Professionalism and Pharmacy Unionism

Professionalism and J;>harmacy Unionism By J. Michael Rayburn

J. Michael Rayburn is a staff pharmacist with Baptist Memorial Hospital in ftrfemphis, Tennessee. Before joining the hospital staff, he practiced rommunity pharmacy in Louisiana and Kentucky. He graduated from the University of Tennessee school of pharmacy and recently completed his MBA at Memphis State University. He is curren;tly pursuing a masters in hospital administration at Washington University. Rayburn's memberships include APhA, American Society of Hospital Pharmacists and Kappa Psi.

There is growing interest in whether 1 unionism is consistent with professionalism. This is a critical issue in a health care profession such as pharmacy. Unionization is vi~wed by pharmacists with questi~n and concern. This concern has been shared by national, state and local professional associations, as well as the employers of pharmacists such as hospital, chain and independent pharmacies. So-me pharmacists have initiated self-organization movements in addition to the efforts of labor unions to organize pharmacists. The employee pharmacist does not have any professional organization tpat represents him in seeking economic advancement. Many pharmacists are desperately looking for som.e organization to help them fulfill their economic needs. These pharmacists feel that without organizational skills' they cannot achieve their aims. This is an ideal time for a union to undertake a vigorous campaign to persuade the employed pharmacists that their best interests lie in joining that particular union. Labor unions attempt to fill the organizational skills void by aggressive recruitment tactics. This is true because a labor union lives and grows by convincing employees that it can do more to improve their conditions of employment than they can do for themselves. . However, many p,harmacists show lrttle interest in an organization that cooperates with established unions or that resembles a union. They recognize the need for an organization which represents theq::t in job and professional interests. Ideally they feel this new kind of organization should be dedicated to achieving the specific goals associated with traditional unionism. At the same time this organization should avoid the tac-

tics and type of structural organization associated with unions. Non-Economic Needs Some pharmacists feel that unionism has been accelerated in their profession because the non-economic needs · of the employee-pharmacists have been ignored. Often intangilJle generalized dissatisfaction with day-today relationships is the main reason an employee seeks union representation. Often wage rate dissatisfaction is given as ' the reason for joining a union when wage rates play only a minor part in such employee behavior. The real reason is often related to an employee's feelings about his Jcompany. · Many pharmacists feel that the alarming rate at which food 1ntert(sts are acquiring drugstores may give· rise to a necessity for their unionization. Many of these new drugstore operations give little attention to the profession of pharmacy. They are the first stores to discount and the first to take shortcuts in their professional service. This isolates the pharmacists and creates a public impression that there is no profeg,sional service involved in the dispensing of a prescription order. Many pharmacists feel that these practices make it mandatory that pharmacists have some kind of bargaining agent if they are to survive economically and attain the salary level to · which they feel they are entitl~d. This is true especially under some chain store policies that exclude registered pharmacists from management positions. This problem will likely increase as more nonprofessionals become store owners. Management in the food industry seems to be the worst offender and it is coming into the pharmacy market strongly.

Employed pharmacists need some organizational help which ' will enable them to attain managerial positions in chain drugstores arid al~o help them improve their working conditions. Some pharmacists feel that unioQ.s may be a part of the solqtion 'to this type of situation. ... The Hospital Administrator The attitudes of hospital administrators and the arguments they use in opposing collective bargaining have also been an inhibiting factor. They point out the service nature of nonprofit and public hospitals. They believe that hospitals are helpless against strikes if desired health care standards are to be maintained. ·They stress the risk of endangering lives and/ or delaying the relief of suffering if health care professions should b~come unionized. Hospital administrators argue that it would be neces~ary to pass salary increases onto the patients who are already faced with rising costs of an essential service. As a result, some health care professionals, like pharmacists and nurses, have subsidized hospital service consumers by accepting little or no salary increases. This approach does not appear valid with regard to taxation. Taxes are increased no matter how sensitive the public may be to rising costs. Salary scales should be fairly established and budgets revised. More effective administration is needed for better utilization of hospital employees' skills and optimum use of physical facilities. 1 Professionalism Often management's opposition to unions reflects purely managerial interests more than concern for high professional standards. Both hospital administrators and chain store management often equate professionalism with loyalty to management and perceive unions as threats to pharmacists' loyalty. Any pharmacist who joins a union is perceived as disloyal and by extension is behaving unprofessionally. The real fear management may have is the loss of control. They may be scared that the unions will assume an Vol. NSll, No. 10, October 1971

