Those who wish to win their own view at all costs have the potential of doing serious damage to the Association and to the profession. I guess my greatest disappointment is the sense that we have not made American Pharmacy, Vol. NS29, No.5 May 1989/348
more progress in people understanding the value of using the Association as a forum for debate rather than a forum to win, no matter what the damage to others.
We have a tendency in pharmacy to focus on ourselves, and I am convinced that such a focus will not assure the long-term health and prosperity of the profession.
What advice do you have for the Association as you leave office?
What are your personal plans for the future?
Continue the course that we have set for (1) broad participation by many members in the affairs of the Association, (2) serving the profession broadly and not concentrating too heavily on anyone segment of the profession, and (3) continuing to maintain a high profile among those who influence the development of health policy in the United States. Certainly, it's appropriate for the new executive officer and newly elected volunteer leaders to bring their own sense of priorities and style to the Association. I hope, however, that the Association remains focused on the big picture in health care, for the struggle is to increase the meaningful participation by pharmacists in the delivery of health care. When one recognizes how desperately society wishes to have information about the appropriate use of medications, the niche for our profession is clear. And so while some resources are spent on addressing issues that are unique and important within the profession, APhA should always keep its eye on the long ball.
I plan to stay in Washington, D.C., and continue to work in areas where I can have an influence on the development of health policy. For over 20 years, I have tried to use each of my positions in pharmacy to increase the influence pharmacy has had in the broader world of health care. Certainly, this has been the ultimate position within pharmacy for bringing the profession into high-level discussions that are shaping the manner in which health-care services are delivered and health-care professionals are compensated. When I interviewed with the Board ofTrustees, I made it clear that I did not see my work at APhA as the end point of my career. Now I plan to take off my pharmacy hat and work to address more broadly the health-care policy issues being debated in this country. However, my sensitivity for the great potential of our profession will never be forgotten, and it will be a role for which I will always be the strongest advocate.@>
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248). past 5 years has seen the revitalization and reorganization of the Association, and increasing recognition of the trend toward and the need for reorientation of pharmacy from dispensing to counseling and monitoring. As we look ahead to new leadership, it is appropriate to look back at what has been accomplished and what is yet to be done. In this interview with American Pharmacy, Jack Schlegel reviews his years at the helm, discusses why he is changing career direction, and shares his views about the future for the pharmacist and the association.
Your announced resignation came as a shock to many. Why are you stepping down? This was not an easy decision, and I tried to explain this in an open letter to my colleagues [see opposite page]. Also, it is one of those decisions that is hard for anyone to understand unless they have actually walked in my shoes. We have taken APhA through enormous change in recent years, and I believe that most will agree that the organization is better for it. The turnaround in a IO-year decline in membership is just one indicator, albeit a strong one, that we are on the right track. When an organization goes through such dramatic change, quite frankly, it causes a fair amount of stress - stress for the organization and stress for the leadership. For nearly 5 years, my wife, Priscilla, and I have lived and breathed APhA 24 hours a day, 365 days a year. Sure, there have been stressful moments, but even so we have been proud to serve what we considered to be the ultimate calling in pharmacy. Now the time seems right to let someone else take up the baton and carry 34
American Pharmacy, Vol. NS29, No.5 May 1989/342
An Open Letter to My Colleagues from John F. Schlegel, PharmD, President Dear Colleagues: On March 4, I submitted to the APhA Board ofTrnstees my resignation as President and CEO of the American Pharmaceutical Association, effective March 31, 1989. It was not an easy decision - such decisions never are. Being your CEO has been ever exciting and immensely satisfying. I truly love this Association - it literally has been my life for the past 5 years - so to serve it in this capacity has been a rare privilege. One of the greatest pleasures has been the many fine people I have had the opportunity to work with - our exceptionally qualified members, our dedicated volunteer leadership, and our talented and devoted staff. Nevertheless, in every career there must be points when one assesses what has been accomplished and decides whether it is time to move on. For me, that time has come. Ilook back with a great deal of pride in what we have accomplished together over the past 5 years. Our Association is in excellent health. We undertook a major strategic planning exercise that resulted in a new and dynamic direction for the Association. We established major outreach programs to pharmacy students, women pharmacists, employed pharmacists, and young pharmacists. There has been strong financial