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Quality of Life for the Community Pharmacist
VOICE
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Quality of Life for the Community Pharmacist by Gregory A. Fox, as Pharm
White Paper Series No. 4 Too much to do, too little time to do i t keeping pace with rapid changes in the workplace has created a number of employee issues that community pharmacists are working to resolve.
CE Credit CE Credit To obtain one hour of continuing education credit (0.1 CEU) for completing "Quality of Life for the Community Pharmacist," complete the assessment exercise and CE registration form and return it to APhA. A certificate will be awarded for achieving a passing grade of 70% or better. Pharmacists completing this article by July 31, 1998, can receive credit.
IFE PC I The American Pharmaceutical Associa® tion is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education.
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APhA provider number \(QJ is: 680-202-95-008.
AMERICAN PHARMACY
Learning Objectives Upon successful completion of this continuing education program, the pharmacist should be able to: • Summarize recent changes that have had a dramatic impact on the worklife of community pharmacists. • Discuss OBRA '90 and its effects on the community pharmacist. • Review the changing demographics of practicing pharmacists. • Explain the benefits and drawbacks associated with increasing use of computers in community pharmacy. • Discuss strategies for optimal use of pharmacy technicians and available technology. • Describe plans to establish uniform credentialing for pharmacy technicians.
Introduction For generations, the worklife of the American community pharmacist has been one of quiet, low-key service aimed at ensuring accuracy in processing patients' prescription orders. Now, the pharmacist's typical day is characterized by additional responsibilities that vie for limited time resources. The many factors affecting the way a pharmacist works today include tremendously expanded counseling requirements and opportunities, due in part to passage of the Omnibus Budget Reconciliation Act of 1990 COBRA '90), which took effect January 1, 1993; dramatically changing workforce demographics and customer needs; and the anticipated overhaul of the entire national health care system. Most of these shifts have occurred fairly suddenly, offering little chance for a comfortable transition. July 1995
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Employee Issues Lack of empowerment is a frequent source of frustration for community pharmacists. Forces that are beyond most phannacists' control and shape their daily activities include third party contracts, government decisions, and the policy pronouncements of large pharmacy employers. Especially for new pharmacists who are just starting their careers, this lack of professional autonomy can lead to feelings of depersonalization and loss of idealism. In particular, those who graduate with the expectation of spending much of their time delivering pharmaceutical care may become disillusioned when their employment consists almost entirely of processing prescriptions. Pharmacists are for the most part unable to determine their work hours, work pace, or working conditions. True, staffing a pharmacy adequately can be difficult when patient demand is uneven, but a critical question remains: What is a reasonable number of prescriptions to process within a specified period without jeopardizing quality and safety? A 1992 survey showed that, on an average day, the typical community pharmacist dispenses 129 prescription medications (109 for independents, 154 for chains), consults with physicians seven times, and counsels 31 patients. 1 These activities represent only one aspect of the job as it exists today. Since the survey was conducted, OBRA '90 guidelines have mandated counseling for all Medicaid patients, and most states have passed laws that mandate counseling for all patients. Although it clearly takes time to learn to use new technology, including computer systems, formal training during work hours is often lacking. When the pharmacy owner or chain brings in new equipment that is for sale or rental, the employed pharmacist must become suffiCiently adept at its use to be able to instruct patients who want to buy or rent it. For example, the pharmacist may be called on to provide guidelines for proper use of home blood pressure monitors, breast pumps, and crutches. Finding time to do so may be as difficult as fmding time to learn new computer systems and programs. Nevertheless, this learning must be done. On the bright side, each new skill learned gives the pharmacist additional satisfaction, usefulness, and employability. If asked, employees who complain about their working conditions can often make constructive suggestions for correcting them. Employees are usually grateful when their supervisors make an effort to listen to their problems and implement improvements. Providing classes in time management, stress reduction, negotiation, and customer relations techniques during paid work hours will be increasingly useful to community pharmacists and, in the long run, their employers. In geographic areas suffering from a shortage of pharmacists, keeping staff pharmacists happy reduces attrition and brings in good employees through positive word of mouth. If they were choosing a career now, would most pharmacists still elect to enter the field? In a recent survey, only slightly more than half (55%) said yes. 1 Nevertheless, that percentage was higher than the 47% who gave similar answers a decade Vol. NS35, No.7
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before. Additionally, the proportion of those saying that they would opt for a different profession dropped from 34% in 1983 to 26% in 1992.1 Chain pharmacists were less satisfied overall than were hospital and independent pharmacists in both the 1983 and 1992 surveys. Among the 8% of 1992 respondents who planned to switch to a different type of practice, the highest proportion worked in chains. Cited most often as reasons to change were a desire for better hours and working conditions and the lack of challenge in current positions.
Owner Issues For many years, pharmacy was often a working-class person's route to respectability and fmancial security. As a profession that opened its doors to aspirants from diverse cultural and socioeconomic backgrounds, pharmacy also provided opportunities for children of working-class families to achieve profe~ sional status. Under the GI Bill of Rights, a pharmacy degree became a ticket to middle-American security. It was a route to socioeconomic improvement, a stable worklife, responsibility and autonomy, and prominence in the community. The children of these pharmacists grew up watching their parents, usually their fathers, work extraordinarily hard to make a living. As the career possibilities open to young people seeking a medicine-related career have widened, their interest in pursuing a lifestyle that calls for decades of commitment and sacrifice has narrowed. With small pharmacies closing at an alarming rate-5% or 6% each year for the past several years-security is no longer so certain as it once was. Making a living as a pharmacy owner has become increasingly difficult, not only because of the strictures of state and federallaws, but also as a result of numerous other profit-squeezing economic and health care trends; but it can be done. A seemingly insoluble problem for the owner of the community pharmacy is the inability to be in more than one place at the same time. The public expects to fmd a pharmacist on duty at every moment. This expectation can quickly propel the beleaguered single staff pharmacist or store owner to the point of burnout. It may mean either working 80 hours per week, as owners are increasingly disinclined to do, or hiring more staff. Unlike other profeSSionals, such as physicians, dentists, and accountants, community pharmacists with small staffs may fmd it difficult to take adequate lunch breaks or even steal a few minutes to use the lavatory, much less to answer or return physicians' calls, counsel patients, and pursue continuing education required for license renewal. Time-related pressure can become a major deterrent to the appeal of community pharmacy ownership as a career, if not addressed. On the other hand, owners of community pharmacies usually thrive on the challenges and rewards of entrepreneurship and enjoy the professional independence that comes with owning a business. Community pharmacists also enjoy daily contact with the public and derive personal fulfillment from providing a critical health care service that is generally highly AMERICAN PHARMACY
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respected and appreciated within the community. Another issue of great concern to community pharmacy owners is the extent to which they may become exposed to liability as patient counseling and other aspects of pharmaceutical care become increasingly integrated into their daily routines. Standards of practice for the "dispensing" of information directly to patients remain to be clearly defmed. Conflicting counseling information from the physician and pharmacist could confuse the patient. Worse, misunderstandings in communicating with physicians could conceivably lead to litigation by patients if the phYSician's intent in prescribing was not followed. Lack of action on the pharmacist's part also may prompt litigation, if the pharmacist neglects to provide a critical component of patient counseling. Lawsuits are now being ftled by patients against pharmacists, sometimes related to counseling given because of OBRA '90 mandates. 2 Pharmacists will have to remain cognizant of indications not only for prescribed medications, but for all health-related products the pharmacy sells. If a patient operates medical devices improperly after being trained by a pharmacist, who will be liable? Who should be held responsible if the patient supplies an inaccurate or incomplete medical history? As health care counseling reaches unprecedented levels in the pharmacy, leaders in the field must establish clear guidelines for these new activities.
