Many are over 55, and new recruits are drawn to part-time work
By Alan Mozes
HealthDay Reporter
FRIDAY, March 17 (HealthDay News) -- U.S. pharmacists could be become a rare breed over the coming decade, as aging male practitioners retire and workers of both genders choose part-time work over a full-time work week, a new survey reveals.
The shortage looms even as the demand for prescription services rises, and pharmacists themselves call for more time to focus on patient care (such as immunization and drug counseling), beyond just dispensing medications.
"The key message is that there is a shortage of pharmacists," said survey project director David A. Mott, an associate professor in the school of pharmacy at the University of Wisconsin. "And certainly, pharmacists are busier than ever, and they may not have enough time to spend with patients answering questions about how to take their medications."
The survey, presented Friday at the American Pharmacists Association's annual meeting in San Francisco, was prepared by the Pharmacy Manpower Project Inc., a non-profit grouping of national pharmaceutical, professional, and trade organizations.
Mott and his colleagues reviewed written questionnaires completed in 2004 by 1,470 pharmacists randomly sampled from across the United States.
The surveys collected information on the pharmacists' demographic and employment status, hours worked per week, type and quality of work environment, and his or her future work plans.
The portrait that emerges is one of a shrinking workforce and the potential for a real shortage over the coming decade.
Almost 46 percent of practicing pharmacists are now female, the survey revealed -- up from 31 percent in 1990 and rising slightly since 2000. More than a quarter of these women are working part-time.
Just over 15 percent of male pharmacists were also found to be working similarly shortened hours.
Pharmacists are also an aging group, particularly men. More than 40 percent of male pharmacists are over 55, compared with just 10 percent of female pharmacists.
The researchers also found that, overall, both full- and part-time pharmacists -- whether stationed in a chain, supermarket, independent business, or hospital -- are working less than they did four years ago, while earning an average 38 percent more for their time.
Yet, despite a cutback in their work week, pharmacists are actually handling more prescriptions now than in the past -- presumably taking advantage of a rise in the number of non-pharmacist technicians who now assist drugstore customers.
Technology may also figure in pharmacists' ability to maintain service levels more efficiently. More than 60 percent of those surveyed said new equipment -- such as refill phone systems, bar coding, and medication counters -- have improved both productivity and quality of care, while boosting job satisfaction.
However, as technology improves service, it appears to be geared more toward enabling the faster dispensing of drugs, rather than expanding patient-care services such as face-to-face consultations.
In this respect, Mott and his team found that as pharmacies change, pharmacists still spend most of their time doing what they've always done: dispensing medications. In fact, pharmacists indicated that nearly half of their time is spent filling prescriptions, much as it was in 2000.
Patient consultation takes up 19 percent of their time, followed by business management (16 percent) and drug-use management (13 percent).
In general, the pharmacists said this emphasis on filling prescriptions takes away from consultation and drug-use management.
More than one out of every two pharmacists said their workload was high or excessively high, with 58 percent stating that their workload had increased (sometimes greatly) over the prior year.
Stress also figured into the work mix. Pharmacists often complained of inadequate staff, workloads that may hamper the level of service they can provide, difficulties with hard-to-handle patients, and being interrupted by people and phone calls.
Yet, despite these reservations, the survey did uncover several positive indicators. The pharmacist's attitude toward his or her job, for example, has become a more rosy one since 2000, particularly among those employed by independent stores.
More than 77 percent said they have a high level of job satisfaction, up from 66 percent in 2000.
Mott's team believes the nation's pharmacy schools need to emphasize this good news, while acknowledging that the industry is changing.
"We're looking 10 or 15 years down the road at a real change in our pool of pharmacists," said Mott. "There are only about 100 pharmacy schools in the country that graduate about 80 to 100 students [each] per year, so there's a limit to how we can deal with a shortage."
Sharlea Leatherwood, a past president of the National Community Pharmacists Association and a pharmacy owner in Kansas City, Mo., agreed that the problem is real and looming.
"We are experiencing a very large growth in the boomer population, and they are the ones who are taking a very large number of the meds," she noted. "So, the need for filling prescriptions grows just as we are losing pharmacists. This makes for a very serious situation."
