I Love My Job...

I recently went through and read my blog and I've come to see that it may seem as I hate my job.  I'm sure there are people out there reading saying "Why don't you just get a new career?"  Well, it's because I love my job.  I couldn't imagine myself anything other than a pharmacist (maybe other than a professional baseball player).

I remember as a young one, going with my mother to the local pharmacy and feeling like it was a store that had all that I ever wanted.  There was cool pens, little keychains, trapper keepers, small gifts, and best of all, loads of candy.  It wasn't until later that I learned what the pharmacy was actually there for.  And I was fascinated by the concept of taking a pill and it working throughout the body and actually find the purpose it was intended for.  When I was in high school, I finally got my first job as a pharmacy tech.  I worked in an independent store and my experience there validated my desire to become a pharmacist.  I worked as I saw people come in day after day and get their medications, all the while answering the countless questions people asked.  Back in those days, the profession of pharmacy was ranked #1 as the most trusted professional year after year.

Now, as a pharmacist, I live for helping people.  I enjoy filling scripts and making sure everything is in line.  I also enjoy the consultations most of all.  I'm honored that people come and ask me questions and consider me an expert in what I do.  In my mind I always think of the saying that if you love what you do, then you will never work a day in your life.  I feel that as a pharmacist, I haven't worked a day yet.

Sick Days....

It's days like today where I wish I didn't work in the healthcare field.  I am here at work, sick as a dog, and can't leave.  It's not because I am the owner and sole pharmacist of my store, it's because I'm a pharmacist.  I did my fair share of rounds at a chain.  I was pharmacist in charge at a high volume store in an urban area at one point of my career.  But it's the same there too.  Let me paint a picture...

The night before I work, I start feeling achy, feverish, stuffy, coughing, sneezing, runny, pretty much everything imaginable.  I call my district manager/supervisor and let them know what I'm feeling and tell them that I'm not sure if I can work tomorrow.  Then he/she tells me that they are going to call around and see if they can find me coverage, but, if they don't call me back to let me know, then assume that no coverage was found and go into work anyway.  So I go to bed with no call back and sleep for about 2 hours because of my sickness.  I get into work and call my supervisor again and say that I'm dying out there that I can't work these 14 hours I'm scheduled to work.  He/she tells me that they will make some phone calls and maybe I can get out of work early.  A little hope sparks me.  I work and work and work, checking prescriptions, sneezing in pill bottles, and giving flu shots.  Minutes turn to hours and next thing you know, I've been working for 13 and 1/2 hours already.  I close the pharmacy and about 10:30 and drive my 35 minute commute.  After getting home and showering, I get to bed close to midnight.  Time to go to sleep and do this all again tomorrow.

Unfortunately, that's reality for pharmacists.  I'm sick now, but like I said earlier, I run my own store, so being sick is not so much of a big deal now.  I suck it up and fill my scripts, as many as I can.  And there's the benefit of not working 14 hours.

Feel free to leave a comment...

Mandatory Mail Order...

This post is in response to something I found on the NCPA website.  Here is the link...

Mail Order Waste

Basically, it's a series of photos that pharmacists and patients took of their medications that were sent through mail order.  For whatever reason, be it the unfortunate death of a loved one or just simply the doctor saying that the medication was no longer needed, people received a 3 month supply of the drug in order to "save" money.  Therefore, many boxes and of unused medication pretty much goes in the trash.

For those of you not in the pharmacy profession, you are probably saying they should just send it back and get a refund or part of their money back.  However, the rule usually is, once a medication leaves the pharmacy and is paid for, if you return it for whatever reason, we are NOT allowed to resell that drug.  So if you bring it back to us, it's going in our trash.

These mandatory mail order programs and specialty drug mailings are marketed as a way to save the patient some money.  What it actually is doing is making more profit for the insurance companies.  They tell pharmacists like myself, who owns his own business, that we can't fill your medication, even if you prefer the hassle of walking or driving to your local pharmacy.  And for specialty medications, which normally are crazy expensive, can't be filled in my store, so I lose a potential $5000 check in my bank account.

I believe people should have a choice.  If your choice is to get your drugs through mail, then I'm not going to complain, just like I don't complain if you choose to go to Walmart to fill you scripts.  But the fact that it's mandatory and because it's insurance from your job, you don't really have a choice to switch insurances either.  I've talked to way too many former business owners that had to close their doors because of this.  It's a shame.  This is America, give the patient the freedom of choice!

Should Pharmacists Bill Insurances for Services?

Should pharmacists be able to bill insurances for services they perform?  I think that they should.  Pharmacists aren't just pill pushers who are like robots where all they do is count to 30 and stick a label on the bottle.  We are more than that.  The schooling we go through is pretty intense.  We don't just learn about the drugs and how it affects the body, they make us learn about the disease it treats and how to disease manifests.  We learn the tests that need to be done to diagnose them.  We also learn how to treat certain things both pharmacologically and non-pharmacologically.

