The Value Strategy Guy
I help frustrated, overworked professionals worried about the state of their profession, select and implement the best value strategy possible so they can get paid what they are worth and build a secure future for themselves and their families.
The profession of pharmacy has been an awesome career for me. It has allowed me the freedom to practice in a variety of environments and to provide for my family. But the profession I entered in 1977 is not the profession we are looking at today. And in my opinion, many of the commonly held beliefs about the profession are keeping people from being successful. My goal is to challenge your unsaid assumptions and internal biases. By challenging those biases, I believe you will discover a new world of opportunity for your career.
There are three big misconceptions that I believe the profession has been singing the wrong song about. I don’t think anybody has been doing this intentionally to harm the profession and yet I think the lack of progress the profession has made primarily emanates from some of these misguided assumptions.
The Field of Dreams Strategy
The first mantra that has been pounding through the profession for the last 40 years is what I call, the field of dreams strategy. We have felt that, “if we build it they will come.” We have believed that if we improved the clinical skills of our professional pharmacists that the public would willingly pay for these new services. However, this has failed to happen, and it has failed to happen because leadership misunderstands how value is created for a target market.
A recent article in the American Journal of the Pharmacy Association pointed this out very clearly when their survey of patients who had been exposed to medication therapy management services came back with some unexpectedly negative results. Approximately 60% of the patients who were aware of the services and aware of what the pharmacist could do said they had no interest or not very much interest in receiving the services.
Let me tell you what I think this means. It does not mean that those services are not valuable. It does not mean that people don’t need those services. What it means is our profession has done a terrible job of marketing those services. We argue with ourselves. We write articles in our journals. We complained to our legislators. But we have never made a compelling case to our patients that what we do is critical for their health.
There is no more clear proof of this than comparing what pharmacists have done for their profession to what dentists have done for their profession. If you ask any adult in America how often they need to go to their dentist to have a good thorough cleaning and inspection they will tell you every six months. If you ask anyone in America how often should a person taking multiple medications go to their pharmacist for a complete medication review, you will be met with blank stares. Again, we have done a terrible job of marketing our profession.
The Technology will set you free Myth
The next misguided assumption that has been percolating for years is the idea that technology will set the pharmacist free to do their job better. The huge mistake here has been that leaders have failed to differentiate between sustaining innovations and disruptive innovations. The technologies they tout, as wonderful have largely been sustaining innovations like robotic dispensing devices, automated Pyxis machines, automated packaging devices, central fill and computerized messaging services. All of these sustaining innovations have one simple goal, to reduce the amount of labor needed to fill a prescription. As a result, employers have used these technological innovations as a way to reduce payroll and not expand services. Translation, less pharmacists needed.
The real power of technology will be when disruptive innovations create entirely new markets in which pharmacists can operate in charge for their value. Failing to differentiate between sustaining and disruptive innovations has caused confusion and led to in action. We need to stop repeating the lies and start living the truth. Those of you with great ideas need to create technological innovations that improve patient outcomes and when that happens patients will pay for what we do. But you must liberate your brain from the dollar per our mindset in order to see the possibilities.
The Health Systems Pharmacy Practice is the Future of Pharmacy Myth
For many years pharmacy leaders especially in the academic realm have been touting the development of highly skilled health system pharmacist clinicians. The drive to require everyone to do residencies and to advance their clinical skills to become better pharmacists however is also a bit misguided in my opinion.
The facts are that over 60% of all pharmacists practice in the community pharmacy setting and it is likely that over 90% of all patient encounters occur in the community setting. In addition, Medicare policy drives hospital policy. Medicare is scheduled to be insolvent in the next few years. The government is essentially broke. What this has meant is that health care systems payment policies are now geared to keeping people out of the hospitals. Hospitals are rewarded for shorter stays. Hospitals are penalized for readmissions. And less than 25% of all pharmacists work in health systems positions. Clearly then the future of pharmacy practice is not going to reside in health systems pharmacy practice.
Again, this does not mean that what health systems pharmacists do is not valuable. The extremely talented pharmacists working in those environments do a great job. But they will probably never be more than 25% of working pharmacists if you believe the projections of the United States Department of Labor Bureau of labor Statistics. They are getting paid less than community pharmacists in many cases. And they will never see the number of patient encounters the community practice pharmacist see. The big challenges we have in medication adherence, compliance with therapy, transitions of care, and achievement of patient outcomes all need to be managed in the community environment. That is where people live. That is where they have access to the pharmacist. And that is where those services can be paid for.
New hospitals are simply not being built. Small hospitals are being absorbed into big hospitals. Large hospital systems are consolidating their clinical services to centralized formats. What this means is that less pharmacists will be working in that environment over time.
So why is this important for you to understand?
If you wish to have a long and prosperous career in the practice of pharmacy you are going to have to learn how to create valuable services for paying customers, how to market those services effectively, and how to sustain that value over the length of your career.