More information
For more on pharmacy issues, visit the American Pharmacists Association.
SOURCES: David A. Mott, Ph.D., associate professor, school of pharmacy, University of Wisconsin, Madison; Sharlea Leatherwood, past president, National Community Pharmacists Association, D.C., and pharmacy owner, Kansas City, Mo.; March 17, 2006, presentation, American Pharmacists Association annual meeting, San Francisco
Last Updated: March 17, 2006
Copyright © 2006 ScoutNews LLC. All rights reserved.
Source
Friday, March 17, 2006
Thursday, March 16, 2006
Pharmacy Manpower Project Report Finds Ranks of Pharmacists Shrink as Job Demands Grow; Pharmacists Want More Time to Counsel Patients, Less Time Disp
3/15/2006 2:51:00 PM EST
The U.S. pharmacy profession could face a worsening
shortage of pharmacists in the next decade as more men prepare to
retire and more men and women opt for part-time work, according to a
new study released today by the Pharmacy Manpower Project, Inc. (PMP).
The National Pharmacist Workforce Study finds the potential worsening
shortfall coming at a pivotal time with pharmacists wanting to spend
less time dispensing drugs and more time providing patient-centered
services such as immunizations and counseling seniors on proper
medication usage and the Medicare Prescription Drug Plan. The study
was released today at the American Pharmacists Association's Annual
Meeting & Exposition and will be published in the May/June 2006 issue
of the Journal of the American Pharmacists Association (JAPhA).
The number of practicing women pharmacists increased from 31
percent in 1990 to 46 percent in 2004. The study finds a large
percentage of male pharmacists nearing retirement, with more than four
in 10 (41.2 percent) age 55 and over, compared with only about 10
percent of women. Meanwhile, more men and women are working part
time--27 percent of women and 15.5 percent of men in 2004 (compared to
23.4 percent and 11.6 percent, respectively, in 2000).
"The changing face of pharmacy will be increasingly evident in the
next five to 10 years with more women in the workforce, the potential
for more part-time work by pharmacists, and the desire of pharmacists
to spend more time on counseling and other patient services," says
David A. Mott, Ph.D., the study's project director and associate
professor and Hammel/Sanders chair in pharmacy administration at the
University of Wisconsin.
Although the trend of part-time work is increasing for both men
and women pharmacists, the study finds the trend toward more part-time
work is being fueled by women. For women age 31-50, more than 30
percent are working part time.
Pharmacists' roles are very diverse. In 2004 pharmacists spent 49
percent of their day dispensing drugs and 32 percent of their time on
activities such as advising patients on drug therapies, evaluating the
safety of drug therapy, administering vaccines, and counseling
patients on services ranging from self-care to disease management. The
results suggest pharmacists would like to spend only 39 percent of
their day dispensing drugs and increase the time spent providing
services to patients to 48 percent of their day.
"The roles of pharmacists continue to expand to meet the growing
and diverse needs of patients," says Lucinda L. Maine, Ph.D., PMP
President and Executive Vice President of the American Association of
Colleges of Pharmacy. Maine cited the critical role that pharmacists
have played this year in administering the Medicare Prescription Drug
Plan.
Consistent with the growing number of prescriptions dispensed in
community pharmacies, the workload for pharmacists has increased
between 2000 and 2004. Pharmacists report the high workload can
negatively affect their work, including activities such as ability to
take a break (48 percent), opportunity to reduce errors (36 percent),
time spent with patients (35 percent); and ability to solve drug
therapy problems (33 percent).
The most stressful events for pharmacists include inadequate
pharmacy technician staffing levels (38 percent), phone interruptions
(37 percent), and inadequate pharmacists' staffing (34 percent).
"Dealing with difficult patients" and "dealing with difficult
co-workers" are cited by 33 percent of pharmacists.
Despite the high workload, the study finds a high level of job
satisfaction. More than three-quarters (77 percent) of pharmacists in
2004 report a "high level" of job satisfaction compared with 66
percent in 2000.
"This study shows the need for pharmacy schools to produce the
best and brightest to meet these new health care challenges and
provide patients with the highest level of quality care," says Maine.
