‘Usurper’ pharmacists have ‘perverse profit incentive,’ says GP

doctor wearing boxing glove

Another prominent GP has accused pharmacists of pushing beyond their scope of practice in a bid to make more money

AMA vice president Dr Chris Zappala has penned a piece in the AMA’s Australian Medicine publication, in which he says doctors should become “more determined in defending the critical importance of a medical-led model of care”.

He also outlined a case for doctors dispensing medications.

Initiatives such as the Victorian Government’s funding of the MMR vaccines in pharmacies, as well as the “truly perplexing” Pain MedsChecks, will “push the patient out of GP-centred care i.e. away from the trained and experienced professional able to genuinely help,” writes Dr Zappala.

“At $100 a pop for potentially ill-advised direction from a pharmacist who lacks detailed anatomy or pathology knowledge or any greater sense of medicine or what else might be wrong with a patient seems awfully expensive compared to the cost of any engaged, family GP who costs less and is able to achieve a better, holistic outcome,” he writes.

“The desire for pharmacists (and others) to push beyond trained scope of practice straying dangerously into medical territory is conceivably a strategy of self-defined job redefinition in order to improve market share and profit, given how aggressive the pharmacy retail market has become.

“The conflict that all pharmacists face when offering ‘medical advice’ to patients needs highlighting.

“When a doctor writes a script (or not) there is no change in the consultation fee. By contrast, whenever a pharmacist/retailer persuades a shopper to buy something as a result of their advice, they make more money.”

Dr Zappala writes that if doctors dispensed medications, only covering the cost of the dispensing, “there would be less cost to the patient and system, and no perverse profit incentive as exists for the pharmacist”.

This would be the ultimate in efficiency and convenience, he says.

“I can hear the usurpers citing benefits from drug companies to doctors as a prescribing incentive. This is nonsense… Non-educational benefits from industry to doctors is non-existent. My plumber can give me notepaper and a pen with company details, but a drug company cannot.”

Meanwhile pharmacies receive “representation and benefits from drug companies to stock certain items in their stores and promote certain products,” he says.

“Any retail shop owner obviously makes more money if they can persuade shoppers to purchase, for a pharmacy this might occur as a result of providing ‘medical advice’.”

Collaboration is a euphemism for role substitution, he writes.

“What usurper groups manage to gain, they should be solely and proportionately responsible for – they cannot take the cream but leave the real work and responsibility to doctors given the training and experiential requirements of future generations of doctors.”

He called on the Pharmacy Guild to “put profits aside” and help ease pharmacists into general practice.

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  1. Bruce ANNABEL

    The good doctor makes some good points. Pharmacists have so many opportunities to take up sitting right under their noses that can be done without upsetting the medicos.

    • Jarrod McMaugh

      None of what Dr Zapalla had to say has any value, since it is written from a point of insecurity.

      Pharmacists aren’t expanding scope; pharmacists are meeting scope as demonstrated by international evidence.

      The motivation for doing so is professional satisfaction, workforce utilisation, & improved outcomes for the health of the people we serve.

      There may be untapped opportunities for pharmacists with currently recognised settings, but that doesn’t preclude the need for Australia to develop the areas where pharmacists should be operating.

      Dr Zapalla’s article is self serving, and appeals to fear. It’s unoriginal, being the same set of non-facts used by almost ever new medical politician within the first few months of coming to office. This is the medical profession’s version of the debut speech in parliament “please explain” and deserves as much respect.

  2. PharmOwner

    And doctors make more profits when they refuse to authorise repeats so patients have to present to their GP more often than necessary just so the doctor can claim another medicare consultation for prescribing a repeat script.
    There is value in having a clear demarcation between prescribers and dispensers. Just today, I had a patient present a script for Famvir 500mg “3 tablets as a single dose”. The patient told me she had shingles. A phone call to the GP confirmed the lady in question did indeed have shingles so I gently suggested that a more usual dose for shingles would be 250mg tds for 7 days. The doctor agreed, the patient received the appropriate instructions and dose of medication. For the time taken to do this, I can claim a clinical intervention worth less than $2.
    Is it any wonder pharmacists are looking for new opportunities to secure a reasonable income and remain relevant? The plumber the good doctor mentions probably charges $100 per hour, yet pharmacists are lucky to earn a third of that.


