Is It That Bad?

A potential pharmacist student commented on my blog here asking me if pharmacy was really that bad... he said he was reading blogs about the medical profession and all we do is gripe and complain. Got me to thinking this early morning about that question... "Is it that bad?" For me, no way it's not that bad or I would have already gone back to school to do something else. I believe it's human nature to complain some and especially to complain anonymously. Things about pharmacy that I have loved... This is a list probably needed to be completed to tell you guys and gals the GOOD stuff.

1. If you loved science and you loved biology in high school and college then pharmacy could be the career for you. Not only did I have the opportunity to learn about chemicals, etc..., but I learned the various ways they are changed, metabolized, and excreted by the human body. Not only that, but the different ways they can be broken down by DIFFERENT human bodies - some with renal issues, some with hepatic issues, etc... Everyone can be truly different. Drugs can react differently. I found this one single point of pharmacy to be quite fascinating.

2. If you want to graduate in 6-8 years and start out making six figures (potentially) this may be the job for you. I found in 1999 when I graduated that I was making close to six figures, but a lot of the older pharmacists were really ill about the new guys on the block because they knew we were making the exact same pay. It wasn't pay based on performance but LICENSURE. For the new guy, this is great; for the old guy, it can be disheartening to think that little youngin' next to you is bringing home the same bucks. I'm almost 10 years out of pharmacy school now (unbelievable time flies!) and it STILL DOES NOT BOTHER ME. I don't get wrapped up in petty stuff, and I figure if you really want a dollar more per hour, you could have negotiated up front. BE A SHARK when you negotiate - ASK FOR THE IMPOSSIBLE. If you do not ask, you will NOT RECEIVE. Vacation... they say we'll give you 3 weeks. Tell them that you want 4 weeks. Go up on pay by at least 5-10K per year. Why not? They want you and they will negotiate just like if you are selling a house.

3. Options other than retail. When I tell people I'm a "pharmacist," the majority think retail. What is great about pharmacy is that there are MANY MANY options in different jobs. Of course coming out of school, retail is the most lucrative in pay, but over time other positions can be just as tasty. There are the hospital pharmacists (me), the home infusion pharmacists, the nuclear pharmacists, the retail pharmacists, the professors in a pharmacy school, the long-term care pharmacist, the consultant pharmacist, and the specialty pharmacists within other settings. You can do a residency, make yourself a little different than Joe PharmD next to you, and land a Critical Care Specialty Pharmacist position at a big city hospital, make rounds with a physician that actually respects you if you know your shit and drink Starbucks coffee everyday leaving for home at 5pm like the rest with bankers' hours. The CHOICES ARE ENDLESS really.

I've been out of school, like I said, for 10 years almost. I have tried retail, home infusion, long-term care, and hospital. I love little bits of all of them... but I find hospital to be the most comfortable for me.

I would never tell someone to NOT pursue pharmacy. It's a great career for anyone... BUT you will find some complaining out there... even from me.

Blogs have to be funny after all, right?

Another one bites the dust... (almost)

I have a dear friend in pharmacy that moved into retail solely because his job at X Company (long-term care) was eliminated.  I personally left the job prior to the massive overhauling of layoffs that ended up leaving a staff of twenty pharmacists to about 2 full-time and a couple of part-time pharmacists.  Sad, really.  It was such a great company at one time...  tons of cubicles where there all sorts of different things to do from the front-end work to the back-end work of shipping the meds to different places.  This dear friend of mine is in his 60s now and was let go as the others and joined up with a chain store.  I talked to him recently.  He's already ready to quit after just 6-8 months.  You see, this chain company had him in a brand new store down in his home town.  That same chain drug store posted signs out front that stated:

"Your prescription filled in 15 minutes or less"

Can you believe that?  So over time, customers came, dropping off their prescriptions while complaining about the Walgreens down the road where they had to wait a whole hour to three hours for their medications.  Over time that same pharmacist saw the business grow and grow to a point where more help was needed.

Guess what?  No help is hired.

