We Are One

Part 3 of a Three-Part Series

“The whole is greater than the sums of its parts”

Aristotle

As I started out this three-part series, it now almost a decade later and the thoughts and feelings I had back then are still very real to me now.   It is not a place I want to return nor ever feel that desperate again.  I am fortunate that my family—my son—were able to reignite the fire that had been extinguished—my passion to be a pharmacist, to make a difference for my patients, to be happy and productive in my chosen career.  That passion was almost lost because of external factors, factors that negatively affected me and my practice, factors I did not anticipate nor fully understand when I became a pharmacist. 

I had my own vision of how I wanted to practice when I graduated from the University of Iowa College of Pharmacy.  Little did I know that there were opposing forces beyond my comprehension that would create obstacles to my vision and make it challenging for me to achieve that vision. I have learned so much during my 35 years as a pharmacist and I will provide those key learnings—but the one most important lesson is that being part of a profession engenders great responsibilities for all of us.

So what does it mean to be part of a profession?  It means we are autonomous and guided by a code of ethics.  It means to profess a commitment to life-long learning, competence, integrity, altruism, and professional accountability to those we serve.   

I am afraid that professional autonomy has been eroded in pharmacy.  We have been commoditized by employers, payers, and other stakeholders (including Pharmacy Benefit Managers or PBMs)  who do not recognize the true value or impact pharmacists have in healthcare—ensuring patients’ medications are optimized, are achieving therapeutic outcomes, and are safe and effective.  In other words, our value as providers has been cheapened and it is time we change that. 

This leads to one of our responsibilities as a member of a profession - to engage in the profession.  Engagement means actively belonging to our professional associations—many of whom are fighting our professional battles at the state and federal levels with legislators, regulators, and payers.  I would not have had success without the help and support of my state association, IPA, and several national organizations including APhA and NCPA. 

Another professional responsibility is that of self-regulation.  Pharmacy, much like other health professions, have established standards of education and training, entry into practice, and the practice itself.  As a member of that profession, it is our responsibility and obligation to ensure practices are meeting those standards and initiate remediation or discipline if they are not.

This self-regulation also means we have a responsibility to each other.   We are all pharmacists and are connected by the commonality of our professional responsibilities and code of ethics.  We should engage with one another, understand the challenges many of our colleagues are experiencing, and be willing to fight for our colleagues and profession. 

For some time now we have recognized concerns related to workplace challenges and pharmacy staff wellbeing.  Burn out is real amongst our colleagues.  Most of us went into health care because we wanted to help people and make a difference in our communities.  We were taught how to work up our patients, provide clinical services, identify and resolve medication-related problems, work collaboratively with other providers, and document our care. 

It sounds great unless you work in an environment that prevents you from practicing this way. When your professional expectations are mismatched with practice realities, it leads to frustration, emotional and mental stress, and eventually burnout.  Somewhere along the way we lost our autonomy. We became fragmented and siloed, and we lost our professional connections. 

It's time we reconnect with one another and “take back” our profession by standing up to external forces that have negatively affected our profession.  We must have one common voice and each pharmacist needs to be engaged, recognized, and heard.  We can overcome these external forces, but only as a united profession.

Here are the learnings from my own experience.  I hope these can provide hope and encouragement to my fellow pharmacists—I do care and I am listening!

1.     Losing control of one’s destiny can evoke feelings of helplessness and hopelessness.  For me, regaining control of the things I can affect was the first step to healing.  It wasn’t that the eternal factors ceased to be, I just made the conscious decision to not let them get the best of me.  There were things/actions I could control which helped make me emotionally stronger, more confident, and energized.

2.     Making a difference in your corner of the world may have a ripple effect that can positively affect others.  In the words of JFK “One person can make a difference and everyone should try.”

3.     Pharmacy has been commoditized by multiple stakeholders including PBMs.  I learned that I needed to engage more within my profession by contributing my time, talents, and/or treasures to those organizations that have supported me during my battles with PBMs. These include state and national pharmacy associations, colleges/schools of pharmacy, boards of pharmacy, and various other pharmacy-related stakeholders.  It’s always easier to point a finger at others and complain about the problems, but it is harder to point the finger back at oneself and reflect on how you are engaging and committing to be part of the solution.

4.     Never become complacent or apathetic and don’t assume others will fix the problems.  You may very well be the solution to the problems—don’t underestimate your value.

5.     It’s a marathon, not a race.  This means we need to commit to the process, stay disciplined, and persevere.  There will be obstacles that cause you stumble—but that is a learning moment. Pick yourself up, learn from the challenge, and continue on.  Celebrate the successes when they occur, but don’t rest on your laurels—continue to strive to make a difference.