      Pharmacists will soon be at the bottom of the healthcare food chain! You will be the victims of offloading by other health professionals – you are even doing the jobs of nurses vaccinating patients!
      This is benefiting OWNERS. Especially non-present owners of multiple pharmacies / brands. Why would the Guild be supporting such things otherwise if it was of nil monetary benefit to pharmacist owners?
      Reducing pressure on GPs will be just another straw on the back of the pharmacist donkey. No approintment needed. No significant extra remuneration to the employee pharmacist.
      Remember pharmacists earn less per hour than many professions and trades.
      Pharmacists will face higher and more unrealistic unrealistic expectations from their patients; and we all know what that will lead to.
      Trust me. READ between the lines. Don’t be a pawn in a much bigger game. I predict ordinary pharmacists on the coalface will feel even more pressure and stress as time goes on.
      Without adequate pay commensurate with their expected professionalism how can they be happy?

      • PharmOwner

        I couldn’t agree more. Adequate remuneration is not just about being happy, it’s being able to provide a reasonable standard of living for your family during working age and then into retirement. This is why I refer to pharmacists as the “working poor”. It’s just not good enough.

  3. Karalyn Huxhagen

    GPs who do work collaboratively with pharmacists in the true sense of the word gain as much value from our expertise as they possibly can. In my role the GP practice and the GP has me on speed dial and I answer the questions while the patient is in front of GP. The GP folllows up with whatever recommendation is then needed e.g DAA, HMR, follow up on adherence to therapy. The same applies with the chronic disease nurse, diabetes educator. We are the GPs support team. The GP has to be the gatekeeper for the patient’s health management as they hold all of the information and the Aus system of health provision is built that way. ultimately the patient is in the driver seat and every HP that touches the patient has a duty of care to ensure the patient health literacy is enabled to allow them to make the best decisions. Ask your patients how they feel about a GP using google search to help them understand and manage a problem VS a GP who calls/refers to an apporopriate HP who uses their expertise to support both the GP and the patient.

    This is not a war about profit, this is a battle to maximise patient health outcomes using available and appropriate workforce

    • Willy the chemist

      “Collaboration is a euphemism for role substitution, he writes.”

      Now we know why it’s about power and control and not about HP working as a collaborative team.
      Unfortunately in the minds of many doctors, they still believe in the archaic “I can never be wrong, I must be in charge” mentality.

      Now I’m not saying that all doctors are like these few closed minded individuals but enough of these represent the collective leaderships that no inter-professional collaborations are possible until a more collaborative mindset is more prominent.

  4. B Lee

    This article is not worth reading, commenting and knowing what a desparate GP thinks. I am sure all fellow pharmacists know some GPs can become a little desperate on increasing revenue and they are shifting blame on pharmacists. The fact is, Guild will do whatever it is in the best interests for pharmacy owners regardless if it is favourable to pharmacists or not and GPs will keep being arrogant saying they know everything when they do not.

  5. Susan Shaffer

    I think there is some merit in the Dr’s writing. The reason is that I had been on this forum regarding the rescheduling of S3 Codeine preparations. I had serious back issues. I was under a Drs care. I had radiology, spinal injections, S4 scripts and finally surgery. Post surgery my back still plays up from time to time. If I cannot get to the dr then taking S3 in higher dose for a day held me over. Then I would be put onto S4 and maybe more spinal injections. One pharmacist said I needed orthotics without knowing exactly what was my back issue. Imagine someone with back issues going to his pharmacy! There are so many diagnostics available to a dr that a pharmacist cannot. Even drs don’t get pain right all the time. That is why they have specialist pain drs now. I remember one customer came in crying that her husband had been going to a nearby dr and he had been given pain meds for his back for some time. It turned out he had cancer in the spine and a few months to live. The thing about life is that you don’t know what you don’t know and many pharmacist posters seem to fall into that category.

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