Results of the National Pharmacist Workforce Study were compiled
by a questionnaire completed by 1,470 practicing pharmacists.
The study was commissioned by the PMP. The PMP is comprised of
Academy of Managed Care Pharmacy, American Association of Colleges of
Pharmacy, American College of Apothecaries, American College of
Clinical Pharmacy, American Pharmacists Association, American Society
of Consultant Pharmacists, American Society of Health-System
Pharmacists, Bureau of Health Professions, National Association of
Chain Drug Stores, National Community Pharmacists Association,
National Council of State Pharmacy Association Executives, National
Pharmaceutical Association, Pharmaceutical Research and Manufacturers
of America and Pharmacy Technician Certification Board.
The Pharmacy Manpower Project, Inc. is a nonprofit corporation
consisting of all major national, pharmaceutical professional and
trade organizations. Its mission is to serve the public and the
profession by developing data regarding the size and demography of the
pharmacy practitioner workforce and conducting and supporting research
in areas related to that workforce.
(End of advance for release 12:01 a.m. PST March 17.)
CONTACT:
Pharmacy Manpower Project, Inc. (PMP)
Norida Torriente, 703-739-2330, ext. 1015
ntorriente@aacp.org
or
Brian Ruberry, 301-948-1709
br@allhealthpr.com
Source
Wednesday, March 15, 2006
Pharmacy Manpower Project Report Finds Ranks of Pharmacists Could Face Worsening Shortage
3/15/2006 2:51:00 PM EST
A new report finds the numbers of U.S. pharmacists could
continue to dwindle in the next decade as more men retire and more
professionals, particularly women, choose part-time work. The report,
prepared by the Pharmacy Manpower Project, Inc., will be released at a
press briefing on Friday, March 17, 4:30 p.m. PST, at the American
Pharmacists Association's Annual Meeting & Exposition in San
Francisco.
The National Pharmacist Workforce Study, to be published in the
May/June 2006 issue of the Journal of the American Pharmacists
Association, finds the potential shortfall coming at a pivotal time
with pharmacists desiring to spend less time dispensing drugs and more
time providing patient-centered services like immunizations and
counseling seniors about the new Medicare Prescription Drug Plan.
Who David A. Mott, Ph.D., Study Project Director and Associate
Professor & Hammel/Sanders Chair in pharmacy
administration, University of Wisconsin-Madison
Lucinda L. Maine, Ph.D., Pharmacy Manpower Project
President & Executive Vice President, American Association
of Colleges of Pharmacy
Katherine Knapp, Ph.D., Project Director, the Aggregate
Demand Index & Dean, College of Pharmacy, Touro
University-California
What National Pharmacist Workforce Study
When &
Where Friday, March 17, 4:30 p.m. PST
San Francisco Moscone Convention Center, Room 2018
San Francisco, CA
The Pharmacy Manpower Project, Inc. is a nonprofit corporation
consisting of all major national, pharmaceutical professional and
trade organizations. Its mission is to serve the public and the
profession by developing data regarding the size and demography of the
pharmacy practitioner workforce and conducting and supporting research
in areas related to that workforce.
CONTACT:
Pharmacy Manpower Project, Inc.
Norida Torriente, 202-253-5058
ntorriente@aacp.org
or
Brian Ruberry, 301-948-1709
br@allhealthpr.com
Source
Tuesday, March 14, 2006
Telepharmacy Project Expands Students' Practice Experience
Pharmacy students at Texas Tech University Health Sciences Center (TTUHSC) in Lubbock are now learning about telemedicine as a tool to deliver pharmacy services to a rural community. Third- and fourth-year students on the TTUHSC Lubbock campus spend a week during their rural rotation working with the telepharmacy system that links the TTUHSC Southwest Clinic pharmacy, the isolated community of Turkey, Texas, and Dr. Sid Ontai of Plainview, Texas.
In addition to providing needed pharmacy services in Turkey and nearby Quitaque, where residents have to drive an hour each way to the nearest pharmacy, the new telepharmacy project also enhances the education of pharmacy students. TTUHSC School of Pharmacy is the only pharmacy school in the state-and one of only two pharmacy schools in the nation-that requires students complete a Rural Clerkship in its Doctor of Pharmacy Program. Students complete six hours of didactic training prior to the rotation, where they learn the basics of telemedicine and telepharmacy.
