Why I became a pharmacist, and why that’s not the question that really matters.

One of the most common questions I get asked when someone inquires about my profession is, “Why did you choose to be a pharmacist?” My answer often strikes people as odd: “My high school chemistry teacher told me to.”

Like a lot of kids, I didn’t like school. I didn’t get the point of most assignments, and would frequently “forget” my homework at school, which got me into hot water on a number of occasions. I was, I’ll be honest, a pretty lazy student who was quite content to do the bare minimum. This continued to be an issue until I was about half way through high school. I don’t know if it was the knowledge that real life was fast approaching or if I just finally felt challenged and interested, but something finally clicked.

School wasn’t my thing.

Obviously there were still classes I didn’t like and areas where I didn’t fully apply myself, but I found that science class was my happy place. Chemistry and biology were my favorites, and I took every class available to me, including an anatomy/physiology course offered at my high school by the local tech college. I was able to take advanced placement classes in most of these areas, which actually translated into college credit, so I was able to get ahead of the game. I still struggled with completing the assigned homework, but I managed to convince most of the teachers in my preferred subjects that I was skipping homework because it was too easy, not due to lack of ability. Somehow that worked more often than it should have. 

I always knew what I wanted to be when I grew up. Sure, I dreamed about a lot of occupations, but I always KNEW I would go into medicine. I wanted to be a veterinarian, specifically. When I was around 9 years old I called every local animal shelter and vet clinic in search of one that would let me spend a day shadowing a vet or volunteering in some capacity. Most wouldn’t hear of it (apparently a 9 year old poses a liability problem), but I was undeterred. I was the type of child who was terrified of talking to strangers, so my insistence on cold-calling everyone in town was rather shocking. But I was determined to get my foot in the door, and finally found a clinic that agreed to let me spend the day with their veterinarian. She let me stay in the room when she examined the well-behaved animals, and showed me x-rays and patient charts (HIPAA doesn’t apply to animals, right?) to give me a feel for what she did every day. It was amazing, and I’m still so grateful to her and her clinic for taking me seriously and treating me like the little adult I thought I was.

As I worked my way through high school, I began to examine my future a little more closely. I realized that the tuition for vet school is insane, and they don’t get paid as much as they probably should. The general internet consensus is that it’s financially worth the cost of tuition, but just barely. Couple that with the fact that I don’t think I have it in me to euthanize a puppy, and I began to doubt the future in which I had once been so confident. But what were my other options? I still wanted to work in medicine, but could I be a nurse or doctor? To be honest, my dislike of physical human contact immediately turned those options into non-options.

Veterinarians have one of the highest debt-to-income ratios of any of the “high paying” professions. Basically, their schooling is hella expensive and they’re not paid well for it.

It was in this moment of hitherto unknown indecision that my high school chemistry teacher said, “You should be a pharmacist.” I come from a family of relatively healthy people, so I honestly had no idea what a pharmacist did apart from handing you a pill bottle, but I trusted this teacher’s judgment. As I looked into it further, I became more confident that this was the occupation for me. From that point on, my mind was made up and it was just a matter of making it happen.

My high school advanced placement classes gave me a leg up, and I was able to test out of some of the prerequisite classes. I was accepted into pharmacy school after only 2 years of undergrad rather than the typical 3-4, which made me one of the youngest people in my pharmacy class (I was 20 but looked closer to 16). I still struggled with studying, but there was no plan B to fall back on so failure wasn’t an option. Four years later, I was a licensed pharmacist. 

It’s what I do.

I’ve been a pharmacist for 12 years now, and I don’t think I regret my decision. I don’t enjoy my job the way I used to, but I’m happier now that I only work part time. I dislike what the profession has become over the past decade, but I still feel like I’m doing something worthwhile most of the time. 

So that’s the question I get asked most often, but here’s the question I wish more people would ask: What does a pharmacist do?

A pharmacist is a doctor who specializes in pharmaceuticals. They are, quite literally, a “doctor of medicines.” I’ll add a caveat here that a PharmD (doctor of pharmacy) degree has only been a requirement since 2004, so anyone who was licensed before that time may not technically be a doctor, despite being an RPh (registered pharmacist). 