Yes, I understand we don't learn how to do certain procedures, like drain an abscess and suture a wound, but for many common things, we are just as knowledgeable as the common doctor.  When I've gone to my primary doctor and I look at the breakdown of the bill, I see that I get charged for pretty much everything.  Some doctors just bill an overall "physical" for a flat fee, but others itemize it and break down the individual procedures.  Blood pressure check, $X.  Temperature check, $X, etc.  People often bypass going to the doctor's and come to the pharmacist to see if he or she can recommend something to them.

In my school, we were taught how to do these basic things, blood pressure, blood sugar, mini mental status exam, reflexes, diabetic neuropathy, etc.  Pharmacies don't offer these services because we don't get reimbursed for them.  As an independent pharmacist, I would be willing to offer these services in order to get people in my door an away from the chains.  They take enough business as it is with them being "preferred" pharmacies, offering $4 90 day supplies, and mandatory mail order.  Vaccinations is a great first step for people to realize that pharmacists are more than just a person with a spatula and an empty bottle.

Zombie Pharmacists

Those of you not in the industry may not know the hours of a typical pharmacist.  For those of you in it, I feel for you.  Pharmacists sometime are walking, talking, counting, typing zombies.

Well, the average chain pharmacy is open from 8 in the morning until 10 at night.  That's a full 14 hours.  I say full because the majority of pharmacists don't have the luxury of taking a couple of 15 minute breaks and a 30 minute lunch because it is just too busy.   And god forbid we do decide to tell a customer that it will be ready in 30 minutes because the pharmacist is taking his or her lunch.  We all know too well that that will be the customer to call the 800 number and complain to the higher ups and then we get written up.

I used to work in a pharmacy in an urban area because I grew up not too far from there.  When I became a pharmacist and finally had some money, I moved to the suburbs to get away from the city life.  So my commute is about 30 minutes if there is no traffic.  However, I happen to work at a pharmacy that is close to the Lincoln Tunnel, Holland Tunnel, and George Washington Bridge, so my commute is more like 45 minutes to an hour depending on the day.  So my day actually starts at about 6:30 and usually ends at around 11:30. I remember one week, my partner had first had to attend a funeral and wake and then at the same time had gotten really sick, so since there was no one the district manager had to replace, I had to bite the bullet and work 6 days in a row.  So that was five 14 hour shifts and one 8 hour shift.  If you were one of my customers that week and I growled at you or dropped an f-bomb or two, my bad.

I myself used to work these hours at a store that did about 600 scripts a day.  I, like most pharmacists, have made mistakes.  It's tough juggling both being as accurate as possible with each and every prescriptions and churning out the 600 plus scripts I need to fill in what the corporation deems a "timely manner."  Not going to lie, but our definitions of a timely manner differ quite a bit.

I used to be the type of person that had a zest for working in a busy store.  Then I came to an important realization that Joe Schmo working at the pharmacy in Nowhere, USA fills about fills about 100 scripts per week and get paid just about the same as I do.  Also, when the annual review comes around, he gets a raise for being about to satisfy his 100 total customers, whereas I didn't receive a raise because my drive thru time was 5.6 seconds instead of 5.0.  So I got fed up and decided to go to greener pastures.

I know there are studies out there that show a correlation between how many hours in a shift and mistakes.  Why do most big chains ignore these studies?  Why is the public not demanding those that make pharmacists work 14 hours change their policy?  If their in existence to help their patients manage their medicine and improve overall health, then shouldn't their goal be to minimize errors?  But, unfortunately, they are in existence to please their stockholders and increase their overall wallets.  So the world of pharmacist zombies will continue.

Things I hate hearing

Here are some things I have hearing as a pharmacist, so if you're my customer and you say any one of these, don't be surprised when I jump over the counter and pump your belly full of potassium pills (and try to stab you with my blunt spatula).

1.  My copay is $3.50?!?!  Why so much?!?!

2.  Why isn't the insurance paying for it, didn't the doctor write that I needed it?

3.  I'm allergic to that, it made my stomach hurt

4.  15 minutes?  But the medicine is made already, you just have to put a label on it

5.  Too soon? Oh i lost my pills/my roommate took them/they fell in the sink/etc.

6.  Why do you need my ID for Sudafed, Walgreens doesn't ask for it

7.  What aisle can I find the milk?

8.  How much is amoxicillin?  Ok, can I have it?  Wait, your saying you need a prescription?

9.  Why do I even have insurance?

10.  (Phone call) I have a prescription in my hand, can I tell you what it says and you have it ready?  I will be there in 5 minutes

I'm sure there are a lot more.  What makes you all heated?  Leave it in the comments

Seriously?!

So this happened to me the other day. It was just a regular day and the pharmacy, people coming in, thousands of phone calls, my stomach growling, you know, the usual. Then the most unusual character comes up to the consultation area.

I call him unusual because he was dressed in shorts, tshirt, and flip flops. It’s still winter and he looks like he’s ready for the beach. He’s got a plastic bag in his one hand and reaches out his other to shake mine. I shake because I don’t want to leave him hanging and we begin our conversation.