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"Some pharmacists feel that the issue now is who will be the bargaining agent, whether it will be a trade union or a professional association." unnecessary number of management's prerogatives. Even if most pharmacists concede that the above statement is correct, they will still have to admit that the issue of professionalism is at the heart of most unionization arguments. There is considerable interest as to whether unionism is consistent with professionalism. It has been suggested that one reason why pharmacy unions are relatively weak is that pharmacists in fact do sense this conflict between their economic and service values. Collective Bargaining in Nursing Some pharmacists feel that the appearance of unions in other professions, notably teaching and nursing, has not impaired their professional image. Among professional hospital employees, the American Nurses' Association has been a leading organization as its Economic Security Program has been effective for nearly 25 years. The device of collective bargaining was adopted as a part of its Economic Security Program in 1946. The program also has been adopted by each of the respective state nurses' associations including the collective bargaining clause.2 The official position of The Canadian Nurses' Association was stated in 1944 when the principle of collective bargaining was approved. This position has been supported actively by programs instituted at the national level. For example, the social and economic welfare committee was formed within The Canadian Nurses' Association in April 1965. The association does not have a stated policy concerning strikes; however, the apparent policy is that nurses should take whatever steps are necessary to gain their legitimate ends.s However, the spread of collective bargaining as a means of improving the nurses' economic situation has been slow in their profession. Attempts to influence their working conditions and wages by registered nurses have been labeled ·as "unprofessional." However, recently nurses have manned the picket lines to emphasize their demands for higher salaries and positions on patient-treatment committees. They were able to effectively use a union technique while maintaining their image of professional integrity and concern. Bargaining Agent Some pharmacists feel that the issue now is who will be the bargaining agent, whether it will be a trade union 542

or a professional association. Some feel that the professional associations should adopt collective bargaining methods to avert trade union membership of professionals. Certainly pharmacists do not want their standards to be developed by their professional associations and then negotiated away by an outside labor union. Some pharmacists have the opinion that unless professional associations adopt collective bargaining they will be in danger of losing their strength. Professional associations must guard against their prospective members being drawn into other organizations which attempt to satisfy pharmacists' needs. It is important for pharmacists to understand precisely what is involved in collective bargaining. This is a process in which an employer and the representative of his employees are compelled by law to bargain in good faith to reach agreement with regard to wages, hours and working conditions for the employees. These obligations are imposed equally on the employer and the representative of his employees. It is an unfair labor practice for either party to refuse to bargain collectively with the other. In order to have collective bargaining, it is not necessary that the representative of its employees be called a union. The pharmacy profession has at least three possible parties to choose from for their bargaining agent-professional associations, pharmacists' guilds and trade unions. Professional Associations The American Pharmaceutical Association has traditionally taken the position that working conditions were professional matters to be settled whenever possible by the employer and employees involved. The Association has felt that recourse to the remedies offered by trade unionism should be avoided if at all possible. In 1969 the APhA House of Delegates issued a "Provisional Policy Statement on Employment Standards" which had been submitted to it for consideration by the APhA Board of Trustees. The APhA House of Delegates approved the policy statement in April 1970. The APhA policy statement calls on pharmaceutical associations to set local employment guidelines and mediate or arbitrate labor disputes but does not call for collective bargaining for employee members. The employment standards call for APhA to aid state pharmaceutical associations with arbitration

