Professional services and total compensation: A model shift?

I was fortunate to attend and speak at the awesome OPA RxTalks conference recently and was on stage for a panel on pharmacist compensation—specifically revenue sharing of professional services. I shocked the crowd by sharing the revenue I generated from nondispensing, publicly- funded services. In 2023 I billed just north of $40k for my pharmacy in MedsCheck, Pharmaceutical Opinion & Minor Ailment services. Given my constant push for more more and more in the pharmacy space, I’m sure the audience expected something substantially greater. But it’s time we talk about the true value of these services and what that means on the ground for staff pharmacists.Publicly-funded professional services are not, at this time, an opportunity to “make money” so much as an opportunity to be paid for the care we ought to be providing. Take Diabetes MedsCheck for example. We can bill $75 for a fulsome discussion around blood glucose control, targets, vaccines, footcare, eye care, lab checks, device training and more. That amount does not cover the actual time it takes to perform the service as intended. And $19 for a minor ailment to assess conjunctivitis in the pharmacy— when we were already in the aisle begging patients not to use Visine—is payment for work being done.First, let’s address the obvious. Yes, these services are underfunded in the context of the value. Full stop. We can agree that publicly-funded services rarely meet the threshold of adequate funding, whether that’s dispensing fees, MedsChecks, minor ailments, flu shots, Covid shots… and don’t get me started on compounds. We (via our advocacy associations) continue to advocate for adequate funding for all that we do and for inflationary increases on the regular. We know these are necessary for the continued sustainability of the community pharmacy model.Since we know advocacy continues for funding increases and adequate funding, let’s talk about the current state of affairs. In a busy community pharmacy focused on professional services, it’s impossible to sustain even one pharmacist via professional service dollars alone. We use those professional dollars to pay for the staff on site to facilitate booking patients, the software for booking, the software for documentation, business overhead (lights, rent, etc.). As a result, that professional service interaction becomes a valuable service for the patient that is supported by adequate staff; but it’s not a money maker for the business.To be clear, I do not expect any minimum professional service dollar standards from my staff pharmacists. Having a dollar target is abhorrent and we all know that. That business model does not recognize what we do in the spirit of patient care; it subjugates the pharmacist to the will of the shareholder. Unacceptable. In the end, the community pharmacy is becoming a hub for all things health care, especially in the context of reduced access to family physicians. Sometimes we are the only option for patients outside of the emergency department. We should rise to the occasion and check labs, adjust meds and provide that full care that we were trained to provide, instead of chasing after revenue sharing (of the paltry revenue available). At the same conference, Dr. Kelly Grindrod taught us attendees how to negotiate a more complete total compensation package (I left the conference with a purse full of glowsticks thanks to a negotiating exercise during her talk). Total compensation will impact our workforce and our sustainability as a sector more than anything else. Employees who feel not just adequately compensated, but adequately supported, provide higher levels of care and consistently perform at that level. In the end, these same employees find additional opportunities to use funded services to provide care and it all becomes a (slightly lopsided) perpetuating circle.The point of this is to say that compensation alone is not what pharmacists are looking for. But in the current climate, it may be the only leverage they have. If we properly support our workforce, we can then properly support our patients. And as we diligently and compassionately provide care, we can shift the entire model towards compensation for that care and away from “dispensing” as the only funded portion of the interaction. And if we can do that, everyone wins.

Professional services and total compensation: A model shift?

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Blog Author

Kristen Watt

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