The general idea is that a physician diagnoses an illness and prescribes a treatment, and the pharmacist’s job is to confirm that the treatment is safe and appropriate for that diagnosis. We verify that the dosage is correct for the patient’s age, weight, gender, and other health conditions, and that there are no contraindications or drug interactions with the patient’s other medications or health conditions. We also recommend alternative treatments when an insurance company refuses to pay for a drug, or when a patient can’t afford the medicine that was prescribed. Our technicians fill the prescription, and then we confirm that the drug in the bottle matches the drug prescribed. It’s also our responsibility to ensure that patients understand what drugs they’ve been prescribed, and have all the information they need in order to take their medication correctly. We warn patients of potential side effects or drug interactions to be aware of, and what they can do to manage minor side effects at home. We act as a sort of triage for minor injuries and illnesses, and spend a decent amount of time answering questions and instructing our patients about what OTC medications and treatments are appropriate for their situation, and when they should seek medical attention. We also administer vaccines to anyone over the age of 3 (age varies by state).

Because the American healthcare system is broken, our “real” job (everything in the previous paragraph) isn’t viewed as being very important by corporate America or the general population. Most of what we do isn’t seen by the public and can’t be monetized (patients seem to think their doctors don’t make mistakes, and I can’t charge someone for asking if they can take Motrin and Aleve together), so our corporate overlords have come up with other ways for us to be “useful.”

PBMs have sucked a lot of the profit out of dispensing medications, but we still need record-breaking profits every year so we’re being asked to do more with less. Hours get cut so that pharmacists have to do their own job as well as the jobs of technicians. We’re asked to do MTMs (“medication therapy management,” or in-depth 1-on-1 consultations with patients who take multiple medications to treat a multitude of illnesses) without pharmacist overlap or extra help, and corporate wants us to cold call people to badger them into signing up for additional programs and services that they don’t want. Don’t get me wrong – MTMs are incredibly important when done right, and auto-filling prescriptions can improve compliance, but we’re doing it all wrong. I can’t do a proper MTM while filling prescriptions at the same time, and we frequently auto-fill medications that people don’t even take anymore. It can’t be about the number of people we sign up for these services, but about how these services can best be utilized to serve our patients. As it stands right now, all the emphasis is placed on the number of prescriptions we can fill, MTMs we can do, and vaccines we give, rather than on whether we’re actually keeping our patients safe and healthy.

From the Journal of the American Pharmacists Association – our skills are being underutilized. We’re not doing what we’ve been trained for, and our patients are suffering for it.

I wish I could say that it was just a single company’s problem, but it’s trickled down from the big 3 (Walgreens, CVS, Walmart) to include pretty much every pharmacy except the few independents that haven’t yet been bought by the chains. The emphasis placed on metrics and customer satisfaction surveys have meant that I’m no longer able to properly use my professional judgment to ensure the safety of my patients. We do the best we can with what we’re given, but we’re not given much. Patients care more about getting their medication quickly than safely, and don’t want to hear that it took longer than expected because their doctor accidentally prescribed clomiphene (for infertility) instead of clomipramine (for OCD or depression), or because they pushed the wrong button on their calculator and prescribed an overdose of an antibiotic to an infant. They don’t want to wait for the pharmacist to walk over and counsel them on how to take their medication (even though I’m legally required to talk to them) because “the doctor told me how to take it.” These are, inevitably, the people who call an hour later to ask what the drug they picked up is for, if they should take it with food, or who stop taking it entirely because it’s making them queasy. The introduction of the drive-thru has made us synonymous with fast food in the eyes of many, and the “$4 generic” program started by Walmart has made it clear that it’s the pill bottle they’re paying for, and we as healthcare professionals have nothing of value to offer.

A survey of American pharmacists showed that more than half of pharmacists working in a chain retail pharmacy believe that their employers are actively working against the best interest of their patients. They don’t care how many patients get hurt so long as they’re still turning a profit.

There’s a saying in pharmacy that goes “You can get your medication fast, cheap, or safe. Pick two.” Unfortunately, safety has taken a backseat. I don’t regret my decision to become a pharmacist. I still feel like I’m making a difference. But if I had to do it all again, knowing what I know now, I don’t think I’d make the same choice. The question I keep asking myself now is this: “Is it better to keep working in retail and fight for the safety of your patients, or should you get out while you can before your employer’s reckless pursuit of profit causes you to make a mistake that causes serious harm?” I’m still working out the answer to that one.

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