ABC News' show 20/20 on March 30 presented a report on chain pharmacies. Typically for television news, the report lacked depth, but the basic message came through clearly enough: at many high volume chain stores, prescriptions are actually filled by teen-age technicians, and the pharmacists are so rushed that they can't do their job properly. As a result, mistakes get through the system, sometimes with tragic results.
This doesn't mean that every chain store sacrifices professionalism for volume, and it doesn't mean that independent stores are inherently better. It's not even a problem limited to pharmacists or pharmacy -- it's just another symptom of a health care financing system that's busted beyond repair.
Health care professionals, at every level, make a high investment in education and have reasonable expectations of a decent income. According to Salary.com, the median salary for a registered nurse is about $60,000 per year, for a pharmacist about $100,000, and for a physician $144,000. Dentists do the best, with a median of over $150,000. Those are respectable incomes, but hardly unreasonable once you consider the personal investment in education
Part of the reason for going into one of these occupations is the money, the assurance of a steady job at a comfortable salary, but another part is the belief that being in the field of health is a chance to help people.
The problem is that in real life, health professionals are paid, not by patients, but by insurance companies, and insurance companies have their own agenda. Insurance companies are in business for their health, not yours. They need the money. According to Forbes magazine, William McGuire, of UnitedHealth Group, the nation's leading insurer, was the third highest-paid CEO in 2005, with a compensation of $124.8 million.
That money has to come from somewhere, and the obvious place is to pay MDs a little bit less. So, in order to make a living, physicians have to see more patients, and spend a little bit less time with each one. A modern medical practice moves with the precision of the Bolshoi Ballet. After all, your physician not only has to bring in enough money for her own salary, she has to generate the income to pay for a billing clerk and a coding clerk, people whose sole functions are to be sure that everything that's done is billed for according to insurance company specifications.
So, the physician is rushed, and writes a prescription a bit too hurriedly. A drug name may be scribbled, or a decimal point may be misplaced. Stuff happens.
It's the same story at the pharmacy. The payment from the insurance company not only has to cover the pharmacist's salary, but if it's a CVS store, has to pay a share of Thomas Ryan's $1,000,000 salary, $3,800,000 bonus, as well as the restricted stock awards and options. So, as ABC News reported, the technique is simple enough -- hire high school students to prepare the prescriptions, and then have a registered pharmacist do the checking.
There's nothing inherently wrong with this, until the pace of filling and checking gets too fast for a careful review, or until the repeated act of checking and initially gets stultifyingly dull, and the brain turns off. When the assembly line is going too quickly, errors slip through, and the system, which is increasingly based on low payments and high volume, is guaranteed to permit more errors.
There are answers. In the long run, the answer may be technology -- more and better computers, systems that don't get overloaded with work, or bored or distracted, and don't make decimal errors. But in the short run, we need to rethink how we're paying for health care. For years there have been proposals to use bar code technology on drugs, and with some modifications to the system, this could go a long way to improving safety -- bar codes are used now, but only to the extent of monitoring inventory and improving profits.
But the first step is to decide that health care is a basic right not a privilege, and not a commodity to marketed. We're paying for the best health care in the world. We're entitled to ask why we're not getting it.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
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