Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Prime Minister John Howard probably never thought that he would become a role model when he decided not to stand aside in favour of his Treasurer, Peter Costello, on his 64th birthday.
The obvious vigor involved as he engages in his daily activities (constantly reinforced by television images of his daily walk) has awakened a nation to the fact that retirement, as we know it, need not be inevitable.
This awakening has come through the realisation that our population is aging and that a rapid decline in living standards will be inevitable, if labor shortages, due to retirements, are not able to be replaced.
With Australia's low birth rate, we will not have this replacement capacity.
This also means there will not be a strong enough tax base to levy taxation, sufficient to sustain pensions and healthcare schemes into old age.

It is estimated that there will be an across-the-board loss of 60 percent of highly experienced personnel over the next five years.
In Pharmacy, the trend has been most obvious over the past two to three years.

In year 2000 I commented in some of my website editorial that:

" I see an opportunity to reverse the trend of a diminishing pool of trained pharmacy human resources, by developing retention strategies, specialised training in new skills such as information technology, and in the provision of access to continuing education, principally via the Internet."

I further commented:

"All pharmacy areas are affected, including hospital pharmacy departments, with the situation becoming chronic in rural and remote areas.
The reasons for pharmacist shortage are multiple:

* Professional morale is in decline, concurrent with a harsher economic climate and stress increases in the workplace. These processes are all exacerbated as the Internet creates either an opportunity or a threat.

* There are many pharmacists on the register that have made themselves unavailable for community and hospital work.

* Medicine requires a degree in any other discipline before students can enter this faculty. There is a leakage of pharmacy students to medicine, because it is a logical course through which to achieve entry requirements.

* There is some evidence that a loss of new disillusioned pharmacists is occurring in the community, because of perceived unethical practices.

* The high purchase cost of community practice is seen as a deterrent to being able to improve income levels, and opportunity is sought elsewhere.

* The pharmaceutical industry is offering more varied work with higher remuneration and there is leakage to this area.

* Attitudes are changing towards work and many are endeavoring to adapt their work to a chosen lifestyle. This means working lesser hours and being available on a more or less irregular basis.

* Workplaces are not flexible, interesting, or financially stimulating and there is a permanent loss as pharmacists seek alternatives totally outside of pharmacy.
Hospital pharmacy is particularly vulnerable in this respect with its low hourly rate coupled with high levels of responsibility.

* The average age of community pharmacist proprietors is 55+ and the retirement rate is increasing. There is the prospect that many of these pharmacists will not be able to sell their practices, with the consequent loss of future job opportunities.

* Trained pharmacy resources in the form of dispensary assistants and pharmacy assistants qualified in one or more sales specialty are also becoming scarce. "

While there has been some movement by our professional bodies to stem the outflow, this has not been enough. It could be said that succession planning within pharmacy has been nonexistent and we are now suffering the outcome of a lack of suitable policies and strategies.

We are not doing enough to encourage our senior pharmacists to stay on.
And why would you stay on?
Having now joined the ranks of the elderly myself (although I never think of myself in those terms-that term is for all those other "old" people out there!), I decided to put in some time back into community pharmacy, after an absence of approximately a decade.

Well, the first day, after nine hours of constant standing, plus the supervision of 350-400 prescription items, saw me very tired, with everything aching.
I have obviously lost my retail "legs"
Why would these conditions encourage me to stay on in pharmacy?
Why would anyone at any age persist in trying to work continuously under such stressful conditions?

Yet this scenario is probably reflective of all "successful" pharmacies.

I would now make another comment:

"Forget about the Woolworths of this world, the brand images of marketing groups and the bone-numbing quantities of prescriptions that you dispense, If you do not have an assured depth of human resources covering all skill aspects of your pharmacy practice and an assured supply well into the future, you can forget about surviving in business."

This is the next challenge to step up in line with all the other challenges that are coming together, to overwhelm an already stretched community pharmacy proprietor, no matter what stage of development or size you may be.

The cost of retaining a good pharmacist is about to escalate, and I will give you an example.

I have been working for a number of years to develop a training and succession model for the fast tracking of students and preregistration pharmacists, in a local hospital.
The system is also designed to train and develop clinical support staff and dispensary support staff.
A link to community pharmacy was planned as well, so that as the system produced trained people surplus to the hospital environment, community pharmacies would take these people in a seamless process, on the proviso that the hospital could have them back for short periods each year as locum staff. This aspect has only just been recently negotiated.

