Women at the Forefront of Pharmacy

While we often hear the statistics highlighting how many women are studying and practicing pharmacy, there is a growing number of women who are assuming leadership roles and driving change that will impact generations of pharmacists to come. We sat down recently with 3 such women who are thought leaders and changemakers within the pharmacy profession:

• Theresa Tolle, BPharm, who is owner and pharmacist of Bay Street Pharmacy
• DeAnn Mullins, BPharm, CDE, who is co-owner and pharmacist of Mullin’s Pharmacy
• Erin L. Albert, MBA, PharmD, JD, PAHM, founder of Pharm, LLC
• Moderator: Eden Sulzer, director of the Women and Pharmacy initiative at Cardinal Health

Left to right: Theresa Tolle, DeAnn Mullins, Erin L. Albert, and Eden Sulzer.

What are the biggest changes happening in pharmacy and how have you adapted?

Theresa: After 18 years as an owner, one thing I have learned is that our industry is constantly evolving! The status quo is never enough; we need to stay one step ahead of the changes that are coming. We should monitor trends, be an active member of an association, and network with our colleagues to learn what is working and what is not. Today, some of the biggest challenges are the impact of DIR fees (which are retroactive), as well as closed or preferred pharmacy networks that Independents are unable to participate in. These challenges force us to find other ways to drive revenue.

DeAnn: That reminds me of a quote from Leonardo Da Vinci: "All great acts of genius began with the same consideration: do not be constrained by your present reality."

Independents are fighting for survival in a rapidly changing healthcare ecosystem. Fortunately, transformative trends like value based care, precision medicine, consumerism and healthcare consolidation bring enormous opportunities for market disruption and economic viability.

Like it or not, change is our new normal and the speed of change will continue to accelerate like nothing we’ve ever experienced.

Leveraging technology to improve efficiencies and implementing processes like med sync, medication adherence strategies and financial analysis of DIR fees is a big part of our strategy to survive and thrive.

I'm also trying to approach challenges by using First Principles thinking. Aristotle defined the concept over 2,000 years ago. Elon Musk brought it to my attention. Our current challenges are complex, and reasoning from First Principles just makes sense. True innovation isn't tweaking a current process. It's inventing a new one.

The same concept applies to battling the PBMs. If you hate the current payment model, build a new payment model that makes our current one obsolete. I believe that the Community Pharmacy Enhanced Services Network (CPESN) can help us build a new payment model through a clinically integrated network of pharmacies.

Erin: For me, there are 3 game changers:

• Consolidation - In my world, the potential for Amazon to tap into the pharmacy business is huge. On top of that, we're watching huge mergers unfold. The big players are getting much bigger, which is somewhat concerning. What about the pharmacists serving the underserved? While I understand the economies of scale argument for the large chains, I am very concerned about the independents who serve populations that the big chains can't or won't cover.
• Specialty -Specialty drugs and new drugs are significant in my business, and the cost of drugs is becoming astronomical. Hundreds of thousands of dollars for one treatment can burst budgets quickly. How can we balance innovation in pharma and biotech to revolutionize patient care, shift to value-based outcomes for reimbursement, and yet keep drugs, biologicals and therapies affordable? I adapt here by being as educated as I can be in watching trends and identifying best practices to reapply within the profession.
• 21st century pharmacy education - I'm extremely concerned that educational standards are not keeping up with the skills pharmacists require for the evolving industry. Pharmacy students are not offered enough entrepreneurial education, big data management, pharmaceutical pricing, and health outcomes curricula. They also need to learn advocacy and policy and legal issues; I'm seeing pharmacy schools treat these critical topics as optional. I try to make a difference by ensuring students where I precept have projects in these areas.

How can people make a difference to inspire change in the current environment?

Theresa: We need to be involved! This includes active participation in pharmacy associations at the local, state and national level. Also, as Erin discussed previously, we should be monitoring legislative activity to be aware of changes that might impact our profession or our small businesses. We must work through our associations to advocate for legislation that will benefit patients and our businesses. We are the leaders in our communities; if we don't step up, who will?

DeAnn: Exactly, Theresa. Shared beliefs can change the world. I spent my NCPA presidential year writing and speaking about ways pharmacists can unite with each other and with the broader healthcare community. Coming together requires getting out of your pharmacy and working with your fellow pharmacists through your local, state and national associations. You have no right to complain about things like DIR fees if you aren’t at least writing a membership check to your state association and NCPA.