Coping lNith Impatient Patients The constant of pharmacists' interactions with customers, once a mainstay of the comer drugstore (and a major source of its appeal), has faded over the past two decades. Instead, the pharmacist worked on a platform, typically well behind the counter and virtually out of sight. Sometimes a wall of glass firmly separated the pharmacist from the customer. Many patrons did not know what the pharmacist looked like. That distance is being closed with the promulgation of patient counseling. Food and Drug Administration Commissioner David A. Kessler has been outspoken about the need for pharmacists to take a proactive role in patient counseling, supplying written information in all cases and initiating dialogue when patients do not. As an unexpected benefit, passage of OBRA '90 has accommodated the desire of many pharmacists to provide more extensive patient-oriented care. To ensure equal services for all patients, many state pharmacy boards have issued a mandate to counsel not only Medicaid patients (as stipulated under OBRA '90) but everyone receiving a prescription medication. Patients transfer much of their frustration with phYSicians, employers, pharmaceutical manufacturers, and insurance companies to the pharmacist. They may be appalled at drug prices that they will have to pay partially out of pocket or entirely up front (with reimbursement coming weeks or months later). The pharmacist, typically the most accessible health care provider, must be prepared to handle patients' AMERICAN PHARMACY
anger. The key is not to take such outbursts personally. Expressing sympathy is far more likely to soothe irate patients than is indignation. What of the pharmacist trained not to answer patients' questions, but to refer them to the physician, as the 1975 pharmacist's Code of Ethics of the American Pharmaceutical Association (APhA) required? Until recently, those who went to pharmacy school received minimal instruction in patient counseling, communication, or teaching techniques. Yet they now see their former primary role-processing of prescription orders-being taken over by technicians, or even by machines. Adapting to change of such magnitude can be difficult. As long as counseling by pharmacists is viewed by the public, the legislatures, and the medical and legal communities as an important added component of health care delivery, pharmacists will have the potential to benefit both fmancially and professionally from their expanded role. If this added responsibility leads to unfair liability, however, pharmacists will need to address this.
Salaries According to a nationwide survey of 6,300 pharmacists, the average base pay for employee pharmacists in early 1993 was $49,800. 3 The average yeady increase of 9.7% was acceptable, but lower than in previous years. Pay raises were highest for those employed by chain pharmacies (11.4%) and health maintenance organizations 01.3%). For independents, the average increase was 8.1%. The average hourly pay for a full week's work was $23.62. About 60% of respondents said that they worked overtime. Bonuses were given to 58% of pharmaciSts, down 7% from 1990 and 12% from 1988. The newly graduated pharmacist may be pleased with a substantial starting salary (averaging close to $50,000) that will help payoff education loans and support a family. However, pharmacists working in community pharmacies may later be disappointed by the small increments to follow -some salaries increase only two or three percentage points per year, granted as cost-of-living adjustments. As compensation for cognitive and therapeutic services beyond dispensing continues to grow, owners and chains could, in all fairness, divert a proportion of payments for those services to employee pharmacists. Whether this proves to be the case remains to be seen.
Working Conditions Across the nation, pharmacies are being reconfigured to reduce or eliminate the separation between patient and pharmacist. The driving reason for much of the remodeling is the counseling mandated by OBRA '90 and many state boards of pharmacy. Some chains advertise the advantages of their new consultation areas. When patients discuss personal health issues during pharmacist consultations, they appreciate the privacy provided by these special areas. Pharmacists also July 1995
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benefit from creating an atmosphere that enhances recognition of the value of their counseling. Pharmacists spend a great deal of time on their feet, often reading small type. Padded carpeting and pleasant, nonglare lighting help minimize the discomfort that detracts from job satisfaction and productivity. Large chains are more likely to explore the advantages of ergonomic design extensively, but even small operations should make the effort to introduce these elements to improve the working environment and increase employee comfort, satisfaction, and productivity. Pharmacists increasingly enjoy the chance to step from behind the counter to "detail" physicians, meeting with them by appointment at their offices to discuss special services and products available at the pharmacy. Pharmacists may also speak at local schools about drug abuse, pharmacy careers, and other topics. Giving presentations at senior citizens' centers can help promote compliance with prescribed drug regimens.
Cotnputers Change Practice As in many other profeSSions, the advent of computers has
overwhelmingly and irrevocably changed the daily practice of pharmacy. In a relatively short time, computerization has become an inescapable component of the well-run pharmacy. More than 75% of independent and hospital pharmacies and 100% of chain pharmacies are computerized.3 The manual records on which pharmacists relied for many decades have become obsolete. Pharmacists who were educated and trained before the computer revolution, and who still feel more comfortable with a pencil and index cards, can no longer allow themselves to resist moving to the world of computer monitors and keyboards. The massive data storage and easy information retrieval made possible by computers enable pharmacists to print drug information as needed, thus obviating the storage of cartons of patient education materials. Electronic claims processing has introduced both timesaving and time-consuming tasks for the pharmacist. On the positive side, drug utilization review is greatly facilitated. Software is available to facilitate a vast array of actions, from checking drug-drug interactions to identifying potential allergic reactions to newly prescribed medications. "The Voice of Pharmacy" is an American Pharmaceutical Association educational program sponsored by an unrestricted grant from Schein Pharmaceutical, Inc. It is intended to provide pharmacists with a spectrum of opinions and information about the subjects they themselves feel are the most important issues facing pharmacytoday.
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On the negative side, every patient who walks in the door seems to have a different third party payer-each with an individual program and method of access to illes. Access can vary from calling up a patient's file by entering the patient's name, to entering the patient's Social Security number, special identification number, or address. The onslaught of literally hundreds of different health plans has made it crucial for pharmacists to be fast learners. Because this change to computerized health care tracking is most visible in the pharmacy, the patient tends to see it as a standard part of pharmacy practice and often expects the pharmacist to know everything about a particular plan instantaneously. Any hesitation or delay irritates the patient, who wants the prescription order processed without delay and without having to answer questions on plan procedures. Precisely when the pharmacist is expected to fmd the time to learn to operate these new computerized systems has not been defmed. As in other fields, such learning may have to take place on the pharmacist's own time. For those who grew up and were educated before the electronic era, adapting to an entirely new way of working-relying on a machine rather than handwritten notes and human contact-can be disorienting. Yet the field of pharmacy does tend to attract people who are conscientious, responSible, and scientific.