So now my dear pharmacist friend is on a month long trip to a tropical place while he told his boss that 14 hour days were not for him nor was not having a lunch.  He told them he'd be back in a month and when he came back may not stay there.  They are so desperate enough that they are sitting and waiting on his return.

Walgreens - the Superpower

Walgreens September Sales Increase 9.5 Percent;Opens 6,000^th Store

DEERFIELD, Ill.--(BUSINESS WIRE)--Walgreens (NYSE: WAG)(NASDAQ: WAG) had September sales of $4,413,000,000, an increase of 9.5 percent from $4,031,527,000 for the same month in 2006. Sales in comparable stores (those open at least a year) rose 4.7 percent.

September pharmacy sales increased 8.8 percent, while comparable pharmacy sales increased 3.9 percent. Comparable pharmacy sales were negatively impacted by 3.8 percentage points due to generic drug introductions in the last 12 months.Total prescriptions filled at comparable stores increased 1.6 percent. Pharmacy sales accounted for 66.4 percent of total sales for the month.

Comparable store front-end sales increased 6.3 percent during September.

Calendar day shifts accounted for a negative impact of 1.6 percentage points on comparable pharmacy sales. Patients fill more prescriptions on weekdays compared to weekends, and this year’s September had one additional Sunday and one fewer Friday compared to September 2006.

Calendar year-to-date sales were $40,357,306,000, an increase of 11.9 percent from $36,056,997,000 in 2006.

Walgreens fiscal year began Sept. 1, so fiscal year-to-date sales are the same as the month’s sales.

Walgreens opened 18 stores during September, including two relocations, and acquired one store. The company opened its 6,000th store in New Orleans and will celebrate the grand opening in October.

At Sept. 30, Walgreens operated 6,014 drugstores (including 101 home care division locations, eight specialty pharmacies and three mail service facilities) in 48 states and Puerto Rico, versus 5,475 a year ago. Franchisees of Option Care, Inc., a wholly owned subsidiary of Walgreens, are not included in Walgreens store count.

Please note: Monthly sales numbers are preliminary and unaudited. Comparable stores are defined as those locations open for at least 12 consecutive months without closure for seven or more consecutive days and without a major remodel or a natural disaster in the past 12 months. Relocated and acquired stores are not included as comparable stores for the first 12 months after the relocation or acquisition.

Magic Mouthwash (the vague term for a concoction of ANYTHING)

When I worked in retail pharmacy, a physician would write a prescription for "Magic Mouthwash" and the patient would hand over the prescription with this look of "magic."  This special blend of WHATEVER would be the cureall for their sore mouth and throat caused by thrush or radiation or any other mouth/throat pain condition.  The physician rarely would include what he/she "thought" to be their special recipe.  So, we would have to call and clarify. "What would Dr. Doe like in his magic mouthwash?"  I would ask simply.

"Magic Mouthwash?"  asks the nurse, "I don't know.  What do you normally put in it?"

Sigh.  "Well we could start with diphenhydramine, lidocaine, and nystatin all at a 1:1:1 ratio or we could do tetracycline and throw in some mylanta with the formerly mentioned ingredients at all different ratios.  There are probably a 100 different magic mouthwashes out there.  What is the doctor treating?"

And it would end up that I could pick whatever I wanted.  That made me think... hmmm  placebo effect.

So what exactly should you put in Magic Mouthwash?

The usual concoction contains equal amounts of viscous lidocaine and diphenhydramine for analgesia...and Maalox or a similar antacid to enhance coating of the ingredients in the mouth.  Some also include nystatin to prevent or treat fungal growth...a corticosteroid to reduce inflammation...or tetracycline to prevent secondary bacterial infections.

Who knows if this stuff even works and is worth the money since we pharmacists usually tack on a compounding fee.  I say get a prescription for lidocaine viscous and buy your own benadryl solution and mylanta and make your own... for less.

