[haha13]

My mother has rheumatoid arthritis and is now on Remicade. However because of her past medical history of TB, she is required to take Isoniazid. The doctor said she has to be on it for 5 months ( she has been on for over 1 month ) but lately she has been experiencing severe headaches, high blood pressure, and nausea. She believes it is Isoniazid's side effects and the doctor does not seem to believe so. My question to you is, is there any thing we can do to alleviate the side effects? I read on wiki that it metabolize in the liver and creates a toxic by-product which is linked to hepatitis thus the side effects. Thanks!

[Nocardia]

I think the best thing to do would be to go to a pharmacy like Medicine Centre or People's. They actually give you good advice and take the time to listen to you (vs. shoppers/superstore/any big box pharmacy). Its not a good idea to give specific medical advice over the internet without the entire story :P

[dinosaur]

Drug Interaction Checker — Identify Interactions Between Prescriptions, Food, and Herbal Supplements : Healthline.com (http://www.healthline.com/druginteractions)

[truth]

Like Nocardia stated, it's best to go to your mother's regular pharmacy and get a medication review done. If she doesn't have a regular pharmacy, any pharmacy can look up the list of meds that have been filled through 'Pharmanet', which every pharmacy in the province is linked up to. Seems like a thorough workup needs to be done in a situation like this and missing info can be harmful. Online interactions can be useful in some cases, but a pharmacist can tell you which ones are relevant and which ones are irrelevant.

If she has high blood pressure, it could be harmful to other organs and contribute to severe headaches. Best to get it checked out in person and not over the internet.

PS. the reason why I recommend her regular pharmacy is because they are more likely to spend quality time with her, rather than a pharmacy that does not have any past history.

Good luck!

[Okami]

PS. the reason why I recommend her regular pharmacy is because they are more likely to spend quality time with her, rather than a pharmacy that does not have any past history.

Good luck!

if your mother takes the same medications regularly you can just bring your bottles into a "dead" looking pharmacy as well.. if they have no business then they can afford to spend more time with you for the $60 fee they receive.. or they will scam you.. YMMW

[SiRV]

1 - What other medical conditions does she have? (high blood pressure?...)
2 - What are her typical average blood pressure levels ? (prior to starting new med, and after starting the isoniazid)

3 - What other medications is she on? (prescription and non-prescription.. advil/tylenol etc.)
4 - What was she on for the initial treatment of her TB? (How did she catch TB?)
5 - How long has she been on Remicade?

6 - When did she actually see the doctor and, did the doctor put in any kind of lab-work requests?

[Okami]

^he's a pharmacist so answer his questions XD

[yameen]

is your mom being monitored by the DOT program or some sort of organization for her TB treatment? usually if the side-effects aren't severe, they can be treated with drugs to minimize the headaches and nausea. and as sirV is asking, what is your mom's regular BP? if it suddenly shot up after taking the drug, it may or may not be the drug. there are so many causes to high blood pressure which makes it difficult to point out what's causing it.

remicade can be an immunosuppressant, which basically means it weakens your body's immune system. while your mom is on antibiotics, remicade may be contraindicated (incompatible taking two drugs together) when taking isoniazid because the immune system is needed to kill TB.

if you're worried about the liver, you can always ask your family doctor to order liver enzyme tests to determine if there is any damage to the liver. it's just a simple blood test. don't count on my information being 100% accurate. i'm just giving you information based on what i know. see a pharmacist or wait for sirvfung =)

[sindragon]

SIRV really a pharmacist? I plan to persue a career in pharmacy, any tips? :D did you graduate in BC as well?

[CP.AR]

^ go get your PCAT done, apply at UBC.
It'll be best if you have a science background

[truth]

get some volunteer/work experience at a pharmacy to see if it's really what you want to do. it's also good for a reference too.

[SiRV]

to be honest, super shitty time to get into pharmacy.. bad investment in my opinion. Jobs are few and far in between now. Government legislation has cut funding for pharmaceuticals by over 80% in Ontario, shrinking budgets of all the major pharm companies (SDM, LD, Superstore etc.). Staff cuts, hour cuts, wage cuts going on across the board, and other provinces following suit in attempts to save money on healthcare.

[Okami]

+1.. got an interview last year.. didnt get in.. but kind of glad i didnt.. my pcat is still good for a year.. but i'm jumping ship because of the regulated technician initiative..

now trying to get into BCIT nursing :lawl::gay:

[spoon.ek9]

to be honest, super shitty time to get into pharmacy.. bad investment in my opinion. Jobs are few and far in between now. Government legislation has cut funding for pharmaceuticals by over 80% in Ontario, shrinking budgets of all the major pharm companies (SDM, LD, Superstore etc.). Staff cuts, hour cuts, wage cuts going on across the board, and other provinces following suit in attempts to save money on healthcare.

i blame the college of pharmacists for technician regulation. it looks good on paper but is clearly being used by retail pharmacies to cut pharmacist positions and save on labour.

[yameen]

+1.. got an interview last year.. didnt get in.. but kind of glad i didnt.. my pcat is still good for a year.. but i'm jumping ship because of the regulated technician initiative..

now trying to get into BCIT nursing :lawl::gay:

i'm in bcit nursing. if you have any questions, feel free to ask. it's no joke when people mention that it's a very intense program. i have no bias, but after working in 5 different hospitals, almost every RN prefers a bcit>ubc grad. however, ubc is 2 years and bcit is 3. great profession and i highly recommend =)

[truth]

i blame the college of pharmacists for technician regulation. it looks good on paper but is clearly being used by retail pharmacies to cut pharmacist positions and save on labour.

huge conflict of interest when you look at the people lobbying for it.

[SiRV]

^I kind of assumed so... but are there actually names of people who are lobbying for it that are posted somewhere? There should be some kind of uproar from the pharm community also.. protests on campus etc. about the expansion program at UBC and what the college is doing.

[JDMCivic]

SIRV really a pharmacist? I plan to persue a career in pharmacy, any tips? :D did you graduate in BC as well?

He's not a pharmacist. Still a pharmacy student
Posted via RS Mobile (http://www.revscene.net/forums/announcement.php?a=228)

[R5x]

^I kind of assumed so... but are there actually names of people who are lobbying for it that are posted somewhere? There should be some kind of uproar from the pharm community also.. protests on campus etc. about the expansion program at UBC and what the college is doing.

Yeah. Basically any upper level management at EVERY pharmacy chain, starting with Randy Conrad, the regional/district manager of Safeway who also happens to be the chair of our College. :heckno:

Last year there was an extraordinary College meeting where registrants were also invited to attend. The majority of us voted against the whole certified tech movement. It was firmly smacked down because the vote is non-binding and the College wrote it off as "a misunderstanding/lack of information between pharmacists and the certified tech movement".

[Jermyzy]

Yeah. Basically any upper level management at EVERY pharmacy chain, starting with Randy Conrad, the regional/district manager of Safeway who also happens to be the chair of our College. :heckno:


Actually, didn't he get voted out in the most recent election? :lol

[spoon.ek9]

the cost of the bridging programs and the intensity of them is also ridiculous. technicians all recognize this as a huge money grab.

[Nocardia]

I had no idea there were pharmacists on Revscene! Thread has been officially hijacked. Anyone in the hospital setting?

PS. Did OP get answers?

[haha13]

Yes SiRV answered my questions, thanks everyone for their input!

[What_the?]

Warning: Long post up ahead.

Pharmacists are the easiest to shaft because so many are employed by the big chains. You could easily start an uprising against the motives of the big chains, but jeopardize your own job as the leader... Plus it'd be hard to get overwhelming support when it's difficult for others to join you because they can't go against what the big companies want while also working for them... Tough spot to be in.

If you try to shaft physicians, they can say screw you, we're looking after our own best interests or we don't have to see patients.

If you try to shaft nurses, they can say screw you, we're looking after our own best interests or we're going on strike.

If you try to shaft pharmacists, they can say screw you... then the corporations say you're fired...

It's a funny position that we're in unfortunately. With the regulated technicians, it is what it is, and it's too late to complain and bitch about it when they already exist. Yes, there are less jobs, and yes it is stupid that they're increasing enrolment to the pharmacy program at this time, but someone has to pay for the new building (i.e. more students = more tuition). Everything is happening, there is no way for us to stop it really. However, all it means, is that Pharmacy jobs are now competitive, just like NORMAL jobs. No more wining and dining by companies during recruitment, you actually have to look for work like normal people. You no longer get hired just by having a pulse and a pharmacy degree, you actually have to be good now. So as long as you're a good pharmacist, there's no need to worry. If you aren't, then now is a good time to learn to be good.