Changing Demographics
One element that makes the pharmaciSt's worklife an entirely different experience from that in the traditional pharmacy of 20- 25 years ago is changing demographics. As a neighborhood changes, the rush that used to be expected in the evenings and on weekends may occur at lunchtime. As the patient mix changes-for example, from young urbanites to geriatric patients-patients' needs shift. Pharmacists may fmd themselves accommodating a different clientele, with changes in average age, family structure, fmancial status, ethnic background, and even language. If a nearby company changes its health plan, patients may suddenly expect the pharmacist to understand the plan's most minute ramifications.
Best Use of Technicians
Pharmacists who want to spend more time on cognitive serVices and other endeavors, but who are too pressed by the demands of processing prescription orders, can benefit from the assistance of pharmacy technicians in dispensing and related activities acceptable to state law and the individual pharmacist. In California, pharmacy technicians have been permitted to work in outpatient pharmacies only since November 1, 1992. The state pharmacy board approved the new regulation in conjunction with a requirement that pharmacists counsel all patients. Until then, powerful pharmacist unions and other forces had prevented passage of regulations allowing wider use of technicians. The change was promoted by counseling requirements that were issued during a long-term, statewide
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shortage of pharmacists. The shortage had been intensified by California's traditional refusal to grant reciprocal status to health care professionals who earned their licenses in other states; thus, pharmacists are required to pass California's examination in order to practice there. Being able to employ pharmacy technicians has allowed busy pharmacists the time to do the counseling they are required by law to perform. In 22 states, only the phannacist can make the "offer to counsel" the patient or the patient's agent to whom a prescription drug is being dispensed. In other states, support personnel are learning communication skills to help cany the load of required consultation, assuming the phatmacist in question allows support staff to act as the first point of contact with the patient. Technicians have been fulfilling more extensive fimctions in phannacies since OBRA '90 went into effect. 4 APhA, the National Association of Boards of Pharmacy (NABP), and NARD say that the offer to counsel should be made by phatmacists only. The National Ass0ciation of Chain Drug Stores, however, has expressed the strong belief that individual companies should make that decision.5 Nationwide, one impediment to the widespread use of pharmacy technicians in the past has been lack of uniform credentialing of technicians. In California, for example, 1,500 hours of pharmacy work experience, with some stipulations as to what that experience included, is sufficient to permit registration as a pharmacy technician. Without a standard course of study and certification examination, technicians have had no official proof of their education and skills. Efforts are being made to correct that deficiency. APhA has joined with the American Society of Health-System Pharmacists (ASHP), the Michigan Pharmacists Association, and the Illinois Council of Hospital Pharmacists on a national voluntary pharmacy technician certification program. The first examination will be offered at 120 sites on July 29. 6 The functions, responsibilities, and tasks of pharmacists and pharmacy technicians were delineated by the comprehensive Scope of Pharmacy Practice Project. 7 The two-year study, concluded in 1994, was jointly sponsored by the American Association of Colleges of Pharmacy (AACP), APhA, ASHP, and NABP, under a $150,000 grant from the Pew Charitable Trusts. The project updated and revalidated the National Study of the Practice of Pharmacy, which was published in 1979.
Women's Issues The increasing number of women in pharmacy has been one of the profession's most highly visible trends. During the mid-1970s, the proportion of women in pharmacy schools more than doubled previous levels. In 1976, women received 30% of pharmacy degrees conferred. The proportion of women to men studying pharmacy first jumped beyond half in 1982 (51.9%). In 1993 (the latest year for which figures are available), among students pursuing a first pharmacy degree (BS or PharmD), 20,821 (63.2%) were women and 12,117 (36.8%) were men, according to AACP. AMERICAN PHARMACY
Not surprisingly, the number of women in practice is even· tually expected to catch up to the number of men in practice. A federal report predicts an increase in women practitioners from 48 ,900 in 1991 to 69,500 in 2000 , and to 105,900 in 2020. In contrast, the number of men in practice is expected to drop from 114,700 in 1991 to 111,900 in 2000, and to 107,900 in 2020. By 2020, the ratio of men to women among practicing pharmacists has been predicted to be virtually 1: 1. 5 This trend toward equal representation of the sexes in pharmacy offers impressive potential benefits for patient counseling efforts. Even though counseling has been mandated by OBRA '90 and many state pharmacy boards, its effective implementation clearly turns on the patient's willingness to communicate openly with the pharmacist. With the increasing likelihood of fmding both women and men pharmacists available to provide cOlIDseling, the individual patient who feels more comfortable talking about personal medical issues with either a woman or a man will have a choice. Many of the students now graduating from pharmacy school recognize the important contribution they can make toward strengthening the role that open, unbiased communication can play in the delivery of quality health care, and they have focused some of their energies on the issue of patient adv(} cacy. In many cases, patients may tell women pharmacists about health problems that they have not revealed even to their physicians. 5 The new face of phannacy-neither predominantly male nor female-will encompass the health care of every patient population and will focus sharply on efficient, effective delivery of pharmaceutical care. Eventually, the growing ranks of women pharmacists will help to erode any lingering vestiges of sexism, whether real or perceived, that remain from the time when pharmacy was ovelWhelmingly dominated by men schooled in an era that, to some degree, tolerated sexual discrimination. A nation of pharmacists comprised of women and men working side by side as colleagues and equals will surely help all pharmacists to embody more of the qualities of effective health care practitioners, including being caring, compassionate, patient, and sensitive, and using effective commlmication skills, particularly when interacting with difficult or elderly patients. Salaries during the first 15 years of a pharmacist'S professional practice are essentially equal for men and women. During the period from 16 to 35 years out of school, however, men's hourly wage equivalents seem to be higher than those of women, according to APhA's Committee on Women's Affairs. 5 One reason may be the higher proportion of men in management positions, especially top management. A 1988 APhA study showed that management positions were held more commonly by men than by women.5 Regarding pharmacy ownership or partnership , the discrepancy is even greater: 23.3% of men, compared with 4.5% of women. As fewer pharmacists recognize the desirability of owning a community pharmacy-formerly the July 1995