"Students review various operating models that utilize telemedicine technology, such as primary to specialty care, low and mid-level provider to primary and specialty care, correctional and geriatric care," says Chuck Seifert, PharmD, regional dean for the TTUHSC School of Pharmacy in Lubbock. The classroom session also covers: 1) the technology issues of remote dispensing of medications, digitizing information and bandwidth requirements; and 2) practical issues of accessibility, quality of transmission, ability to make diagnoses, outcomes, and patient satisfaction.
During the week-long, hands-on telepharmacy experience, students spend one day observing the physician in Plainview, two days in Turkey and Quitaque observing the emergency medical technician delivering health care services under the direction of the Plainview physician, and one day working with the central pharmacist in Lubbock who receives prescription orders, performs validation activities, approves label generation at the remote site and counsels patients by videoconference.
"I really had a chance to see the telemedicine patient care process from all sides- doctor, patient, and pharmacist-and to see what is required on each end to make telepharmacy work," says Kris Zepeda, a 4th year pharmacy student from Seagraves, Texas. Suzanne Thompson, another 4th year pharmacy student from Seminole, Texas, says that the housecall experience she had in Turkey was unique and educational.
"For patients that were unable to leave their homes, we would deliver their medicines to them and do patient education in the home. On one of my days, a lady called in with an upset stomach. The doctor wasn't available to write a prescription, but we went to Allsup's and took her some Gatorade and pepto. I couldn't help think about when my grandparents lived in a small town. This would have been a great service for them," Thompson adds. One aspect that students really enjoy is the small-town atmosphere.
"The clinic in Turkey is in the same building as the Bob Wills' Museum-he's the Founder of Texas Swing. And patients come in to get their medications and stay and chat awhile,"
Zepeda says.
Both Thompson and Zepeda graduate in May 2004 and both have plans to return to their rural roots to practice pharmacy. Thompson will stay in Seminole, where she and her family have lived for 15 years, and work in a retail pharmacy. Zepeda plans to go into partnership at Nelson
Pharmacy in Brownfield, Texas. Both can foresee telepharmacy providing a needed service to isolated rural populations.
The telepharmacy project by Texas Tech-the first in Texas-was launched in September 2002. Since that time 26 students from the Lubbock campus have completed the telepharmacy component of the Rural Clerkship. Future plans include involving TTUHSC Amarillo and Dallas campus students in the telepharmacy rotation.
Source
Monday, March 13, 2006
Rural pharmacies torn between tradition, technology
By MICHAEL JAMISON
Missoulian
Source
Missoulian
KALISPELL -- Perched on the second floor of Harlowton's hospital is a big beige and blue vending machine.
It doesn't wear a starched smock, doesn't pace a raised dais, doesn't ask about your kids or remind you to stay out of the sun while you're on certain meds.
But it is, nevertheless, a pharmacist. Of sorts.
"The pharmacist of tomorrow is going to be unrecognizable to most of us," said Jim Ammen, pharmacy director at Missoula's Partnership Health Center and owner of Mission Drug in St. Ignatius. "He might not be a vending machine, but he's not going to be that quiet old white-haired guy up behind the counter, either."
Harlowton's vending machine arrived in 2004, not long after the town's last retail pharmacy was shuttered. Nowadays, a pharmacist 100 miles away in Billings punches a few buttons and that brown box in Wheatland County delivers your meds.
Patients step into a nearby phone booth undoubtedly the only of its kind in Harlowton for a quick video-chat with the pharmacist in Billings.
There are 60 meds in the big machine, half that in one slightly smaller, everything from antibiotics to inhalers to creams and salves.
"Telepharmacy," Ammen said, isn't nearly as good as the real thing, "but for some of these places, it's better than nothing."
Nothing is precisely what many small towns can expect if trends continue, pharmacists warn, as a new breed of drug plan "managers" whittle away profit margins.
It's a bit counterintuitive. More folks are using drugs. More drugs are available. More money is being spent and the drugs themselves are more expensive than ever. But pharmacists are facing tight margins, with not a few squeezed right out of the business.