As for selection of pharmacy, I believe that finding a good pharmacist is a total crapshoot. It is totally wrong to generalize saying that small independent pharmacies are going to provide better care than a chain one. It is purely luck of the draw, depending on the pharmacist. A good pharmacist is a good one no matter where they work. In fact, I think it may be better to find a good pharmacist at a chain, as opposed to a good pharmacist that owns his own independent shop for example. I work for a chain myself, and would consider myself reasonably good at what I do. Come Christmas time I usually get enough gifts, chocolates, bottles of wine, and thank you cards from my patients to fill up my whole locker and then some. When it comes down to it, my motivation for being good is purely for the patient. I make the same amount of money regardless of what I do, so I have no incentive to sell you more over the counter goods, cough and cold products, etc. If you don't need something I'll tell you straight up, don't waste your money. If we were in a situation where the pharmacy may lose money, it's not my money, so I could really care less if the chain takes a hit. Just a cost of doing business.

But think on the flip side, if every dollar you spend in a small independent were incentive for the Pharmacist owner because every dollar goes into their pocket? If a hit to the store is a hit to their paycheque, it might make them think twice.

Either way, if you find a pharmacist that is willing to take the time to go through your concerns, no matter what setting, you've got yourself a keeper. Keep in mind, that spending time is one thing, but also a good idea to make sure they actually know what they're talking about. Try asking some questions, see if they'll spend time answering them, and then ask "why?", or "how does that work?", and see if they can explain it. Or if they can't see if they're able/willing to look it up.

Last but not least, it's one thing to see if a pharmacist will spend time with you, but also it's nice to be respectful of their time as well. If they're totally slammed and a huge lineup is forming behind you, if it's not an urgent question, offer to leave your number so they can get back to you when it's slower.

[What_the?]

Ok haha13, here's some information for you. I generally try to refrain from giving any specific medical advice because it would be to a patient that isn't one of mines, and I don't have all the appropriate information about them to make all my decisions with. Any specific questions should be directed to the healthcare professionals taking care of your mom. However, here are some suggestions, just by looking at the general information you posted.

First off, find out how high your mom's blood pressure is. If it's consistently over 140/90 it is considered normally high, but if you're looking at like 180/90 or something like that then that'd be pretty dangerously high. High blood pressure may cause headaches also because of the extra pressure pushing outwards on the blood vessels in the brain pressing on pain receptors in the brain (sort of like a migraine headache). Nausea from things like migraine headaches can be very common as well, just because of how bad the pain is.

Isoniazid can sometimes cause an increase in blood pressure because it has a little bit of what's called Monoamine Oxidase Inhibitory activity. (MAO-I). This basically blocks the breakdown of things like Tyramine which we find in lots of foods like pickled foods, smoked foods, cheeses, alcohol, chocolate, etc. If you're not breaking down Tyramine normally, it can lead to a push/increase in norepinephrine leading to a spike in blood pressure.

The MAO-I effect of isoniazid isn't really huge, but if your mom is having symptoms, she would likely benefit from cutting out or down on Tyramine rich foods. Google a list of Tyramine rich foods, and experiment by having her cut down on eating those things as much as she can and see if she feels better. Monitor her blood pressure during this time, and see if things become controlled again.

Plus also, during this time when we're trying to get her blood pressure down, have her cut down or out caffeine (i.e. tea, coffee, cola), and reduce salt intake. All the usual high blood pressure precautions for the time being, to see if it will help.

Anyways, these are merely suggestions, and not to be taken as definitive medical advice, given the lack of information about your mom that I have.

Best of luck :D

[R5x]

As for selection of pharmacy, I believe that finding a good pharmacist is a total crapshoot. It is totally wrong to generalize saying that small independent pharmacies are going to provide better care than a chain one. It is purely luck of the draw, depending on the pharmacist. A good pharmacist is a good one no matter where they work. In fact, I think it may be better to find a good pharmacist at a chain, as opposed to a good pharmacist that owns his own independent shop for example. I work for a chain myself, and would consider myself reasonably good at what I do. Come Christmas time I usually get enough gifts, chocolates, bottles of wine, and thank you cards from my patients to fill up my whole locker and then some. When it comes down to it, my motivation for being good is purely for the patient. I make the same amount of money regardless of what I do, so I have no incentive to sell you more over the counter goods, cough and cold products, etc. If you don't need something I'll tell you straight up, don't waste your money. If we were in a situation where the pharmacy may lose money, it's not my money, so I could really care less if the chain takes a hit. Just a cost of doing business.

But think on the flip side, if every dollar you spend in a small independent were incentive for the Pharmacist owner because every dollar goes into their pocket? If a hit to the store is a hit to their paycheque, it might make them think twice.

Although I know what you're getting at here and some of your points are valid, I feel the need to comment for small independent pharmacies as well since my family owns one. I will not deny that there is financial motivation for selling something vs not selling something when it's your own pharmacy; however, I do also feel strongly that I would go the extra mile for a patient vs an average pharmacist working at a chain. I have come across SO many complacent pharmacists at chains since I got licensed that it's just mind-boggling. From pharmacists unwilling to do a medication review/get injection training/any clinical services, to pharmacists that need to be kicked in the ass just to even do the BARE MINIMUM expected of them. A large number of chain pharmacists only work as hard as they need to (as long as they do not do LESS than their competition - the other pharmacists working there).

The common line I hear from them is: "Why should I do it? Why should I take on the extra responsibility? Why do I need to do extra when I'm already so busy?" And some of these are people I know that graduated WITH me and are pretty much fresh out of school; not just the old-timers. What almost every chain pharmacist fails to understand is that these things are NOT extra. They are part of your daily routine and responsibility as a pharmacist. And if you don't do them, not only are you short-changing your patients, but head-office will eventually look at you and wonder why you're worth your $40/hour. I also feel that chains exploit every loophole in the system to extract the most money possible (eg. loyalty points, Airmiles, half-assed incomplete med reviews, encouraging using private flu stocks vs public flu stocks to make more money, forcing stores to meet a quota for injections, etc.) and compromise ethical boundaries just as much (if not more) as any "shady" independent pharmacy. Chains just have a larger market share and more power in the industry and can get away with things more easily. If push comes to shove and headoffice tells chain pharmacists to do something or risk losing hours or their job, what do you think the majority of them would do? Money is king even in the health care system.

The problem here is really complacency in our profession - too many people that are not held accountable BECAUSE too many pharmacists work for chains. If you own a pharmacy, you are automatically held accountable and are motivated to work harder as compared to working at a chain simply because your livelihood depends on it. Our prices for Rxs are generally the same and there is no way we can compete selling OTCs vs the buying volume of a chain. The only thing we really have left is to work our asses off and provide better service.

But I completely agree with you that it really is a crapshoot as far as finding a good pharmacist. There are good and bad ones EVERYWHERE and it really comes down to the individual vs blatant generalization. The busier pharmacies are also generally the ones less willing to help. Head offices will schedule the minimum # of pharmacists to cover a certain Rx volume. It is not based on patient care whatsoever, unfortunately.

[Ulic Qel-Droma]

lol if i was a pharmacy graduate, i'd be working with a crooked lab technician... lol.

[Jermyzy]

I had no idea there were pharmacists on Revscene! Thread has been officially hijacked. Anyone in the hospital setting?


Leaving community and starting hospital pharmacy in January :)

[Jermyzy]

I also feel that chains exploit every loophole in the system to extract the most money possible (eg. loyalty points, Airmiles, half-assed incomplete med reviews, encouraging using private flu stocks vs public flu stocks to make more money, etc.) and are just as "shady" as independents if you want to look at it that way. They just have a larger market share and can get away with it easier.


When I worked for a chain (won't name which one), they encouraged us to print a medication history sheet for each patient who drops off a prescription, and to go over it quickly with them (basic cousel) when they pick up and get them to initial it, so they could bill the government for a med review even if a patient was just on birth control...no wonder they changed the criteria for med reviews.

But I agree with most of you other points as well. My dad owns an independent pharmacy and I work there two days/week. We go way over and beyond what is required of us for our patients, and that's how we managed to stay in business despite all the competition and with no points/rewards system. We have patients who have been with us for 30 years, have moved to another part of the lower mainland and still come in to us for their prescriptions, because they appreciate the level of service.

[R5x]

When I worked for a chain (won't name which one), they encouraged us to print a medication history sheet for each patient who drops off a prescription, and to go over it quickly with them (basic cousel) when they pick up and get them to initial it, so they could bill the government for a med review even if a patient was just on birth control...no wonder they changed the criteria for med reviews.

Yeah I heard a lot of pharmacies abusing the med review criteria before as well..and they weren't independents that were doing that. If anything we would be more scared to lose money if we were audited and deemed to be abusing the system and we wouldn't want to risk it.

But I agree with most of you other points as well. My dad owns an independent pharmacy and I work there two days/week. We go way over and beyond what is required of us for our patients, and that's how we managed to stay in business despite all the competition and with no points/rewards system. We have patients who have been with us for 30 years, have moved to another part of the lower mainland and still come in to us for their prescriptions, because they appreciate the level of service.