Wittiest comebacks in retail pharmacy

This morning I am not scheduled to work, so I decided to look around the blogosphere and find some retail pharmacy blogs.  They are the funniest ones after all constantly reminding us all what assholes the general public is today.  Without further ado here is a good one.  The Angriest Pharmacist posts about receiving a fax from a CUSTOMER to refill his meds.  I probably in my passive-aggressive style would have personally played the blonde card and pretended the fax was broken and that I didn't get the fax.  Then, I would have probably continued on to do more things to have my own satisfaction internally at watching an asshole customer squirm.  These are some of the reasons I left the retail world.  I wanted to personally choke about 30% of my customers. Case-in-point, one of my favorite top three stories from retail occurred at the same store while floating that the gay man visited in my previous post.  A man walks in holding his five year old son and asks me to refill his son's albuterol nebules for his breathing treatments.  Of course, the man has TennCare.  Don't you just miss TennCare pharmacists in Tennessee?  What a crock of shit.  Anyway, I submit the claim online, as we do immediately to file for coverage, get the copay, etc... and lo and behold this man had JUST refilled it a few days ago.

"Sir, I submitted your claim through your insurance."  Keep in mind here that I didn't say TennCare.  I could have done that.  Still staying professional.  "Unfortunately, it was just refilled a week ago, and because the doctor's directions specify a certain number of days per refill, your insurance will not cover the cost this time."  I always hated that explanation.  I hated that I HAD to represent the thousands of insurance companies out there telling them why FOR the companies.  Toward the end of my 3 year tenure in retail, I learned to plaster a face on that basically said, "These insurance companies are so..." and then I would proceed to dial the phone number to the company and get a rep on the phone and then HAND THE PHONE TO THE CUSTOMER for any questions about the copay, when it was last filled, etc...  I got to the point where I would actually say, "Ma'am, I'm sorry.  I work for (Drugstore).  I'm not familiar with the thousands of insurance plans out there.  Can I dial your insurance company for you as I really have no information about your insurance that YOU pay for..."

Anyway, I digress, the man holding his son wanting his albuterol refilled raised his voice immediately and going into what I called "Bulldog Stance."  "WHAT?!  It's not going to cover it?  Little Johnny NEEDS his BREATHING treatment for his ASTHMA!"  Customers nearby start to notice his loud mouth.  He's trying to draw them in for backing of sympathy.

I had none.  "Sir, I'll be glad to ring this up for you - cash price is $21.00."

"I am NOT paying for it!!!!  It's supposed to be covered."  He is obviously enraged.  I had a certifiable nutcase.  Great.

"Sir, once again.  I don't know how else to explain it but to get TennCare on the phone to explain it to you.  I don't work for them and only submit the claim where they decide to approve or deny.  They are stating via computer, "TOO SOON."  I look sympathetically at his son in his arms.  Too big to be carried, but he's witnessing his Dad's total ASS-OUT.

"I cannot beLIEVE you will not fill that prescription."

"Sir, I filled your prescription.  It's right here.  YOUR INSURANCE WILL NOT COVER IT.  I will gladly ring it up for cash price and you can call your insurance company and file it at home if you wish."  Here we go.  Now I'm not filling the rx.  Yep, that's right.

He's ranting and raving and as he does so he must be squeezing his child tighter because the child wimpers, "Daddy, you are hurting me..."

He looked at his child and then at me, even go as far as pointing one of his fingers at me, "No son, I am not hurting you.  SHE is."

I immediately said, "What am I doing over here?  A Jedi mind trick for you to squeeze your child because you are being completely irrational and not listening to me about the insurance that you own, not me?  UNREAL."  I put his prescription in the bins again turning my back on him.

"I WILL HAVE YOUR JOB; I WILL TALK TO YOUR BOSS!!"  He's livid at this point and the crowd about him seems to realize that he's a nutcase as well and throws me sympathy looks.

"I really could care less about this job and having to deal with people like you."  This is where I lost it.  He stares at me and I continue, "But I want to congratulate you on giving everyone, including your son, a fine performance of how to be an asshole."  And then, no I didn't.  I CLAPPED.

I kind of realized then it was time for me to move on.  Retail wasn't for me anymore.  I'd get myself shot.

Sometimes I have to remember the horror of retail pharmacy...

