Removing Silos from the Pharmacy Profession

In the last decade, pharmacists have identified their career sector by the way in which they describe themselves. One might identify as a community pharmacist, another as a clinical specialist in an academic medical center, and yet another as a pharmacy faculty member.

This usually communicated an elitist attitude, as some positions were considered better than others and the descriptions carried stereotypes about the individual’s duties. This inevitably created silos in the pharmacy profession and destructive “us versus them” attitudes.

Today, significant consolidation in health care has occurred. National chain drug stores have purchased regional chains and hospitals have merged or acquired other hospitals in order to enhance their geographic footprint and negotiating power. Even private equity groups have purchased health-systems.

There is also vertical integration happening across pharmacy. National chains have purchased pharmacy benefit managers, specialty pharmacies, wholesalers, and even nursing homes. While national chains are actively participating with hospitals to reduce readmissions, it is almost a matter of time before hospital inpatient pharmacies are outsourced to such a chain.

When that happens, pharmacists will no longer be able to sort themselves into traditional silos. I would even argue that these silos do not exist today.

There may be differences in practice sites, but when you work for the same organization or receive a check from the same corporation, it is hard to defend the distinctions in the jobs and the accompanying elitist attitudes. With the exception of independent pharmacies that only own 1 or a few stores, all pharmacists work for large organizations that have the primary obligation of managing patients’ health while balancing finances. Ensuring that all operations are efficient, the skill mix of employees is optimized, and the focus is on the bottom line are critical to the health of any organization.

These areas of importance are concerning to many pharmacists who entered the profession to help others, not run a business. Lean methodology and Six Sigma, managing employees and technology, and evaluating an income statement and balance sheet were not taught in pharmacy school or offered as continuing education sessions at professional meetings.

This is the current state of pharmacy, however, so instead of longing for the past, pharmacists need to take advantage of the present and prepare for the future.

To do this:

• Recognize that almost all pharmacists work for a big company — Pharmacists have to follow corporate policies, ensure that everyone is working to help the organization meet its desired goals, and realize that their success is tied to the company’s success. This axiom is true regardless of whether you are a director of pharmacy or a front-line employee, or whether you work for a chain store or a health-system. Looking down on another sector serves no purpose, as everyone is held to the organization’s policies equally.
• Be active with pharmacy associations — Because most of us are employees of a corporate entity, we have little power and ability to change its direction—but that doesn’t mean we can’t try. Therefore, it is important to work with pharmacy associations that work for their collective members. Pour your energy and passion into activities within your associations. Their goal is to advocate for you, and the only way for them to do this is through your membership and participation. It is important to be a professional and not an employee.
• Learn new skills — What you learned in pharmacy school might not be what is needed for your job responsibilities today or in the future. Take advantage of learning new skills to ensure you remain relevant to your organization and help it succeed. This will provide the job security we all desire.

The removal of silos is good for the pharmacy profession, though it also means pharmacists are becoming employees of big companies and losing their individual sense of control. However, the profession should not be dictated by these external factors. We need to work together to advocate for the reforms and advancement we desire.

I would appreciate any insights you might have on this perspective. You can let me know what you think via e-mail at seckel@unc.edu.