In this fourth installment of Dr. Tice's responses, you will find: discussion of CEO compensation, provider status, "too little too late", Dr. Tice's blogging and social media involvement, and Dr. Tice's new opportunity, Aspen RxHealth
This next one is a very forward question, but one which I have seen referenced several times in discussion already, so I feel I would be remiss to leave it out. How do you defend the fact that APhA's CEO receives greater than $700,000 per year in total compensation for his duties, when so many pharmacists feel that APhA has utterly failed them in its primary responsibility: advocacy for the profession?
BT: Tom has been a tremendous leader for the profession. He lives the job 24/7 and leads a very complex organization, while being on the road nearly 50% of year. APhA’s staff salaries are generally in the 50th percentile of pay for peer organizations, and that is the case for Tom. He is by no means paid exorbitantly when looking at his peers. To attract the best talent and leadership, our salaries need to be competitive.
Tom is a “pharmacist’s pharmacist” who has lived our profession, as a community chain and independent pharmacist, home health, specialty, and infusion pharmacist, and pharmacy entrepreneur. He has done tremendous work to bring the profession’s associations closer today. Tom has also taken the position of, “You can accomplish anything you want if you don’t care who gets the credit.” Tom has navigated many broad, deep, and complex waters through his time leading APhA. We’re stronger for his work and leadership.
Over the last 10 years, he has strengthened relations across the profession and diversified APhA’s revenue streams so it is not solely dependent on one area for revenue. He always puts the organization first. Yet we could do SO MUCH MORE if the majority of pharmacists were members. Responsibility for our status as a profession does not fall on one individual’s shoulders. I would say many of the people voicing criticism say they are not members of APhA or do not engage in working to advance their profession. If someone is dissatisfied, I would encourage them to get involved and be a part of the solution.
One of the most common critiques of APhA besides those listed above is that too much time has been spent on ideas like "Provider Status" and the development of MTM and immunizer roles which had the potential to advance patient care, but have been distorted into a mockery that essentially advances only the intensity of pharmacist stress levels rather than patient care. What is your response?
BT: I see a big part of APhA’s role as being strategic while also addressing the issues affecting pharmacists daily. One of APhA’s responsibilities is to monitor the environment and identify current and future directions that provide challenges and opportunities for the profession. The shifting and tightening of reimbursement formulas regarding products signaled a need to shift to our compensation coming more from patient care activities—improving patient health and outcomes—and less dependent on pharmaceuticals being treated as commodities.
Oftentimes, that does not materialize into a “what have you done for me lately” answer. Immunizations, MTM, and provider status are shepherding the profession to larger goals. They have provided opportunities for pharmacists to demonstrate their impact and have enabled the profession to take a seat at important decision-making tables. Some may observe we’ve not focused on their issue, but I might ask in return, who is the “we”? APhA is a member-led organization that pursues the issues our volunteer leaders say we should pursue. “We” are all pharmacists, from all areas of practice, working to advance the profession. We have a big tent, and all are welcome. Being involved doesn’t require showing up for meetings. There are many other ways.
If you think we have not had enough involvement from those in the trenches to hear that voice loudly enough, join the fight with us! I do not consider that “victim blaming,” as one responder said. Every pharmacist out there has just as much of a responsibility and a voice for this profession. If you can’t or don’t feel comfortable talking to legislators or attending meetings, let’s find a way to get your voice heard through a virtual Special Interest Group or other outlet. It should be easier than ever with social media and advances in technology. Sometimes it just takes stepping out there and yes, it is often uncomfortable at first. I can’t say I initially enjoyed talking to legislators or going to a meeting where I didn’t know anyone and figuring out how to get involved. It takes time and effort. At the same time, as I posted, most pharmacists feel that they get more back from their involvement than they give, and it provides connections during tough times that help us find new opportunities and show us how to get involved in them.
While many have openly appreciated your willingness to engage in these tough discussions, others have touted the belief that anything APhA could do now is too little, too late, and that APhA has been asleep at the wheel for decades or too distracted by lesser priority issues until it was "too late". What do you think about that?
BT: I would actually say because of APhA and APhA’s work with the state associations and other national associations, it is not too late. We have laid tremendous groundwork laid for community pharmacy and new models of practice. We have to understand society does not owe us a job. Professions and trades get disrupted. Look at where your local blacksmith is today! We do not want to go down that path and have been feverishly trying to define our role and demonstrating our value. Technology is disrupting many industries right now, but more than ever, people need help using medication correctly and getting their full benefit. No one can provide that better than pharmacists. Yet there are tremendous resources available to our “opposition”—those who would limit our scope of practice or coverage for services we provide. The more people we have involved, the better and faster we can make it happen.
I noted that you have published your own blog post in the aftermath of your first foray into pharmacy-centered social media. I will link that to this interview when it is posted, and I wanted to thank you for your tenacity and sticking these conversations out. Do you plan to continue posting and engaging more often after all this?
BT: I do plan to continue posting and being engaged in social media. I have found it to be greatly beneficial to understanding where people are at and what their concerns are. It has also provided me a greater understanding of where we are in the profession and what needs to be addressed. I hope people will engage positively and help us find reasonable solutions that we can collectively implement.
I'm sure you've seen the attempts of several of us frustrated groups of pharmacists out here feeling out the possibility of starting a new organization to aggressively advocate for pharmacy professionals, due to the sentiment of abandonment by APhA. What are your thoughts on that? Would it change if I told you nearly 3,000 pharmacists have come out to express their support for that, and that those numbers are skewed towards primarily the younger, more social media-savvy pharmacists?