The problem, according to pharmacists such as Ammen, is a thing called a PBM. That's shorthand for "pharmacy benefits manager," the company your insurer hires to control escalating health care costs.
Used to be, most folk paid for their prescription with cash. Nowadays, most prescriptions are covered, at least in part, by insurance.
Of course, those insurers and the people who pay the premiums want the best deal possible. So they get together and hire a pharmacy benefits manager, which then negotiates with both drug companies and pharmacies.
With the drug companies, PBMs try to get the best deal on a certain kind of medicine. If different companies make similar drugs, the lowest bidder becomes the "preferred" drug of choice for patients covered by that pharmacy benefits manager.
Often, drug companies give PBMs "rebates" pharmacists call them "kickbacks" if the PBM can assure that granting a company's drug "preferred" status will capture a certain percentage of the market share.
Pharmacy benefits managers also negotiate with pharmacists, using the combined weight of all their clients to leverage cheaper retail prices. Often, Ammen said, independent pharmacists have no footing from which to negotiate, and so are offered take-it-or-leave-it deals.
Accept it, and you make less money but retain more customers. Reject it, and your losses are less, but so is your volume.
"An independent pharmacist can't win," Ammen said. "At these prices, they can't stay in business."
When a pharmacist in a rural state like Montana can't stay in business, Paul Brand said, it can change everything for patients. Just remember that big beige box up in Harlowton.
"The PBMs are getting to the point where something has to break," Brand said.
Brand owns Florence Pharmacy south of Missoula, and also serves as president of the Montana Pharmacy Association. He predicts that "in five years, you're not going to see any pharmacy that's going to make it on prescriptions. Everything we think of when we think of a pharmacist is going to have to change."
His office is a good example, what with its newly opened medical equipment business.
Up at Ammen's office, there's a "clinical pharmacist" on staff,essentially a cross-breed between a physician and a pharmacist, a "pharmician," if you will.
The pharmician, Brand said, does some lab work, adjusts some doses, even crafts custom-made meds for individual patients.
For some patients, Brand said, he makes appointments, sees them in an office setting, helps to balance their medications, helps to measure meds' efficacy, helps to make sure they're not on too much or too little.
"This is a people business, not a money business," he said. "You have to know people, talk to them. It's become more and more of a price-driven marketplace, and that never is a good thing for health care, not when you're dealing with a system as complex as the human body."
Nevertheless, Brand touts the pharmician on the business of money, not just the business of people.
The hope is that pharmicians will actually save people money by reducing doctor visits and by catching drug problems that might otherwise result in a hospital or nursing home stay. If those savings can be proved, Brand said, then insurers will be more likely to pay for the pharmician's service.
"That's the bottleneck," Ammen agreed. "How do we convince people to pay?"
First, all agree, they will have to change people's very definition of pharmacist.
Such a definition shift isn't likely to come from the bottom up, because people's impression of what a pharmacist looks like is pretty firmly established. And it's not likely to come from the top down, because insurers and government aren't known for their progressive embrace of new and costly paradigms.
And so it will have to come from the middle out from the employers and others who provide coverage for millions of Americans. They are the ones, Ammen said, who must be convinced pharmicians will save them money in the long run.
The process, he said, recently received a boost from Medicare, which included as part of its latest prescription drug benefit overhaul a provision allowing for payments to pharmicians.
If the effort to shift from pharmacist to pharmician fails, he said, PBMs and competition from chain stores will push many more independents out of business.
"It's a horrible situation we're in right now," he said. "The time has come to evolve or go extinct..
"Right now, the only way it makes sense to run a rural pharmacy is in terms of job satisfaction," Brand said. "From a fiscal standpoint, it makes no sense at all."
That's one big reason small towns are finding it harder and harder to replace retiring pharmacists.
Start with a national pharmacist shortage. Add in competition from mail-order drug retailers. Complicate matters with reduced reimbursements, shrinking profit margins, increasing liability insurance costs. Coat it all with long hours, no vacation and you have a prescription for trouble in rural states such as Montana.
It's particularly worrisome, said Tim Stratton, because the connection between access to medication and quality of life is both strong and direct.
Stratton spent about a decade working on Missoula's university campus, studying and teaching the intricacies of medicine's socio-economic element.