I’m also a big fan of the Health 3.0 movement. Leading that effort is Dr. Zubin Damania, aka ZDOGGMD. Check him out via Facebook or zdoggmd.com. He uses humor and music to shine a light on the dysfunction of medicine. I’m proud of the work we’ve done to bring pharmacists into this movement of over one million healthcare providers focused on changing the healthcare ecosystem.

See the tribute video to pharmacists here: http://zdoggmd.com/just-a-pharmacist/

Erin: Once again, I use the rule of three:

• Advocate - I preach all the time to my students that they signed up for a profession. Thus, part of being a professional means advocating for the profession. As Theresa and DeAnn said, that means getting involved in the community, talking to law makers about the profession, and advocating for the profession (as well as patients). That also may mean helping out on a political campaign or running for an office.
• Communicate - What is making you mad? Rebates? DIR fees? Non-transparency in drug pricing? Lack of access for patients? Pick a passion and start discussing it. Offer to discuss it in your community. Use social media judiciously and professionally, to communicate points of view on a topic and share process improvement.
• Network - Pharmacists tend to stick within the profession and network well, but we must step outside of the profession to really affect positive change. The most valuable asset pharmacists have is their knowledge. Share it widely and be sure to bring back great ideas from other professions to challenge pharmacy to think and practice more broadly.

How are women uniquely positioned to help the pharmacy profession evolve?

Theresa: The face of the profession is changing due to a much higher percent of women graduating from pharmacy school each year, and more and more men retiring from the baby boomer generation. Due to this change, women need to step up as the new leaders of pharmacy. We are seeing a growing trend in women owners as well. I believe that the women who are pursuing the role of ownership understand the need to be invested in their communities and create business environments that will impact health outcomes in their communities.

DeAnn: We think differently. We bring a fresh perspective to a sea of “sameness.” Studies show that women tend to challenge the status quo when included on corporate boards. We need more female leaders to step up and speak out. We need more role models for our girls, too.

Erin: As Theresa mentioned, pharmacy is unique in that the majority of professionals who have entered pharmacy since the 1980s are women. So, we have the numbers. Unfortunately, women are not the majority in senior leadership positions within pharmaceutical, biotech and healthcare companies. While we are starting to see more women lead organizations (in 2017, for the first time, we had a woman at the helm of a top 15 pharmaceutical company, and now there is a woman taking over Anthem), we must get more women at the top of organizations faster. When women are making most of the decisions in their households for healthcare, it only makes sense for women to run more healthcare organizations.

What advice would you give to up-and-coming pharmacy entrepreneurs?

Theresa: Spend a lot of time researching and networking as you plan for being an entrepreneur. I certainly am "bullish" on new pharmacy entrepreneurs being successful; however, you may find there are skills you need to obtain through additional education before you dive in.

Also, it is incredibly helpful to have a team of professional advisors (banker, lawyer, CPA, etc.) and a mentor group of other pharmacy owners to lean on for guidance and advice. Take advantage of resources offered by NCPA, Cardinal Health's Women in Pharmacy group, and others.

DeAnn: Life balance is a myth. You will never be the perfect wife, mother, business owner and pharmacy leader all at the same time. You prioritize. You go hard in a few areas for a while, then you re-prioritize. For me, during the early years, I worked hard in my pharmacy, developed a successful diabetes-self management program that touched thousands of local patients and started my family. The past few years have been focused on my national leadership duties with NCPA. Owning my own pharmacy has allowed me to be a better mom with more flexibility. It’s also helped me show my girls, by example, how to be a leader and that finding solutions to the problems in our world is a lot better use of your time than just complaining about them.

Erin: Stop waiting and start doing. Don't look for permission to start something as an entrepreneur - you'll be waiting for the rest of your life. You don't need permission! If you see something wrong, try and right it. And it doesn't matter who you collect a paycheck from; you can be an employee and think like an entrepreneur (it's called an intrapreneur).

If you see an opportunity, start doing something to seize it. Don't wait for your boss, a mentor, your significant other, or some external force in your life to tell you to go for it. You already have a permission slip from the universe!

To read more about how these women leaders are changing pharmacy, click here.