Customer: “I was wondering if you could help me with something and ask you a question”

Me: “Sure, ask me two if you’d like”

Customer: “My girl took a pregnancy test and I was wondering if you could tell me about it”

Me: “Tell you something about it, well, what it does is read the hormone levels in her urine and lets her know if she’s pregnant”

C: “No, I know all that”
Then he reaches into the bag he was carrying and pulls out the freaking stick. He then tries to hand it to me.
C: “Does this mean she’s pregnant”

After taking a step back out of disgust, I look and tell him that yes, she is pregnant. I chose my words wisely, and didn’t say congratulations because judging by the look on his face, he definitely was not expecting this.

So he leaves and during some down time, I remembered he shook my hand and handles the test with the same one. After throwing up in my mouth a little, I quickly pump about half the hand sanitzer in my hand and proceed to clean.

Seriously?! Some people just don’t have proper brain function.

When calling in a prescription...

To all the doctors, nurses, dentists, PAs, or whoever calls in a prescription to a pharmacy:  please follow these guidelines and your relationship with your pharmacist will be much better.

First complaint I always hear from all of my fellow pharmers is that people need to slow down!  I’m not sure if you realize this, but the words that are coming out of your mouth need to be written down and all I have is a pen and paper.  Don’t start rambling without any pauses because I can’t keep up.

Spell out the name of the patient and doctor and give us the DOB.  That last name might be common place in your place of origin but I don’t always know where that silent H goes.  And you might be the only Dr. Patel in your neighborhood, but my computer says there are over 500 of you, so please specify with your first name, DEA number, or NPI.  And lastly, little old Maria Rodriguez from Main Street may be your only Maria Rodriguez that goes to your office, but I have 18 different Maria’s in my system, so give me the patient’s DOB.

Please give me quantity and directions.  You guys might be able to get away without giving insurance companies exact details on what you do, but if you prescribe Coumadin #100 with direction as “Use as directed” I’m going to tell you to please give me the EXACT directions.  Because if I get audited, that money I just made off the prescription is going to be taken right back.  Same goes for insulin, prednisone, etc.

Please don’t call the prescription in and tell the patient that the pharmacist will have it ready in 10 minutes.  You are not at my store and you don’t know my current workload.  And also don’t give a price to people when you clearly don’t know how much it cost.

It’s also frustrating how many of prescribers are not familiar with the laws of guidelines that entail prescriptions.  No you cannot phone in a CII, you can only phone in a 3 day supply and must mail the prescription immediately or you will be reported to the DEA.  No you cannot give more than a 6 month supply of any controlled medication.  And no I cannot make an exception for you, it’s my license on the line. 

I don’t think I’m asking for anything that’s not close to common sense.  But, all in all, if you are nice and personable to me, you will get the same in return and maybe I will overlook the mistakes you make and not get as frustrated.

Wonderful Customers...

First off, I would like to say that 85% of the people that come in and drop off and pick up prescriptions are fine and dandy.  I appreciate them and look forward to seeing the frequent flyers once a month (or sometimes once a week for some).  But there are about 15% of you out there that just amaze me.

I admit, there are times when I can’t understand the crap that your doctor has written on the prescription.  Most of the time, I can look at the first letter, the strength, and directions and decipher it.  But when I need more help than that, I usually ask the patient “What did you go to the doctor for?”  If you tell me I went because I have a cold, my brain works and focuses on antibiotics and cough suppressants   There are way too many times when I ask that simple question and the answer I get is “I dunno.”  Or “What did the doctor tell you?”  And they respond, “Nothing…I dunno.”  So your basically telling me that you went to the doctor just to go, he gives you a medicine that you have to ingest that affects your body and possibly changes your internal chemistry and you didn’t bother to say, “Hey Doc, what are you going to give me?” or “How will this help my _____?”  No, you come to the pharmacy to fill it and when I tell you it won’t be ready in 5 minutes because I can’t understand what’s written you complain that I don’t know how to do my job.  Ugh.

Please carry your insurance cards with you.  And no, the card you give to the dentist and the doctor is not always the same card that I need.  And for the senior citizens, your Medicare Part B card (red, white, and blue card) is not your prescription insurance.  And if your copay is $1 to $15 dollars, don’t complain.  Your one of the lucky ones.  You may not know this but there are drugs where for 1 bottle the cost is over $4,000.  So your $15 copay doesn’t look so bad. 

Your insurance doesn’t cover everything.  There will be times when a med needs a prior authorization or non-formulary.  You would probably say “But the doctor wrote it so it has to be covered.”  Well, the reason for it is because that prescription for the brand new brand name medication the doc wrote for has a cheaper cousin that does the same exact job and works equally as well for a fraction of the cost.  The only reason that doctor actually wrote for the medication is because he was probably enamored by the blonde pharm sales rep that stopped by his office and gave him some donuts.  Trust me, that is the reason why.  You may wonder, “Why do I have to use the cheaper ones?”  Well, what people don’t realize is that the more generics you use, the lower the cost of healthcare becomes.  It’s simple math, if your insurance has to pay out an average of $700 a prescription to a pharmacy, then they have to charge you a higher monthly rate than if they pay pharmacies $10 a prescription.  

There are many more stories, but my hands are cramping, so I’m sure there will be a part two.

Feel free to leave your comments!