growth, with annual income increasing 34%, and membership is on the rise for the first time in 10 years. The Association's physical capacities have been significantly expanded. We have built a staff unequaled in the nation's capital, we have equipped them with the modern tools they need to do their jobs, and we have renovated our exceptional headquarters building so that it is recognized as one of the jewels on the Washington landscape. APhA has reestablished its presence in the Washington legislative and regulatory community to an unprecedented level. In the process we have become highly respected for the quality of our advocacy for the profession and our proactive and problem-solving approach to government affairs- to a level worthy of receiving an award of excellence from our colleagues in the American Society of Association Executives. Pharmacy has participated in the development of more federal legislation during this period than ever before in recent memory - including pharmacy crime legislation, the Prescription Drug Marketing Act, the Veterans Benefits and Services Act, the Employee Polygraph Protection Act, and the Medicare Catastrophic Coverage Act. We have been equally active on the political front, with the APhA Political Action Committee being formed and becoming one of the top 15% of all national PACs. We have refocused our scientific activities, so that APhA's scientist members are beginning to nerican Phannacy, Vol. NS29, No. 5 May 1989/343
have a significant impact on the national scientific policy scene. Never have so many members directly participated in the affairs of the Association. Our new organizational structure has dramatically increased member input into our policy making, educational programming, publications, and awards activities. APhA has reached out anew to other pharmacy organizations by rejoining the National Drug Trade Conference, becoming a member of the Joint Commission of Pharmacy Practitioners, and exercising leadership in the building of coalitions on a number of government-affairs issues. Our Annual Meeting has become a showcase, both within the profession and as an example that other professions are emulating. It has gained a widespread reputation for its consistently excellent educational, exhibit, and social programs. Our participation and reputation in the international pharmacy community have been revitalized. Our professional-affairs activities have resulted in major initiatives on issues such as third-party payment programs and physician dispensing, and major new training programs have been established like the community-pharmacy residency program, the executive residency in association management, and the Apple Pharmacy Management Program. We have significantly strengthened our stateoutreach efforts, including the launching of an intensive state pharmacy association visitation program and the establishment of a State Affairs Department. Our publications efforts have been upgraded, with several new publications on the market and many others in the pipeline. In public relations, we have added a full-time staff position with the result that the profession's and the Association's visibility in the professional and public media have reached unprecedented heights, resulting in our winning the Silver Anvil Award - the public-relations profession's "Oscar." I think most must agree, APhA truly is poised for greatness. I extend to my successor both my best wishes and my continuing support as APhA takes the next steps that will bring this Association and the profession to the heights to which we are destined. To all of you who helped in bringing us to where we are today, I thank you. It has been an experience I will never forget. Sincerely,
~l~'PhannD 35
the Association forward. I feel as though I have done the job that I was asked to do - that of revitalizing APhA, bringing a growth in members and stature within the profession and the national legislative arena. But why step down now, especially just before an Annual Meeting? Our staff meetings for the past couple of months have been at least as intensive in planning the 1990 Annual Meeting as they have been for executing the 1989 Annual Meeting. APhA's Annual Meeting has become one of the most complex in the health field. When it's a month before an Annual Meeting, everything has been set in place and very little can be done to influence its outcome. A goal of mine was to build an organization with highly competent staff and decentralized authority and responsibility so that the organization would have the ability to function effectively and efficiently without the need for one hand on the wheel all the time. This approach results in a better-run organization and allows the CEO to spend time more effectively where his or her expertise and unique perspective are most needed. My departure before the Annual Meeting will take advantage of the fact that leadership and members can actively discuss what type of executive officer they wish to have lead the Association for the next few years. I would hope that the Board of Trustees will listen very carefully to what they hear from the members at the meeting. Earlier you spoke of the fact that you believe you accomplished much of what you were asked to do when you were selected to be president 5 years ago. Can you shed some light on the agenda you brought with you to APhA? I just reviewed once again the statement I presented when I interviewed with the APhA Board of Trustees on April 6, 1984. I spoke of social-political, technological, and economic trends that gave insight to a very different future for providers of health care. I predicted increased competition and a shifting away from a regulatory and planning approach to containing costs to an unfettered medical-care marketplace. I also suggested that there would be changes in the structure of health services with a likely decline in the independent, free-standing delivery of health services. Also, I indicated that we should anticipate a continuing shift from a fee-for-service payment to prepaid comprehensive health plans, noting the need for predictability of costs and hope of lowering costs as driving forces. Finally, I suggested that 36
