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On Being a Doctor |

A Day in the Life of a Corporate Retail Pharmacist

David D. Dore, PharmD, PhD
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From The Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Requests for Single Reprints: David D. Dore, PharmD, PhD, Brown University, Box G-121-7, 121 South Main Street, Providence, RI 02903; e-mail, david_dore@brown.edu.

Ann Intern Med. 2013;159(5):366-367. doi:10.7326/0003-4819-159-5-201309030-00014
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As a community pharmacist, I cannot be expected to be a patient's primary care provider. However, it seems that improving the patient-centeredness rather than the profit-centeredness of pharmacy care would prevent lost opportunities for patient–provider dialogue.





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sad but true observations bya pharmacist
Posted on September 7, 2013
Owen Linder MD FACP
solo private practice Medicare Advantage; in practice since 1982
Conflict of Interest: None Declared
Fight back
Control your destiny.
How? For you and your profession, I don't know.
The barbarians have breached the Rubicon.
Just off the cuff could you visualize a consortium of like minded pharmacists developing an independent concierge pharmacy chain?
Try being a compounding pharmacist.
My empathy, your game.
Best wishes
Be the change
Posted on September 30, 2013
Tina Brock
University of California, San Francisco
Conflict of Interest: None Declared
Dr Dore’s commentary certainly represents a composite case of what can be wrong with the job of a “corporate retail” pharmacist; however, I contrast the account of his first pharmacy job with that of my own. It was in a small town in an underserved state and the pharmacy was staffed by two pharmacists who had completed bachelor’s degrees in pharmacy and a technician who trained via the apprenticeship model. It, too, had a mirrored wall left from the soda fountain days. But we had great rapport with both the local medical community and the patients who sought us out for the excellent care they received. We didn't have turf battles – we were clearly considered part of the wider team working together to make our community healthier. The days were long, the salaries were nowhere near the current rate, but we had enough and the job was very fulfilling. I think Mrs da Silva and her family would have received better care at Medical Center Pharmacy. And I am thankful there are still some models like this out there though I agree the medical community as a whole could do better at standing up to the constraints of the insurance industry.

Stephen Covey said it best. “You have to decide what your highest priorities are and have the courage—pleasantly, smilingly, nonapologetically, to say ‘no’ to other things. And the way you do that is by having a bigger ‘yes’ burning inside.” Health care is broken – no doubt. But individual health care providers still have some choices and taken together those choices do not have to result in ineffectualness. These may, however, require some sacrifice at both the personal and professional levels.

If as a patient you or your family aren't receiving the attention you need to get the best results from your medicines, it’s time to find a better pharmacist. And if as a pharmacist, you can’t provide the care your patients deserve, it’s time to find a better job.
Author's Response
Posted on November 4, 2013
David Dore, PharmD, PhD
Brown Universtiy
Conflict of Interest: None Declared

I would like to thank Dr. Brock for noting that there are pharmacies where patient care is excellent. It was not these pharmacies, or pharmacists in general, that I intended to impeach in my characterization of the “typical” day in a corporate retail pharmacy. Rather, these pharmacies should stand as a model for the rest of the profession. My criticism was of the several-fold more prevalent chain pharmacies, which fill approximately 70% of all prescriptions in the US.(1)

Deserving of scrutiny in particular is the system of pharmacy, which like other healthcare systems provides a complex milieu. Early in my training I learned the well-known statement that, “every system is designed to get the results it gets” a philosophical idea that has helped other professions maintain the focus of quality improvement(2) on structure, processes, and outcomes of care in their plurality (3)and to recognize that the power of systems trumps individual wherewithal. Indeed, systems are complex, and if a patient is unhappy, finding a better pharmacist is a tall order. What defines a better pharmacist? How will I know when I have found him or her? What is the influence of his or her colleagues, pharmacy, bosses, sales incentives, and the like on his or her outcomes? Which pharmacists get the best outcomes and what are the outcomes we should care about anyway? How do we measure them? We have begun addressing these questions in other settings and perhaps now it is pharmacy’s turn.

I am afraid too that telling pharmacists to find a better job will do little to improve care. The system incentivizes many pharmacists to follow their “burning yes” right out of pharmacy practice, in part because of low interest in owning an independent pharmacy, the recognized setting in which local changes to systems are feasible(4). Certainly I am uninterested in owning a business that must compete with the vast economies of scale realized by the national chains.

Stephen Covey is also known for saying, “The main thing is to keep the main thing the main thing.” We, as a broader healthcare community, must first seek to understand the main influences on the quality of pharmacy care before proactively attending to change.

[1] National Association of Chain Drug Stores, 2011-2012 Chain Pharmacy Industry Profile, (Alexandria, VA: 2011).

[2] O’Connor GT. Every system is designed to get the results it gets. BMJ. 1997;315(7113):897-8.

[3] Donabedian A. Explorations in quality assessment and monitoring: the definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press; 1980.

[4] Brown CM, Cantu R, Corbell Z, Roberts K. Attitudes and interest of pharmacists regarding independent pharmacy ownership. J Am Pharm Assoc (2003). 2007;47(2):174-80.

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