Dr. Chrystian Pereira
Appearances
Health Chatter
Pharmacy Deserts
That some of the numbers they don't have available to me like the number of independent pharmacies versus like versus chain retailers. In the in Minnesota those those numbers are available, and I think some of your research had some of those kind of like rough numbers out but, like the research we did didn't distinguish between those yet and we'll look at those some more to um and I think.
Health Chatter
Pharmacy Deserts
I did start by describing a pharmacy as a business, but I do want to say that I don't believe it behaves completely as a business all the time. There are reasons why pharmacies are open right now, and there are reasons why pharmacists kind of do this. The pharmacists that are very outspoken right now in Minnesota with independent pharmacies, they'll tell you that they're just...
Health Chatter
Pharmacy Deserts
they're just struggling right now because they're, they're doing everything they can to kind of keep their doors open and keep the, and keep their staff, keep their staff period since COVID very difficult, like maintaining staff in any health at any health level. And then, And so they're operating at a very kind of razor limited budget, razor thin budget.
Health Chatter
Pharmacy Deserts
Well, Clarence brought up the great point of PBMs, and we haven't really talked about how that's changing the market. I want to go back and talk about that point. But Barry, one of the things that you're saying is that, wow, what's going on when there's a consolidation?
Health Chatter
Pharmacy Deserts
And what's happening in Minnesota is when there's a consolidation and there's larger pharmacies or chains and organizations that own multiple pharmacies, we are at their whim of when they close a pharmacy. And we are at their whim of where they close their pharmacies. And so if you start to look at where they start to close their pharmacies, that might be a very vulnerable community.
Health Chatter
Pharmacy Deserts
And whereas an independent pharmacy that's open one or two stores, they've intentionally opened in that location. And honestly, as a profession, they're probably committed to that location or that community, right?
Health Chatter
Pharmacy Deserts
But a large organization that has multiple, multiple, multiple stores, when they have to close stores, because the larger organization business requires some consolidation, where are they going to close? They're not going to really consider the factor on the community or the impact on the community.
Health Chatter
Pharmacy Deserts
They're going to really factor on like, well, how much do we sell there versus how much do we not sell there? Or how much theft is there versus how much not theft is there in their stores? And so they're making decisions based on that without really a connection to the community and how that's changing.
Health Chatter
Pharmacy Deserts
Now we can look at other states like North Dakota that have kind of made policies like statewide laws that don't allow chain pharmacies.
Health Chatter
Pharmacy Deserts
uh or a pharmacy to be owned by like uh an organization that will multiple pharmacies so they're they're in some ways insulated by that but you know unfortunately our state did not make a law like that and so we're not insulated from those kind of for those women but you we can say we can We can look at this as like a chain pharmacy issue, but other health institutions are doing the same thing.
Health Chatter
Pharmacy Deserts
So, and look at different health systems that have pharmacies, or they have clinics, and they've closed over the last 3 or 4 years. Same the same thing, and they're closing in places that may be vulnerable as well. So it's not just retail chain pharmacies, but.
Health Chatter
Pharmacy Deserts
But to your point of saying it's like when there is large organizations, all of a sudden when they close or they disappear, then we are, you know, we suffer. The community might suffer a loss that that organization doesn't really need to factor into their consideration.
Health Chatter
Pharmacy Deserts
Wait, Clarence, I want to understand your question. Are you asking, like, what is the state of, like, pharmacy? How many pharmacies we're producing? Go ahead. I'm sorry. No, are you asking how many pharmacies are we producing?
Health Chatter
Pharmacy Deserts
No, that's where I am right now. That's what I work for. I wake up thinking about students. I go to sleep thinking about like students at the College of Pharmacy. So I love talking about it. Yeah. OK, so so let's go back to like me. I graduated in 2001 when I graduated pharmacy school in the early 2000s. Pharmacy schools were booming. Like it was a profession that was exciting.
