Blogs: Focus on Current Thinking

Keeping Pharmacists from Being Outsourced

Published Online: Wednesday, July 16, 2014
I recently read Thomas Friedman’s book The World is Flat. While it was written almost 10 years ago, it is still as true today as it was then. He provides insight and support for the global connections between products and services, and how these relationships can advance the economies for those countries that choose to engage with others.

In the book, Friedman has a chapter titled “The Untouchables.” He describes these individuals as people whose job cannot be outsourced. He categorizes and defines these untouchables in the following ways:
  • Special – people with an innate talent, like LeBron James and Tom Brady
  • Specialized – people like neurosurgeons, whose skills cannot be outsourced to others
  • Anchored – jobs that require a person to be local (chefs, electricians, real estate agents)
  • Really adaptable – constant acquisition of new skills in order to continually create value
In thinking through this, is there the potential for the profession of pharmacy or the role of pharmacists to be outsourced, or are they considered to be untouchables?

The profession of pharmacy has always consisted of getting the right drug to the right person. Clearly, there will always be a need for medication use by individuals and because of this, I think pharmacy can be considered as an untouchable.

However, some of you might disagree with this proposed definition of pharmacy. Nothing in there describes patient education or adherence monitoring. I do not think there is widespread recognition by pharmacists that this is required. I say this because I do not see evidence that it is consistently practiced. This is definitely true in the health-system setting.

Others might suggest that there is nothing in the definition about product selection, ensuring that a drug is the best and most appropriate for that patient. I would argue that this is encompassed in the term “right drug.” It is not only that the drug that the patient is dispensed is the one that is prescribed, but that it is the best one for them.

The real question is whether a pharmacist is considered an untouchable. Meaning, are they the only one who can do the job? Clearly, everyone would only want a transplant surgeon replacing one’s kidney. However, is there something unique that a pharmacist does that cannot be replaced? This can be determined based upon the definition of pharmacy, as the pharmacist is the one who primarily fills that role.

Is there something unique that a pharmacist does that cannot be replaced? When thinking through all of the various activities of a pharmacist, one realizes that they are not the only professionals who can dispense, provide medication education, give immunizations, monitor for drug compliance, or conduct medication therapy management visits.

Therefore, for our jobs not to be outsourced to lower paid individuals that provide the same services, I believe we must become “really adaptable.” I think this means we have to internalize and act like professionals with a unique knowledge base who provide care to patients, not just as pharmacists who dispense drugs. Here are 3 things one can do to start the journey.
  1. Know more than anybody else about medications and their appropriate use. We should not be relying upon others to exclusively dictate what medications are used, but we should be confidently educating them on what is most appropriate, using literature support for these recommendations. After doing this a few times, health care providers will begin to notice and treat you differently. One easy step to gain the knowledge for this is to embrace continuing professional development, not just getting continuing education hours for relicensure.
  2. Treat all patients like your mother. If patients begin to see that you genuinely care for them, they will begin to appreciate your unique skills and role. Without having this personal connection about their welfare, we become just another health care provider who is not differentiated in what we do and the value we provide.
  3. Be willing to embrace new changes. In essence, we need to be early adopters of activities that bring value to the patients and the health care system. A recent example is immunization. While some people quickly got trained and embraced it in their practice, others only did it because their employer required it. I am not sure what the next activity will be, but could be genetic testing, or requiring all pharmacists to get credentialed and privileged as providers in the hospital, or something not even considered yet. Either way, we need to be ready and to quickly embrace it.
I always remain optimistic about our profession being made up of professionals, but for us to be truly untouchables, we need to embrace being “really adaptable.” I know we can do it, if each of us has a passion to change.

I would appreciate any insights you might have on this perspective. You can let me know what you think by email at

Stephen F. Eckel, PharmD, MHA, Pharmacy Times Health-System Edition Editor
Blog Info
Stephen Eckel is an avid reader on issues impacting the practice of health-system pharmacy. His writings discuss recent articles or books he has read, with perspectives on how they relate to the current practice of health-system pharmacy. He enjoys hearing feedback from readers of his work, even if they do not agree with his opinions.
Author Bio
Stephen Eckel received his bachelor of science in pharmacy and doctor of pharmacy from the University of North Carolina at Chapel Hill. He completed a pharmacy practice residency at Duke University Medical Center and then joined UNC Hospitals as a clinical pharmacist. Eckel also holds a master's of health care administration from the UNC Gillings School of Global Public Health.

Eckel is a clinical associate professor in the Division of Practice Advancement and Clinical Education and is the division's vice chair for graduate and postgraduate education. He is also director of graduate studies and is in charge of the 2-year master of science program in pharmaceutical sciences with a specialization in health-system pharmacy administration, which is hosted at multiple sites across North Carolina. He is associate director of pharmacy and director of pharmacy residency programs at UNC Hospitals, where he leads and develops a dynamic group of patient-care providers. He has worked with almost 200 residents in his career. Eckel is a board certified pharmacotherapy specialist.

As an innovator and entrepreneur, Eckel spearheaded the development of UNC Pharmacy Grand Rounds with ASHP and launched ChemoGLO LLC with Bill Zamboni, PharmD, PhD. He is the editor of the health-system edition of Pharmacy Times and a passionate supporter of the role of the pharmacist in patient care. He regularly publishes his research and is frequently asked to speak around the world on these issues.

Eckel has also been very active in the North Carolina Association of Pharmacists. He has been elected chair of the Acute Care Practice Forum and a board member. He has served many years in the ASHP House of Delegates. He was also the chair of the ASHP Council of Pharmacy Practice from 2009 to 2010. His is a Fellow of ASHP and APhA.
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