That's awesome to hear! That's how it should be and these are the kind of patients we have as well. Patients should be coming to look for YOU; not coming to you because your dispensary happens to be there while they do other shopping.

[What_the?]

Like I said before, it's the person, not the company... if you have a good pharmacist, it doesn't matter where they're from.

I work for a big chain myself, and do the same things everyone else does, if not more.

I provide immunizations. In fact, I am an immunization trainer certified with the APHA that trains other pharrmacists to provide immunizations. My company is very keen on providing immunizations, and at least 95% of the pharmacists working in the company are trained to give shots.

I provide medication reviews. I was the first one in my company in all of BC to provide a medication review, and probably one of the first in BC period to provide them. I am also part of the medication management pilot, and conduct thorough discussions with my patients where problems are always found.

I run off site flu shot clinics, I write articles for magazines, I teach pharmacy students and certified technicians, I do presentations and talks in the community for corporations and community groups, I'm trained in central aortic blood pressure screening, and I'm an editor for a new publication coming out.

Thing is, most of these opportunities to go above and beyond clinically, and for the community/patients, were facilitated and encouraged through the "big faceless company" I work for. Head office is pushing hard for Pharmacists to perform clinical services, because that is the future. They know that also. I told head office that I wanted to have a computer setup in my counselling area so I can use it during my sit-down medication consults. And BAM! I get a new computer installed.

So what's the take home message? I believe it's not a matter of where or who you work for that determines the quality of the pharmacy care you provide. It depends on the pharmacist. So I still stand by the concept that as a pharmacist, if you're good, you can be good no matter where you work. If you don't give a shit, and are complacent, and could care less, then you'll suck even if you are put into the most clinical of all clinical pharmacies in the world.

No disrespect to independents, or chains alike. It doesn't matter what environment you work in because that part is just the job part. We all work wherever we can find someone to pay our wage... That part I understand.

If you are committed to your patients and to good patient care, then you will earn their respect and mines. So that's about it.

On a side note: we've begun a gift pile at my work for christmas to see how tall it gets before the new year. We're keeping it in plain view, and I think that's helping it get bigger because alot of people never think about thanking their pharmacy staff for all their help in the year... at least not until they see our gift pile hahaha... :D

[sindragon]

great to hear a lot of pharmacists here. I am planning to get in a program either in BC or somewhere in canada in a few years. A main thing that i have learned here is not to be a dick and enjoy what I do in the future. :D thanks

[yameen]

^ that goes for all health professions. don't be a dick and you may actually enjoy your job by helping people. many health care professionals lose sight of why they entered into their specific field in the first place.

i believe you get paid substantially less, but i have the most respect for clinical pharmacists =)

[What_the?]

clinical pharmacists get paid more than us in the community... at least in Vancouver :(

Work is work... you work to live, not live to work...

I've had so many friends graduate, thinking there should be some sort of profound satisfaction and fulfillment of their inner soul associated with their jobs... and then when they realize it's not really that profound, and it's really just a job, then they become unsatisfied and unhappy... but this is mainly because they put such high expectations on their work and what they want to get out of it that it's sort of unrealistic...

It almost seems like people are expecting to everyday save a child's life and have their parents profess their eternal gratitude for your amazing skills and talents as a healthcare professional or something... but realistically sometimes the biggest differences we make are the little things that happen day to day.

The other day I had a gentleman come to the counter and whip out a list written in my handwriting for some supplies and drugs to pack when going on a trip. He came and said "Oh! you wrote this list for me of things to bring on a trip... can you help me round them all up?" So I put together everything on the list, and went over when and how to use them. Rang him up at the cash register, and before he left he said "Thanks so much for your help in this whole process! You're awesome" I'm happy for casual interventions like this, and why i'm more of a community pharmacy kind of person.

Anyways, Sindragon, regardless of what profession you pick, just remember ultimately it's still a job. You can do good at your job, but make sure not to lose sight of your passions elsewhere. I go to work, do my 8 hours, then at 4 o'clock on the dot, i'm gone... out on the water, exercising/training, and enjoying the sun (i do alot of water sports). This kind of stuff is what keeps me sane... My gf is a physician, and i'm sure she saves tons of lives and things during the day, but still, work is work. The long hours still suck, and outside of work she balances things out with rock climbing, baking, and eating lots of candy.

A job is just a job, if we had enough money we probably wouldn't work or work part time and just do things we enjoyed. Make sure not to lose sight of these things when you're pursuing your career. :D

[Jermyzy]

clinical pharmacists get paid more than us in the community... at least in Vancouver :(


Not just clinical. Grade I pharmacist make about ~20% (hourly wage) more than I was getting paid at a community chain pharmacy, it's ridiculous. But I guess that's the same with any government job :lol

What_the? --> It's obvious from what you do that you are a great pharmacist, but from my experience in working at a chain pharmacy, you are definitely an exception. I'm glad that you are getting support from your head office. When I worked at a chain, they were putting constant pressure on us to increase numbers. They cut a lot of hours from our staffing levels, and would constantly be hounding us why weren't doing as many adaptations, med reviews, recruiting new blisterpack patients etc. that they wanted.

[SiRV]

Damn, your getting put at the top payscale for the grade 1!
We have a pharmacist at my hospital that also did a community -> hospital transfer after 9 years and ended up on the top payscale as well

[R5x]

So what's the take home message? I believe it's not a matter of where or who you work for that determines the quality of the pharmacy care you provide. It depends on the pharmacist. So I still stand by the concept that as a pharmacist, if you're good, you can be good no matter where you work. If you don't give a shit, and are complacent, and could care less, then you'll suck even if you are put into the most clinical of all clinical pharmacies in the world.

Yeah I just wish pharmacists in general would be less complacent and from what I know, you are definitely an exception. The profession was spoiled for too long and it's pretty frustrating sometimes. The result of the certified tech movement is a typical example of this. Pharmacists only started to scream when shit hit the fan and it was too late.

[jACEDesignsLtd]

I've had my fair share of working with pharmacists.. hospital, community, chain, independent. I agree that it's the person that fills the job that makes the difference.

Same goes for any job really.

[yameen]

^yup. you'll see tons of nurses that hate their jobs and tons that love it. those who hate it do it for the money and benefits and those who love it find the job less stressful. i've had nothing but good experiences from clinical pharmacists and they seem to enjoy their jobs. when i approach someone from london drugs, they don't seem to give a direct answer or look into the question if they don't know the answer. i'm not generalizing this to everyone, but this is strictly based on my own experience.

[Nocardia]

Leaving community and starting hospital pharmacy in January :)

Yikes, sorry to hear. Hospital pharmacists are getting a 14% roll back in wages starting in April :(

http://www.vancouversun.com/health/Government+hands+wage+hospital+pharmacists/5988345/story.html

[truth]

heard the news last week through a friend, pretty brutal. was there any indication of this or just a sudden announcement?

[pharmed]

Leaving community and starting hospital pharmacy in January :)

Yikes, sorry to hear. Hospital pharmacists are getting a 14% roll back in wages starting in April :(

Government hands wage cut to B.C. hospital pharmacists (http://www.vancouversun.com/health/Government+hands+wage+hospital+pharmacists/5988345/story.html)


Yes, that may be, but you can't say that having a higher salary trumps a fulfilling job in which you continually learn, are challenged, exercise your mind and actually use your knowledge. I still keep a casual position in a retail chain and can pick up 5-10 shifts if I feel like it. A foot in both doors helps me stay grounded and (regretfully) be reminded to avoid indifferent health care.

[Nocardia]

heard the news last week through a friend, pretty brutal. was there any indication of this or just a sudden announcement?

Very sudden, our managers had no idea and even their managers had no idea. There are still plenty of open positions because many pharmacists are not adequately trained to work in the hospital. Our schooling does not prepare graduates to work in the hospital, many try to go onto complete a residency but there are only limited spots across canada.

Anyways, if anyone is reading, please spend the time to click a few buttons to help out @ Stop unilateral wage rollback for BC (http://www.pharmacistsmatter.ca)

Ask questions if you would like before you send away the letter, or draft your own.

Yes, that may be, but you can't say that having a higher salary trumps a fulfilling job in which you continually learn, are challenged, exercise your mind and actually use your knowledge.

Agreed.
The only problem is when people have mortgages that are dictated by their wage. A few % drop isn't the end of the world but double digits makes life difficult.

[pharmed]

The only problem is when people have mortgages that are dictated by their wage. A few % drop isn't the end of the world but double digits makes life difficult.

Sorry, didn't mean to downplay it. I guess we're still okay for the time being in Alberta and it doesn't really register yet.

[spoon.ek9]

can't really call it a wage cut when it was offered as a bonus all along. the extra 14-15% was offered when there was a huge shortage of pharmacists. since that shortage no longer exists, it makes sense that they would remove that bonus.

does it suck for pharmacists? hell ya it does. but to act like this was a wage increase instead of a bonus is wrong imo. there are however some pharmacists who didn't realize it was a bonus at all and those are the ones who are hit the hardest by this.

also, don't forget, technicians are the ones who had their wages cut long ago and to this day have still not regained what they lost. they were also labelled as "glorified janitors" by Gordon Campbell.