Health Chatter
Pharmacy Deserts
There were newspaper articles about being a wonderful profession. Parents were getting their kids to go into pharmacy schools. And I mean, as pharmacy school in Minnesota, like we were, you know, just getting such wonderful applicants. And we still do. We still get wonderful applicants, but it was a boom. And in the nation, there were there was a huge increase in number of pharmacy schools.
Health Chatter
Pharmacy Deserts
Now, in Minnesota, I would say that the University of Minnesota College of Pharmacy was very strategic and kind of like kind of kind of being careful about not having another pharmacy school in the state of Minnesota. So we expanded and we went to open up a campus in Duluth because of the high demand.
Health Chatter
Pharmacy Deserts
And so nationally, I think like, oh, I don't know the numbers, but like, I remember there being about like a there are more pharmacy schools within a 10 to 15 year period. So there's a big boom in number of pharmacists. Now there's a concern that there was like a surplus of pharmacists graduating into the workforce.
Health Chatter
Pharmacy Deserts
And so in the tens, in the 2010 to 2000, like there was a concern that there was too many pharmacists.
Health Chatter
Pharmacy Deserts
um so since then like the admissions has gone down uh nationally and including minnesota so that minnesota has suffered kind of a decrease in admissions we still have two campuses open there are colleges of pharmacy in neighboring or in uh close by states that have closed campuses not necessarily all together pharmacies so there have been like consolidations in pharmacy schools like i'm thinking
Health Chatter
Pharmacy Deserts
in Missouri is where some of the campuses have closed, and I think Illinois too. So there have been consolidations, but there's still just a lot of pharmacists being graduated. So I would say like, we still have a healthy number of pharmacists that we graduate from the College of Pharmacy every year, but I'll tell you, these students are kind of nervous.
Health Chatter
Pharmacy Deserts
When I graduated from pharmacy school, I went to a, and I was a new faculty member, and I went to a lecture, and we were, I don't know what the, at a national conference, And the speaker was so flippant about it. He said, okay, well, you don't have to worry about job security because if everyone could feel their pulse, if you feel that pulse there, then you're probably okay with it.
Health Chatter
Pharmacy Deserts
If you have that thing there and the license, you're going to be fine for a job. And that was the sentiment. Like it was like, oh, there were just so many jobs available. But today this is very different. And like, Number of pharmacy jobs are consolidating and there's fewer. And so there is a stress in terms of job placement and where people are going to work as pharmacists.
Health Chatter
Pharmacy Deserts
So from my perspective is I think we're graduating close to a hundred pharmacy students every year with they're highly qualified and then have gotten a top level education, national education. And I can't guarantee that they're gonna get a job day one.
Health Chatter
Pharmacy Deserts
They do get placed and we have great placement for our students, but there is kind of like a stretch and not everyone is going to work for a community pharmacy. So we have people divided into going into other training, working in hospitals, working community pharmacies, very few pharmacy owners.
Health Chatter
Pharmacy Deserts
well first like whenever pharmacists ask that to a patient i i i think they're working at a high level i think that is that is that makes me really proud uh yeah i think it's a great question yeah our job is not to like is to think like problem solve and and think beyond kind of like what's right in front of us because like you know that pharmacist works in a hospital with tons of drugs and they right but
Health Chatter
Pharmacy Deserts
But that's transitions of care. So that's a passion area for me too. So very proud that that was being asked and asking a patient for further information. One thing I'll just... just bring up here is to say that that's a good example of a patient that needs acute medicine. And so needs acute acute therapy.
Health Chatter
Pharmacy Deserts
One of the kind of counter arguments to like the pharmacy shortage is to say, well, what about mail order? I get my, you know, I get my chewing gum delivered to me. I get like groceries delivered to me. I get other things delivered to me. What, what is, what is the problem? doesn't that just solve this problem? But there are acute needs that someone needs.