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

and mediation activities but discourages collective bargaining by professional organizations. APhA is trying to maintain a balance between two attitudes. They admit first that employers too often have refused to recognize the professional and economic needs of employee pharmacists. Second, they feel that employed pharmacists should stay away from collective bargaining and that they should stay away from labor unions and renounce any claim to the right to strike as a means of relieving grievances. Some pharmacists feel that the unions are a necessary way of enforcing the APhA policy statements. They feel that these statements by themselves are totally worthless. They point out that some associations are reluctant to negotiate for employed pharmacists because the associations are usually dominated by pharmacy owners. The professional associations must show art even balance of employee and employer pharmacists in order to counteract this argument. Some pharmacists believe that APhA should provide the necessary leadership to enable employee pharmacists to have the opportunity to earn financial rewards in addition to their salary. In order to assist the employee and employer in arriving at this agreement, APhA is presently working on a portable retirement plan which its employer members could offer to employee members. This would better allow independent community pharmacy owners to compete with larger employers in recruiting pharmacists. This portable retirement plan is one which an employee can take with him from one job to another as long as he is employed in the pharmacy profession. The employee pharmacist has more flexibility in changing jobs since he does not lose fringe benefits which accumulate on the job. 4 ASHP Many pharmacists feel that the APhA policy statement is an initial step in the right direction but that it does not fulfill the needs of substantial numbers of APhA members, especially Rethose employed by hospitals. cently, at its 1971 annual meeting, the American Society of Hospital Pharmacists house of delegates adopted its policy on economic status. ASHP felt that there were three alternative courses of action available for them. One alternative is that ASHP could oppose all collective bargaining

"Many pharmacists apparently have been told that it would never be necessary for them to strike in support of their union." activity either by trade unions or professional pharmacy organizations. This has been the traditional position of APhA and some state pharmaceutical associations. While this approach would have the advantage of protecting the professional image, it would also have the potential danger of forcing hospital pharmacists to turn to trade unions since they would feel that their society is not willing to take action to protect their economic interests. 5 A second approach would be that ASHP could remain neutral and not take any action or position in relation to unionism. However, this approach is not realistic as the existing problem of unionization will not disappear just because no action is taken. ASHP would likely receive criticism from both sides, the anti-union group and also the pro-union group. Both elements would likely condemn the society for not taking any action on an issue of such great importance. 6 A third approach was for ASHP to support collective action by its members. This support could be in varying degrees. One variation would have been for the society to actively undertake collective bargaining in its own name on behalf of its members. The economic burden would be spread on a nationwide basis. It would also provide a national policy for hospital pharmacy throughout the United States in relation to demands made and methods used to achieve objectives.7 The ASHP house of delegates authorized the societyTo engage in collective bargaining by assisting Affiliated Chapters, upon request, in accordance with policies and guidelines as established by the House of Delegates of the American Society of Hospital Pharmacists; further, To adopt the Statement, "Economic Status Program of the American Society of Hospital Pharmacists."

In accordance with the adoption of this policy, guidelines have been developed for individual members, affiliated chapters and ASHP.s Professional Guilds While some pharmacists feel that the best approach is to turn to traditional trade unions for collective bargaining presentation, other pharmacists feel that their professional associatiOns should assume this role. There is also a growing number of associations and independent unions of pharmacists. One such organization is the Chicago-based Professional Pharmacists Association (PPA). This organization

combines the traditional features of a union and a guild. It claims as its objectives to upgrade the profession while improving the practitioners' working conditions. Membership in the association is open only to pharmacists, but not to store owners. Skipper Andrade, secretary-treasurer of the PPA, has noted that while the association would welcome links with other guild-type organizations, that under no circumstances would it affiliate with the AFL-CIO or any other labor union. Another guild-type organization has been originated in Metairie, Louisiana, a suburb of New Orleans. This has close ties with the AFL-CIO, for which it received its charter. It really is a subsidiary of the Barbers, Beauticians and Allied Industries International Association, AFL-CIQ.9 Even though pharmacists comprise less than five percent of the membership of Local 1199, Drug and Hospital Employee Union, this organization is sometimes referred to as the pharmacists' union. There are drives underway in all parts of the country to enroll pharmacists into the ranks of either trade unions or pharmacy guilds which restrict membership to only pharmacists. For exampleIn Arizona, the Retail Clerks International Association, Local 99, won a National Labor Relations Board election designating it as the collective bargaining agent for 34 employed by the Thrifty drug chain. In Indianapolis, the Indiana Pharmacists Guild has an organizing drive underway. In Omaha, the Chemical Workers Union is negotiating on behalf of pharmacists employed by Skaggs. In Washington, D.C., the Metropolitan Guild of Pharmacists won an NLRB election Ill to 75, designating it the bargaining agent for about 200 Drug Fair pharmacists. Negotiations are expected to begin shortly. Also in Washington, the Retail Clerks International Association is negotiating with the Peoples Drug Chain, covering approximately 200 pharmacists!"