[Nocardia]

can't really call it a wage cut when it was offered as a bonus all along. the extra 14-15% was offered when there was a huge shortage of pharmacists. since that shortage no longer exists, it makes sense that they would remove that bonus.

does it suck for pharmacists? hell ya it does. but to act like this was a wage increase instead of a bonus is wrong imo. there are however some pharmacists who didn't realize it was a bonus at all and those are the ones who are hit the hardest by this.

I understand the wage increase was due to a shortage but to call it a bonus is incorrect. Technically it was a "market adjustment".
When community counterparts are making ~%20 more to start, the adjustment was required to entice pharmacists into the hospital.

This adjustment actually put the new grads closer to what can be made in the community and those with 6 years of experience, more than what community pharmacists make *IN THE LOWER MAINLAND*. Unfortunately with the union being BC wide, there is still a large difference between wages when you move North.

So, who should we compare our wages to? Across Canada? Even with the current wages, BC Pharmacists are a few percent under the national average, with this wage decrease, they will be >15% below national average.

Should we compare to our american counterpart - you don't want to see the differences.
since that shortage no longer exists, it makes sense that they would remove that bonus.$


Since this market adjustment was due to a shortage, if the shortage is gone, you would assume the market would adjust itself and wages to follow. So what definition of shortage would you use? I believe the minister noted the increase in # pharmacists, I can't find the exact number stated however I can tell you that an increase in number does not equal an increase in FTE's. Due to the shortage at the hospital I work at, we have only 2 full time pharmacists at the moment.
Maternity leaves (female dominated profession now) and retirement (~20% of pharmacists are in the retirement window), leaves staff shortages. Yes, jobs are posted. No these jobs are not filled. It has been noted that >50 clinical pharmacist jobs are posted in BC, the only applicants at the hospital I work at are unqualified for the position. Is there still a shortage?

It was discussed this wage decrease will save the government $8 million per year. I suppose it is up to you to decide if this is negligible to the >$62 billion budget. It is all relative and we pay a price to live in BC, but the idea is to get people informed about this and understand the value of pharmacists. I do note that there is very minimal claimed overtime by pharmacists and when someone calls in sick, there is no replacement (like physicians). Pharmacists are encouraged to claim overtime to show the financial impact of our extra work. Suffice to say that the impact is large.

If you are interested in the actual wages made by pharmacists (no, they do not make $80/hr), you are welcome to view it here: Health Sciences Association of BC :: Health science professionals (http://www.hsabc.org/content.php?id=44)


Anyways, I do not mean to attack your post, but explain where I come from on the issue. Many posts/people/comments like this wage roll back to a patient on insulin wrt their blood sugar. When you give insulin (wages), the diabetic is fine, so naturally you may assume you can withdrawal insulin (like in cats), but the diabetic patient still has diabetes and will soon have complications.

[spoon.ek9]

I understand the wage increase was due to a shortage but to call it a bonus is incorrect. Technically it was a "market adjustment".
When community counterparts are making ~%20 more to start, the adjustment was required to entice pharmacists into the hospital.

You can call it anything you like, but that still doesn't change the fact that this was a temporary increase from the very beginning. We see similar situations arise in community wages for techs. Techs can be paid anywhere between $10-$14/hr to start while pharmacies located near a hospital must offer more to entice techs to work for them. In those cases, techs start at $18/hr or higher and that is still less than what a Hospital tech is paid.

This adjustment actually put the new grads closer to what can be made in the community and those with 6 years of experience, more than what community pharmacists make *IN THE LOWER MAINLAND*. Unfortunately with the union being BC wide, there is still a large difference between wages when you move North.

So, who should we compare our wages to? Across Canada? Even with the current wages, BC Pharmacists are a few percent under the national average, with this wage decrease, they will be >15% below national average.

Should we compare to our american counterpart - you don't want to see the differences.

I am aware there is a large difference. there is also a large difference in the amount of income tax taken by the US gov't.

Since this market adjustment was due to a shortage, if the shortage is gone, you would assume the market would adjust itself and wages to follow. So what definition of shortage would you use? I believe the minister noted the increase in # pharmacists, I can't find the exact number stated however I can tell you that an increase in number does not equal an increase in FTE's. Due to the shortage at the hospital I work at, we have only 2 full time pharmacists at the moment.
Maternity leaves (female dominated profession now) and retirement (~20% of pharmacists are in the retirement window), leaves staff shortages. Yes, jobs are posted. No these jobs are not filled. It has been noted that >50 clinical pharmacist jobs are posted in BC, the only applicants at the hospital I work at are unqualified for the position. Is there still a shortage?

I think what you may be forgetting here is the role of technician regulation. The number of pharmacist positions (especially in community, of course) will decrease. Guaranteed.

IIRC, back in 2004, UBC accepted 125 students into the Pharmacy program. I haven't looked up the number for current numbers but I'm told it's around 200-225 students being accepted. That's nearly double the amount of graduates compared to just 8 years ago. UBC doesn't care if you get a job, their business is to pump out as many graduates as they can handle.

In my opinion, this is part of the problem. The minister would of course look at these numbers and conclude (however incorrect they may be, as you pointed out) that the shortage is over. Add to that the fact that RPT's will be taking many Pharmacist positions in the community, and you can see why the shortage no longer seems to exist.

I can't speak for your hospital, but for the one I work at, positions are filled on average between 1-4 weeks. Even clinical positions.


It was discussed this wage decrease will save the government $8 million per year. I suppose it is up to you to decide if this is negligible to the >$62 billion budget. It is all relative and we pay a price to live in BC, but the idea is to get people informed about this and understand the value of pharmacists. I do note that there is very minimal claimed overtime by pharmacists and when someone calls in sick, there is no replacement (like physicians). Pharmacists are encouraged to claim overtime to show the financial impact of our extra work. Suffice to say that the impact is large.

I am aware that many Pharmacists refuse to claim overtime. It's done in good nature but also in fear that it won't be accepted by their employers. IMO, this is totally wrong! If you work extra, you should be paid accordingly. And to answer your previous point, the gov't doesn't care how insignificant a number may seem to the employees. Their bottom line is what's most important to them and they are willing to cut costs anywhere they can.


If you are interested in the actual wages made by pharmacists (no, they do not make $80/hr), you are welcome to view it here: Health Sciences Association of BC :: Health science professionals (http://www.hsabc.org/content.php?id=44)

I never made such a claim... not sure where that came from.


Anyways, I do not mean to attack your post, but explain where I come from on the issue. Many posts/people/comments like this wage roll back to a patient on insulin wrt their blood sugar. When you give insulin (wages), the diabetic is fine, so naturally you may assume you can withdrawal insulin (like in cats), but the diabetic patient still has diabetes and will soon have complications.

I'm not trying to attack your post either, just replying to some of the points you made.

[Nocardia]

You can call it anything you like, but that still doesn't change the fact that this was a temporary increase from the very beginning. We see similar situations arise in community wages for techs. Techs can be paid anywhere between $10-$14/hr to start while pharmacies located near a hospital must offer more to entice techs to work for them. In those cases, techs start at $18/hr or higher and that is still less than what a Hospital tech is paid.

It is interesting you state this actually because it leads into the point further down. Community technicians pay scale changes compared to where they work, similar to community pharmacists. However the job of a hospital technician is different as well, not harder or easier, but different. Your comments here neglect the comments I had right after you wrote this, pharmacists in any hospital in BC make the same wage. There is no shortage of pharmacists west of Surrey. Most pharmacists in rural hospitals are part time (usually mothers) who take the wage cut for the schedule, but as they move to maternity leaves, retirement or if they were able to entice a full timer, they generally move away to a larger centre for a more challenging position.

I am aware there is a large difference. there is also a large difference in the amount of income tax taken by the US gov't.

They also have more litigation and more responsibilities in their roles so our jobs, while similar, are not identical.

I think what you may be forgetting here is the role of technician regulation. The number of pharmacist positions (especially in community, of course) will decrease. Guaranteed.
At least at the hospital I am at, technician regulation does not impact pharmacists as there is already a tech-check-tech process and the hospital pharmacists only position in the dispensary is to verify prescriptions and take clinical calls. I believe at other hospitals pharmacists may check chemotherapy so I can't comment in those specific situations but I would be surprised if it is significant.

IIRC, back in 2004, UBC accepted 125 students into the Pharmacy program. I haven't looked up the number for current numbers but I'm told it's around 200-225 students being accepted. That's nearly double the amount of graduates compared to just 8 years ago. UBC doesn't care if you get a job, their business is to pump out as many graduates as they can handle.