Health Chatter
Pharmacy Deserts
So someone leaving the hospital for pain medications for a controlled substance, that is an acute need. Or when there's some therapy that needs to be changed quickly and without some delay, those are things that need to happen quickly. And so having access to a location that can sell you those things or kind of provide those things through your insurance is necessary. So I think that's the
Health Chatter
Pharmacy Deserts
kind of questions we have to ask is to say like, what is your access? And access means different things to different people. For some people, it just means that like, well, you know, I'll just drive to a pharmacy. If the pharmacy that's three miles away from me closed, I can drive 10 miles away for me to close. But then, you know, it's 10 miles a lot, or what about like
Health Chatter
Pharmacy Deserts
20 miles if it's 10 miles closing 20 miles or if someone doesn't have a car what does that mean like if the pharmacy closes that's a mile away from them then three miles away from them so it is a relative question so it's a question you have to ask an individual person because for that individual person distance to that pharmacy might be totally different
Health Chatter
Pharmacy Deserts
I have a I have a family member that has a disability and can't travel, doesn't drive. And so I go and pick up their medication for them when they need it. And it's it's not fun. I have to go and go in the pharmacy and then explain that they need it. And then I have to wait because it's not ready and then get it ready and then and then get it and then bring it back to my family member.
Health Chatter
Pharmacy Deserts
But that's a person that just if if he didn't have me, then, you know, getting his medication would be a lot harder. Um, so, so I think, yeah, I think access is a big thing and then it's, it's, uh, relative to that person in terms of how can they get to a pharmacy.
Health Chatter
Pharmacy Deserts
Yeah, I'll say that delivery to homes is a complicated question as well. It's, you know, it's the gift giving season right now, but it's also the packages taken from porches season. And all of us have kind of seen like theft happening at people's places. I've had patients that can't receive medications because they live in a facility that doesn't really easily accept packages for them.
Health Chatter
Pharmacy Deserts
During COVID, I was losing my mind because there was locations and organizations that weren't delivering medications to the neighborhood where my patients lived because they told me it was unsafe. but it was like, it's unsafe not to have your medications either.
Health Chatter
Pharmacy Deserts
There are so many aspects to that that also kind of, we have to kind of remember that not everyone lives in a place or is in a situation where they can receive the medication easily. And so that's another kind of a part of my practice that I kind of have to kind of factor in as well for how people receive medications.
Health Chatter
Pharmacy Deserts
Oh, yeah, the people that own data rule the world, right? So we know that from how social media works or how the internet works and how – so, yeah, this is a very easy point to get around to say that data has to be really important. Yeah, my practice is in primary care, so I've always –
Health Chatter
Pharmacy Deserts
just really struggled with what you're saying is on the primary care side, saying, like, I know that data is out there, but why can't I see it, what's happening? And the truth is, is because that data is being farmed and sold and used and kind of manipulated to other people's business interests. Pleasures or kind of what they need from that. That's true.
Health Chatter
Pharmacy Deserts
And that's that's their data and that's their business. And so that's that's true. I'll say, though, that more recently. The the information I can only tell you about what my practice in my practice, in my organization, we use that product epic as well. And in that in that practice is becoming more and more accessible to see products sold. So now there is like a kind of like a.
Health Chatter
Pharmacy Deserts
a little bit of a linkage to see like, not only can I see what this organization, our clinic is prescribing, but we're also seeing like at a pharmacy, how is that being sold and at what rate? And so that I would say that that is becoming a tiny bit more transparent. And with every upgrade we get in our software, the more I'm able to see it.
Health Chatter
Pharmacy Deserts
So yes, for 80%, 85% of my patients, when they come into me, I can go and say like, oh, let's look and see how often you've picked up your blood pressure. Wow, you've only picked it up twice in the last eight months. I think this might be why your blood pressure is too high. So I use that data regularly. So I'll say that data is a little bit more available. It's not...
Health Chatter
Pharmacy Deserts
I don't know if we're using it or leveraging it enough for public health good for our population health, but it is getting a little bit better.
Health Chatter
Pharmacy Deserts
I don't think the pharmacy, on the pharmacy side, I don't think they're seeing it and I don't think they're using it as much. So I think right now it's favoring the provider side where we can see a little bit more.