BT: I would encourage those pharmacists to join APhA and create a stronger, more unified voice for the profession. Our New Practitioner group is one of the most vital, active sectors of our membership! If those same pharmacists had tried to engage in APhA and then felt that they had not been listened to or found it ineffective, I could understand the sentiments for starting a new organization more. I often hear people say we have too many pharmacy organizations. Creating another voice with a different message would only fragment the profession further. The infrastructure is in place at APhA to get your voices heard. I would ask those who support a new organization what they think a new organization could do for them that an existing one can’t. What would they have APhA reasonably do to overcome their feeling of abandonment? Getting involved in an existing organization would make more sense to effect change faster and with greater impact, but I want to hear your recommendations for what APhA should do.
For further background, APhA is structured in three academies—the Academy of Student Pharmacists (APhA-ASP), the Academy of Pharmacy Practice and Management (APPM), and the Academy of Pharmaceutical Research and Science (APRS). APhA-ASP is what most students are aware of and speaks for itself. When joining as a pharmacist, most practitioners fall into the APPM category. There are Special Interest Groups (SIGS) that focus on specific areas of practice (e.g., diabetes, immunizations, medication management). Anyone can start a SIG. You just need 250 members to sign up. You then get staff resources to support the SIG. We are working on additional, less formal discussion groups that can come and go more easily and allow pharmacists to connect. APRS is the science section and focuses on pharmaceutical research and has an administrative section as well, called ESAS. ESAS’s focus is economic, social, and administrative sciences and it’s a great place to go to get workplace studies done.
PA: Thank you so much for your time Dr. Tice. No matter how vehemently many of us may disagree with any statements made by yourself or other leaders, I have a great deal of respect for you coming out on this limb to engage with us. One final question from me before I launch into some questions from a friend you may know as The Cynical Pharmacist, you mentioned a professional project of your own in some of your posts, Aspen RxHealth. Can you give us some insight and/or updates on how this innovative service is planned for use?
BT: The work of the APhA president is a volunteer, elected position. As with the other leadership positions, all pharmacists involved have their day jobs. I work for Aspen RxHealth as senior vice president of pharmacy practice. Aspen is the brainchild of David Medvedeff. David is an excellent, non-residency trained pharmacist (although he did also get his MBA) and has been successful in many areas of pharmacy already in his career. Aspen is the gig economy solution for pharmacists. It is essentially provider status without the legislation—think Uber meets Match.com. In this model, pharmacists (not pharmacies) can log into an app, see opportunities to get paid to deliver services, call patients to talk to them about improving their medication use, and get paid directly into their account for delivering those services. We match pharmacists to patients based on clinical interests, language, proximity, and more on the front end. Then, on the back end, patients can rate their pharmacist and determine if they want to receive services from them in the future. If yes, the next time the patient has an opportunity for a service the payer will pay for, that pharmacist will get the first option to deliver that service. This model pays pharmacists in an independent contractor model and they can work as little or as much as they like, just like an Uber driver. Over time we will build this out into face-to-face offerings and additional services.
There are no requirements beyond having an active pharmacist license to participate. We believe the quality will rise to the top and the system can measure how patients respond and what the outcomes are. Quality measurement will include clinical outcomes, communication skills, ability to effect change in patient behaviors, and more. Pharmacists who perform the best will have more opportunities and potentially higher pay. It will be based on performance, not training. Training may better enable quality performance, but it is certainly possible that those with more experience, better communication skills, etc. also deliver quality services.
For the first time we are truly separating the pharmacist from the product. Of note, this business actually started with a health plan that was not happy how MTM was being offered in community pharmacy today. The plan wanted to see pharmacists more involved and delivering with higher quality. The lack of quality isn’t a knock on community pharmacists. It is that the way MTM and clinical services have been implemented has provided too many distractions and not enough focus. We believe this model can be a game-changer for the industry.
My other project is a company called RxGenomix. I started this company several years ago seeing pharmacogenomics (PGx) as the next big clinical opportunity for pharmacists. The time it takes to do a buccal cheek swab is about the same as the time of doing a vaccination. PGx is solely focused on medications, not testing cholesterol or blood sugar, for which patients see their other health care providers. PGx is all about medications and how they are metabolized. It is truly the domain of pharmacists and one we need to own. I am obviously pulled in a lot of directions, especially with being the APhA president this year, so I have another pharmacist, Blake Keller, running the show there. Blake is a community pharmacist from Walgreens who is not residency trained. I point that out to say there are opportunities out there. A pharmacy degree is multi-faceted and opens doors to a myriad number of options.
Interview continues in:
Part 1: background, introduction, pharmacy working conditions
Part 2: oversaturation, regulatory capture, PBM/DIR abuse, and the practices and number of pharmacy schools, resident pay
Part 3: lack of professional mobility between types of practice, board certification, age discrimination, calling out companies for abusive practices, traditional pharmacists and technicians
Part 5: The Cynical Pharmacist came to play! Read about compensation for services, corporate abuse of scope of practice, polling and scientific studies on the state of the profession
Footnote from Dr. Tice:
"Thank you for the opportunity and taking the time to read the responses. If there is something missing, that you do not like, or even better yet, that you do like and what to get more engaged, please feel free to reach out to me directly at firstname.lastname@example.org or text me at 615-574-9638."
As a note from PA to my readers: PLEASE, help with providing constructive feedback and represent our community well. Dr. Tice spent a great deal of time to provide us with these answers to questions I curated from site member feedback. If you take issue with his answers, please say so in a respectfully dissenting manner. Dr. Tice's contact information is listed at the bottom of each installment and he is listening to your feedback. I would love to see the conversation continue in the blog comments below each installment.