I remember several years ago... in 2001 to be exact... I was floating for a pharmacy corporation which meant I would be sent to the worst part of town during the most unsafe times.  My first experience at this particular store included a homosexual man demanding that his valium would be filled by a certain time that day.  It was coming in the order, so I couldn't fill it until the delivery guy brought the drugs the pharmacy was out of...  his valium was one of those drugs.  The customer told me that his medicine would be filled by 2pm because he had to catch a plane. UM... ok.  2pm.  Sounds good, except buddy, I don't know what times the drugs are delivered.  I am a floater... not a regular pharmacist that you can verbally abuse.  Needless to say, he threw around the ultimatum again in the air and flippantly walked out with his head held high like a proud rooster ruling the coop.

2pm rolls around.  The drugs aren't delivered yet.  Mr. Homosexual comes back and demands his pills.  "I'm sorry, sir, the delivery hasn't made it yet.  I don't have your medication filled."

He was beyond upset.  He was livid as he spewed, "You have NO idea what it feels like to be gay and flying into BUSH COUNTRY for the funeral of a dear friend who died of AIDS."

"Nope," I said, "I sure don't.  I don't have a clue."

He got his meds at 2:30pm.  I did the best I could!

Teamwork and Positive Attitude!!!

There was this cheery orientation video that we all had to watch with the rest of the newbies during the Human Resources' led introduction. I cannot remember the exact name of it, but it had phrases come across the screen of what staff members should NOT say to other members of the staff or patients in the hospital. Rather than: "No. I don't know." Say: "No... but let me find out for you."

There were twenty or more of them, and oh... what a perfect world it seemed for that 10 minutes of listening to those positive and helpful statements. In the real world, I remember the first three weeks of work. I heard them all.

"No... it's not my job."

"Sorry, I don't know."

Or just ignored me. I felt like the biggest idiot asking question after question but considering there was no real formal training program, I guess I got by after four weeks of it.

Andy gave me a brand-new shiny white notebook filled with a 5 week training schedule, a page to write down all my usernames and passwords... (um... doesn't that defeat the purpose?), and blank pages to write notes. OK.

A few words about the training schedule.

I don't know how many of you pharmacists out there have specialty pharmacists, but it's this new phenomenon of further separating the pharmacists from those with residencies and fellowships. We have a few female specialty pharmacists: critical care, infectious disease, pain management, and a couple of others. And their boss, Ann, who has about a month left before she moves away. Most of the regular staff (non-residency pharmacists) cannot stand Ann because they say she forced more work on them and our boss Andy didn't stand up for them. OK. Whatever. Now we have to calculate creatinine clearances for Vancomycin, etc... Big deal. Doesn't matter to me.

Part of the training schedule included meeting with every single one of the specialty pharmacists, etc... and discussing what they do and taking me up on the floors to see them in action. One of them did her job with that setting up the meeting and showing me what she does, etc... One of them mentioned setting something up in three or four days but never delivered or remembered it later (That would be Jessica, who seems nice enough)... is that MY job to remind her? It's THEIR TRAINING PROGRAM! Another one of them, Kimmie, never mentioned it or anything. Geeze. So I didn't see any of it.

The third week, I saw my boss Andy completely ass out. We have automatic orders that can be ordered in group by physicians and we don't have to see the actual written orders... they are pre-approved orders. They print off all day as the orders are being entered along with the scanned and written images we see. Sometimes we get a little bit behind on the pre-approved orders. Andy waltzes into our little room and asses out one day as we are behind on them but also severly understaffed. I saw the real Andy. He's passive aggressive.

Also the third week was when it was discovered by me that although we are in one department, we are severly divided. Staff vs. Clinical. I'm staff. Ann, Kimmie, Jessica, and management with some others are clinical. They have private celebrations for one another without including the staff and don't have the decency enough to take it off site but rather leaves us out. Like I care... but I remember the terms used in my interview...

"Oh Blonde Pharmacist...." Andy says nicely, "We have the best team attitude and everyone is positive and we are making sure that all new hires fit with us and vice versa."

Um. OK. I see what's going on here. He's hiring one person at a time to try to change the culture.

I don't want to be a part of the revolution!