Health Chatter
Pharmacy Deserts
Yeah, I'll just respond to some of this. There are two really important points that you're saying, Claire. It's about like medications. I actually have to say a few different things. First, like as a pharmacist, like we are like we're
Health Chatter
Pharmacy Deserts
Hello. Thank you. Thank you for having me on. Just for clarification, my name is pronounced Christian Pereira. Christian. Yeah, perfect. Thank you. All right. So what is a pharmacy desert? I think there's a lot of interpretations for it. And our group has come up with a definition that fits Minnesota and looks at as a state.
Health Chatter
Pharmacy Deserts
of our main things that we're trained to do is evaluate for safety so we're just always supposed to kind of think about safety as part of looking at in fact at the college pharmacy we say indication efficacy safety and convenience those are the ways we evaluate like someone's medication regimen just that's just ingrained into every single pharmacy student that graduates from our program in any program really okay but
Health Chatter
Pharmacy Deserts
Pharmacy and the medical complex has a lot of blame to share about the opioid epidemic. There was a problem in kind of over-prescribing and over-dispensing and over-administering opioids that we're still reeling from.
Health Chatter
Pharmacy Deserts
As a society today and it's still a huge issue so that that is no joke and so there's there's always to say that there's there's blame to go around and pharmacy and wholesalers have a lot that they can kind of like talk to around this now. what are we doing to fix the problem? And this goes back to being a resource. Now, I think, Barry, you kind of talked about immunizations as a resource.
Health Chatter
Pharmacy Deserts
In COVID, when there was a shutdown and people were told to stay home, don't go to work, work from home, pharmacies were given a dispensary, like they're called essential workers. They said, oh yeah, but if you work in a pharmacy, you need to go. We didn't have a vaccine for COVID.
Health Chatter
Pharmacy Deserts
We just knew these places had to stay open because they had to kind of be a resource to people so people could not miss their medications and become less healthy. So that was the thing. Likewise, pharmacies can be a resource to fix other like health ills.
Health Chatter
Pharmacy Deserts
So Clarence, you're saying about opioids, pharmacies have like now policy where they can prescribe naloxone or can prescribe opioids, opioid antagonists to prevent opioids. And that is one way a pharmacy can contribute as a resource. Pharmacies can also do hazard reduction.
Health Chatter
Pharmacy Deserts
Pharmacies can sell clean needles for those that use needles, maybe for illicit reasons, but still clean needles to reduce illicit. And that's a policy by the state of Minnesota where we can do this to reduce hazard to the population. And these are examples of how pharmacies can be resources for the community to fix or to help problems.
Health Chatter
Pharmacy Deserts
And so vaccinations, prescribing to like hazard reduce, to keep people safe, these are what local pharmacies can do for a community.
Health Chatter
Pharmacy Deserts
But I think it's describing what you're saying is the saying like this, a sense of a loss, a sense of a loss of a resource for a community, for a neighborhood, for a group of people. And when that when that resource is gone, like in this vacuum, then what happens? And that's kind of what I like to talk about and what I like to think about, too.
Health Chatter
Pharmacy Deserts
Yeah. You know, public health is one of our core curriculums. I give a lot of lectures at the College of Pharmacy on public health. We have pharmacists, you know, a lot of like one of my favorite stories is like the cryptococcal like epidemic in Milwaukee.
Health Chatter
Pharmacy Deserts
It was recognized by pharmacists because people were coming in like we were like the Milwaukee pharmacists were selling out of anti-diarrheal medication. Like, why is this happening? Why is this happening? Calling into the uh, state public health to say like, Hey, something is going on. And we are, we pharmacy can be the canary in the coal mine can say like, Hey, what is going on?
Health Chatter
Pharmacy Deserts
And people are, are really struggling here. Uh, and, and yeah, so it warms my heart to say, you know, these pharmacy students are not in this, uh, in their seats in their classroom for so many years, just to learn about like how to count by fives. They're learning, you know, like they're learning about like carbohydrates. They're learning about like proteins. People do like the value of exercise.