there would be a greater demand for an emphasis on ambulatory home health care. To meet these societal changes, I argued that pharmacy must become more patient-centered and information-based, rather than being primarily a skill-based profession. Practiced to its fullest potential, pharmacy can keep more people out of acute-care settings, can reduce institutional stays of the acutely ill, and can playa primary role in disease prevention and health promotion. I urged that APhA must bring together the best minds of the profession to look into the future and lay a strategy for preparing current and future practitioners for change. APhA, as the foundation organization for the profession, must be a preeminent example of national leadership. It is unrealistic for the Association to believe that it has a special mission to lead all other organizations, for there are other significant state and national organizations with the capacity to serve elements ofthe profession as well. Thus, APhA must increasingly work through coalitions. And APhA must be an active force in these coalitions, and gain respect through its desire to cooperate in discussions, debates, and programs. The Association cannot stand outside these discussions and pursue its own agenda, for the bulk of members belong to these other state and national organizations as well. I did not take the job with an agenda directed at changing APhA in any particular way, other than to revitalize the organization so that it could better achieve results in the areas I have outlined on behalf of the profession. Much of what I predicted unfolded over the ensuing years, and the pride I feel upon leaving office is that the Association has been a major player in many of these broad health-policy discussions. Today, the Association is better prepared than ever before to weigh in on behalf of the profession on discussions at the highest level dealing with the delivery of health care in the United States. You have spoken in broad terms about changes in pharmacy and in health care, but what about the changes that have occurred within APhA itself? When I became President on June 1, 1984, the APhA House of Delegates had just adopted a resolution that called for the Board of Trustees to immediately undertake a strategic planning effort. Although some maintained that such strategic planning should be conducted on behalf of the profession, it was clear that APhA first needed to get its own house in order. APhA had bee~ losing members since 1978, had reAmerican Pharmacy, Vol. NS29, No. 5 May 1989/344
duced its staff to an alarmingly low level, and had cut back substantially on activities, programs, and services for members. As a result, the Association had diminished influence within the profession. Consequently, strategic planning was directed early on at rebuilding the Association so that it would be in a better position to serve both its members and the profession as a whole. The details of our strategic planning work have been reported on several occasions and so I will not go into them now. Suffice it to say that no stone was unturned in our early stages of planning to gather information about APhA and how it was perceived by leaders, members, nonmembers, colleague associations, and the community at large. The strategic thrusts of renewal, growth, and efficiency were identified, and it was recognized that growth could not be achieved until the other two thrusts were addressed. The reorganization of the Association, the building of staff, and the modernizing of technology and management systems were addressed first. By mid-March 1987, the Board approved an Action Plan that would roll out nearly 20 programs over the next 3 years, targeted at employee pharmacists, young pharmacists, women pharmacists, and pharmacy students - the four segments of the profession with the highest potential for increasing membership in APhA. Over the next 18 months, the Action Plan was able to stay pretty much on target. As a result, we closed 1988 with the first annual increase in APhA membership in 10 years, thus satisfying the strategic thrust of growth. It has been only since the Association has had its own house in order that we have been in a position to most effectively address the needs of the profession. Are you saying that it has taken 5 years for the Association to reach the point
Act, which restricted the' distribution of samples. That year we also worked for successful enactment of the Veterans Benefit and Services Act that increased benefits to pharmacists working in the Veterans Administration; ensured fair treatment for pharmacists and pharmacy students under the Employee Polygraph Protection Act; and were key players in obtaining a drug-benefit provision in the Medicare Catastrophic Coverage Act. I would not presume to claim that APhA was solely responsible for all of this activity; however, there is no doubt that we were central players.
where it can only now begin to address the needs of the profession?
Do I take it that the major accomplishments of the Association during your tenure then have been in government affairs?
