Congress is not listening. Its latest proposal to save billions of dollars in Medicaid expenses involves cutting pharmacy dispensing fees. As I write this, both the Senate and the House of Representatives are planning to act on committee recommendations to cut pharmacist dispensing fees, and pharmacy is attempting a grassroots campaign asking pharmacists to inform their representatives and senators of the dire consequences of such action.
The NCPA says the cuts "will result in less access to lifesaving medication and sicker patients. These cuts could force up to 40% of this nation's community pharmacies to close their door." Merrill Lynch analyst Patricia Baker, stated that, "the smaller chains and independents, will be harder hit, possibly sparking a wave of industry buyouts." It appears that pharmacy's message is clear, but no one is listening. So, my question is, "Why isn't anyone listening?" We all have our ideas on "why," and pharmacists quickly share their opinions on "why," but how thoughtful are these opinions? Maybe it is time to think out of the box, examine some of our "sacred cows," and maybe even be critical of what we are doing and not doing.
These are my possible answers for why people are not listening:
1. Maybe "one message, many voices" from the multitude of pharmacy organizations is not the most effective way to get attention and achieve results. It does not seem to be working, so maybe it is time to talk about consolidation in pharmacy organizations, as is happening in other industries.
2. Maybe our message is not accepted because what we say does not seem to agree with what people see. We talk about pharmacies closing, but on many street corners, in many towns across the country, new, large pharmacies are opening. Grocery stores are adding pharmacies. Even new independent stores are opening. Perhaps legislators and others do not pay attention to what we say because community pharmacy appears to be very prosperous.
3. Maybe our message is not believed because what we say we do and what most pharmacists actually do are different. We talk about the value of counseling; yet most patients interact with a clerk and not a pharmacist. We say we are the most accessible health professionals, but consumers have a hard time getting real access to a pharmacist. How long does it take a patient to get to talk to a pharmacist in your store?
4. Could it be that influencing legislation actually takes grassroots involvement, and too many pharmacists are not politically active? Maybe relying on a lobbyist is not effective unless we have real grassroots involvement. How many letters have you written to your senators or representatives? How about local candidates? Did you even vote in the last election? Did you ever make a contribution to a political campaign?
5. Maybe community pharmacy is not as important to the local community as we like to think it is. I have a hard time with this possibility because I have built my career on promoting the role of the pharmacist. Watching how our message is ignored, however, I have to at least deal with this possibility. Much of what we do is behind the scenes, so patients never even know what we did. We do not tell them about the mistake we caught because we do not want to put down another professional. Maybe we need to start "tooting our own horn." The American Pharmacists Association featured October as American Pharmacists Month. What did your pharmacy do in October to promote the profession? What did you do personally to promote yourself, or your profession, in October? Could it be that many consumers do not know what you do, and that is why no one is listening?
This is my attempt to answer the question "Why isn't anyone listening?" How do you answer that question?
Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.
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