The system has worked well.
Too well!

Three pharmacists associated with its development have been progressively "poached" over the past three years. Despite this, I have progressed the system to the stage where I am "graduating" the first preregistration pharmacist. This pharmacist was targeted to be a clinical pharmacist for 2004 within the hospital.
Before this person has even been registered a "poaching" has already occurred with an offer by a community pharmacy, which is slightly in excess of what the chief pharmacist of that hospital can expect to earn.

While I can appreciate that this particular community pharmacist has his back to the wall, having lost three pharmacists from his environment over a 12 month period, it is extremely damaging to the hospital system, for two reasons:

* The hospital is unable to "grow" additional pharmacists, because it is operating on a "train-the-trainer" approach. Taking out such a highly trained resource completely destroys our ability to produce other graduates for 2004 because we need this person's expertise.
With this particular preregistration pharmacist we would have had the ability to intensively train two more potential pharmacists for 2004.
This has been immediately downgraded to an intake of one preregistration pharmacist for 2004.

* By benchmarking a new value for the pharmacists emerging from my system, the pharmacists already working in community pharmacies are devalued, as are those in the hospital system endeavoring to produce pharmacists of a high standard in a regular flow.
Within the hospital system we have a rigid adherence to a hopelessly outdated award system, so there is no hope of matching community pharmacy offers to our system "graduates".

* The end result of this "poaching" process is that the hospital training system will self destruct as the minimal number of trainers left, allow themselves in turn, to be poached.
Why put yourself through the laborious rigors of training someone who is immediately going to disappear, and who will be probably paid at a rate higher than your own?

* And if you follow this thinking through to its final conclusion, without a local hospital training system being allowed to develop for the benefit of the entire region, the poaching pharmacist will be back where he started from in about two years time, this time having to poach from local community pharmacies rather than the hospital. It will be a battle of who has the biggest cheque book as to who will be left standing at the end of this destructive process.
Now stand back and imagine if a Woolworths pharmacy, or even an already established wholesaler branded group engages in the same process, how will you stand up to it?

The hospital training system has taken patience to develop and involves the use of drug monitoring "tools". It was developed out of desperation, when the rurally-based hospital lost over 50 percent of its pharmacists over a three year period, which brought the entire clinical service to its knees.
Only distributive services could be performed (inpatient and outpatient dispensing, and imprest servicing).

A new approach was then taken by inducting some nurses into a clinical team as a clinical support system to pharmacists. Instead of trying to service every patient in every bed in the hospital, only patients attached to drugs that have been proven to cause discomfort, adverse events or death within the hospital system, were serviced.
This meant that the system operated by exception, with a global approach being taken, not just confining one pharmacist to manage a specific ward, which was the old system.

Not only have the support staff been successful in identifying patients attached to the nominated drugs, but they have been able to refer those patients identified as having a real or potential problem.
This, of course, can only be done with a properly crafted monitoring tool developed by a pharmacist, and the support staff must refer back to a clinical pharmacist for intervention.
This system also provided a training system for student pharmacists and preregistration pharmacists, because with minimal training, they can be set free to screen patients.
They are able to apply their university acquired learning immediately.
So a high number of students that pass through our hospital want to work there full time.
We can absorb fairly large numbers, but the local hospital budget cannot afford it.
We can only talk in numbers of one or two per annum, and we must release them if our internal budget becomes stretched, or we simply cease recruiting.
The system has been highly successful in extending the effectiveness of the small number of clinical pharmacists, and the hospital is now receiving a good basic clinical service, which even has a small research component measuring in dollar terms, pharmacist effectiveness.

It has become a highly effective and respected patient safety model.

When we train students, the deal is that if we help them with their university set assignments, they must help us by developing one or more monitoring tools.
At the moment, we have slightly more tools that we can actually implement, but this ensures smooth progress into the future, provided our trainee pharmacist stream is not disrupted.

In the learning phase of developing and applying our training methods, we have discovered that while money is a motivating force in where a new pharmacist will turn their attention for their preregistration period and beyond, the initial attractant is a staff-friendly environment where they can practice clinically.
In return for a value training, these pharmacists will initially forgo a high salary, because they quickly become aware that they can attract a premium at a later date.
We suggest they have at least three years hospital experience before flying the coop.
My only problem is that market forces are taking over too quickly.