Not at all. Throughout these years, we have been working on behalf of the profession, but if you take a look at our accomplishments, they have increased exponentially over the past couple of years. As an example, take a look at our achievements in government affairs. In 1984 we successfully lobbied for the passage of pharmacycrime legislation. In 1987 we worked for the introduction of federal legislation to restrict physician dispensing for profit, and although the legislation was never passed, it did serve as a useful strategy in helping some states develop such legislation. In 1988 we were instrumental in successful enactment of the Prescription Drug Marketing
Definitely not. I am proud of our accomplishments in that area, but I am equally proud of what we have done in many other areas of the Association. We have a 12-page document that details by department the accomplishments of APhA over the past 5 years. For instance, we either revitalized or started several new entities under the umbrella of APhA, such as the political-action committee. In terms of money contributed, it is already among the top 15% of all national PACs. The APhA Foundation was revitalized and in the past 3 years has funded such activities as the Pharmacy Commission on Third Party Programs, the founding and implementing of the Residency in Community Pharmacy pro-
American Pharmacy, Vol. NS29, No.5 May 1989/345
37
gram, and the founding of the American Pharmaceutical Institute. The Foundation also has supported a consortium of pharmacy schools developing curricular materials for external PharmD programs, supported original research in the recovering pharmacists' program, and supported a study on the impact of pharmacists' prescribing. The Pharmacists Insurance Trust was given new life and today offers a broad mix of new insurance programs, which are serving increasing numbers of our members. The activities of the Board of Pharmaceutical Specialties, although independent of APhA, depend on financial and staffing support by APhA, and BPS has been increasingly active to support new petitions for specialties that have been recognized in nutrition support pharmacy and pharmacotherapy. The Association has reentered the international arena by rejoining the Federation Internationale Pharmaceutique, supported the activities of the Pan American Federation of Pharmacy and Biochemistry, and co-organized and executed a major scientific symposium in conjunction with the Pharmaceutical Society of Japan. In the policy arena, the Association has increased its activities to the point where we are submitting formal testimony or comment letters to the federal government on an average of nearly one every 2 weeks. We have a long list of achievements in the professional-affairs area, including holding regional hearings and issuing a major report on third-party payment programs, holding regional hearings and issuing a major report on reimbursement under Medicaid, initiating a number of committee activities jointly with industry and medicine dealing with the issue of therapeutic interchange, initiating planning for a major national forum on the employee pharmacist to be held in 1990, and establishing a cognitiveservices working group. Our public-relations and public-affairs program has launched several new programs that have increased the frequency with which pharmacy is referenced in national and local press, and we have participated in the development or released on our own several public-affairs programs that deal with the role ofthe pharmacist in patient education, medication usage by older Americans,and a range of public-health programs such as AIDS, cholesterol education, high blood pressure, smoking, and immunization. In scientific affairs, the Association has substantially contributed to discussions within FDA of bioequivalence, the cost-effectiveness of pharmaceutical products and pharmacy services, postmarketing surveillance, and treatment INns, and also by participating in 38
international scientific symposia and initiat· ing an annual End-of-SUIllIller Science Sym. posium.
