Y’know, my youngest voted in her first election this year. Beforehand, she asked me whom I was voting for. I suggested that she learn about the issues and decide whom she thought was right for the job.She answered that whomever I voted for would not influence her and she was only curious to know who my choice was. She is so like her mother…The trouble with thinking about the issues is that it seems like in most campaigns these days the main activity is sniping at the personalities of the leaders. The only issues they talk about are the ones they accuse each other of lying about.This got me to thinking about how your vote matters even if you don’t know what you’re voting for. It is our job to find out as much as we can—we cannot expect someone else to spoon-feed us. These thoughts inspired me to write a blog.Honestly, I've felt uncomfortable writing about the following issue for some time. Not because I lack conviction, but rather because of how difficult it is giving up on something you worked hard and fought hard for and believed in for so long.Irreconcilable differencesA few years ago I decided to test my vote at the Annual General Meeting of the Ontario Pharmacists Association (OPA).I made a motion to be discussed at the AGM about who should and shouldn’t be members of OPA. The reason for the motion was quite simple—we need to decide if the same organization can serve the best interests of both pharmacy owners and pharmacists.To clarify, I have nothing against pharmacy owners, and my record as chair of OPA should be enough to satisfy that. In fact, it may be against the best interests of both parties to be under the same roof.I could spend a lot of ink (or megabytes) describing the conflicting interests of the two groups. But, ultimately, there are two camps—those who think OPA can represent both groups and those who think it can’t.Not surprisingly, the former is made up mostly of owners, while the latter—the large majority of OPA members—are frontline staff pharmacists. It is also unsurprising where the bias of the association lies because of where most board members come from.Of course, unlike political claims, I should at least have some proof to back me up. So here is the history of what happened after I made the motion.Story behind the motionFirst, I was contacted because I did not have someone second my motion. This was purposeful, because I wanted to see if anyone at the association had the guts to tackle such a difficult question.Nobody did, so I had to find my own person to second the motion, which I did. By the way, this person is a pharmacy owner.The next step was a friendly amendment, which usually happens when people get nervous about a polarizing motion. The problem is, it is then no longer your motion and it can’t be brought back.But because the replacement motion was to be about billing numbers and alternate payment models I agreed, for a couple of very important reasons.The first is that the two groups that like or don’t like the idea of pharmacist billing numbers are the same two I mentioned earlier.The second is that now the motion was also about professional autonomy. The test of the association would be what it did with the idea of professional autonomy and exploring possible vehicles like a new billing arrangement.But then the motion was tabled. That means it didn’t really get voted on, but voted on to be voted on later. There was much discomfort about this motion being passed, and just as much with it not being passed.The reason was quite simple. It is embarrassing that our profession and our professional association are not mature enough to grapple with the disconnect between what pharmacists do to help patients and the compensation models that are supposed to engage that to the fullest.Fear mongeringSo the deal was the board of directors would investigate. And so they surveyed the membership and asked about several versions of a scary future for pharmacists. Not surprisingly, people were uncomfortable with a scary future.The board could’ve shown some leadership by investigating different models and sharing their findings with members so that they could answer a survey in an informed fashion, but they chose not to.Even with an inadequate question about self-determination (that context was left off of the survey), it was clear that pharmacists were unhappy with the way things were.So committees were to be formed, people were chosen, promises were made and then the issue just disappeared. I would learn why later.Priorities in conflictWe also remember the controversy of an investigative news piece on pharmacists missing drug interactions and how their working environments were at the root of the problem.There were disguised pharmacists, fearful of reprisals, talking about how their professional autonomy is not only disrespected but also crushed under the weight of being overworked and unsupported in their efforts to serve patients.There were also patients and families who had been affected by these drug interactions. What’s more, there were plenty of worries about the potential disaster of pharmacists missing drug interactions and imperilling patients. A scary thing, but it only scratched the surface.Imagine if the public actually knew that checking drug interactions is only one of the many functions outlined in the pharmaceutical care process. In fact, they are not even close to being the most common problems.Untreated illnesses, low adherence rates and failure to reach outcomes affect hundreds if not thousands of times the population as drug interactions do. Yet, many of these happen because pharmacists aren’t in a place to address them because the pharmaceutical