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goal of many young pharmacy graduates-the national trend is against ownership overall. Women as well as men are more likely to seek employment in pharmacy chains. A 1992 salary study showed that men were earning slightly more than women in both independent pharmacies and chains. 3 Women's raises, however, were proportionately higher than men's, and the gap in base pay between men and women was narrowing as well. Another issue pharmacists may face in the workplace is sexual harassment. New laws and a growing national awareness of the problem should help employees speak out when they are uncomfortable with the way they are being treated. APhA recommends that all pharmacy practice environments and educational settings have a written policy on sexual harassment prevention and grievance procedures. 8 APhA further recommends that sexual harassment awareness education be offered in every facility where pharmacists work. Problems with sexual harassment can occur both in larger settings, where a complex chain of command might make the woman pharmacist vulnerable to unwanted advances from a supervisor or co-worker, and in smaller phannacies, where no third person may be present to observe the situation or provide assistance. Safety is another concern for women pharmaciSts. Health con\ siderations must be factored into the tasks handled by phannacists. For example, special care must be taken in the handling of cytotoxic agents, a concern for both men and women. Physical safety can be an issue as well. The manager of a chain phannacy, for example, may be inclined to hire a man rather than a woman if the position requires the phannacist to work in isolation or late at night. 1bis sort of situation, which typifies the potential complexity of addressing the issue of sexual equality in the phannacy setting, can be seen as either discrimination or protection, depending on one's point of view. Many pharmacists also take advantage of flexible hours to balance their work and family responsibilities. Approximately 25% of practicing women pharmacists work part time. 5 That option may be beneficial for pregnant women and those with young children or other caretaking responsibilities. But it raises questions about effects on the job market. How will the potentially increasing cadre of part-time workers affect the workforce? Will it exacerbate the pharmacist shortage of today? How will the profession react to a change to part-time status by many, when it is already having difficulty covering the hours required in pharmacies that remain open more and more hours per day, seven days per week? Part-time opportunities may be the only alternative to the long hours that often characterize the pharmacy careers of those returning to full-time work. Community pharmacy employers may need to offer enticements to pharmacy school graduates, many of whom have shown a preference for hospital phannacy. Desirable benefits include flexible scheduling, flextime, on-site day-care centers Or reimbursement for day care, paid parental leave, job sharing, and part-time positions of responsibility. 5 Vol. NS35, No.7
July 1995
Follow the Vision, or Vanish Remarkable and swift changes in the health care environment have affected the community phannacy deeply. The traditional time crunch and rush to serve patients waiting for a prescription medication have grown tighter as demands on the phannacist increase. The only way to survive will be to investigate all conceivable methods of saving time. Chief among these will probably be the extensive, intelligent use of technicians and available technology. Product-oriented phannacists must rethink their priorities and become more patient oriented, acting as preceptors to students and colleagues. Those who fail to seize OpportLmities for increased patient counseling may be doomed to extinction. Technicians, robots, and other machines may essentially take over prescription preparation. Pharmacists who cling to the belief that they can continue to practice their profession in the same way it was practiced until the beginning of this decade are destined to experience frustration and, ultimately, financial distress. In contrast, tremendous opportunities await the entrepreneurial practitioner who is eager to explore diverse opportunities in the many areas now open to pharmaceutical care providers and in those that will unfold in years to come. Gregory A. Fox is a pharmacist and managed care coordinator at The Kroger Co., Cincinnati, Ohio.
References 1. Chi J. Inside today's pharmacist: 1992. Careers and workplace: part 1. Drug Topics. March 23, 1992:46-57. 2. Woo J. Suits against pharmacists are on the rise. Wall Street Journal. October 29, 1993:5. 3. Ukens C. Pharmacist salaries: who's getting the bigger bite? Drug Topics. April 5, 1993:42-54. 4. A conversation on compliance. The impact of OBRA '90: part 1. Drug Topics. March 22,1993:38-50. 5. Avery CS. The feminization of pharmacy. Am Druggist. September 1991:21-9. 6. Flanagan ME. Voluntary technician certification program reflects changes in practice. Am Pharm. May 1995;NS35:18-23. 7. Meade V. Scope of practice study: results now in. Am Pharm. September 1994;NS34:23-25. 8. APhA policy on sexual harassment and model guidelines. Am Pharm. December 1994;NS34:52-3.
Assessment Questions
Instructions: For each question, blacken the letter on the answer sheet corresponding to the answer you select as being the correct one. please review all answers to be sure you have blackened the proper spaces. There is only one correct answer to each question. 1.
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One of the most important obstacles to the widespread u e of phannacy technicians has been: . ., . a. State laws restricting use of techniClans ill commuruty pharmacies. . . b. Nationwide shortage of pharmacy techniClans. c. High wages demanded by pharmacy, technician unions. d. Lack of uniform credentialing for t~hnicians. e. Inability of technicians to perform dispensing functions. A IERICA. PHAR 1,\ Y
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2.
According to a 1992 survey, if choosing a career today, what percentage of pharmacists would still elect to enter the profession? a.25% b.45% c. 55% d. 75% e. 85%
Instructions
3.
The Omnibus Budget Reconciliation Act of 1990 mandates: a. Counseling on prescription medications for all patients. b. Counseling on prescription medications for all Medicaid patients. c. Referral of patients' medication questions to phYSicians. d. Counseling on prescription medications for all insured patients. e. None of the above.
4.
Which of the following changes has had a major impact on the worklife of the community phatmacist? a. Passage of OBRA '90. b. Changes in pharmacist demographics. c. Changes in health care delivery. d. Increasing use of computers. e. All of the above.
5.
In 1993, the average base pay for a community pharmacist was nearly: a. $35,000 b. $40,000 c. $45,000 d. $50,000 e. $60,000
6.
In 1993, among students enrolled in programs to earn a flrst pharmacy degree (BS or PharmD), approximately what per· centage were women? a. 15% b.22% c. 30% d.42% e. 63%
7.
Which of the following statements about the issue of sexual parity in pharmacy is false? a. More men than women phatmacists hold management positions. b. Nearly five times as many men as women own pharmacies. c. Raises for women pharmacists are lower than those for men. d. For both men and women, the trend is against pharmacy ownership. e. By 2020, the ratio of men to women among practicing pharmacists has been predicted to be virtually 1: 1.
8.
The objective of the Scope of Pharmacy Practice Project was to: a. Delineate the functions and responsibilities of pharmacists and pharmacy technicians. b. Study issues of sexual parity in pharmacy. c. Evaluate the impact of computerization on the community pharmacist. d. Investigate the use of robotics in pharmacy dispensing functions. e. None of the above.
9.
Job benefits that are important in recruiting and retaining pharmacists in community phatmacy include: a. Flextime. b. On-site day care. c. Paid parental leave. d. Job sharing. e. All of the above.
To receive one hour of continuing education credit (0.1 CEU) for successful completion of this program, you must: 1. Complete answer sheet and type or print your name, address, and Social Security number in the space provided. 2. Mail your completed answer sheet to:
Processing DesklEducation American Pharmaceutical Association 2215 Constitution Ave., NW Washington, DC 20037-2985 Processing fees paid by Schein Pharmaceutical, Inc. Certificates will be issued to those who score 70% or higher. Those who score below 70% will be notified, and no credit will be recorded. Allow four weeks for processing. Expiration date: July 31, 1998
Answer Sheet 1. 2. 3. 4. 5.
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Quality of Life for the Community Pharmacist APhA provider number for this program is: 680-202-95-008. Nrune __________________________________________ Address_________________________________________ City _ _ _ _ _ _ _ _ _ _ _ _ State
ZIP _________
Social Security # ____________________________ I hereby certify that I have taken this test: (signature)
Program Evaluation Excellent 5 5 5 Agree Important to phannacists 5 Increased my knowledge 5 Achieved stated objectives 5 Did not promote particular productorconapany 5 It took me hours and complete the assessment questions.
Overall quality Relevance to practice Value of content
AMERICAN PHARMACY
Poor
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10. Methods pharmacists can employ to manage the changes occurring in pharmacy include: a. Using technicians intelligently. b. Keeping up with advancing technology. c. Becoming more patient oriented. d. Acting as preceptors to students and colleagues. e. All of the above.