Health Chatter
Pharmacy Deserts
preventative health so we're not teaching how to like you know sell to disease we're teaching how to like like you know how to boost health and so and and so like when a pharmacist takes the time to give someone a book to read or when someone a pharmacist gives takes the time to send them to like another resource in the community that can get help or to point out healthy foods that is what we do and so i think that's what we want to do i think and and you know to me that
Health Chatter
Pharmacy Deserts
We do have the Pharmacy Professional Organization, the Minnesota Public Health, I'm sorry, Pharmacy Association that lobbies for pharmacists and works toward kind of improving policies. There are, there's a new national, like an independent pharmacy organization that right now is also lobbying for kind of more protection against contracts and unfair business practices in Minnesota.
Health Chatter
Pharmacy Deserts
I think there is some very recent movement in terms of PBM management and controls over pricing. These are where the changes are. I'm not an expert in knowing exactly where these efforts are going, but that's where the change has to happen in terms of Minnesota policy. Sheridan, you got a question?
Health Chatter
Pharmacy Deserts
Yeah, let me respond to something I shared. And I've been in pharmacy lines, too. I've been where I had to come back. I hold my tongue so much when I'm at a pharmacy. Like, I don't want to say, like, I'm a pharmacist. Why was this thing so long? But these are real things that happen in pharmacies. And so, like, just any other health...
Health Chatter
Pharmacy Deserts
health industry, healthcare industry, there are challenges that happen. But one kind of point to say is like, why are these things happening? Why are these things, these frustrations happening at the pharmacy? When we talk about health deserts or pharmacy deserts, we're really focusing on like where the like black hole is for the pharmacy, like where there's no pharmacy.
Health Chatter
Pharmacy Deserts
But one area that we're not talking about is like the stress it creates on the other pharmacy. So now if like the radius for one pharmacy was before only a five mile radius like that they were servicing. But now those other pharmacies closed. Now they service a 20 mile radius. That means that their business is going to go like it is going to get bigger.
Health Chatter
Pharmacy Deserts
But it means that they're going to be a lot busier. And there is no cap in terms of how many prescriptions a pharmacy can sell or sell per day or try to produce per day. But what it does is just it overburdens that pharmacy.
Health Chatter
Pharmacy Deserts
So while we all have stories about having a pharmacist that we loved that kind of walked us around and kind of took the time to kind of talk to us about things, if you go to a pharmacy right now, They are swamped and they are stressed. And one thing that we haven't talked about, too, is like the stress that the community pharmacist is under right now.
Health Chatter
Pharmacy Deserts
Two years ago, there was a lot there or a year ago, I think, in 2023, there were walkouts of pharmacies. There were pharmacists that were frustrated by their working conditions. And this is all related. Number one, pharmacy deserts are having a consolidation number of pharmacies. Number two, that volume is shifting to someone else. They're stressed out.
Health Chatter
Pharmacy Deserts
Number three, those pharmacies are trying to get by because they're not getting reimbursed enough for their product. I want to go back to that point. But when that happens, what is the most expensive cost for a business? It's personnel. So they streamline personnel. If you streamline the personnel, then that means everyone's stretched and just stretched to a limit.
Health Chatter
Pharmacy Deserts
And that is a strain on our profession. And then pharmacies are just not... When a business is stretched, it's not going to provide the perfect service to the consumer. And so I... I have a lot of sympathy for pharmacies that are trying to, trying to get by right now, uh, and kind of service their community the best that they can. Uh, a lot of them are kind of like holding on as much as they can.
Health Chatter
Pharmacy Deserts
And a lot of them are kind of like figuring out how they can stretch that dollar the most. And that's sometimes can be a very uncomfortable encounter with the pharmacy too. So I think that's all a part of this problem.
Health Chatter
Pharmacy Deserts
Yeah, there is one point that we haven't addressed enough. And I just want to be very clear, especially my community pharmacists are going to want me to say and describe this. Right now, as PBMs are creating contracts, there are unfair contracts being made with independent pharmacies because they don't have the negotiating power. They don't have a negotiating power that another pharmacy may.
