The ‘hidden’ healthcare profession?


Pharmacists believe they are seen as “shopkeepers” and do not feel adequately recognised as registered healthcare professionals

Community and hospital pharmacists want to be recognised as medicines experts but are aware that they are mainly seen by the public as dispensers and “shopkeepers”, according to a study by researchers from Brighton General Hospital and the University of Brighton in the UK.

The researchers conducted 20 face-to-face semi-structured interviews with a combination of community pharmacists, acute hospital pharmacists, and hospital pharmacists specialising in mental health and community health services based in England.

They found ambiguities about pharmacists’ perceptions of being professionals, with some using terms such as “shopkeepers” and “sticking labels on boxes” to describe images others had of them.

Similar perceptions of pharmacists as mere retailers and a lack of understanding about what they do have been expressed in Australia, including through mainstream media.

Some hospital pharmacists said they believed the public viewed all pharmacists as community pharmacists, and that their practice was “just dispensing”.

Pharmacists also did not think the public viewed them as registered healthcare professionals.

“I do not think that pharmacy itself is particularly perceived as a profession by the general public,” said one community pharmacist.

“People do not understand, are we part of the NHS [UK’s National Health Service] or are we a shop?” they said.

Another community pharmacist highlighted their conflicting roles as both pharmacist and business manager, explaining that they were “two separate things as much as the two collide”.

For community pharmacists working in a retail environment, having to achieve targets for services and being constrained by medicines regulations adversely affected their autonomy and judgement, introducing an element of disempowerment, said the researchers.

The interviews also revealed divisions between hospital and community pharmacists.

Hospital pharmacists expressed limited solidarity with community pharmacists who were not working to professional standards as they expected.

“I get really furious with that because that is my profession,” said a hospital pharmacist specialising in community health services.

Hospital pharmacists also felt community pharmacists did not see “further than their dispensing role” with no ambition to elevate the profession.

Meanwhile community pharmacists shared their difficulties in rising above their workload to develop their practice due to “increasing scripts figures”.

Community pharmacists had limited access to postgraduate education and training while working as “isolated practitioners” with “no career structure”, compared to hospital pharmacists who worked in environments that facilitated further education and training.

In general pharmacists felt the public did not view them as registered healthcare professionals, say the researchers in their article published in the International Journal of Pharmacy Practice.

“Pharmacists want to be recognised as medicines experts within health care,” they write.

“They acknowledge that their status is assessed by the public based on their act of practice, which is traditionally the dispensing of medicines, and that the public’s image of all pharmacists is that of ‘a typical community pharmacist’ working in a retail shop.

“Pharmacists remain the hidden healthcare profession. They need to act in practice as healthcare professionals so the public and wider society is aware of their contributions to healthcare.”

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13 Comments

  1. Michael Serafin
    11/01/2019

    If the UK is anything like Australia then the pharmacists themselves are responsible for the way the public perceive them. Over the last 20 years I have observed fellow pharmacists in Australia cheapen our profession to the point where no wonder we are considered nothing more than a supermarket check out operator. Slashing prices instead of offering better service or professional services unavailable elsewhere to maintain business, opening long hours, warehouse style shop fronts, selling trinkets and gift ware, not banding together as a united profession, etc, etc all cheapen our profession. Do you see accountants and solicitors behaving the way we do or opening 24/7 – No! They act like professionals and thus are perceived as professionals. About time we do the same. If you want respect then earn it.

    • fiquet
      11/01/2019

      I’m so with you , Michael.
      We’ve made our bed & now must lie in it- embracing societal disrespect & misunderstanding of our profession & low wages…

      It’s up to us to remedy that , even if it starts with doing small promotional campaigns in individual pharmacies.

    • Geoffrey Colledge
      11/01/2019

      Exactly true. Most people nowadays just want to get “cheap”.
      It’s pharmacists own fault that the perception of the profession has been devalued .
      How many other professionals ( or even tradespeople) would
      1. Discount price,
      2.Offer quicker time as a feature ,
      3.Take on an amount of work in one day, that is twice as much as safety dictates,
      4. Work 9-15 hours without a complete rest or meal break,
      5. Work for a salary that, in some cases, is only $3 an hour more than a “checkout chick”.
      6. In general,give advice and perform tests free of charge,
      7. Deliver and sometimes pick-up products free of charge.??
      Over my lifetime I have seen more and more things like the above happen in the pharmacy industry and usually offfered as a feature to outdo the opposition pharmacy.
      We are now at a point where customers demand all of the above or they’ll go somewhere else.
      So why would they think of us as a professional when we don’t even treat ourselves as a professional?

      • Jarrod McMaugh
        11/01/2019

        I’m not going to disagree with your sentiment, but I will disagree with your comparison.

        Pharmacists are not the only people who’s practice has been moulded by a demand for “cheapest cheapest cheapest” – tradesmen DEFINITELY compete in this area (the apps used to get work done are super convenient! …and drive prices & waiting times down), and it affects medical services as well.

        Dental is coming in to this arena, as are opticians, medical bulk billing,

        “free” pathology….. is anyone aware that a pathologist can actually only claim a small number of requests per referral form, but they just claim the most expensive ones up to this limit and wear the costs on the rest?

        Yes pharmacy is being affected by this demand from society, but do not kid yourself into thinking that pharmacists are alone – or even hard done by – with this. It’s a fact of life, even if we don’t like it and even if pushing back makes little impact.