1
2 3 nainutes to read this article and
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July 1995
Vol. NS35, No.7
OF
PHARMACY
TM
GOMMUNlili¥
Quality of Life for the Community Pharmacist by Gregory A. Fox, as Pharm
White Paper Series No. 4 Too much to do, too little time to do i t keeping pace with rapid changes in the workplace has created a number of employee issues that community pharmacists are working to resolve.
CE Credit CE Credit To obtain one hour of continuing education credit (0.1 CEU) for completing "Quality of Life for the Community Pharmacist," complete the assessment exercise and CE registration form and return it to APhA. A certificate will be awarded for achieving a passing grade of 70% or better. Pharmacists completing this article by July 31, 1998, can receive credit.
IFE PC I The American Pharmaceutical Associa® tion is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education.
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APhA provider number \(QJ is: 680-202-95-008.
AMERICAN PHARMACY
Learning Objectives Upon successful completion of this continuing education program, the pharmacist should be able to: • Summarize recent changes that have had a dramatic impact on the worklife of community pharmacists. • Discuss OBRA '90 and its effects on the community pharmacist. • Review the changing demographics of practicing pharmacists. • Explain the benefits and drawbacks associated with increasing use of computers in community pharmacy. • Discuss strategies for optimal use of pharmacy technicians and available technology. • Describe plans to establish uniform credentialing for pharmacy technicians.
Introduction For generations, the worklife of the American community pharmacist has been one of quiet, low-key service aimed at ensuring accuracy in processing patients' prescription orders. Now, the pharmacist's typical day is characterized by additional responsibilities that vie for limited time resources. The many factors affecting the way a pharmacist works today include tremendously expanded counseling requirements and opportunities, due in part to passage of the Omnibus Budget Reconciliation Act of 1990 COBRA '90), which took effect January 1, 1993; dramatically changing workforce demographics and customer needs; and the anticipated overhaul of the entire national health care system. Most of these shifts have occurred fairly suddenly, offering little chance for a comfortable transition. July 1995
Vol. NS35, No.7
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Employee Issues Lack of empowerment is a frequent source of frustration for community pharmacists. Forces that are beyond most phannacists' control and shape their daily activities include third party contracts, government decisions, and the policy pronouncements of large pharmacy employers. Especially for new pharmacists who are just starting their careers, this lack of professional autonomy can lead to feelings of depersonalization and loss of idealism. In particular, those who graduate with the expectation of spending much of their time delivering pharmaceutical care may become disillusioned when their employment consists almost entirely of processing prescriptions. Pharmacists are for the most part unable to determine their work hours, work pace, or working conditions. True, staffing a pharmacy adequately can be difficult when patient demand is uneven, but a critical question remains: What is a reasonable number of prescriptions to process within a specified period without jeopardizing quality and safety? A 1992 survey showed that, on an average day, the typical community pharmacist dispenses 129 prescription medications (109 for independents, 154 for chains), consults with physicians seven times, and counsels 31 patients. 1 These activities represent only one aspect of the job as it exists today. Since the survey was conducted, OBRA '90 guidelines have mandated counseling for all Medicaid patients, and most states have passed laws that mandate counseling for all patients. Although it clearly takes time to learn to use new technology, including computer systems, formal training during work hours is often lacking. When the pharmacy owner or chain brings in new equipment that is for sale or rental, the employed pharmacist must become suffiCiently adept at its use to be able to instruct patients who want to buy or rent it. For example, the pharmacist may be called on to provide guidelines for proper use of home blood pressure monitors, breast pumps, and crutches. Finding time to do so may be as difficult as fmding time to learn new computer systems and programs. Nevertheless, this learning must be done. On the bright side, each new skill learned gives the pharmacist additional satisfaction, usefulness, and employability. If asked, employees who complain about their working conditions can often make constructive suggestions for correcting them. Employees are usually grateful when their supervisors make an effort to listen to their problems and implement improvements. Providing classes in time management, stress reduction, negotiation, and customer relations techniques during paid work hours will be increasingly useful to community pharmacists and, in the long run, their employers. In geographic areas suffering from a shortage of pharmacists, keeping staff pharmacists happy reduces attrition and brings in good employees through positive word of mouth. If they were choosing a career now, would most pharmacists still elect to enter the field? In a recent survey, only slightly more than half (55%) said yes. 1 Nevertheless, that percentage was higher than the 47% who gave similar answers a decade Vol. NS35, No.7
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before. Additionally, the proportion of those saying that they would opt for a different profession dropped from 34% in 1983 to 26% in 1992.1 Chain pharmacists were less satisfied overall than were hospital and independent pharmacists in both the 1983 and 1992 surveys. Among the 8% of 1992 respondents who planned to switch to a different type of practice, the highest proportion worked in chains. Cited most often as reasons to change were a desire for better hours and working conditions and the lack of challenge in current positions.
Owner Issues For many years, pharmacy was often a working-class person's route to respectability and fmancial security. As a profession that opened its doors to aspirants from diverse cultural and socioeconomic backgrounds, pharmacy also provided opportunities for children of working-class families to achieve profe~ sional status. Under the GI Bill of Rights, a pharmacy degree became a ticket to middle-American security. It was a route to socioeconomic improvement, a stable worklife, responsibility and autonomy, and prominence in the community. The children of these pharmacists grew up watching their parents, usually their fathers, work extraordinarily hard to make a living. As the career possibilities open to young people seeking a medicine-related career have widened, their interest in pursuing a lifestyle that calls for decades of commitment and sacrifice has narrowed. With small pharmacies closing at an alarming rate-5% or 6% each year for the past several years-security is no longer so certain as it once was. Making a living as a pharmacy owner has become increasingly difficult, not only because of the strictures of state and federallaws, but also as a result of numerous other profit-squeezing economic and health care trends; but it can be done. A seemingly insoluble problem for the owner of the community pharmacy is the inability to be in more than one place at the same time. The public expects to fmd a pharmacist on duty at every moment. This expectation can quickly propel the beleaguered single staff pharmacist or store owner to the point of burnout. It may mean either working 80 hours per week, as owners are increasingly disinclined to do, or hiring more staff. Unlike other profeSSionals, such as physicians, dentists, and accountants, community pharmacists with small staffs may fmd it difficult to take adequate lunch breaks or even steal a few minutes to use the lavatory, much less to answer or return physicians' calls, counsel patients, and pursue continuing education required for license renewal. Time-related pressure can become a major deterrent to the appeal of community pharmacy ownership as a career, if not addressed. On the other hand, owners of community pharmacies usually thrive on the challenges and rewards of entrepreneurship and enjoy the professional independence that comes with owning a business. Community pharmacists also enjoy daily contact with the public and derive personal fulfillment from providing a critical health care service that is generally highly AMERICAN PHARMACY
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respected and appreciated within the community. Another issue of great concern to community pharmacy owners is the extent to which they may become exposed to liability as patient counseling and other aspects of pharmaceutical care become increasingly integrated into their daily routines. Standards of practice for the "dispensing" of information directly to patients remain to be clearly defmed. Conflicting counseling information from the physician and pharmacist could confuse the patient. Worse, misunderstandings in communicating with physicians could conceivably lead to litigation by patients if the phYSician's intent in prescribing was not followed. Lack of action on the pharmacist's part also may prompt litigation, if the pharmacist neglects to provide a critical component of patient counseling. Lawsuits are now being ftled by patients against pharmacists, sometimes related to counseling given because of OBRA '90 mandates. 2 Pharmacists will have to remain cognizant of indications not only for prescribed medications, but for all health-related products the pharmacy sells. If a patient operates medical devices improperly after being trained by a pharmacist, who will be liable? Who should be held responsible if the patient supplies an inaccurate or incomplete medical history? As health care counseling reaches unprecedented levels in the pharmacy, leaders in the field must establish clear guidelines for these new activities.