In my opinion, this is part of the problem. The minister would of course look at these numbers and conclude (however incorrect they may be, as you pointed out) that the shortage is over. Add to that the fact that RPT's will be taking many Pharmacist positions in the community, and you can see why the shortage no longer seems to exist.

I can't speak for your hospital, but for the one I work at, positions are filled on average between 1-4 weeks. Even clinical positions.

I agree with your comments, but from this information, I assume you work in a large centre or one in vancouver. This is precisely why the shortage does not appear as dire. Areas around a pharmacy school, specifically a large city (ie vancouver) will never have problems attracting emplyees due to their proximity to the school, academic opportunities and interesting jobs. Outlying and rural hospitals loose all their pharmacists because they go to these jobs for the same pay they get at their small, underfunded hospitals. I myself may move to a larger hospital for that very reason. You mentioned earlier that techs in the community are paid differently depending on where specifically they work, pharmacists in the community do as well, but the hospital, due to the provincial union, do not, hence more reason to go to a larger centre.
So to give some credence to what I have said:
Currently the 1 position open (other positions taken down/removed due to financial/inactive issues) at my hospital has only been applied to by community pharmacists, who are unqualified.
Over the past 2 years Northern Health has had 4 pharmacists for their residency program, not 1 has stayed (med school, community pharmacy, move to vancouver...as for the comment I noted above)
Ridge Meadows hospital runs with 2 clinical pharmacists and one is going on maternity leave shortly, they have not been able to hire a new pharmacist for ~1.5 years

I am aware that many Pharmacists refuse to claim overtime. It's done in good nature but also in fear that it won't be accepted by their employers. IMO, this is totally wrong! If you work extra, you should be paid accordingly. And to answer your previous point, the gov't doesn't care how insignificant a number may seem to the employees. Their bottom line is what's most important to them and they are willing to cut costs anywhere they can.
I don't think pharmacists refuse to do it, it is their obligation to claim it. It is clearly a culture and I have seen it change over the past few weeks. I understand $8 million is still a large pot of money, I am just trying to give my comments substance and not just "I feel" or "I want" or "I deserve"

I never made such a claim... not sure where that came from.
The wage claim was not directed at you by any means, after discussing the issue with friends and LPN/RN/RD/OT/PT, not one thought we made under $70/hr, so it was more of a blanket statement

Anyways, I do not mean to attack your post.[/B]

So I can see that the issues will be long standing and with the new technician regulations changing their scope, community pharmacy will have a huge impact. I can only assume that once hospital pharmacists wage decrease, community pharmacists wage will decrease, leading to technician wage decreases (or at least frozen again for the umpteenth year). International grads are having an increasingly difficult time working towards being licensed in BC (which is likely a good thing as you noted BC will start graduating ~225 grads) and even our own grads will start having issues finding positions in the next few years. This means that their options will be to fill positions in rural areas or go to the USA. I can only imagine that people would work in Bellingham, Burlington or Seattle over Bella Bella or Kitimat because of the wages and proximity to Vancouver.

[SiRV]

Speaking of USA.. anyone written the NAPLEX? which states are we eligible to work I'm sure the geography of where we are allowed to go has changed over the last 15 years.

[Okami]

Speaking of USA.. anyone written the NAPLEX? which states are we eligible to work I'm sure the geography of where we are allowed to go has changed over the last 15 years.

sorry not answering your question.

but now i remember where i saw you!

you were at burnaby hospital giving a presentation about careers in pharmacy.

:yuno: tell us about this

lol kidding aside.. the info we had then and the info we had a few months later was such a big difference..

[truth]

community pharmacy to take another hit:

B.C. to end generic drug pricing agreement - British Columbia - CBC News (http://www.cbc.ca/news/canada/british-columbia/story/2012/02/29/bc-generic-drugs.html)

[Jermyzy]

Just a quick update, hospital pharmacist wage rollback has been temporarily rescinded. But community pharmacy is still getting reamed by the government...

[SiRV]

Looks like you switched boats at the perfect time

[pinkeye]

What's the best way to land a job as a pharmacist in Vancouver? Seems like there's no openings at all. So would it be best to float with one company and hopefully they will acknowledge my services and consider me for a spot in Vancouver when there is one available? What are your thoughts? Thanks!

[R5x]

SDM is always looking.
Try some Pharmasaves and independents too.
Most chains are cutting back hours because of the changes that are already happening. Things will only get tougher in the next 5 years.
If you work for a chain now, you'll have the highest probability getting hired by them. If not then just gotta get out there and compete.

[6793026]

it's not that, each yr there's like 86 grads that comes out, but there are only 20-30 or so positions... what do you expect? there are too many grads right now and there just aren't even placements available.

and to see fresh grads coming out asking for 35-40 dollars... get a grip buddy, there are tons of people waiting in line working for less than 35.

this is coming from a store owner and their observations.

[R5x]

There has ALWAYS been an over-saturation of pharmacists in the lower mainland. There are always jobs available in BC. It's only a matter of how far you want to travel. Your best bet is just to go knocking everywhere. You'll find something; just a matter of how persistent you are. There ARE still jobs available at the moment. Might have to pick up multiple part-times, go further out, or accept a lower wage.

And jobs WILL be more scarce in the coming years. The reduction/potential loss in generic support hurts everyone: chains, independents alike and is the biggest blow to pharmacy in the last 15-20 years.
The certified tech movement hurts pharmacists at chains moreso than anywhere else because suddenly your $35-40/hour position is replaced by a $20-25/hour tech. And it's only a matter of 5 years before they estimate the # of certified techs will exceed the # of pharmacists at our own College.

Everyone is waiting for the impact of the new legislation and its effects on the way pharmacy business will be run in the next few years before it settles down. That is the true reason why there is a wage freeze/downward trend in hiring at the moment. Clinical services like adaptations, injections and medication reviews can only help so much but regardless those things can only make up a fraction of the money from the expected loss in generic support/legislation rules. Things do not look good in community. This is how I see it, and I'm a part-owner.

[SiRV]

And it's only a matter of 5 years before they estimate the # of certified techs will exceed the # of pharmacists at our own College.

What the.. how many techs are getting regulated every year? I thought to date, there are still less than 100 in all of BC...

[R5x]

What the.. how many techs are getting regulated every year? I thought to date, there are still less than 100 in all of BC...

Don't know the current number. But check out the section on pharmacy technicians in the latest Readlinks from the College. According to them, they expect up to 5000 registered techs by 2015. They are taking into account those assistants that will complete a bridging program too.

Last I recall, there are roughly 3000 pharmacists in total registered with the College. How pathetic is that that the College of Pharmacists will have more (or equal) certified techs? What happens by 2020? Maybe the College should consider changing their name to College of Pharmacy Technicians & pharmacists.

[twitchyzero]

it's not that, each yr there's like 86 grads that comes out, but there are only 20-30 or so positions... what do you expect?

86?:badpokerface:

even accounting for attrition try 200 by 2016

[R5x]

Yeah not sure where that 86 figure came from......?

My class had 155 which was the norm for a while.

The class sizes have now jumped to 225 and started with grad 2015, I believe.

[pinkeye]

There has ALWAYS been an over-saturation of pharmacists in the lower mainland. There are always jobs available in BC. It's only a matter of how far you want to travel. Your best bet is just to go knocking everywhere. You'll find something; just a matter of how persistent you are. There ARE still jobs available at the moment. Might have to pick up multiple part-times, go further out, or accept a lower wage.

And jobs WILL be more scarce in the coming years. The reduction/potential loss in generic support hurts everyone: chains, independents alike and is the biggest blow to pharmacy in the last 15-20 years.
The certified tech movement hurts pharmacists at chains moreso than anywhere else because suddenly your $35-40/hour position is replaced by a $20-25/hour tech. And it's only a matter of 5 years before they estimate the # of certified techs will exceed the # of pharmacists at our own College.

Everyone is waiting for the impact of the new legislation and its effects on the way pharmacy business will be run in the next few years before it settles down. That is the true reason why there is a wage freeze/downward trend in hiring at the moment. Clinical services like adaptations, injections and medication reviews can only help so much but regardless those things can only make up a fraction of the money from the expected loss in generic support/legislation rules. Things do not look good in community. This is how I see it, and I'm a part-owner.


So with the generic support and rebates ending next year ...how have pharmacies adapted to this projected decrease in revenue? i've heard multiple reports from regional mangers saying how low the wages in toronto are (ld in particular is 25/hour; safeway is 28/hour)...and sadly it seems to be going in that direction....like you said...clinical services won't cover the lost revenue...and if we hold clinics on acne or stuff like that...i don't feel anyone would be willing to pay for it. it's really difficult to see how we can preemptively do some damage control before the legislation is implemented.

[tool001]

weren’t zellers and other comp, hiring pharmacists from other countries, and training them here, . i know this girl a while back came in from Philippines and was going thru zellers training and they were paying for her lic. and stay etc.