"There's a big gap between urban and rural," he said.
In rural towns, the pharmacist is almost certainly an independent, as chains don't generally set up shop in small markets. And so they have no vacation time, no sick leave and, you guessed it, no prescription drug coverage.
But they do have debt, as do new pharmacy grads. Faced with a choice between living in rural Montana on a shoestring or making $100,000 working for a chain, the decision for most is a no-brainer.
It's also one reason Minnesota has a brand-new law offering a $12,000-per-year reimbursement for student loan debt to freshly minted pharmacists who are willing to take on a rural practice.
"There is little optimism," Stratton wrote back in 2001, "that these harsh realities will soon ease."
And the dilemma for independents, he wrote, "should create concern among policymakers for the economic viability of rural pharmacies."
Policymakers might take special note in Montana, a state predicted to soon rank third nationally in the number of people over age 65 per capita, from 13 percent in 2000 to nearly 25 percent in 2025.
"That's a lot of elderly people," Stratton said, "and they'll need a lot of pharmacy access. It's getting worse rather than better."
Source
Rural pharmacies’ future uncertain
KALISPELL (AP) — Perched on the second floor of Harlowton's hospital is a big beige and blue vending machine. It doesn't wear a starched smock, doesn't pace a raised dais, doesn't ask about your kids or remind you to stay out of the sun while you're on certain meds. But it is, nevertheless, a pharmacist. Of sorts.
"The pharmacist of tomorrow is going to be unrecognizable to most of us," said Jim Ammen, pharmacy director at Missoula's Partnership Health Center and owner of Mission Drug in St. Ignatius. "He might not be a vending machine, but he's not going to be that quiet old white-haired guy up behind the counter, either."
Harlowton's vending machine arrived in 2004, not long after the town's last retail pharmacy was shuttered. Nowadays, a pharmacist 100 miles away in Billings punches a few buttons and that brown box in Wheatland County delivers your meds.
Patients step into a nearby phone booth — undoubtedly the only of its kind in Harlowton — for a quick video-chat with the pharmacist in Billings.
There are 60 meds in the big machine, half that in one slightly smaller, everything from antibiotics to inhalers to creams and salves.
"Telepharmacy," Ammen said, isn't nearly as good as the real thing, "but for some of these places, it's better than nothing."
Nothing is precisely what many small towns can expect if trends continue, pharmacists warn, as a new breed of drug plan "managers" whittle away profit margins.
Pharmacists are facing tight margins, with not a few squeezed right out of the business.
One of the problems, according to pharmacists such as Ammen, are "pharmacy benefits managers," the company insurers hire to control escalating health care costs.
Of course, those insurers — and the people who pay the premiums — want the best deal possible, so they hire a pharmacy benefits manager, who then negotiates with both drug companies and pharmacies.
"An independent pharmacist can't win," Ammen said. "At these prices, they can't stay in business."
When a pharmacist in a rural state like Montana can't stay in business, Paul Brand said, it can change everything for patients.
"The PBMs are getting to the point where something has to break," Brand said.
Brand owns Florence Pharmacy south of Missoula, and serves as president of the Montana Pharmacy Association. He predicts that in five years, pharmacies in Montana aren't going to be able to survive on filling prescriptions.
"Everything we think of when we think of a pharmacist is going to have to change," he said.
His office is a good example, what with its newly opened medical equipment business.
"We do all sorts of things now," he said. "Home oxygen, you name it."
Up at Ammen's office, there's a "clinical pharmacist" on staff — essentially a crossbreed between a physician and a pharmacist.
The clinical pharmacist does some lab work, adjusts some doses, even crafts custom-made meds for individual patients, Brand said.
For some patients, Brand said, he makes appointments, sees them in an office setting, helps to balance their medications, helps to measure meds' efficacy, helps to make sure they're not on too much or too little.
"This is a people business, not a money business," he said. "You have to know people, talk to them. It's become more and more of a price-driven marketplace, and that never is a good thing for health care, not when you're dealing with a system as complex as the human body."
Nevertheless, Brand touts the clinical pharmacist on the business of money, not just the business of people.