Coping lNith Impatient Patients The constant of pharmacists' interactions with customers, once a mainstay of the comer drugstore (and a major source of its appeal), has faded over the past two decades. Instead, the pharmacist worked on a platform, typically well behind the counter and virtually out of sight. Sometimes a wall of glass firmly separated the pharmacist from the customer. Many patrons did not know what the pharmacist looked like. That distance is being closed with the promulgation of patient counseling. Food and Drug Administration Commissioner David A. Kessler has been outspoken about the need for pharmacists to take a proactive role in patient counseling, supplying written information in all cases and initiating dialogue when patients do not. As an unexpected benefit, passage of OBRA '90 has accommodated the desire of many pharmacists to provide more extensive patient-oriented care. To ensure equal services for all patients, many state pharmacy boards have issued a mandate to counsel not only Medicaid patients (as stipulated under OBRA '90) but everyone receiving a prescription medication. Patients transfer much of their frustration with phYSicians, employers, pharmaceutical manufacturers, and insurance companies to the pharmacist. They may be appalled at drug prices that they will have to pay partially out of pocket or entirely up front (with reimbursement coming weeks or months later). The pharmacist, typically the most accessible health care provider, must be prepared to handle patients' AMERICAN PHARMACY
anger. The key is not to take such outbursts personally. Expressing sympathy is far more likely to soothe irate patients than is indignation. What of the pharmacist trained not to answer patients' questions, but to refer them to the physician, as the 1975 pharmacist's Code of Ethics of the American Pharmaceutical Association (APhA) required? Until recently, those who went to pharmacy school received minimal instruction in patient counseling, communication, or teaching techniques. Yet they now see their former primary role-processing of prescription orders-being taken over by technicians, or even by machines. Adapting to change of such magnitude can be difficult. As long as counseling by pharmacists is viewed by the public, the legislatures, and the medical and legal communities as an important added component of health care delivery, pharmacists will have the potential to benefit both fmancially and professionally from their expanded role. If this added responsibility leads to unfair liability, however, pharmacists will need to address this.
Salaries According to a nationwide survey of 6,300 pharmacists, the average base pay for employee pharmacists in early 1993 was $49,800. 3 The average yeady increase of 9.7% was acceptable, but lower than in previous years. Pay raises were highest for those employed by chain pharmacies (11.4%) and health maintenance organizations 01.3%). For independents, the average increase was 8.1%. The average hourly pay for a full week's work was $23.62. About 60% of respondents said that they worked overtime. Bonuses were given to 58% of pharmaciSts, down 7% from 1990 and 12% from 1988. The newly graduated pharmacist may be pleased with a substantial starting salary (averaging close to $50,000) that will help payoff education loans and support a family. However, pharmacists working in community pharmacies may later be disappointed by the small increments to follow -some salaries increase only two or three percentage points per year, granted as cost-of-living adjustments. As compensation for cognitive and therapeutic services beyond dispensing continues to grow, owners and chains could, in all fairness, divert a proportion of payments for those services to employee pharmacists. Whether this proves to be the case remains to be seen.
Working Conditions Across the nation, pharmacies are being reconfigured to reduce or eliminate the separation between patient and pharmacist. The driving reason for much of the remodeling is the counseling mandated by OBRA '90 and many state boards of pharmacy. Some chains advertise the advantages of their new consultation areas. When patients discuss personal health issues during pharmacist consultations, they appreciate the privacy provided by these special areas. Pharmacists also July 1995
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benefit from creating an atmosphere that enhances recognition of the value of their counseling. Pharmacists spend a great deal of time on their feet, often reading small type. Padded carpeting and pleasant, nonglare lighting help minimize the discomfort that detracts from job satisfaction and productivity. Large chains are more likely to explore the advantages of ergonomic design extensively, but even small operations should make the effort to introduce these elements to improve the working environment and increase employee comfort, satisfaction, and productivity. Pharmacists increasingly enjoy the chance to step from behind the counter to "detail" physicians, meeting with them by appointment at their offices to discuss special services and products available at the pharmacy. Pharmacists may also speak at local schools about drug abuse, pharmacy careers, and other topics. Giving presentations at senior citizens' centers can help promote compliance with prescribed drug regimens.
Cotnputers Change Practice As in many other profeSSions, the advent of computers has
overwhelmingly and irrevocably changed the daily practice of pharmacy. In a relatively short time, computerization has become an inescapable component of the well-run pharmacy. More than 75% of independent and hospital pharmacies and 100% of chain pharmacies are computerized.3 The manual records on which pharmacists relied for many decades have become obsolete. Pharmacists who were educated and trained before the computer revolution, and who still feel more comfortable with a pencil and index cards, can no longer allow themselves to resist moving to the world of computer monitors and keyboards. The massive data storage and easy information retrieval made possible by computers enable pharmacists to print drug information as needed, thus obviating the storage of cartons of patient education materials. Electronic claims processing has introduced both timesaving and time-consuming tasks for the pharmacist. On the positive side, drug utilization review is greatly facilitated. Software is available to facilitate a vast array of actions, from checking drug-drug interactions to identifying potential allergic reactions to newly prescribed medications. "The Voice of Pharmacy" is an American Pharmaceutical Association educational program sponsored by an unrestricted grant from Schein Pharmaceutical, Inc. It is intended to provide pharmacists with a spectrum of opinions and information about the subjects they themselves feel are the most important issues facing pharmacytoday.
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On the negative side, every patient who walks in the door seems to have a different third party payer-each with an individual program and method of access to illes. Access can vary from calling up a patient's file by entering the patient's name, to entering the patient's Social Security number, special identification number, or address. The onslaught of literally hundreds of different health plans has made it crucial for pharmacists to be fast learners. Because this change to computerized health care tracking is most visible in the pharmacy, the patient tends to see it as a standard part of pharmacy practice and often expects the pharmacist to know everything about a particular plan instantaneously. Any hesitation or delay irritates the patient, who wants the prescription order processed without delay and without having to answer questions on plan procedures. Precisely when the pharmacist is expected to fmd the time to learn to operate these new computerized systems has not been defmed. As in other fields, such learning may have to take place on the pharmacist's own time. For those who grew up and were educated before the electronic era, adapting to an entirely new way of working-relying on a machine rather than handwritten notes and human contact-can be disorienting. Yet the field of pharmacy does tend to attract people who are conscientious, responSible, and scientific.