[R5x]

So with the generic support and rebates ending next year ...how have pharmacies adapted to this projected decrease in revenue? i've heard multiple reports from regional mangers saying how low the wages in toronto are (ld in particular is 25/hour; safeway is 28/hour)...and sadly it seems to be going in that direction....like you said...clinical services won't cover the lost revenue...and if we hold clinics on acne or stuff like that...i don't feel anyone would be willing to pay for it. it's really difficult to see how we can preemptively do some damage control before the legislation is implemented.

It's unclear what will happen to generic support at the moment. It all hinges on the wording of the legislation. Time will tell if there are ways to work around it or if the transition will be more gradual. But regardless, the best days are behind us now for the foreseeable future.

Wages for existing pharmacists seem to be holding as it's too demoralizing to cut across the board that way for now. New pharmacist wages are the ones that are being hit first. I believe the wage is sitting somewhere between $32-35/hr at the moment.
Next to go will probably be the # of hours of existing pharmacists before actual layoffs or decrease in wages occur.
The only other thing that pharmacies can do is to maximize earnings while it's still available from whatever clinical services are available and getting that generic money while it's still there. There are SO many factors working against pharmacy at the moment. Even among pharmacists, it is absolutely retarded when I hear that they "don't want to do a medication review for a patient because it's not worth $60 of the government money to do it" without even understanding where the hell this money is coming from. And yet these same pharmacists think they deserve their $38-40/hour. It's absolutely ridiculous and shows how little they understand what's going on in this profession and the landscape of the current economic situation with pharmacy.

I encourage all the pharmacists here that are part of BCPhA to actually listen to some of the member briefings from a few months ago. They are archived under Professional Resources\Bill 35. All 3 archived clips have mostly the same information, but the last briefing on May 2nd in Victoria is the best. It really sums up how pharmacy got to its current state and why negotiations fell apart. The attendance (online and in person) was pathetic for these and just goes to show what is wrong with our profession and how the majority of pharmacists are so misinformed and don't give a shit until it's too late and they're about to get axed.

[Nocardia]

Wages for existing pharmacists seem to be holding as it's too demoralizing to cut across the board that way for now. New pharmacist wages are the ones that are being hit first. I believe the wage is sitting somewhere between $32-35/hr at the moment.

The only other thing that pharmacies can do is to maximize earnings while it's still available from whatever clinical services are available and getting that generic money while it's still there. There are SO many factors working against pharmacy at the moment. Even among pharmacists, it is absolutely retarded when I hear that they "don't want to do a medication review for a patient because it's not worth $60 of the government money to do it" without even understanding where the hell this money is coming from. And yet these same pharmacists think they deserve their $38-40/hour. It's absolutely ridiculous and shows how little they understand what's going on in this profession and the landscape of the current economic situation with pharmacy.


There is a lot of misunderstanding about what pharmacists do and how much/why they get paid what they get paid because there really isn't a physical aspect to it. In the end I think that new prescriptions should costs much more as a dispensing fee whereas the refills should be the current cost. I actually wish community pharmacy was government owned because I also think that the business of healthcare is getting out of hand, but thats an entire other topic.

I work in a hospital and I can tell you on a daily basis I save the hospital 3-4x my wage on a normal day by preventing ADRs or using evidence based medicine. So I think I deserve my wage if not more, we get paged at 2am from doctors asking insanely complex questions over the phone and are expected to aide in patients healthcare. The med reviews done in the community that I have seen are absolutely ridiculous. MOST (not all) community pharmacists are robots and don't understand the medication and how it relates to the patients because the patient only cares about their insurance and therefore that is the only thing people focus on.

Every long term care facility needs a pharmacist so they can manage medications appropriately. The GP with 10,000 patients cannot effective keep these people out of the hospitals and the nurses at these homes are lost because they don't know anything about the medications. They continue to give medications despite obvious side effects or they hold them for some random reason and the patient strokes.

This is a topic I can go on and on about but in the end, 90% of pharmacists don't care enough about healthcare because 99% of patients don't either, they just want pills to fix the problem regardless of the harms or other obvious solutions.

Sorry for the rant....

[R5x]

There is a lot of misunderstanding about what pharmacists do and how much/why they get paid what they get paid because there really isn't a physical aspect to it. In the end I think that new prescriptions should costs much more as a dispensing fee whereas the refills should be the current cost. I actually wish community pharmacy was government owned because I also think that the business of healthcare is getting out of hand, but thats an entire other topic.

I agree that there is a lot of misunderstanding about what pharmacists do and how the whole reimbursement model works for community pharmacy. If community pharmacy were government owned then we'd be the ones striking and causing problems instead ;)

I work in a hospital and I can tell you on a daily basis I save the hospital 3-4x my wage on a normal day by preventing ADRs or using evidence based medicine. So I think I deserve my wage if not more, we get paged at 2am from doctors asking insanely complex questions over the phone and are expected to aide in patients healthcare.

Who among us DOESN'T think we don't get paid enough for our jobs? You're not the only one working your ass off. Different setting, different application of skills, but not more important than anyone else doing their job in community or hospital alike.

The med reviews done in the community that I have seen are absolutely ridiculous. MOST (not all) community pharmacists are robots and don't understand the medication and how it relates to the patients because the patient only cares about their insurance and therefore that is the only thing people focus on.

Why do MOST (not all) hospital pharmacists always have an elitist attitude when it comes to how they view their own colleagues in community pharmacy? Have you read the guidelines for what is required in a med review in the community? What makes you think that something that is 'absolutely ridiculous' to you is not useful for a patient with little or no knowledge of what they are taking? Do not take it for granted that medical knowledge is so easy to come by. Something obvious to you is not obvious or useless to patients.
And the reason why patients only care about insurance is because it hits their bottom-line. If you had to deal with asking a patient for money in the hospital you can be damn sure you'd get yelled at a lot more and would focus on that a lot more as well.

This is a topic I can go on and on about but in the end, 90% of pharmacists don't care enough about healthcare because 99% of patients don't either, they just want pills to fix the problem regardless of the harms or other obvious solutions.

90% of pharmacists care about healthcare but feel their hands are tied because the system in the community does not reward/provide incentive to use their clinical knowledge. Like it or not, the bulk of reimbursement is based on Rxs going out and the individual pharmacist does not see that money which leads to the complacency.

I don't expect a hospital pharmacist to understand the issues at hand in community pharmacy, but for some reason they always tend to chime in about it as if they know better and compare with what they do in hospital and think they do more and deserve more.
Sorry for my rant.

[Okami]

I agree that there is a lot of misunderstanding about what pharmacists do and how the whole reimbursement model works for community pharmacy. If community pharmacy were government owned then we'd be the ones striking and causing problems instead ;)



Who among us DOESN'T think we don't get paid enough for our jobs? You're not the only one working your ass off. Different setting, different application of skills, but not more important than anyone else doing their job in community or hospital alike.



Why do MOST (not all) hospital pharmacists always have an elitist attitude when it comes to how they view their own colleagues in community pharmacy? Have you read the guidelines for what is required in a med review in the community? What makes you think that something that is 'absolutely ridiculous' to you is not useful for a patient with little or no knowledge of what they are taking? Do not take it for granted that medical knowledge is so easy to come by. Something obvious to you is not obvious or useless to patients.
And the reason why patients only care about insurance is because it hits their bottom-line. If you had to deal with asking a patient for money in the hospital you can be damn sure you'd get yelled at a lot more and would focus on that a lot more as well.



90% of pharmacists care about healthcare but feel their hands are tied because the system in the community does not reward/provide incentive to use their clinical knowledge. Like it or not, the bulk of reimbursement is based on Rxs going out and the individual pharmacist does not see that money which leads to the complacency.

I don't expect a hospital pharmacist to understand the issues at hand in community pharmacy, but for some reason they always tend to chime in about it as if they know better and compare with what they do in hospital and think they do more and deserve more.
Sorry for my rant.


http://i11.photobucket.com/albums/a177/schwartzo/blakckid.gif

[pinkeye]

It's unclear what will happen to generic support at the moment. It all hinges on the wording of the legislation. Time will tell if there are ways to work around it or if the transition will be more gradual. But regardless, the best days are behind us now for the foreseeable future.

Wages for existing pharmacists seem to be holding as it's too demoralizing to cut across the board that way for now. New pharmacist wages are the ones that are being hit first. I believe the wage is sitting somewhere between $32-35/hr at the moment.
Next to go will probably be the # of hours of existing pharmacists before actual layoffs or decrease in wages occur.
The only other thing that pharmacies can do is to maximize earnings while it's still available from whatever clinical services are available and getting that generic money while it's still there. There are SO many factors working against pharmacy at the moment. Even among pharmacists, it is absolutely retarded when I hear that they "don't want to do a medication review for a patient because it's not worth $60 of the government money to do it" without even understanding where the hell this money is coming from. And yet these same pharmacists think they deserve their $38-40/hour. It's absolutely ridiculous and shows how little they understand what's going on in this profession and the landscape of the current economic situation with pharmacy.

