WHY ISN'T ANYONE LISTENING?

Congress is not listening. Its latestproposal to save billions of dollars inMedicaid expenses involves cuttingpharmacy dispensing fees. As I writethis, both the Senate and the House ofRepresentatives are planning to act oncommittee recommendations to cutpharmacist dispensing fees, and pharmacyis attempting a grassroots campaignasking pharmacists to informtheir representatives and senators ofthe dire consequences of such action.

The NCPA says the cuts "will resultin less access to lifesaving medicationand sicker patients. These cuts couldforce up to 40% of this nation's communitypharmacies to close their door."Merrill Lynch analyst Patricia Baker,stated that, "the smaller chains and independents,will be harder hit, possiblysparking a wave of industry buyouts."It appears that pharmacy's message isclear, but no one is listening. So, myquestion is, "Why isn't anyone listening?"We all have our ideas on "why,"and pharmacists quickly share theiropinions on "why," but how thoughtfulare these opinions? Maybe it is timeto think out of the box, examine someof our "sacred cows," and maybe evenbe critical of what we are doing and notdoing.

These are my possible answers forwhy people are not listening:

1. Maybe "one message, many voices"from the multitude of pharmacy organizationsis not the most effective wayto get attention and achieve results. Itdoes not seem to be working, so maybeit is time to talk about consolidation inpharmacy organizations, as is happeningin other industries.

2. Maybe our message is not acceptedbecause what we say does not seemto agree with what people see. We talkabout pharmacies closing, but on manystreet corners, in many towns acrossthe country, new, large pharmacies areopening. Grocery stores are addingpharmacies. Even new independentstores are opening. Perhaps legislatorsand others do not pay attention towhat we say because community pharmacyappears to be very prosperous.

3. Maybe our message is not believedbecause what we say we do andwhat most pharmacists actually do aredifferent. We talk about the value ofcounseling; yet most patients interactwith a clerk and not a pharmacist. Wesay we are the most accessible healthprofessionals, but consumers have ahard time getting real access to a pharmacist.How long does it take a patientto get to talk to a pharmacist in yourstore?

4. Could it be that influencing legislationactually takes grassroots involvement,and too many pharmacists arenot politically active? Maybe relyingon a lobbyist is not effective unless wehave real grassroots involvement. Howmany letters have you written to yoursenators or representatives? How aboutlocal candidates? Did you even vote inthe last election? Did you ever make acontribution to a political campaign?

5. Maybe community pharmacy isnot as important to the local communityas we like to think it is. I have ahard time with this possibility becauseI have built my career on promotingthe role of the pharmacist. Watchinghow our message is ignored, however, Ihave to at least deal with this possibility.Much of what we do is behind thescenes, so patients never even knowwhat we did. We do not tell themabout the mistake we caught becausewe do not want to put down anotherprofessional. Maybe we need to start"tooting our own horn." The AmericanPharmacists Association featured Octoberas American Pharmacists Month.What did your pharmacy do in Octoberto promote the profession? Whatdid you do personally to promoteyourself, or your profession, in October?Could it be that many consumersdo not know what you do, and that iswhy no one is listening?

This is my attempt to answer thequestion "Why isn't anyone listening?"How do you answer that question?

Mr. Eckel is professor and director of theOffice of Practice Development and Educationat the School of Pharmacy, University ofNorth Carolina at Chapel Hill.