Discounting domination, accelerated price disclosure, stagnation of pharmacist wages… what happened in the last decade in pharmacy, and will the next be brighter?
In his 2019 Neil Naismith commemorative lecture delivered in Victoria on Tuesday, PSA National President Chris Freeman spoke about the past and present roles of pharmacists—as well as where they could be in the future.
Themed around the recent viral internet sensation called the “10 Year Challenge”, Dr Freeman looked at where the pharmacy industry and pharmacist roles were in 2009 compared to what they are now in 2019.
“It was to demonstrate a point that, in my view, pharmacist practice over the last 10 years hasn’t changed that significantly,” he tells AJP.
“Apart from a few significant components which are things like vaccinations, we have had some additional services available through community pharmacy like MedsChecks and Clinical Interventions, and by the same token we’ve also seen a lot of the other programs capped.
“There is a caveat: in my opinion there has been significant change in the environment in which pharmacists are practising.”
This change includes the rise of the discount pharmacy, combined with enhanced price disclosure leading to stagnation of employee pharmacist wages, he says.
“If you look at the community pharmacy sector for example, in 2009 we had a couple of years of price disclosure but then after that we had several cycles of accelerated price disclosure,” says Dr Freeman.
“Certainly that changed the environment of the community pharmacy sector in terms of sustainability… We also saw as gross profit per pharmacy’s decreased, a decrease in the wage of the pharmacist.
“The hourly rate that I put on my slide was almost arbitrary – if you look anywhere you’ll notice that the numbers vary – those figures I think I got from the ABS. The figure itself wasn’t the point—it’s that there has been stagnation of pharmacist wages.
“And I think the other thing is that in 2009 we saw the emergence of this discounting model. But over the last 10 years what we’ve seen is this discounting really starting to dominate the landscape.
“It’s changed the culture and the conversations that pharmacists are having with patients. Where previously it was around issues with quality use of medicines or around the medicines themselves, more and more members are telling us now that those conversations which are initiated by the patient are focused on price of pharmaceuticals rather than the actual quality use of medicines.”
As a response the PSA and other pharmacy organisations have continued to try and push community pharmacy into a services-based model “and to move away from this volume- or product-driven model,” Dr Freeman says.
“But what we haven’t done for the profession is provide them with frameworks to be able to do that, and that includes a funding framework which would allow community pharmacy in particular to genuinely invest in a services-based model,” he says.
“Part of that is around the Community Pharmacy Agreement. My view is that practice follows funding. If we set the funding framework up properly we will encourage genuine investment by the sector to practise in the way that we think is the best possible way to practise, to deliver the best possible care for patients.
“Instead of having paralysis in the face of ambiguity, we need to be brave in 2019.” – Dr Chris Freeman
“At the moment, the way that the agreement is set up doesn’t allow significant investment in the professional services that are delivered through the CPA.
“And that’s because the funding volume is not great, comparative to other parts of the agreement, and that there are limitations on those services in terms of capping.
“To add to that is that we’ve now got a real opportunity to look outside the CPAs to support investment in pharmacist services beyond the typical channels that we’re used to.”
Dr Freeman refers to the PSA’s continual push to have pharmacists added to the MBS, being the only AHPRA-registered health professional not able to deliver chronic disease management under the scheme.
“It doesn’t make sense. It makes me so furious that pharmacy is constantly left off any policy or services that are coming out, they’re pushed to one side. You’ve got to be seen as an absolute necessity rather than as a ‘nice to have’, and we’ve got to change that perception,” he tells AJP.
“And I think we’ve got to be able to look at other funding sources such as potential patient contribution and private health insurance.
“If we have access to those funding sources I think we will see an increase in funding into the sector, and in my view we would see a rise in not only the sustainability of the community pharmacy sector, but also a rise in the wage in which pharmacists are being paid based on what they should be paid.”
Dr Freeman refers to a quote shared at the lecture by Martin Luther King which says: “You don’t have to see the whole staircase, just take the first step”.
“It was a call to action in that yes, we may not be able to see what lies in front of us over the next 10 years, but instead of doing nothing we’ve got to do something and we’ve got to take the first step together.
“Instead of having this paralysis in the face of ambiguity, we need to be brave in 2019.”
What pharmacists said in response to Dr Freeman’s #10YearChallenge:
The answer is pharmacists.
Pharmacists are the biggest barrier to change and growth in practice, as well as being the ones to help drive it.
Let’s hope by 2025 and 2030 the state we are in is different, better. @PSA_National
— Vasili Sotiropoulos (@Vasili_Sotiro) February 5, 2019
I agree individuals bare a lot of responsibility but let’s not forget Gov has implemented policies that reduce real revenue from pharmacies without supporting new roles/practices/opportunities
Player quality is less impactful if the ref’s always ruling against you
— Samuel Keitaanpaa (@SKeitaanpaa) February 5, 2019
$2/hr increase over 10 years, even lower than I would have expected. Wonder where other healthcare professionals sit 🤔
— Matt Scott (@MattScott410) February 5, 2019
That is true @elliott_rohan but sadly the status of the profession is impacted by low salary rate in community pharmacy. Not everyone can work in a hospital setting & we need a soldid community pharmacy sector to prevent medication misadventure & unplanned hospital admissions.
— Kay Dunkley (@M_Kay_Dunkley) February 5, 2019