I encourage all the pharmacists here that are part of BCPhA to actually listen to some of the member briefings from a few months ago. They are archived under Professional Resources\Bill 35. All 3 archived clips have mostly the same information, but the last briefing on May 2nd in Victoria is the best. It really sums up how pharmacy got to its current state and why negotiations fell apart. The attendance (online and in person) was pathetic for these and just goes to show what is wrong with our profession and how the majority of pharmacists are so misinformed and don't give a shit until it's too late and they're about to get axed.

i was here for the term 1 interviews this year and something that surprised me was rexall. in the okanagan area...they're offering new grads $51 an hour, which is considered to be high even for that area.....my sister makes $45 for superstore there....are any of you familiar with rexall at all? they're expanding massively in bc right now and it's really counter intuitive from my point of view. i'm really tempted to take the offer, but no information was given on the working conditions...staffing...etc. i know that we have to manage the drive through pharmacy tho.

[SiRV]

$45 in okanagan seems low, unless she graduated recently. The historical going rate is around $47-54/h (from maybe 5-6 years ago).

Rexall in terms of compensation is fantastic. Be prepared to work like a dog though. You'll be 'expected' to be doing at least one med review per day. You'll likely be taking a manager position, and if thats the case, a free trip to Niagra falls every Autumn! In addition, based on the performance of your store, you get annual bonuses as well. My friend took over management of a store on the island and turned his numbers from -10% to +15% (in his first year of work from May-December) and around January, he received a $15,000 bonus, on top of his regular $5x.xx/hour.

They are expanding massively, trying to be on the same scale as SDM. From a market view perspective, they are doing exactly what makes sense, in my opinion.. Buying spaces in a time of 'low', when independents are shutting down etc. and riding it through the highs, which will likely come again in several years - decade. Due to the evolving nature of the profession, it's not likely that we will have pharmacist salary cuts indefinitely. We may very well one day become independent prescribers (especially if the naturopathic doctors can do it).

I currently work in a community pharmacy and a local hospital as well... and I can say from experience that each respective position is difficult in it's own ways. Community pharmacy, you always feel the push to be faster, do med reviews (which btw, you will feel like a sleazy car salesman 50-60% of the time, giving someone a product they don't really need just to increase the store numbers) and all the while not f'ing up the patients insurance.

In the hospital, it's a lot more mentally stimulating from a clinical perspective. Get asked lots of questions, most of the time it's not so hard to be honest, the resources are all in front of us. Even when I'm 'on-call' all I have to do is go to my computer at home and verify certain things. The super clinically-complex questions are usually referred to other physicians (mostly internal medicine). There are definitely LOTS more clinical problems in the hospital, mistakes everywhere, things that are usually overlooked, renal function, allergies, duplication, etc.etc. It's easy to make our money in 'cost-savings' in the hospital, but in community it's a little more difficult because we do not have the full clinical picture in front of us. Once lab values become available on community pharmacy systems, we will probably be making a lot more clinical interventions than we currently do.

[pinkeye]

thanks for the fabulous insight sirv! do you know anything about the support that rexall usually gives? is there overlap most of the time, or are we gonna have to feign for ourselves


also one thing that's strange is they have gave us a verbal confirmation of the offer about day days ago...however i see the job websites and they posted
a public job offering for my position 10 days ago

http://ca.indeed.com/jobs?q=Pharmacist&l=Vernon%2C+BC

https://katz-openhire.silkroad.com/epostings/index.cfm?fuseaction=app.jobinfo&jobid=297&source=ONLINE&JobOwner=992278&company_id=30029&version=2&byBusinessUnit=NULL&bycountry=0&bystate=0&bylocation=&keywords=&byCat=&proximityCountry=&postalCode=&radiusDistance=&isKilometers=&tosearch=yes



$45 in okanagan seems low, unless she graduated recently. The historical going rate is around $47-54/h (from maybe 5-6 years ago).

Rexall in terms of compensation is fantastic. Be prepared to work like a dog though. You'll be 'expected' to be doing at least one med review per day. You'll likely be taking a manager position, and if thats the case, a free trip to Niagra falls every Autumn! In addition, based on the performance of your store, you get annual bonuses as well. My friend took over management of a store on the island and turned his numbers from -10% to +15% (in his first year of work from May-December) and around January, he received a $15,000 bonus, on top of his regular $5x.xx/hour.

They are expanding massively, trying to be on the same scale as SDM. From a market view perspective, they are doing exactly what makes sense, in my opinion.. Buying spaces in a time of 'low', when independents are shutting down etc. and riding it through the highs, which will likely come again in several years - decade. Due to the evolving nature of the profession, it's not likely that we will have pharmacist salary cuts indefinitely. We may very well one day become independent prescribers (especially if the naturopathic doctors can do it).

I currently work in a community pharmacy and a local hospital as well... and I can say from experience that each respective position is difficult in it's own ways. Community pharmacy, you always feel the push to be faster, do med reviews (which btw, you will feel like a sleazy car salesman 50-60% of the time, giving someone a product they don't really need just to increase the store numbers) and all the while not f'ing up the patients insurance.

In the hospital, it's a lot more mentally stimulating from a clinical perspective. Get asked lots of questions, most of the time it's not so hard to be honest, the resources are all in front of us. Even when I'm 'on-call' all I have to do is go to my computer at home and verify certain things. The super clinically-complex questions are usually referred to other physicians (mostly internal medicine). There are definitely LOTS more clinical problems in the hospital, mistakes everywhere, things that are usually overlooked, renal function, allergies, duplication, etc.etc. It's easy to make our money in 'cost-savings' in the hospital, but in community it's a little more difficult because we do not have the full clinical picture in front of us. Once lab values become available on community pharmacy systems, we will probably be making a lot more clinical interventions than we currently do.

[truth]

I currently work in a community pharmacy and a local hospital as well... and I can say from experience that each respective position is difficult in it's own ways. Community pharmacy, you always feel the push to be faster, do med reviews (which btw, you will feel like a sleazy car salesman 50-60% of the time, giving someone a product they don't really need just to increase the store numbers) and all the while not f'ing up the patients insurance.


Will have to strongly disagree with this point. I don't put my integrity on the line when making recommendations.

[SiRV]

Thats great.

I wasn't talking about a specific physical product per say (i.e. multivitamin reccomendations etc.), but the product being the 'med review', paperwork etc. Especially if patients were on a topical cream 3 months ago, naproxen 2 months ago, and most recently a nasal spray, tylenol 3 and amoxil. Med reviews for these guys are pointless, yet I see them being done on people all the time when I pull Pharmanets on patients while I'm in hospital (a note of caution, it's gotten to the point now where a few of us are REPORTING these types of med reviews to the college).

Don't get me wrong, I think our job is important in the community and I don't like the sleezy way of doing it either, hence why my numbers are quite below par. I do however, make up for my shortcomings in adaptations, immunizations and other things that I think are actually useful and time saving for patients (couple common examples being patanol --> pataday interchanging because it's on manufacturer short, flonase/nasonex to mylan-beclomethasone for full pharmacare coverage for those that cannot afford, list goes on).

It's hard for majority of companies to follow the rules of integrity because they just can not sustain themselves, they will starve, especially if they are independent low volume stores to begin with. When we go the way of Ontario and have 0% rebates eventually, these guys can either do tonnes of med reviews to feed their families (and I'll bet hard money that 60-80% of these reviews would not be necessary), or they can follow their integrity and shut down shop to join a corporation paying them 30$/hour or less.

In an ideal world, integrity should = employability, but I think very soon, this might not be the case, the bottom line for most corporations and even independents is numbers, numbers, numbers. If someone can bring that in while keeping their integrity, thats great, but just from the viewpoint I've developed through hearsay about how to boost numbers (of MR's), I get the impression that individuals pulling in 10+ med reviews per week care more for their job and career goals than they do for actual patients. I would be happy if you could change my viewpoint on that to help make me better at my job.

It was disappointing to me while I was in school that even one of our guest lecturers from CPSBC told us that if a patient does not meet the 5 drug criteria for coverage, just recommend that they take a calcium and vitamin D to make their pharmanet total 5 drugs so we could bill for it.

I am praying for the day to come soon where this med review thing goes down the drain, and the government starts reimbursing us for skills where we are actually able to offer something more valuable to society.

[R5x]

Just out of curiosity, in those cases where a patient may be on 5 meds in the last 6 months that you do not feel warrant a med review, what makes you think they AREN'T using their meds improperly or something? Maybe there was an issue that the pharmacist saw after actually SPEAKING to the patient that they wanted to resolve? Did you call you the pharmacy to ask them for a copy of the professional form to see what was written? Did you take that extra step to give the benefit of the doubt to the pharmacist?