No-Strike Clause The constitution of the guild differs from that of a labor union in that all members are generally bound by a nostrike clause. However, often the guild just does not call a strike with that terminology. A guild might resort to a slow-down or a sick call. When a labor dispute arose between pharmacists and their employer, the guild would not request that its members strike. It would instead suggest that they stay away from work for a few days. The guild might also establish a

picket line around the store and assign members of the union not associated with the store to picket-duty. This could mean that the guild would be picketing its own dues-paying members. Many pharmacists think that members can withdraw at any time from a guild. However, in most unions, both professional and nonprofessional, when a member withdraws, he loses his job. Trade Unions Many pharmacists apparently have been told that it would never be necessary for them to strike in support of their union. Some pharmacists apparently believe that by merely joining a union, they have accomplished all that is necessary to force their employer to agree to their grievances. However, a union must have the ability to strike to support its demands. Without the power to strike, sometimes for extended periods, the bargaining power of the union may be weakened to the point where its effectiveness may be virtually nonexistent. Any member of a union must be prepared to accept a situation when a strike will be seen as an absolute necessity to back up bargaining demands. This is true because as soon as a union victory exists, the union representative will ask for more wages. The union promised its members increased wages and it must show some improvement. Pharmacists should consider all aspects of the unionization problem before deciding on their own individual course of action. This is true because once a pharmacist joins a union, it may be extremely difficult for him to obtain a resignation. If pharmacists are unhappy with contracts negotiated by their union or other activities conducted by the union, they may be forced to remain as members of the union for a substantial period of time or alternatively leave their employment for another job. Most individuals, including pharmacists, think only in terms of personal gain. They support collective bargaining because of the possibility of increased salary and fringe benefits. They are frequently unaware of their individual prerogatives which must be sacrificed for the benefit of the group. Unions establish rules for the conduct of their members; these rules are usually enforced by monetary fines which are frequently substantial. Summary The employment relationship between a pharmacist and his employer Vol. NSll, No. 10, October 1971

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must be based on the principle that the pharmacist has a professional inherent right to practice in a manner that will The failure of create self-res,pect. some employers to recognize this principle has led pharmacists to join labor organizations which can satisfy both their professional and economic objectives. However, there is still a question as to whether the means employed through unions do justify the end results. In the author's opinion, efforts to organize pharmacists will increase. Employers can combat this issue by offering their pharmacists feasible alternatives relating both to professional and economic benefits. It is believed that the Provisional Policy Statement is an initial step in the right direction but it does require implementation. If the state and national pharmacy organizations would begin a campaign for in-

A Sociological Evaluation (continued from page 540)

trades have created a new social-psychological concept of the member within such guilds. Rather than looking upon such a union man as being a subservient laborer, we see him with contempt for his demands but appreciation for his position achievement, as a person with a changed status role. Pharmacy has discouraged unions but without offering reasonable alternatives. Potential Proposals for Future

Alternatives to unionism are possible. To induce such a change, the present system of pharmaceutical philosophy needs to be altered if not aborted. One difficulty in overcoming a present establishment attitude is the ephemeral outlook from the units of the establishment, i.e., the welfare "crisis," the drug abuse law requirements of the community pharmacist, etc. Initially, a look at the total situation needs emphasis. If commercialism were reduced, ethical products offered in an ethical manner, less time would be wasted which could be used to instill social status by utilization of basic pharmaceutical training. For example, at least one college of pharmacy offers an undergraduate course in microbiology which would enable a pharmacy to competently operate a small but useful community laboratory.4 How efficient and professional for a pharmacist to culture a potential beta streptococcus and relay the information to the physician promptly and personally rather than another private or state organization; it also would be 544

creased professional salaries for all employee pharmacists, the unions would likely stop their recruitment efforts. It is further believed that a necessary economic balance between employer and employees in the pharmacy profession can be achieved without the necessity of pharmacists adopting the tactics of trade unions. It is felt that many of these tactics are inconsistent with the pharmacist's professional ethics. Everyone must decide what is his best course of action as an individual pharmacist. It is certainly up to each individual pharmacist to decide whether he wants to be a professional or a union worker or if he can justify both roles. I do believe that the decision should be made on the basis of an objective consideration of all the facts with an understanding of all the possible consequences. •