What do you say to the criticism that it has taken the Association too long to turn around? Two things. First, I remind the critic of the basic laws of physics. Any time there is significant momentum, a great deal of energy is expended in slowing that momentum before a new direction can be set. In the late 1970s and early 1980s, the Association began to experience substantial decline. Organizations go through natural cycles and we must remember that as one of the oldest -national associations in the United States, APhA has gone through several cycles of growth and decline or steady state. Having said that, we must be honest in our .recognition that the Association began a period of decline starting about 1978. The decline' had gained a fair amount of momentum when I joined the staff. A great deal of our human and financial resources and organizational energy was spent attempting to stem that tide. By late 1986 and early 1987, we saw the negative slope begin .to level off and indicators of growth begin to appear. Unfortunately, I believe we became overly optimistic and prematurely implemented a dues increase in 1987. It is generally accepted that there will be a 10% drop in membership any time there is a substantial dues increase. Our membership drop in 1987 came at a time when we were not prepared psychologically and programmatically for it. However, we recovered by 1988 and, as I have said before, closed the year with the first annual increase in membership in over 10 years. I have focused on membership figures because a .great many people view them as a barometer for the health of an organization. Let me remind you that membership is only one indicator and that other indicators, such as new programs, activities, member participation in the affairs ofthe Association, and attendance at meetings are other important indio cators. A second point I would like to make here is what I will call information lag. There is a substantial lag - perhaps up to .2 or 3 years - between what happens in a national organization and the perceptions of what is happening by individuals at the grass-roots level. This is not at all surprising, because most people spend the greatest'amount of their energy dealing ·with issues that are the closest to home for them. ' Every organization has a core of individuals who are politically very active in that .organization, but the vast majority of members are American Pharmacy, Vol. NS29, No.5 May 1989/346
not active participants and simply want a strong organization that provides them good leadership, good information, and good products and services. If the organization has been going through a period of decline, there are a number of individuals who have taken themselves out of the information loop by resigning or not joining the organization. Thus, it takes longer for them. to find out that things have indeed changed within that organization. So it is not surprising to me that perceptions at the grass-roots level about APhA, or any other national organization, may lag substantially behind the realities that exist within that organization. This will occur with organizations in periods of growth as well as in periods of decline.
Are you concerned about the deficit spending the Association has .been engaged in?
Certainly. There needs to be close attention paid to the finances of an organization, especially when income is not keeping pace with expenditures. But as with any business, APhA has to plan its business cycles to span at least 2 to 3 years. There will be times in an organization when the situation is right for that organization to contribute to reserves. But reserves should not be amassed simply for the sake of amassing reserves. Reserves should be amassed so that when the time is right to make investments the Association is in a position to do so. The purpose of those investments is to create an opportunity for the Association to have greater income potential down the road. As I say, APhA should be run just like any other business. When I started in 1984, the Association had about $7 million in reserves. In 1984 and 1985, we added an additional $700,000 to reserves, and then in 1986 and 1987 we drew that $700,000 back out of reserves. We projected drawing about $1 million more out of reserves in 1988 and 1989 and anticipated a break-even budget by 1990. Recall that the Action Plan that resulted from strategic planning and was unveiled in mid-1987 was introduced as the "million-dollar action agenda," which anticipated that at the end of the 3-year period the Association would have returned that amount of money as a result of new programs and growth. When I resigned, we were pretty much on schedule with this financial planning. Let me reiterate that the Association is in strong financial health. We have financial reserves that equal 1 year's operation, which is about double that recommended for associations.
Some have criticized you for having a high rate of staff turnover. First, it should be remembered that full-time equivalent staffing grew from about 55 to about 75 during my 5 years at APhA. Many of the new faces were filling new positions. But we have had our share of staff turnover, I must admit. Some of that has been the result of management decisions, and some of that has been the result of mistakes in hiring. However, a good deal of it, especially at the support-staff level, is the result of the Washington employment environment. The unemployment rate for support personnel in Washington, D.C., is almost zero; so competition to retain staff at the clerical, secretarial, and administrative level is intense. Our turnover at that level is no more than that of similar organizations, although this is a phenomenon th~t is hard for people to understand in most parts of the country. I did make a couple of hiring mistakes. I have been in association management for 14 years, and I don't believe it's possible to manage as many people as I have over the years without occasionally not getting a good fit between employee and employer. The higher these indi-
viduals are on the organization chart, the more disruptive these unfortunate decisions are to the organization. APhA has gone through dramatic change over the past 5 years. Some employees cope with such change much better than others. Also, some employees who were hired and seemed right for the organization at one phase of development no longer fit as comfortably when the organization moved to another phase. If you take a look at staffing recently - over the past couple of years or so - I think you will find stability. Even so, as long as management is hiring bright and aggressive people and then allowing those people to gain national stature, some of these individuals will be lured away by other organizations. And there is really nothing wrong with that - it's actually a compliment to APhA.
'Over the past 5 years, there have been more coalitions formed around a wide variety of legislative and regulatory issues than I have ever seen before. I have seen more progress on the development of joint strategies for lobbying than ever before. We must continue in this vein or we will lose to the highly competitive forces that now exist in the health-care arena.'