The same blood test he can do for $20 might run $100 at a physician's office.
The hope is that the position will actually save people money, by reducing doctor visits and by catching drug problems that might otherwise result in a hospital or nursing home stay. If those savings can be proved, Brand said, then insurers will be more likely to pay for the clinical pharmicist's service.
"That's the bottleneck," Ammen agreed. "How do we convince people to pay?"
First, all agree, they will have to change people's very definition of pharmacist.
Such a definition shift isn't likely to come from the bottom up, because people's impression of what a pharmacist looks like is pretty firmly established. And it's not likely to come from the top down, because insurers and government aren't known for their progressive embrace of new and costly paradigms.
And so it will have to come from the middle out — from the employers and others who provide coverage for millions of Americans. They are the ones, Ammen said, who must be convinced clinical pharmicists will save them money in the long run.
The process, he said, recently received a boost from Medicare, which included as part of its latest prescription drug benefit overhaul a provision allowing for payments to clinical pharmicists.
"It's a start," Brand said, "and we've been talking to Blue Cross-Blue Shield here in Montana. They haven't said 'no' yet. There's at least enough interest to keep talking."
If the effort fails, he said, PBMs and competition from chain stores will push many more independents out of business.
"It's a horrible situation we're in right now," he said. "The time has come to evolve or go extinct."
But as the folks in Harlowton learned, extinct isn't a place you want your pharmacist to be.
"Right now, the only way it makes sense to run a rural pharmacy is in terms of job satisfaction," Brand said. "From a fiscal standpoint, it makes no sense at all."
That's one big reason small towns are finding it harder and harder to replace retiring pharmacists.
It's particularly worrisome, said Tim Stratton, because the connection between access to medication and quality of life is both strong and direct.
Stratton spent about a decade working on Missoula's university campus, studying and teaching the intricacies of medicine's socio-economic element.
"There's a big gap between urban and rural," he said.
Minnesota passed a new law offering a $12,000-per-year reimbursement for student loan debt to freshly minted pharmacists who are willing to take on a rural practice.
Policymakers might take special note in Montana, a state predicted to soon rank third nationally in the number of people over age 65 per capita, from 13 percent in 2000 to nearly 25 percent in 2025.
"That's a lot of elderly people," Stratton said, "and they'll need a lot of pharmacy access. It's getting worse rather than better."
Which is why vending machines and "telepharmacy" like the one in Harlowton are being looked at.
Stratton, Brand and others believe telepharmacy may be a big part of the future in rural Montana, just as telemedicine already is.
A pharmacy technician can work the rural site, supplying the medications that pop out of that vending machine even while the pharmacist meets with patients by video conference.
"This is a big, big shift in the pharmaceutical paradigm," Stratton said. "And it's already happening. It's happening right now, and it could save this industry."
Source
"The pharmacist of tomorrow is going to be unrecognizable to most of us," said Jim Ammen, pharmacy director at Missoula's Partnership Health Center and owner of Mission Drug in St. Ignatius. "He might not be a vending machine, but he's not going to be that quiet old white-haired guy up behind the counter, either."
Harlowton's vending machine arrived in 2004, not long after the town's last retail pharmacy was shuttered. Nowadays, a pharmacist 100 miles away in Billings punches a few buttons and that brown box in Wheatland County delivers your meds.
Patients step into a nearby phone booth — undoubtedly the only of its kind in Harlowton — for a quick video-chat with the pharmacist in Billings.
There are 60 meds in the big machine, half that in one slightly smaller, everything from antibiotics to inhalers to creams and salves.
"Telepharmacy," Ammen said, isn't nearly as good as the real thing, "but for some of these places, it's better than nothing."
Nothing is precisely what many small towns can expect if trends continue, pharmacists warn, as a new breed of drug plan "managers" whittle away profit margins.
Pharmacists are facing tight margins, with not a few squeezed right out of the business.
One of the problems, according to pharmacists such as Ammen, are "pharmacy benefits managers," the company insurers hire to control escalating health care costs.
Of course, those insurers — and the people who pay the premiums — want the best deal possible, so they hire a pharmacy benefits manager, who then negotiates with both drug companies and pharmacies.
