Don’t confuse retail pharmacy with pharmacy practice

I was at a volleyball tournament in Forestville, California yesterday. It’s a beautiful place located in Sonoma County above Santa Rosa. Unfortunately it’s also a 4G/3G black hole. I had virtually no connectivity most of the day, but as luck would have it I caught a Tweet from Bob Diamond that led me to an article in The Wall Street Journal, 10 Things Drugstores Won’t Tell You. The article had some interesting things to say, but was terribly biased and incomplete. Was the information accurate? Sure, to a point.

The problem with articles like this is that they focus on a small subsection of pharmacy practice, i.e. retail pharmacy. Retail pharmacies are the scourge of my profession. I’ve worked retail. It’s a soul-sucking environment of profit over patient care, and can quite literally cause pharmacists to rethink their career choice. Have you ever met a retail pharmacist that loves his/her job? I haven’t. Best case scenario they tolerate it. Worst case scenario they hate it so badly that they change careers and leave pharmacy behind.

So why do pharmacists work in the retail environment? I have no idea. It’s likely for a host of reasons: financial, convenience, job market, family life, and so on. Retail pharmacies will continue to be the armpit of pharmacy until pharmacists refuse to work in that environment. I won’t say that I’ll never work retail again because it’s impossible to predict the future. But I will say that if you see me working in a retail store you know I’ve hit rock bottom as a pharmacist.

Before I start getting hate mail make sure you understand what I just said. Retail pharmacy is different than community pharmacy, ambulatory care pharmacy, “outpatient” pharmacy, home infusion pharmacy, acute care pharmacy, academia, long-term care pharmacy, consultant pharmacy, etc. Pharmacy is a diverse profession that affords those with a pharmacy degree a host of opportunities. Retail is but a small piece of pharmacy practice.

The article referenced above made me reflect on my own pharmacy career. As I’ve said before, I’ve been blessed/cursed with a short attention span. I’ve worked in several different areas of pharmacy: six different hospitals (1 in operations, 2 as a clinician, 2 general practice, 1 informatics), one long-term care pharmacy, once as a consultant pharmacist in long term care, in retail for two different retail chains, one community pharmacy (compounding pharmacy) and as a relief pharmacist for about a year.

Each job was different; the best may well have been the compounding pharmacy I worked in. To date it was the only place I ever worked where I looked forward to going in each day. I spent several years compounding. I started as a student, then an intern, then a graduate intern, and finally as full-fledged pharmacist. If hindsight were foresight I would have stayed and taken over the business when my mentor retired, but destiny had something else in store for me.

Acute care pharmacy, i.e. hospital pharmacy was the most exciting environment I worked in. Not to take anything away from pharmacist that practice elsewhere, but “Clinical” work is where the best and brightest tend to congregate. It’s where those that think they can change the world practice. It’s a bit naïve, but it attracts a highly motivated group. That’s a good thing. It’s also where a young mind is an advantage. You have to be willing to continuously absorb new information, learn new things in your off hours and devote time developing your craft.

I found that specializing in “operations” was almost as exciting as the clinical stuff. Operations wasn’t quite as cool, but it brought its own set of unique problems and learning opportunities.

Informatics was cool for a while, but quickly lost its draw. The first year was very exciting. I felt like a kid in a candy store. Everything was new, which brought with it a steep learning curve. But once all the implementations and changes were finished the work became mundane. Maintenance of a drug formulary or resetting passwords is a waste of a Pharm.D. That’s not arrogance, it’s the truth.

Long-term care pharmacy was different, but boring. I was in charge of a small infusion pharmacy inside a large long-term care pharmacy. The work was the same day in and day out. The routine revolved around getting as much product out the door as possible, with little “clinical” thought involved. With that said, I learned quite a bit about outpatient infusion practices; something I was lacking from my acute care pharmacy experience. Still, it was a far cry better than retail.

Consulting pharmacists have an interesting job, if you’re into that kind of thing. It’s more in line with clinical pharmacy than operations, but it’s several steps removed from acute care clinical work. I did it for about a year before I couldn’t take it anymore. In the whole scheme of things I could do it again should the need arise.

See, pharmacy goes way beyond retail. The practice is as diverse as you want it to be. The article like the one in the Wall Street Journal is bad mojo.