Changing Demographics
One element that makes the pharmaciSt's worklife an entirely different experience from that in the traditional pharmacy of 20- 25 years ago is changing demographics. As a neighborhood changes, the rush that used to be expected in the evenings and on weekends may occur at lunchtime. As the patient mix changes-for example, from young urbanites to geriatric patients-patients' needs shift. Pharmacists may fmd themselves accommodating a different clientele, with changes in average age, family structure, fmancial status, ethnic background, and even language. If a nearby company changes its health plan, patients may suddenly expect the pharmacist to understand the plan's most minute ramifications.
Best Use of Technicians
Pharmacists who want to spend more time on cognitive serVices and other endeavors, but who are too pressed by the demands of processing prescription orders, can benefit from the assistance of pharmacy technicians in dispensing and related activities acceptable to state law and the individual pharmacist. In California, pharmacy technicians have been permitted to work in outpatient pharmacies only since November 1, 1992. The state pharmacy board approved the new regulation in conjunction with a requirement that pharmacists counsel all patients. Until then, powerful pharmacist unions and other forces had prevented passage of regulations allowing wider use of technicians. The change was promoted by counseling requirements that were issued during a long-term, statewide
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shortage of pharmacists. The shortage had been intensified by California's traditional refusal to grant reciprocal status to health care professionals who earned their licenses in other states; thus, pharmacists are required to pass California's examination in order to practice there. Being able to employ pharmacy technicians has allowed busy pharmacists the time to do the counseling they are required by law to perform. In 22 states, only the phannacist can make the "offer to counsel" the patient or the patient's agent to whom a prescription drug is being dispensed. In other states, support personnel are learning communication skills to help cany the load of required consultation, assuming the phatmacist in question allows support staff to act as the first point of contact with the patient. Technicians have been fulfilling more extensive fimctions in phannacies since OBRA '90 went into effect. 4 APhA, the National Association of Boards of Pharmacy (NABP), and NARD say that the offer to counsel should be made by phatmacists only. The National Ass0ciation of Chain Drug Stores, however, has expressed the strong belief that individual companies should make that decision.5 Nationwide, one impediment to the widespread use of pharmacy technicians in the past has been lack of uniform credentialing of technicians. In California, for example, 1,500 hours of pharmacy work experience, with some stipulations as to what that experience included, is sufficient to permit registration as a pharmacy technician. Without a standard course of study and certification examination, technicians have had no official proof of their education and skills. Efforts are being made to correct that deficiency. APhA has joined with the American Society of Health-System Pharmacists (ASHP), the Michigan Pharmacists Association, and the Illinois Council of Hospital Pharmacists on a national voluntary pharmacy technician certification program. The first examination will be offered at 120 sites on July 29. 6 The functions, responsibilities, and tasks of pharmacists and pharmacy technicians were delineated by the comprehensive Scope of Pharmacy Practice Project. 7 The two-year study, concluded in 1994, was jointly sponsored by the American Association of Colleges of Pharmacy (AACP), APhA, ASHP, and NABP, under a $150,000 grant from the Pew Charitable Trusts. The project updated and revalidated the National Study of the Practice of Pharmacy, which was published in 1979.
Women's Issues The increasing number of women in pharmacy has been one of the profession's most highly visible trends. During the mid-1970s, the proportion of women in pharmacy schools more than doubled previous levels. In 1976, women received 30% of pharmacy degrees conferred. The proportion of women to men studying pharmacy first jumped beyond half in 1982 (51.9%). In 1993 (the latest year for which figures are available), among students pursuing a first pharmacy degree (BS or PharmD), 20,821 (63.2%) were women and 12,117 (36.8%) were men, according to AACP. AMERICAN PHARMACY
Not surprisingly, the number of women in practice is even· tually expected to catch up to the number of men in practice. A federal report predicts an increase in women practitioners from 48 ,900 in 1991 to 69,500 in 2000 , and to 105,900 in 2020. In contrast, the number of men in practice is expected to drop from 114,700 in 1991 to 111,900 in 2000, and to 107,900 in 2020. By 2020, the ratio of men to women among practicing pharmacists has been predicted to be virtually 1: 1. 5 This trend toward equal representation of the sexes in pharmacy offers impressive potential benefits for patient counseling efforts. Even though counseling has been mandated by OBRA '90 and many state pharmacy boards, its effective implementation clearly turns on the patient's willingness to communicate openly with the pharmacist. With the increasing likelihood of fmding both women and men pharmacists available to provide cOlIDseling, the individual patient who feels more comfortable talking about personal medical issues with either a woman or a man will have a choice. Many of the students now graduating from pharmacy school recognize the important contribution they can make toward strengthening the role that open, unbiased communication can play in the delivery of quality health care, and they have focused some of their energies on the issue of patient adv(} cacy. In many cases, patients may tell women pharmacists about health problems that they have not revealed even to their physicians. 5 The new face of phannacy-neither predominantly male nor female-will encompass the health care of every patient population and will focus sharply on efficient, effective delivery of pharmaceutical care. Eventually, the growing ranks of women pharmacists will help to erode any lingering vestiges of sexism, whether real or perceived, that remain from the time when pharmacy was ovelWhelmingly dominated by men schooled in an era that, to some degree, tolerated sexual discrimination. A nation of pharmacists comprised of women and men working side by side as colleagues and equals will surely help all pharmacists to embody more of the qualities of effective health care practitioners, including being caring, compassionate, patient, and sensitive, and using effective commlmication skills, particularly when interacting with difficult or elderly patients. Salaries during the first 15 years of a pharmacist'S professional practice are essentially equal for men and women. During the period from 16 to 35 years out of school, however, men's hourly wage equivalents seem to be higher than those of women, according to APhA's Committee on Women's Affairs. 5 One reason may be the higher proportion of men in management positions, especially top management. A 1988 APhA study showed that management positions were held more commonly by men than by women.5 Regarding pharmacy ownership or partnership , the discrepancy is even greater: 23.3% of men, compared with 4.5% of women. As fewer pharmacists recognize the desirability of owning a community pharmacy-formerly the July 1995