Health Chatter
Pharmacy Deserts
Another pharmacy may have negotiating power because they might be in line with the same company that owns a PBM. That is one part of it. There's another thing where you have a number of stores and you can negotiate different things. So there are negotiations for prices of medications that are happening.
Health Chatter
Pharmacy Deserts
And there are so many stories in all the articles that you've all read about PVMs where the pharmacist is being sold, is being forced because of their contract to sell a product for less than what their acquisition cost is.
Health Chatter
Pharmacy Deserts
We're no longer like as pharmacy even fighting for dispensing costs because we used to have a dispensing fee that would be like on top of the cost that that would keep the pharmacy float. That doesn't even cover. And we're like so many of the sales for drugs for an independent pharmacy, particularly, and I think true for other places, too.
Health Chatter
Pharmacy Deserts
But they're selling the drug for under the cost of the acquisition costs. And that's just not a sustainable viable. It's not viable. And so and so the more stories you hear about this, this is the central reason why pharmacies are going to go out of business is because they're not getting reimbursed for the cost of the medication. Yeah. Yeah.
Health Chatter
Pharmacy Deserts
And I think that's kind of like my my take home to say, like, that is root for problem for keeping pharmacies open right now. And I think if we don't address that, then I think we're we're in real trouble.
Health Chatter
Pharmacy Deserts
Yeah, that's a great question. So I think the definition was termed or like coined like around 2012. I haven't specifically, but right around like 2010, 2012. And they use a few different phrases for medication desert and pharmacy desert. And it started looking at like really densely populated metros like Chicago and New York and looking at like, oh, how pharmacies were going away. So that's true.
Health Chatter
Pharmacy Deserts
Thank you. I really appreciate the conversation. I really appreciate your perspectives. I do endorse the research that you're putting on your website. I thought those numbers and those points were great. So invite all listeners to take a look at those. I think that's great. Last step is just to say pharmacists are...
Health Chatter
Pharmacy Deserts
coming into your community and they have a passion for helping the community improve in their health, pharmacists are ready for the challenge and to take it on. And I think this is the year to really pay a lot of attention to what's going on because changes in attention to kind of how policies are formed, I think can help relieve the problem here. And I encourage all of those to consider that.
Health Chatter
Pharmacy Deserts
Pharmacies are businesses at their core. Just like you're saying, there's lots of experiences we've had in our neighborhoods where we used to know a pharmacy that's gone away. Then you can tell that building used to be a pharmacy.
Health Chatter
Pharmacy Deserts
one fun thing in Minnesota is that like lettering or like certain words you can only use certain words on certain buildings that are designated as pharmacies so you can't use the word drugs on anything that's not a pharmacy like the the word the lettering uh to the public but sometimes you'll walk by or see a business and they'll have like in stained glass they'll say drugs on it because that building used to be a pharmacy or uh you know there's like examples of liquor stores uh that like
Health Chatter
Pharmacy Deserts
it's just kind of really funny kind of like relics of kind of old pharmacies uh and past businesses have kind of come and then and then unfortunately gone uh so so i think that's been always true as far as a small business that where a pharmacy could come and could go away what we're kind of saying is that there's been an acceleration and where this isn't following a normal business practice uh where they're like an acceleration of just
Health Chatter
Pharmacy Deserts
decreasing uh like fewer pharmacies and why are they going away and where are they going away that is grabbing people's attention and i would say since 2012 is when kind of like the first alarms kind of started going up uh in terms of these going out but these this is accelerated minnesota particularly in 2017 and since 2017 and gotten up through today and yearly today to date it's been a
Health Chatter
Pharmacy Deserts
a big increase in number of pharmacies leaving the state of Minnesota, but it's a national phenomenon, too.
Health Chatter
Pharmacy Deserts
Yeah, no, let's talk about it. I have personal opinions on this and I have like, but let's talk about just the logistics or kind of like the basics of these terms. So a pharmacy benefits manager is an organization that works through, like works on behalf of insurance companies to negotiate prices and to kind of negotiate formulas, formulas and prices.