care process is not applied every place it can be.That is because the professional and profit imperatives are in conflict. Nothing new, but worse than ever, if only because of the larger potential of smarter and more numerous young pharmacists, the best of the best, joining the ranks of pharmacist practice every year.We risk wasting their potential, particularly when certain powerful sectors see this as a commodity to exploit instead of a resource to benefit from.But I digress. Suffice it to say frontline pharmacists’ working conditions, professional autonomy and compensation through wages and benefits are going in the wrong direction. And yet that issue seems to have disappeared as well.What can OPA do for us?So I asked around. Y’know, so I would know how to vote. I questioned if OPA could defend pharmacists in their working conditions, professional autonomy and compensation through wages and benefits. The CEO told me that the association is not constituted to be a union and cannot do so.Next I asked what happened to billing numbers. The board chair told me that they talked about it and decided that any pharmacist can just go get their own billing number and didn’t need the help of their association.Of course, there are two things wrong with that. For one, there is a difference between a pharmacist billing number and a pharmacy billing number (and the goal of this is to provide responsibility and autonomy of the pharmacist, a fact that seemed, well, not understood in these board discussions).I’m also pretty sure that when physicians and nurse practitioners want a billing number their association doesn’t tell him they are on their own.Now I know what OPA cannot do for pharmacists. I already knew that they are completely disconnected from the kind of practice I am in right now. Maybe that is why they don’t understand the need for methods beyond having a pharmacy business to help pharmacists like me develop what they do for the benefit of patients.I still don’t understand why the association can’t do it for community pharmacists. After all, most of their members are retail pharmacists, and they should understand their needs.But, they don’t help these pharmacists with their working conditions, professional autonomy and wages and benefits. And they don’t think you should have a billing number, unless you join the ranks of pharmacy ownership.What is it doing for us?So what is OPA doing for pharmacists, then? I was interested to see that they announced a session for pharmacy owners to help deal with audits and third-party billings. I know from working in community practice for 27 years how frustrating and time-consuming these processes are, and how they can get in the way of the real work being done.They also can have a significant financial impact on the business. It’s a great idea, probably long overdue because pharmacy businesses need to support each other and learning how to improve their lot with an uncertain business future.I should not have to point out the irony, but I will.OPA cannot and will not engage itself in the quality of work life and financial welfare of the pharmacists who are its most numerous members.It will, however, engage itself in the quality of work life and financial welfare of the pharmacies of this province. Even though ‘pharmacist’ is in its name.I do not begrudge pharmacy owners wanting and needing representation with government, payers and public. They need more, in amount and effectiveness.It is just unfortunate that pharmacists do not appear to have anything even close to what owners have.And so then I get to think about voting. I used my vote at my association meeting (with a few others), but the issue was quietly buried and went away. And so I question whether OPA’s directors listen to their membership.A vote by not votingBut I do have another vote. After all, unlike our federal, provincial and municipal elections, I can vote by not doing something.I can choose to not be a member of the association anymore and not pay any dues (it isn’t like I haven’t paid my dues already, anyway).I chose to be a member once upon a time because I believed it was an association about pharmacists. If I no longer believe that why would I continue?It is difficult to give up on something you fought long and hard for. But without faith, trust or confidence in an organization, to continue seems hollow. Maybe it’s time to represent pharmacists in a way that removes the pharmacy business pressure.Autonomy makes business senseThe unfortunate irony is fixing the problems through enabling pharmacist autonomy would likely be a boon to the pharmacy business.How could engaging pharmacists more in the care and outcomes of patients and capturing specialization and services probably not even thought of before be bad for business?Moreover, why are owners scared of pharmacist’s autonomy? (Please, by all means, speculate.) If that conversation can’t happen under one roof maybe, it needs to be had across a table.My daughter reminded me that we should vote, despite our misgivings, frustrations and apprehensions. The same goes for all of us as pharmacists and the future of our profession.Make your voice heard in whatever way you can. And, as my father used to say, if you don’t vote you lose your right to complain about the results. That’s why I vote as a member.When that vote becomes irrelevant, I can vote by saying I will look for another association of pharmacists that cares about the future of pharmacy the way I do.Is there one out there?I am really interested in how you feel. Maybe it’s just me, but I don’t think so.Ken Burns is a pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