If you were to pick one accomplishment of which you are most proud, what would that be? I simply cannot pick one. But if you will allow me three, I would say, first, a dramatically increased number of members participating in all aspects of the Association. Today there are over 50 meetings of various Association committees in anyone year - that's one meeting per week, on average. If you total up all the people who currently participate on APhA's committees, its 400-member House of Delegates, and its 400 members ofthe Congressional Contact Network, we have over 1,000 members actively participating in service to the Association. In January of this year, we held a leadership weekend for all the elected leaders of the Board of Trustees, the three 40
academies, and all the sections of the academies. There were more than 60 individuals in attendance. That kind of participation is what is revitalizing APhA and allowing the organization to be responsive to the needs of members. My second major accomplishment would be the increased presence and stature in the Washington legislative, regulatory, and health-policy community. And in this I must include the founding of the American Pharmaceutical Institute. The dramatic change I have seen in the Association moving from a passive observer to an active participant in these discussions has been most rewarding. And third, great progress toward the ''building bridges" theme unveiled at the 1984 APhA Annual Meeting. For most of my career, I have seen national pharmacy organizations working at cross purposes, refusing to cooperate on too many issues of great importance to the profession. Over the past 5 years, there have been more coalitions formed around a wide variety of legislative and regulatory issues than I have ever seen before. And although we still have a ways to go, I have seen more progress on the development of joint strategies for lobbying than ever before in my career. And we must continue in this vein or we will lose to the highly competitive forces that now exist in the health-care arena. And your greatest disappointment? In my address to the 1985 APhA Annual Meeting, I said that "we must see that we are not diverted by individuals or incidents that would cause the Association to consume its limited resources by infighting and divisiveness. This requires confidence and mutual respect." I have deep concerns that because people are facing so much change in the practice of our profession today, the dog they kick when they go home at night will be their local, state, or national organizations. There is a saying that "the more complex a problem, the more people seek simple solutions." We face a highly complex situation in the provision and financing of health care today, and this will only increase in the future. To the extent that our professionals become too deeply divided and too strongly opinionated as to their own views in response to the threats they face every day, the Association could suffer badly. APhA needs to be a forum where all points of view are openly debated and discussed, and then the Association must attempt to move toward a consensus. Those who wish to win their own view at all costs have the potential of doing serious damage to the Association and to the profession. I guess my greatest disappointment is the sense that we have not made American Pharmacy, Vol. NS29, No.5 May 1989/348
more progress in people understanding the value of using the Association as a forum for debate rather than a forum to win, no matter what the damage to others.
We have a tendency in pharmacy to focus on ourselves, and I am convinced that such a focus will not assure the long-term health and prosperity of the profession.
What advice do you have for the Association as you leave office?
What are your personal plans for the future?
Continue the course that we have set for (1) broad participation by many members in the affairs of the Association, (2) serving the profession broadly and not concentrating too heavily on anyone segment of the profession, and (3) continuing to maintain a high profile among those who influence the development of health policy in the United States. Certainly, it's appropriate for the new executive officer and newly elected volunteer leaders to bring their own sense of priorities and style to the Association. I hope, however, that the Association remains focused on the big picture in health care, for the struggle is to increase the meaningful participation by pharmacists in the delivery of health care. When one recognizes how desperately society wishes to have information about the appropriate use of medications, the niche for our profession is clear. And so while some resources are spent on addressing issues that are unique and important within the profession, APhA should always keep its eye on the long ball.
I plan to stay in Washington, D.C., and continue to work in areas where I can have an influence on the development of health policy. For over 20 years, I have tried to use each of my positions in pharmacy to increase the influence pharmacy has had in the broader world of health care. Certainly, this has been the ultimate position within pharmacy for bringing the profession into high-level discussions that are shaping the manner in which health-care services are delivered and health-care professionals are compensated. When I interviewed with the Board ofTrustees, I made it clear that I did not see my work at APhA as the end point of my career. Now I plan to take off my pharmacy hat and work to address more broadly the health-care policy issues being debated in this country. However, my sensitivity for the great potential of our profession will never be forgotten, and it will be a role for which I will always be the strongest advocate.@>
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