Q. What do you think about pharmacies that set quotas for minimum numbers of clinical services that pharmacists must provide?A. This practice is so shockingly unprofessional it is hard to believe that it is actually happening. However, this relatively new phenomenon appears to be occurring in a majority of community pharmacies in Canada. A recent poll on CanadianHealthcareNetwork.ca found that 67% of Canadian pharmacists are given quotas for tasks such as medication reviews.The first reason that I believe this practice should be banned is that these quotas pose a serious threat to the beneficial impact of the growing list of pharmacist services that provincial health ministries now fund. In order for these services to have a positive impact, they must be provided to the patients who actually need the service and they must be performed properly and thoroughly.In a February 2014 CanadianHealthcareNetwork.ca poll, 89% of pharmacists believed that quotas were negatively affecting patient care and consequently were jeopardizing the funding that exists to provide the services. Respondents commented that they were not offered additional time, resources or training after the quotas were set. Consequently, pharmacists are forced to meet the quotas by offering the services to simple patients (who take less time but who will benefit the least) and by rushing through the interactions (at the risk of not being thorough).The second reason that I do not support these quotas is that they are damaging to our profession and our reputation as a trusted health provider. Clinical services should be provided based on professional opinion of patient need, not by corporate quotas and profit projections.Could you imagine if it was discovered that physicians were being forced to ask their patients to book weekly appointments, when only monthly follow up was required, simply to meet a pre-defined billing quota in their clinic? Or if they were being asked to perform a minimum number of prostate exams each month, regardless of how many men actually needed it?These scenarios would be seen as an unprofessional waste of taxpayer dollars and possibly even medical malpractice. This is no different from the idea that pharmacists are being forced to provide a minimum number of medication reviews, regardless of how many patients that they believe, based on their professional judgment, actually require the service.The final reason that these quotas are a really bad idea is related to employee recruitment and retention. They say that a company is only as good as its employees. Considering that a February 2014 CanadianHealthcareNetwork.ca poll found that 82% of pharmacists thought that these quotas should be banned, this increasingly common policy is certainly not fostering a loyal and happy pharmacist workforce.I can’t imagine what it would do to my professional satisfaction and confidence if my employer asked me to adhere to one of these clinical quotas. Used car salesmen and telemarketers probably have to deal with quotas, but I didn’t spend half a decade in pharmacy school to be treated like a door-to-door salesperson.These pharmacy organizations should be looking for ways to inspire and motivate their professional employees to strive towards excellence. The many new billable pharmacist services available in most provinces represent an incredible opportunity for pharmacy employers to provide the training, support, encouragement, resources and mentorship to ensure their pharmacists can provide high quality services to the patients who need them the most.This seems like a far easier way to increase revenues in a positive and professional manner that will ensure patients benefit and pharmacists are professionally respected and fulfilled.The bottom line is that these quotas are simply unprofessional and unethical. I sincerely hope that our professional organizations and regulatory bodies can find the support to ban this practice before it further damages our professional reputation and before payers realize their funding may be utilized inappropriately.If you also disagree with this practice I encourage you to speak up and let your opinion be heard. Send a message to your national and provincial professional organizations and to your provincial regulatory body and let them know what you think.Please continue to submit your Ethics and Issues questions to derek.jorgenson@usask.ca.