        • Paul Sapardanis
          11/01/2019

          Is working in healthcare the new education

    • Judy Toumeh
      11/01/2019

      Absolutely true. After 22 years of experience!
      I myself have worked at one of these discount pharmacy systems, and was shocked and appalled also at the way pharmacist interns were treated and abused!
      Talked down to by regular staff ( I had a floor manager call the intern “stupid” AND “dumb”; until I pointed out that they didn’t get the top 5% HSC marks in Australia!) It was intern’s job to do absolutely everything- including organising the banking and change each day?!? And there was so much change to count and sort , maybe 5 Kg worth!

      What will these future pharmacists (who are currently like little rats , running , miserable and exhausted) feeling themselves once registered ?
      They WILL FEEL LIKE SHOP KEEPERS. For there is certainly no time for medium to long consultations in these places where scripts never stop coming in ….

  2. Anthony Zehetner
    11/01/2019

    I had a mother tell me yesterday that she uses her local pharmacist more than her GP as (i) she doesn’t have to wait for service, (ii) she doesn’t have to pay, (iii) “she’s just as good” as the GP when managing coughs, colds, skin lesions, etc (she said that her pharmacist trained in South Africa). If some pharmacists are devaluing their profession, then so are GPs. I applaud those pharmacists expanding their skill set and taking on opportunities like immunisation as there are enough patients to go around. It is not that most patients who don’t get immunised by a pharmacist would see their GP, it is just as likely that they wouldn’t get immunised — patient and community safety comes first!

  3. Andrew
    11/01/2019

    The raison d’etre of the peak body that negotiates the bulk of pharmacy funding is to “serve the interests of its members”, who are entirely made up of retailers. Often at the expense of health outcomes and efficiency.

    The community sees pharmacists equally a shop keeper as an allied health professional.

  4. fiquet
    11/01/2019

    That’s because we don’t talk to our customers about what value we can provide…. we don’t run campaigns like the ‘GP- Your specialist in Life’ … we don’t come up on TV to talk about latest drugs or treatments …. but we do hanker on about cheapest toilet paper and handwash in ads, catalogues and our shop fronts….
    Time we ran an ad campaign about what our profession has to offer the public . This could help help stop other health professionals defining what we can and can’t do !!

  5. All of what I hear in the comments (thus far) is true. There are some further measures that I believe we should start to think about and take seriously. a). Stop calling those that use our services “Customers” and start referring to them as “Patients”. b). Stop funding the inefficient PBS which sees approved Pharmacists holding way too much investment in stock and risking shrinkage through expiration and other losses. I have believed for a long time that the Dispensary stock should be owned and supplied by Medicare. Pharmacists should be paid a flat fee for dispensing an item and that all prices are regulated by Medicare – even PBS items below patient contribution. Revenue received from patient contributions is used to offset fees owing from the Government. No dispensing price competition such as the “lost leader” it has disgracefully become. The Government can then negotiate with Pharma to get the best price and I recon they would negotiate a much better lowering of costs. The consumers get a fair price everywhere and stop this incessant badgering of a highly educated professional to “price match”. If an item goes out of date then the Brand Manufacturer has to replace the stock. Big Pharma continues to make billions while Pharmacists become less professional in the race to the bottom of the pond. abrangan@branganmedical.com

    • JimT
      11/01/2019

      straight out of my hymn book…..being saying this for years

  6. H Shan
    11/01/2019

    If you follow the money, you will find the root cause.

    Who gets the money from Medicare for dispensing services- owner or the dispensing pharmacist? For doctors’ services, who gets the money from Medicare- the doctor providing the service or the surgery owner?

    In case of an injury due to a bus or train accident, whom do the passenger normally sue- the driver or the company? In case of harm due to wrong medication dispensed, whom will the patients normally sue- the pharmacist or the company/pharmacy owner?

    Most of the owners see their employees as cost component and pharmacists included. I can bet that if law allows, many owners will get the dispensing done by a cheap technician and not by a pharmacist. I know one owner who thinks, for a new medication, patient counselling using AMH points is enough and providing and explaining CMI is wastage of paper and time (he stopped only when I asked him to give it in writing).

    From owner’s perspective, it is all about money. May be s/he have taken too much loan or paying too high a rent for the pharmacy or may be the entire loan is paid off and the rent is very cheap. Whatever it might be, as long as the owner is an investor and does not work in the pharmacy as full time basis, his/her focus will be on money and NOT on the dignity of the employee (pharmacist).

    • TALL POPPY
      12/01/2019

      Although I’m not proud to admit to it: I can confirm the above is true. As an investor you will see staff merely as ‘costs’. Remotely managing the pharmacy (ie: as a non-present owner) you would try to get the most value out of them as humanly possible in order to meet your personal interests. Often you will have to pretend to actually care about them – have a nice chat once in a while, send an encouraging email etc. Sounds heartless, but this is what is happening in pharmacy today: big boss owners 100’s of kilometers away from their pharmacy earning 100’s of thousands of dollars. These are INVESTORS.
      This is compounded by the existence of PROXY OWNERS.
      **The trouble is that 90% of pharmacists don’t even know what goes on in the industry and 99% won’t ever get a shot at being such an owner. Again, I can confirm the above is 100% correct.

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