There has to be an avenue for a government sponsored initiative to assist training and succession schemes similar to what we have developed.
And our professional bodies need to have a close look at all the initiatives that are already in place. Perhaps a survey needs to be conducted to find out what is already there.

We are also looking at another wing- that of using the system to retrain retired community pharmacists or practicing community pharmacists at any level.
We would argue that we could efficiently trade knowledge for life experience, and end up with a net gain to the hospital, as well as to the local community of pharmacists.
We hope to develop this stream next year if we can get the sanction of the hospital administration, which may prove difficult.

What this article is setting out to demonstrate is that if a system approach is taken to the training and development of pharmacists at all levels of their career, coupled with a staff-friendly environment, there will be a net retention of pharmacists, particularly those contemplating retirement.

In my case, if the community pharmacy I have recently worked in as a locum does not provide a work station where I can be seated for part of the working day, then the old knee joints will give out and I will no longer be capable of working in that pharmacy.
I will not necessarily tell the employer that (because that is an admission that I am "old" and that is something I will not yet admit to) and I will just progressively phase down my available time.
Now there are pharmacies being developed where the "forward pharmacist" is seated to talk with patients and this is both staff-friendly and patient-friendly.
The aging pharmacist will still be able to deliver their intellectual product while simultaneously, preserving most musculo-skeletal functions.

Don't laugh, it is a real problem that the majority of pharmacy shop designers or system designers have yet to come to terms with.
But slight modifications to your environment relating to all aspects of being staff-friendly, must translate into a staff better equipped to be patient-friendly, which will win the day, no matter what age the staff are.
And I will tell you now, no matter what hourly rate is offered (in a pharmacy where I must stand for long periods) I will not accept, if there is a more staff-friendly and adaptable environment offering a lower hourly rate.
For you see, aging pharmacists do not necessarily see themselves as expanding their career choices as they did in their earlier life-they would just like to contribute by giving back some of what they have received over their professional lifetimes.
And this method of "giving back" can be extended if the workplace is made more adaptable.

For example, I could productively function as:

* A director of a pharmacy company (provided we eventually get company structure, which is long overdue and will be another cause of pharmacy disruption when larger predator Woolworths type organistaions start to dismember inappropriately resourced pharmacies).
* A tactical and marketing consultant in just about any aspect of a pharmacy (management, marketing and some specialist aspects of IT).
* A manager, provided this did not involve being a dispenser as well.
* A dispensary manager, provided the environment is staff-friendly and did not involve excessive periods of standing.
* A locum, provided the environment is staff-friendly (as above).
* A staff trainer on a regular basis (shared amongst a group of pharmacies perhaps?).
* The manager of an e-commerce site, which I can do mostly at home and partly within the pharmacy.
* Public relations person, liaising between doctors, nursing homes, private and public hospitals.
* A consultant pharmacist, performing cognitive duties such as medication reviews.

Now surely most community pharmacies could accommodate a person able to perform all of the above, but have they developed a system structure to accommodate these skills?
And have they thought of sharing these skills as a structure between cooperating pharmacies?
And is there a training system, locally-based, to provide ongoing support?

When hiring pharmacists into the immediate future, discrimination against an aged person will need to be put aside.

It is attitude that you will want to hire!

And this applies to all ages, because in a staff-friendly environment there will be a balance in the ages, structured to provide both the energy of youth and the wisdom that comes with age and life experience.

This also implies a mutual respect for what each age group has to contribute.

A systems approach will identify all these aspects and a properly funded human resource program will pay dividends for the entire life of a pharmacy business, and provide a bulwark against the Woolworths of this world, despite their potential to offer larger remuneration packages.

Unfortunately, there has not been enough thought put in to this problem of human resource loss by governments and pharmacy organisations.
Do you wonder that pharmacists about to retire, leave their profession permanently?
What could possibly entice them to stay?

I do think that if a well thought out proposal were to be presented to the Federal Government right now, it would fit in with their national strategy for retaining retirement aged employees, and possibly attract appropriate funding.
If this were to be put in place, it could also ensure pharmacy is ahead strategically, in its ability to compete with the Woolworths of this world.