Health Chatter
Pharmacy Deserts
So there's always been a drive for any kind of business or health institution that has medication that's using therapies to dispense medications. You have to have like,
Health Chatter
Pharmacy Deserts
a pool of medication that you use right so a hospital decides these are the drugs that we're going to use or an insurance company says these are going to be the drugs that we're going to use and that's what we call formulary right but this topic is really broad like drugs are really broad and complicated from anything from chemotherapy to like common cold medication to opioids to NSAIDs like or ibuprofens or over-the-counter products so the the
Health Chatter
Pharmacy Deserts
The complexity is huge. So as things have evolved in the insurance world, in the business world, these were kind of like specialized into a group. And these are pharmacy benefits managers. Now, these pharmacy benefits managers are an offshoot of the insurance company.
Health Chatter
Pharmacy Deserts
And then really kind of like, you know, when I remember it coming up, like it's like, oh, that's where they were kind of pulling all the smartest pharmacists to kind of work for these guys, work for these organizations to really kind of create a good formulary that that's going to make sense for the insurance company.
Health Chatter
Pharmacy Deserts
as time has gone on this has become a big player in how drugs and the movement of medications and the movement of which products are being used a lot of people call them like a middleman saying like there's an insurance company and then there's a middleman the pbms and then there's the whoever you know, sells the pharmacy front lines like a pharmacy or a hospital. And that that's true.
Health Chatter
Pharmacy Deserts
But I kind of like my point is, is that like it's still part of the it comes from the health insurance like world.
Health Chatter
Pharmacy Deserts
But but the pharmacy benefits manager is like that, that middle person, that middle organization that's now kind of like dedicated to kind of understand how the drugs, which drugs should be used or per the per the contracts that they're kind of like negotiating for or understanding and who and what the prices are going to be.
Health Chatter
Pharmacy Deserts
uh for those uh reimbursements when someone does go through that through that company so so clearly stated it's just kind of like that that middle organization in the in the insurance kind of cascade of money does that
Health Chatter
Pharmacy Deserts
no no okay but but if if you don't mind i'll tell this story about yeah go ahead in in the in 2000 all schools of pharmacy in the united states decided to change their their degree to a doctorate degree so i am Very proud that in 2001, I earned a PharmD degree at the College of Pharmacy at the University of Minnesota. And so I have a doctorate of pharmacy. We didn't invent it at that time.
Health Chatter
Pharmacy Deserts
The doctorate of pharmacy degree had existed since, I think, the 40s or 60s. So it had existed. It was just a standardization. Pharmacists go to school in a professional school for four years. medical doctors go to school for an MD for four years, DO doctors go to school in a program for four years. And it was just seen as like a comparable level of education.
Health Chatter
Pharmacy Deserts
So given the amount of work that was being put into it, it reached the threshold of being recognized as a doctorate level. of practice and of scholarship. So it's mostly recognition for the amount of information that we take in. And I would say from a professional perspective, it also gave us a sense of also responsibility.
Health Chatter
Pharmacy Deserts
So now we have a doctorate label behind us, and that includes being a teacher, that includes being kind of like a responsible steward for medicine and kind of like an oath to like protect patients and communities for their care. So in a sense, it kind of just, established how pharmacy intends to see itself.
Health Chatter
Pharmacy Deserts
It didn't really open up new avenues for work, or it didn't really create an escape to work at other things. Most pharmacists that you see at a community pharmacy today have a PharmD, and so most of those pharmacists were there. And most pharmacists that you meet at the hospital have a pharmacy, too.
Health Chatter
Pharmacy Deserts
Like there are still like a handful of pharmacists that might have a BS pharmacist or like a master's level pharmacy level. And that's just because the year they graduated. But it doesn't really change their license. Like the state of Minnesota licenses us all the same way.
Health Chatter
Pharmacy Deserts
I am a registered pharmacist, just like any other pharmacist that you meet, regardless of their level of training post-graduation. So I would say, no, that really didn't change. didn't really kind of like, release the workforce into different areas.