Who Moved My Pharmacy?

Adam Chesler

“Chaos: When the present determines the future, but the approximate present does not approximately determine the future.” - Edward Lorenz

Chaotic behavior exists in all natural systems. Nothing is forever, nothing remains perfect. This all became relevant to me during pharmacy school when the great W. Arlen Kloesel at the University of Texas College of Pharmacy assigned us the book Who Moved My Cheese by Spencer Johnson. Just because the world is chaotic, it doesn't mean things are always bad. In fact chaos can sometimes be good, but you do need to always be prepared to adapt and change when chaos comes your way. Never in the history of my career has chaos been more evident in pharmacy than it is today.

There have been hints that change was coming for the last 20 years, but have we acted on it? This brings us back to the title of this blog: Who Moved My Cheese, or in this case, Who Moved My Pharmacy.

If you haven’t read the book, it's a simple tale (or tail) about a few engaging mice (Sniff and Scurry) and some miniature people (Hem and Haw), running through a maze to find cheese. They triumph through hard work and find the cheese at the end of the maze (similar to going through pharmacy school to get a paycheck and great job at the end). Now suddenly, as happens with most experiments involving mice in a maze, the cheese gets moved. The special part of this story is how the mice deal with this change. Spoiler alert: some deviate from what they are used to and find success, while others repeat their same behaviors and fail.

Let's look at three lessons from Who Moved My Cheese and see how they apply to pharmacy today.

Lesson #1 - Stop thinking so much about cheese moving and start chasing after it

Not a day goes by that I don’t read a thread on Reddit, LinkedIn, Facebook, or even text messages from friends referencing change in the industry. New programs, decreased staffing hours, declining salaries, lower reimbursements, new conglomerate entrants, scope pressures from other professions: the list goes on and on. Every pharmacist reading this has to acknowledge that our profession is changing, and it feels like it’s happening so quickly. With all this noise, it's easy to become fearful for the future of pharmacy.

We spend so much time as pharmacists talking about our cheese moving, but we are so reluctant to chase after it. Some pharmacists are making changes. For example, Idaho has transformed their entire regulatory framework. In doing so they’ve enabled pharmacists to provide clinical tests and prescribe medications for minor ailments, permitted pharmacy technicians to administer immunizations (under pharmacist supervision), and have expanded the use of telepharmacy.

Meanwhile, other pharmacists are continuing to fight technology. I’ve had pharmacists tell me they “don’t like computers, telepharmacy involves computers, so I am against telepharmacy.” I can’t make this stuff up.

All the time you spend thinking about doing something versus actually doing it is time wasted. Stop hesitating and try something new. Heck… take your local physician out for lunch and consider ways to improve a formulary or prior authorizations. My favorite quote comes from a fictional character from Point Break - Bodhi (Patrick Swayze) - “Fear causes hesitation, but hesitation makes your greatest fears come true

Bodhi from Point Break

Bodhi - Point Break

Lesson #2 - Even the biggest cheese doesn't last forever, so try to see change coming

In 1962, Everett Rogers popularized the innovation curve that all industries inevitably follow. If you don’t continue to adapt and change, you will eventually be on the wrong side of the curve.

The Innovation Curve

The Innovation Curve

Just because you may have found something that works, remember the innovation curve. As adoption increases, market share decreases. The only thing that is definite is change will always happen.

Pay attention to what is going on around you. If you watch the agendas on boards of pharmacy you might see a demonstration of a new technology or a waiver approved for a new market entrant. You may feel like change is happening quickly, but look around. How long has your reimbursement been going down? How long have we talked about biologics? Amazon purchased Pillpack almost 3 years ago; was it a surprise when they announced their entrance into pharmacy?

The current pandemic has shown that delivery is a necessity, and there is no doubt Amazon will offer same day prescription delivery soon. Reimbursement for Medication Therapy Management is increasing by the day. Texting with your patients helps improve stickiness and brand awareness. Telepharmacy helps improve access to patients. Utilize Collaborative Practice Agreements to improve access to therapy. If legal, offer Point of Care testing at your location. Transparent PBMs are popping up left and right.

Trends are evident all over the country, but if you ignore it, the changes happen TO you instead of BY you.

Lesson #3 - There is always new cheese to be found. The minute you start moving things will improve

Don’t just sit around and wait for change to happen TO you, make the change yourself; plenty of pharmacists already have. With a passion for health, Richard Harris went to pharmacy school, then medical school and even business school; he now owns a health and wellness practice and authors a successful podcast. Ashley Dwyer was passionate about providing fitness advice to her patients at the pharmacy, and decided to open her own health company. Hillary Blackburn wanted her voice to be heard so she created the Talk to Your Pharmacist podcast. Micah Pratt wanted to open a telepharmacy, so he got a pilot approved which eventually led to legislation in Texas. You could do the same. If your state permits telepharmacy, try reaching out to a local clinic or rural town about opening on-site. If not, be an advocate for change.

Whether you just make new contacts, friendships, or potentially discover a whole new career, the outcome is better than doing nothing. Try expanding into new areas. If you attempt to make a change, things will get better. Not taking action toward your goals is the killer of dreams.

It shouldn’t take a pandemic to jump-start the public’s awareness of pharmacists and how important they are to patient care. Had we adapted to the changing world around us, there would have been no need for all these pharmacy waivers at the state and federal level to allow us to practice at the top of our license. Had we adapted, there wouldn’t be any shocking entrants to the market to provide access for patients. It’s safer to go after what you want than to lose hope and be stuck with a horrible reality.

The moral of the story is that you can thrive in an environment of change and uncertainty. Ask yourself, “What would I do if I was not afraid?” - Spencer Johnson

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