ethical and profitable. Utilization of time in such a manner would ensure a use for the training received.* Secondly, consultations for a fee, such as to civic groups, extended care facilities or private patients needing technical knowledge, would be more professional since the "cost of goods" is in education, not physical quantities. Such endeavors would reduce the amount of time needed to be open for public convenience. Notice the word "convenience" is used. Does a pharmacy need to be open 14 hours daily or is it a convenience in order to obtain transient sales of sundries? Certainly if a pharmacy were open at sporadic intervals as are the prescribers' offices, just as many prescription orders would be dispensed in the sporadic hours-the "closed" time then being used for extended professional activities. One recurrent theme herein is that professional conduct often becomes reduced to profit conduct. For example, the Medicare requirements state that each extended care facility have a registered pharmacist as a consuitant. How many such pharmacists charge an adequate fee or simply perform for a minimal fee in order to "get the business." In such a case, isn't professionalism supplanted with prostitution? Also, should not a consultant position be based on competency instead of

~ It might be assumed that another health occupation, that of the medical technologist, would be infringed upon if such laboratories were constructed in pharmacies. It should be stressed that reference is only to simple laboratories. The training a pharmacist receives in this area does not compare to the complex training required of the medical technologist.

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

References 1. Cormick, Gerald W., "The Collective Bargaining Experience of Canadian Registered Nurses," Labor Law ]., XX, No. 10, 680 (Oct. 1969) 2. Baird, William M., "Barriers to Collective Bargaining in Registered Nursing,'' Labor Law]., XX, No.1, 42 (Jan. 1969) 3. Cormick, Gerald W., "The Collective Bargaining Experiences of Canadian Registered Nurses," Labor Law ]., XX, No. 10, 675 (Oct. 1969) 4. Kushner, Dan, "A Piece of the Action," Amer. Drug., 160, 9 (Dec. 15, 1969) 5. "Report on Unionization of Hospital Pharmacists and The American Society of Hospital Pharmacists," Am. ]. of Hosp. Pharm., XXVI, No.9, 516 (Sept. 1969) 6. Ibid. 7. Ibid. .8. "Economic Status Program of the American Society of Hospital Pharmacists,'' Amer. ]. of Hosp. Pharm., 28, No. 7, 517 (July 1971) 9. Gruberg, Leon, "Are GUILDS the Answer to Economic Security for Pharmacists?" Amer. Drug., 160, 14 (Aug. 11, 1969) 10. Gruberg, Leon, "Pace of Union Drives Intensifies," A mer. Drug., 161, 20 (Feb. 9, 1970)

price? If it were, profit would be based on education. The superstructure surrounding pharmacy needs to have internal dynamic interaction and conflict in order to reorganize. As long as stasis remains from the persons involved, realization of ubiquitous acceptance of this profession by the citizenry remains distant. People must have their attitude changed. The pharmacist should be considered a professional at all times and not simply when illness occurs. A true professional cannot have a change of status according to the "special of the month" or the current endemic outbreak. This critique does not try to answer the problems facing pharmacy. It does try, however, to raise issues which must be faced if a change in the entire social-pharmaceutical system is to be obtained. Traditionally the corner drugstore had to be a sundry supply house; traditions, at times, need to be broken. Self-evaluation of a group's social status, even if coupled with legal views, does not establish what society deems necessary for the recognition of a specialized field as a true profession. Practitioners of pharmacy should discontinue incest as a measure of competence but promote general, objective requirements for the functioning roles of pharmacists' levels. • References I. U.S. Department of Labor, Dictionary of Occupational Titles, 1, U.S. Government Printing Office, Washington, D.C., 525 ( 1965) 2. The Commonwealth of Massachusetts Department of Public Welfare Bulletin (Feb. 7, 1970) 3. "Teleflashes," Amer. Druggist, 161, No. 3, 1 (Feb. 1970) 4. Massachusetts College of Pharmacy Bulletin, 59, No. 1, 53 (Jan. 1970)