The time frame concept is an underappreciated through line in most planning efforts.
Imagine attempting to build a skyscraper or a sports stadium and collecting money from investors or taxpayers but not having a projected opening date. Imagine funding a new molecular moiety with the promise to cure all cancers and not planning for a 20-plus-year investigative and go-to-market effort. Imagine you are a public health director dealing with an outbreak of a highly contagious pathogen on a Friday afternoon and delaying action until Tuesday after a Labor Day weekend. In any of those scenarios, you wouldn’t act that way. Why? You have a sense of a time horizon even though it isn’t front of mind. Why wouldn’t you be thinking about your varying time horizons with your goals and aspirations with your career?
As the saying goes, the only certainties in life are death and taxes. I would add a third; while the Earth continues to spin consistently, everything on it changes regularly. As Old Faithful spits water at time intervals more reliable than your smartphone’s clock, change occurs dependably in the world around us. What we need to learn, how we need to learn, and how we apply our skills is ever-changing.
Pharmacy practice as we know it today will change. There is a very low probability that checking prescriptions for accuracy will be a prevailing form of professional activity over a career horizon. There is a very low probability that performing a drug regimen review will go unassisted by artificial intelligence (AI). There is a low probability that a knowledge-based education, or knowing facts (eg, drug interactions), will be superior to a skills-based education, or understanding solutions (eg, learning how to problem-solve when a drug interaction exists). There is a very low probability that new therapies that create cures for cancer and diabetes will not disrupt the trajectory of continued demand for more health care products and services. As a friend of mine once asked, “What would pharmacists do if there were a pill invented that cured everything?” I replied, “Society would find a way to screw it up.”
Natural selection happens daily; glucagon-like peptide-1 receptor agonists are a good example. Although they don’t cure every disease state, they sure are making a run at a majority of what ails modern society. These once-in-a-generation medications are changing the landscape of health care delivery and financing, from direct to consumer to an explosion in compounding to a potential massive reduction in long-term morbidity, mortality, and health care spending. Meanwhile, nearly every conventional pharmacy in the country is losing money buying high and selling low in the traditional business model. New models will undoubtedly emerge based on services, such as deprescribing, titration management (up and down), and lifestyle management, and these will be paid for by employers, taxpayers, and consumers alike because new therapies bring change.
Troy Trygstad, PharmD, PhD, MBA, is the executive director of CPESN USA, a clinically integrated network of more than 3500 participating pharmacies. He received his doctor of pharmacy and master of business administration degrees from Drake University and a doctorate in pharmaceutical outcomes and policy from the University of North Carolina. He has recently served on the board of directors for the Pharmacy Quality Alliance and the American Pharmacists Association Foundation.
It wasn’t long ago on my career horizon when the prevailing clinical service provided by a pharmacist was a “Coumadin clinic,” wherein an international normalized ratio (INR) was regularly needed to properly manage blood thinning, diet, and drug regimen to optimize effectiveness and safety. Then new therapies emerged: The INRs went away, but the drug misadventures continued. My career time horizon currently sits between 10 and 20 years, and the advent of digital 1s and 0s has defined my generation. Ours was the first to have computers—I started hacking at a keyboard on an Apple IIe in second grade—and we will likely be taken out by computers that think for themselves—AI—unless we adapt over these next few years to bring sentient beings into our practice. What is your time horizon, and what contingencies should you be ready for over the next 30 or 40 years?
Maybe the way to think about this is a fourth contingent or constant: people. People make things, and people break things; as long as health care products and services are consumed and received by people, being a people person—communicating well, empathizing, coaching, motivating, problem resolving—rather than finding and solving, should prevail. This is contingent upon people still being around and involved in care delivery. A guaranteed best bet is honing soft skills, the kind that transcend technical skills and knowledge and allow for flexible changes in your job description over time.
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