"An independent pharmacist can't win," Ammen said. "At these prices, they can't stay in business."
When a pharmacist in a rural state like Montana can't stay in business, Paul Brand said, it can change everything for patients.
"The PBMs are getting to the point where something has to break," Brand said.
Brand owns Florence Pharmacy south of Missoula, and serves as president of the Montana Pharmacy Association. He predicts that in five years, pharmacies in Montana aren't going to be able to survive on filling prescriptions.
"Everything we think of when we think of a pharmacist is going to have to change," he said.
His office is a good example, what with its newly opened medical equipment business.
"We do all sorts of things now," he said. "Home oxygen, you name it."
Up at Ammen's office, there's a "clinical pharmacist" on staff — essentially a crossbreed between a physician and a pharmacist.
The clinical pharmacist does some lab work, adjusts some doses, even crafts custom-made meds for individual patients, Brand said.
For some patients, Brand said, he makes appointments, sees them in an office setting, helps to balance their medications, helps to measure meds' efficacy, helps to make sure they're not on too much or too little.
"This is a people business, not a money business," he said. "You have to know people, talk to them. It's become more and more of a price-driven marketplace, and that never is a good thing for health care, not when you're dealing with a system as complex as the human body."
Nevertheless, Brand touts the clinical pharmacist on the business of money, not just the business of people.
The same blood test he can do for $20 might run $100 at a physician's office.
The hope is that the position will actually save people money, by reducing doctor visits and by catching drug problems that might otherwise result in a hospital or nursing home stay. If those savings can be proved, Brand said, then insurers will be more likely to pay for the clinical pharmicist's service.
"That's the bottleneck," Ammen agreed. "How do we convince people to pay?"
First, all agree, they will have to change people's very definition of pharmacist.
Such a definition shift isn't likely to come from the bottom up, because people's impression of what a pharmacist looks like is pretty firmly established. And it's not likely to come from the top down, because insurers and government aren't known for their progressive embrace of new and costly paradigms.
And so it will have to come from the middle out — from the employers and others who provide coverage for millions of Americans. They are the ones, Ammen said, who must be convinced clinical pharmicists will save them money in the long run.
The process, he said, recently received a boost from Medicare, which included as part of its latest prescription drug benefit overhaul a provision allowing for payments to clinical pharmicists.
"It's a start," Brand said, "and we've been talking to Blue Cross-Blue Shield here in Montana. They haven't said 'no' yet. There's at least enough interest to keep talking."
If the effort fails, he said, PBMs and competition from chain stores will push many more independents out of business.
"It's a horrible situation we're in right now," he said. "The time has come to evolve or go extinct."
But as the folks in Harlowton learned, extinct isn't a place you want your pharmacist to be.
"Right now, the only way it makes sense to run a rural pharmacy is in terms of job satisfaction," Brand said. "From a fiscal standpoint, it makes no sense at all."
That's one big reason small towns are finding it harder and harder to replace retiring pharmacists.
It's particularly worrisome, said Tim Stratton, because the connection between access to medication and quality of life is both strong and direct.
Stratton spent about a decade working on Missoula's university campus, studying and teaching the intricacies of medicine's socio-economic element.
"There's a big gap between urban and rural," he said.
Minnesota passed a new law offering a $12,000-per-year reimbursement for student loan debt to freshly minted pharmacists who are willing to take on a rural practice.
Policymakers might take special note in Montana, a state predicted to soon rank third nationally in the number of people over age 65 per capita, from 13 percent in 2000 to nearly 25 percent in 2025.
"That's a lot of elderly people," Stratton said, "and they'll need a lot of pharmacy access. It's getting worse rather than better."
Which is why vending machines and "telepharmacy" like the one in Harlowton are being looked at.
Stratton, Brand and others believe telepharmacy may be a big part of the future in rural Montana, just as telemedicine already is.
A pharmacy technician can work the rural site, supplying the medications that pop out of that vending machine even while the pharmacist meets with patients by video conference.
"This is a big, big shift in the pharmaceutical paradigm," Stratton said. "And it's already happening. It's happening right now, and it could save this industry."
By MICHAEL JAMISON - Missoulian - 02/19/06
Source
Subscribe to:
Posts (Atom)
