Balancing the tension

Do community pharmacists perceive a tension between their roles as healthcare providers and retailers?

Pharmacists experience tension between being healthcare providers and being retailers, but they employ some strategies to manage this, according to a recent article published in the Journal of Pharmacy Practice and Research.

Researchers from Massey Business School in Auckland, New Zealand, conducted a qualitative study through 10 in-depth, semi-structured interviews.

Participants included pharmacy owners and managers of community pharmacies within a major city in New Zealand, across a diverse range of locations.

Several participants perceived that they had to balance a tension between their role as healthcare providers and their retailer activity “to meet commercial objectives”.

One said that: “The margins have been squeezed and it’s more difficult to make a buck, you’re having to balance it against trying to be a professional and what not, and not just being a hard businessman.”

Another acknowledged that owners/managers have to balance these different objectives.

“The two can live quite happily together…It’s that fine balance. The difference is when one overtakes the other. That’s when it becomes dangerous.”

Researchers found that several interviewees initially denied any tension, but eventually described some of the competing values at play.

Others said they personally did not experience tension but knew of others who did.

“You got those that actually really are just in it for the money, trying to make lots of money”, said one participant.

However they added: “There’s no tension for me personally in this pharmacy having to be a health practitioner and a business owner”.

Another participant said they often advise the patient to forgo a product and instead visit the doctor.

“In some instances, they are so sick that we say, look, don’t buy this. It’s a waste of money. You need to see a doctor. You’re that sick that you should go and see a doctor because buying these type of things is just delaying the inevitable or masking signs of something that could be more wrong.”

‘We give a lot for free’

There was also a perception among pharmacy owners that a lot of service provision is given for free and remuneration from government authorities is insufficient or misaligned.

A participant explained: “We do a lot of sort of basic diagnosing within the scope of what we’re allowed. All day long, we’re doing it for people, for which we don’t get reimbursed for.”

“Slowly they’re starting to bring medicines into the scope of where we do get reimbursed for some of the stuff that we do, but it’s very slow coming. We provide a lot of service to the community for nothing.”

There was also tension related to government policy and perceived misalignment in community pharmacy funding models.

Several participants perceived that the commercial side often needs to support the clinical activity within the pharmacy.

“If you just only rely on your income from the government on the dispensing fees, then you’re not going to be able to, anyways, business-wise be viable,” added another participant.

“I think retail is also a very important part of the business to keep us afloat.”

Pharmacy owners and managers said they managed the tension through informal discussions, training and a focus on ‘solutions-based selling’.

Several participants said they believed it was inappropriate to motivate staff with incentives in community pharmacy.

Many described a lack of business management skills, saying they were provided minimal training in pharmacy school.

Ramsay Health recently called for partial deregulation arguing that restricting ownership of pharmacies to pharmacists only potentially poses a risk to consumers.

“The current rules force pharmacist owners to devote significant time and effort towards running a business rather than spending that time focusing on the delivery of pharmacist services to promote quality patient care and public confidence,” stated its submission to a Queensland Parliamentary Inquiry into the pharmacy sector.

“This is the case especially for independent owners. It is no small task for proprietors to have to excel in finance, business management, administration, human resources and marketing as well as their professional obligations as a pharmacist.”

See the full study here

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  1. pagophilus

    Interesting – but only 10 participants? Only owners and managers? Why perform such unrepresentative research? Everything we learn about selecting your sample, ensuring it is representative of your study population, ensuring the validity of the research etc goes out the window.
    Send out a questionnaire or interview 1000+ pharmacists.

    • Greg Kyle

      Pagophilus, I was not involved in this research, but speaking as a researcher, when we do send out thousands of surveys, there are only a small percentage of them that come back! A 15% response rate is considered not too bad. Ideally, researchers would like to have a representative sample respond, but that is where we have no control.
      This study used a method of in-depth interviews. These are time consuming for both researchers and participants to conduct and then to analyse, however, you do get much richer data than a paper or online survey. In this in-depth qualitative research, 10-15 participants is considered a reasonable sample size and usually data saturation (ie. no new themes being identified) will occur around this level.

      • Raymond Li

        Perfect response Greg. The aims of qualitative research such as this one is all about breadth, rather than representation.

    • Gavin Mingay

      Considering it is the owners/managers of pharmacies in one Kiwi city, ten is probably a fairly good number. NZ is a pretty tiny place..

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