I'm not saying doing a med review in those cases is always correct. In fact I'd like to see what justification was given on the professional form for this med review to be done. But perhaps there is more to some of these cases that you did not consider before accusing the pharmacist of being "shady".

Btw, reporting to the college will obviously do nothing because you even illustrated in your own post above that people FROM the college encouraged these types of med reviews to be done.

It is always easy to point out things that are wrong, but can YOU think of a new clinical service in the community that would be sustainable and viable both financially and also that would satisfy your integrity that the government should be funding?

The bottom line is that the government is taking away a lot of money in the community market suddenly and swiftly with very little means to sustain pharmacy which has been so reliant on "rebates" to make up for the lack of funding for the past 15-20 years. Again, I ask, do you even KNOW what is going on and why med reviews, adaptations, injections, and other clinical services are suddenly being pushed and where this funding is coming from?

Maybe we should flip this issue around and change the way hospital pharmacists are reimbursed as well. Let's take away 30% of your yearly wage next year and say that that 30% is being "reinvested into better health outcomes for all British Columbians in hospitals". Then, how about we say you can "earn" your 30% back individually if you complete discharge summaries and transfer summaries for patients in hospital for $60/patient provided they are on 5+ meds and you use government approved forms that are made in such a way that encourage easy auditing and mistakes that will be retroactively audited for clawbacks. I'd like to see what type of anarchy occurs among hospital pharmacists in a hypothetical case like this. As ridiculous an example as this sounds this is exactly what happened in community. So before you hate on community pharmacists, try to understand why this even happened.

Edit: Just out of curiosity, do you even know what is funding your $38-40/hr wage that I assume you expect? Would it shock you to realize that the money to pay for your wage is directly proportional to the number of med reviews done? Maybe you should be asking your employer to pay you less so that nobody needs to commit these acts that lack integrity anymore.
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[SiRV]

I may have overstated the reporting. The actual number of cases I've personally seen reported in total hover around 3. And in each time, what led to the reporting would be us asking for the pharmacy to fax a report of the med review, and when they send us a blank form with just meds listed, and have no idea whether the patient switched from a CCB or BB (or if they are on both continuously - one example) we get frustrated, because the patient has no idea.

One thing that I can think of off the top of my head in terms of sustaining ourselves, I think the adaptation fee schedule should be changed. Adaptations for renewals can remain at $10 since it's not a super cognitive service (I always renew for 1 month max anyway b/c theres no lab work I can ever use to safely give a 3 month for). Drug substitutions, direction changes 15-20$ etc.

An MD bills approximately 30$ for a 15 minute appointment, we tell patients to stay in our pharmacy for 15 minutes after a flu shot and get ~14$ (correct me if I'm wrong) out of it? , maybe give us a little more for injection services because we still DO full assessments on whether or not it's appropriate, whether or not it's provincially funded, or out of pocket etc. After doing injections at high volume (100 injection/day) store, I think it's totally ridiculous how govt spending was mis-allocated to injections being given only by Dr's/public health nurses the last few years when we were already there and able to provide these services.

In addition, I think if we could properly document/bill all our work on pharmanet and get reimbursed for certain OTC counselling ($5), especially after hours when Dr offices are closed.

Last point. I can't remember the exact figures, and I may have already posted this in the thread somewhere here. But last year, I had a big corporate sponsored dinner where I had the chance to speak to some people from Ontario. They were saying that previously, the Ontario government was giving $100 million in funding for pharmacies, after the cuts, it's been brought down to $15 million (85% cut!) almost overnight. They took a huge chunk of money away and gave back 15% just to toss up in the air and say "you guys can use this for your 'clinical services' and be reimbursed from this pot of money". Obviously, even IF they maxed out on all the clinical services they could have possibly done, they would still end up nearly 85% short. The way our professions salary is dictated by the government is very scary, especially for those that have a mortgage/kids/debt.

Eventually, we will probably have to look at people paying out of pocket for these services for us to survive. Or hope that our profession changes enough in the right direction that we can find a different source of income somewhere (drug prescribing within limited scope?).

[R5x]

Yeah that's an example of bad med reviews done in the community. I agree that the quality of them should be improved from the ones I've seen as well, but I don't think it's a bad initiative at all. We're finally getting a chance to get paid for something other than dispensing. It's a good first step and it'll take time for the quality to improve. I'm pretty sure it's here to stay and will be refined over time. I just feel it's about time we get paid to "talk" to patients about their medications. How often do we counsel otcs for 10 mins or something and the patient goes elsewhere that's cheaper? The $10 fee right now does not even cover the cost of dispensing a medication from Pharmacare own joint study (cost is closer to $14).

Good points brought up about adaptation fee schedule changes that would be reasonable. Unfortunately pharmacare doesn't see it that way. In fact for existing adaptations they are paying $9.60 I believe, because they say it was something negotiated before the agreement to increase the fee to the current $10.

Injections are paid at $10. I don't think they'd pay more for us to do injections because that is how much they pay physicians as well. Injections is probably one area that pharmacy's role will gradually expand in and completely overtake the physicians. It's just way more convenient to go to a pharmacy to get them done than to wait at a doctor's office.

The problem with pharmacy is there are only so many revenue streams available: dispensing fees (which we do not get paid enough for to cover the cost of dispensing), injections ($10 does not actually cover the cost of training and supplies unless you do a very large volume yearly), adaptations, med reviews, and generic support. Generic support is by far the only way to sustain pharmacies in the current model. To get rid of it and then reallocate only a small % of it to fund these clinical services is a joke and will not work. I hope they have something better coming or service levels will drop and every little thing will need to come out of pocket from patients. To be honest, it's time patients DO pay for some things we do. Calling doctors for stupid mistakes, or refill requests, answering otc questions, answering questions from patients that did not even get meds from you are all done for free at the moment and they are all time consuming tasks within our work flow. It just annoys the hell out of me that pharmacists have been trained to believe their skills are worth nothing.
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[Sakki]

Sorry to steer away from the topic at hand, but I wanted to reiterate pinkeye's point as to why Rexall would post a public job offer to a position that they agreed to give pharmacy students through a verbal agreement. Is it so they can find the most suitable person for that position? I heard rumors that they flaked out on 4 graduate students last year. Any confirmations?

[LookitsMarkA]

My mother has rheumatoid arthritis and is now on Remicade. However because of her past medical history of TB, she is required to take Isoniazid. The doctor said she has to be on it for 5 months ( she has been on for over 1 month ) but lately she has been experiencing severe headaches, high blood pressure, and nausea. She believes it is Isoniazid's side effects and the doctor does not seem to believe so. My question to you is, is there any thing we can do to alleviate the side effects? I read on wiki that it metabolize in the liver and creates a toxic by-product which is linked to hepatitis thus the side effects. Thanks!

1.try consulting another doctor.
2.if your mom is short like mine, the dosage may vary. weight also affects this.
3.you might want to counter what she eats to regulate side effects
(my dad had rheumatoid arthritis connected to gout from working too much; so he countered all his food intake. eg. less uric acid on all foods. avoiding pork products. but he stuffed himself with chicken. hes more buff than i am)
4. instead of relying on drugs alone (you should start relying on her own capability.) my mom started to work out she used to be 230.. now shes 160.. her high blood pressure is way lower now. her arthritis is going away. her medical dosage is 2x less than it used to be.
5. if this is a weight related problem, start being a better son. convince her to lose weight. i have a background for behavior and convincing so if you need help with this.. pm me

[truth]

Sorry to steer away from the topic at hand, but I wanted to reiterate pinkeye's point as to why Rexall would post a public job offer to a position that they agreed to give pharmacy students through a verbal agreement. Is it so they can find the most suitable person for that position? I heard rumors that they flaked out on 4 graduate students last year. Any confirmations?

Protect yourself by getting the offer in writing, that should be a no-brainer.

[ACURA]

It's expected of Rexall. The contracts will change, the conditions will change and you may not get a job offer at all. If you float, you will be floating for a long time. A VERY LONG TIME. Read the contract, you will see. There is no clause that they will give you a Vancouver store after working a few years. THINK. How many people are ahead of you? People from 2008 are STILL FLOATING. Lots of promises are made in the beginning to get you to work for them. Once you signed in, you will SEE how they really are. You already see a glimpse of their true character by all of the things that they are doing. Is the MONEY worth it for you to be away from your friends and family for an UNKNOWN number of years?

I'm still in Vancouver Island looking for my way back to Vancouver and I graduated many years ago

Any of you still floating? What year did you grad?

[Sakki]

Sorry to revive an old topic but I thought I'd give an update (ACURA I hope you're still around :)) I chose to work for an independent company instead which worked to my advantage as I have more flexibility and freedom than any of my other classmates who are currently working for big chains such as SDM and Safeway. I was even offered to be on the Board of Directors position which I turned down due to several reasons regarding liability.

Are there any updates on the current job market? I'm seeing many job postings on the BCPhA website. I've also heard some good things about Pharmasave. Thoughts?