Uber is a morally reprehensible company, and should never be used as a source of inspiration for a profession entrusted with the health and safety of patients. But hear me out.
Though Uber is morally objectionable, their product is excellent. Millions use the service because of the advantages it provides over traditional taxi cabs and services. Some have argued that Uber’s great product is borne out of the company’s willingness to flaunt legal regulations and ignore municipal by-laws. In other words, Uber is bad because it does bad things; but some of the bad things it does enables a great end result.
There are lessons here to be learned for the future of pharmacy. Rules and regulations bog down the profession of pharmacy (and any industry, including hair braiders) and extensive legal oversight can make innovation difficult. Yes, there have been showcases of innovative pharmacy practices, but none are exemplary, none are scalable, none are models for the future of pharmacy care across the country. They are individual success stories, carved out of the existing legislative constraints. People point to these as examples of the future, and pharmacists’ apathy for why more examples haven’t caught on. I disagree.
Most pharmacists practicing in a strong clinical capacity are doing it in hospitals or government-led practice models. Missing from all this is the Uber pharmacist — or perhaps better put, the entrepreneurial pharmacist. We don’t want innovative pharmacists to break the law or be morally abject, but the laws simply are too restrictive to allow for practice change. Current legislation is intended to regulate a model of pharmacy practice that almost everyone agrees now is out-dated and needs to be changed. What kind of practice change? I don’t know. I’m not the entrepreneurial type I’m talking about. But even I can come up with easy examples.
To open a “pharmacy practice”, the Alberta College of Pharmacists requires me to register as a pharmacy, including my “hours of operation”. What does that mean if I want to open a practice modeled on UBC’s Pharmacist Clinic? What if I wanted to provide professional services akin to in-home doctor services like MedVisit? Notwithstanding remote dispensing laws, can a therapeutic check of a prescription be done off-site? The Ontario College of Pharmacists requires the dispensing area to be no smaller than 200 square feet. What does that mean if I have a home office that provides clinical professional services? Does pharmacist liability insurance cover you if you set up a telephone counseling service?
Consider a pharmacist-led smoking cessation program — offered in a dentist’s office. People in a dentist’s office are thinking about oral health; the dentist may recommend quitting smoking among many ways to improve oral health and reduce the risk of oral cancer. But the conversation often ends there, and the patient is left to figure it out on their own. What if there was an in-house solution whereby the dentist’s receptionist takes an appointment for a smoking cessation program offered through the pharmacist? The appointments take place in the dentist’s counselling office, on site. The result is value added service for the dental office, clinical based community practice for the pharmacist, better health for the patient.
How does the pharmacist get paid? In many provinces, pharmacist-led smoking cessation programs are government-funded programs, and there seems to be no logical reason that a pharmacist couldn’t bill directly for these. Except in all provinces, pharmacists have no way to claim for those services directly. Sure, there’s an opportunity to charge patients directly for the program, but dentists may not like that arrangement, and insurance companies may refuse to reimburse patients when a government program is in place. And patients may not understand why they have to pay for a program when similar services may be available from their physician for “free”, as required under the Canada Health Act. According to the Ontario College of Pharmacists, setting up a patient file is covered under a usual and customary fee. And so the regulatory framework fails everyone and cements the status quo. An entrepreneurial pharmacist sees this smoking cessation proposal as a non-starter.
Even pharmacy operators are beholden to the current regulatory model. Could you set up a pharmacy with $0 dispensing fee, based entirely on markup? If a pharmacy was willing to do this, and live off an 8-10% markup alone, we could see cheaper prescription drug prices for Canadians and better patient outcomes. Or, crazily, what about an advertising-sponsored dispensing model, where generic medications are dispensed free (or nominally so) if it comes with ads (not pharma ads, but any general advertising). I don’t know if these are feasible models or not, but it does seem that US pharmacies are already farther along this spectrum than Canada. I do know that you can’t even begin to explore different models under the current pharmacy paradigm and its regulatory frameworks.
The entrepreneurial pharmacist is a different and rare species. They are creative and can see opportunities where others don’t. Some are nothing short of iconoclastic. And to be clear, I’m not just talking about money-making entrepreneurs, but practice-changing entrepreneurs. People who are looking for new models of practice even if it doesn’t necessarily mean an 8% return on investment. So you can’t do surveys and ask whether current pharmacists would prefer to have a pharmacist’s billing number, or prefer profit sharing, or something of the like. Entrepreneurial pharmacists are looking for any and all avenues for change and don’t care what the majority feel; in fact, by definition they are looking to go against the grain. They need to be less fettered, have less strings attached and initiatives like prescribing authority are only one half of this puzzle. We need to create the environment for the entrepreneurial pharmacist to take the risk and venture on her own and they will lead the way to the future of pharmacy practice.