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goal of many young pharmacy graduates-the national trend is against ownership overall. Women as well as men are more likely to seek employment in pharmacy chains. A 1992 salary study showed that men were earning slightly more than women in both independent pharmacies and chains. 3 Women's raises, however, were proportionately higher than men's, and the gap in base pay between men and women was narrowing as well. Another issue pharmacists may face in the workplace is sexual harassment. New laws and a growing national awareness of the problem should help employees speak out when they are uncomfortable with the way they are being treated. APhA recommends that all pharmacy practice environments and educational settings have a written policy on sexual harassment prevention and grievance procedures. 8 APhA further recommends that sexual harassment awareness education be offered in every facility where pharmacists work. Problems with sexual harassment can occur both in larger settings, where a complex chain of command might make the woman pharmacist vulnerable to unwanted advances from a supervisor or co-worker, and in smaller phannacies, where no third person may be present to observe the situation or provide assistance. Safety is another concern for women pharmaciSts. Health con\ siderations must be factored into the tasks handled by phannacists. For example, special care must be taken in the handling of cytotoxic agents, a concern for both men and women. Physical safety can be an issue as well. The manager of a chain phannacy, for example, may be inclined to hire a man rather than a woman if the position requires the phannacist to work in isolation or late at night. 1bis sort of situation, which typifies the potential complexity of addressing the issue of sexual equality in the phannacy setting, can be seen as either discrimination or protection, depending on one's point of view. Many pharmacists also take advantage of flexible hours to balance their work and family responsibilities. Approximately 25% of practicing women pharmacists work part time. 5 That option may be beneficial for pregnant women and those with young children or other caretaking responsibilities. But it raises questions about effects on the job market. How will the potentially increasing cadre of part-time workers affect the workforce? Will it exacerbate the pharmacist shortage of today? How will the profession react to a change to part-time status by many, when it is already having difficulty covering the hours required in pharmacies that remain open more and more hours per day, seven days per week? Part-time opportunities may be the only alternative to the long hours that often characterize the pharmacy careers of those returning to full-time work. Community pharmacy employers may need to offer enticements to pharmacy school graduates, many of whom have shown a preference for hospital phannacy. Desirable benefits include flexible scheduling, flextime, on-site day-care centers Or reimbursement for day care, paid parental leave, job sharing, and part-time positions of responsibility. 5 Vol. NS35, No.7
July 1995
Follow the Vision, or Vanish Remarkable and swift changes in the health care environment have affected the community phannacy deeply. The traditional time crunch and rush to serve patients waiting for a prescription medication have grown tighter as demands on the phannacist increase. The only way to survive will be to investigate all conceivable methods of saving time. Chief among these will probably be the extensive, intelligent use of technicians and available technology. Product-oriented phannacists must rethink their priorities and become more patient oriented, acting as preceptors to students and colleagues. Those who fail to seize OpportLmities for increased patient counseling may be doomed to extinction. Technicians, robots, and other machines may essentially take over prescription preparation. Pharmacists who cling to the belief that they can continue to practice their profession in the same way it was practiced until the beginning of this decade are destined to experience frustration and, ultimately, financial distress. In contrast, tremendous opportunities await the entrepreneurial practitioner who is eager to explore diverse opportunities in the many areas now open to pharmaceutical care providers and in those that will unfold in years to come. Gregory A. Fox is a pharmacist and managed care coordinator at The Kroger Co., Cincinnati, Ohio.
References 1. Chi J. Inside today's pharmacist: 1992. Careers and workplace: part 1. Drug Topics. March 23, 1992:46-57. 2. Woo J. Suits against pharmacists are on the rise. Wall Street Journal. October 29, 1993:5. 3. Ukens C. Pharmacist salaries: who's getting the bigger bite? Drug Topics. April 5, 1993:42-54. 4. A conversation on compliance. The impact of OBRA '90: part 1. Drug Topics. March 22,1993:38-50. 5. Avery CS. The feminization of pharmacy. Am Druggist. September 1991:21-9. 6. Flanagan ME. Voluntary technician certification program reflects changes in practice. Am Pharm. May 1995;NS35:18-23. 7. Meade V. Scope of practice study: results now in. Am Pharm. September 1994;NS34:23-25. 8. APhA policy on sexual harassment and model guidelines. Am Pharm. December 1994;NS34:52-3.
Assessment Questions
Instructions: For each question, blacken the letter on the answer sheet corresponding to the answer you select as being the correct one. please review all answers to be sure you have blackened the proper spaces. There is only one correct answer to each question. 1.
11
One of the most important obstacles to the widespread u e of phannacy technicians has been: . ., . a. State laws restricting use of techniClans ill commuruty pharmacies. . . b. Nationwide shortage of pharmacy techniClans. c. High wages demanded by pharmacy, technician unions. d. Lack of uniform credentialing for t~hnicians. e. Inability of technicians to perform dispensing functions. A IERICA. PHAR 1,\ Y
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2.
According to a 1992 survey, if choosing a career today, what percentage of pharmacists would still elect to enter the profession? a.25% b.45% c. 55% d. 75% e. 85%
Instructions
3.
The Omnibus Budget Reconciliation Act of 1990 mandates: a. Counseling on prescription medications for all patients. b. Counseling on prescription medications for all Medicaid patients. c. Referral of patients' medication questions to phYSicians. d. Counseling on prescription medications for all insured patients. e. None of the above.
4.
Which of the following changes has had a major impact on the worklife of the community phatmacist? a. Passage of OBRA '90. b. Changes in pharmacist demographics. c. Changes in health care delivery. d. Increasing use of computers. e. All of the above.
5.
In 1993, the average base pay for a community pharmacist was nearly: a. $35,000 b. $40,000 c. $45,000 d. $50,000 e. $60,000
6.
In 1993, among students enrolled in programs to earn a flrst pharmacy degree (BS or PharmD), approximately what per· centage were women? a. 15% b.22% c. 30% d.42% e. 63%
7.
Which of the following statements about the issue of sexual parity in pharmacy is false? a. More men than women phatmacists hold management positions. b. Nearly five times as many men as women own pharmacies. c. Raises for women pharmacists are lower than those for men. d. For both men and women, the trend is against pharmacy ownership. e. By 2020, the ratio of men to women among practicing pharmacists has been predicted to be virtually 1: 1.
8.
The objective of the Scope of Pharmacy Practice Project was to: a. Delineate the functions and responsibilities of pharmacists and pharmacy technicians. b. Study issues of sexual parity in pharmacy. c. Evaluate the impact of computerization on the community pharmacist. d. Investigate the use of robotics in pharmacy dispensing functions. e. None of the above.
9.
Job benefits that are important in recruiting and retaining pharmacists in community phatmacy include: a. Flextime. b. On-site day care. c. Paid parental leave. d. Job sharing. e. All of the above.
To receive one hour of continuing education credit (0.1 CEU) for successful completion of this program, you must: 1. Complete answer sheet and type or print your name, address, and Social Security number in the space provided. 2. Mail your completed answer sheet to:
Processing DesklEducation American Pharmaceutical Association 2215 Constitution Ave., NW Washington, DC 20037-2985 Processing fees paid by Schein Pharmaceutical, Inc. Certificates will be issued to those who score 70% or higher. Those who score below 70% will be notified, and no credit will be recorded. Allow four weeks for processing. Expiration date: July 31, 1998
Answer Sheet 1. 2. 3. 4. 5.
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Quality of Life for the Community Pharmacist APhA provider number for this program is: 680-202-95-008. Nrune __________________________________________ Address_________________________________________ City _ _ _ _ _ _ _ _ _ _ _ _ State
ZIP _________
Social Security # ____________________________ I hereby certify that I have taken this test: (signature)
Program Evaluation Excellent 5 5 5 Agree Important to phannacists 5 Increased my knowledge 5 Achieved stated objectives 5 Did not promote particular productorconapany 5 It took me hours and complete the assessment questions.
Overall quality Relevance to practice Value of content
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Poor
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Disagree
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10. Methods pharmacists can employ to manage the changes occurring in pharmacy include: a. Using technicians intelligently. b. Keeping up with advancing technology. c. Becoming more patient oriented. d. Acting as preceptors to students and colleagues. e. All of the above.
1
2 3 nainutes to read this article and
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July 1995
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