Leaving Pharmacy a Better Place

As Lucinda Maine prepares to retire after 20 years as AACP’s executive vice president and CEO, she considers the challenges and opportunities on the horizon for the pharmacy profession. Read part one of this article, which appeared in Issue 2 of Academic Pharmacy Now.

When you think about the current healthcare environment, what are some of the challenges you see for the profession?

Pharmacists were finding it hard to be excited about their careers before the pandemic. They’ve always been the most accessible healthcare destination, but when doctors’ offices closed and ERs were overloaded with Covid patients early in the pandemic, pharmacists figured out how to be there and be the healthcare provider in their community. And there was a sense of purpose and ‘We can do this,’ even though they didn’t get labeled healthcare heroes the same way that ICU and ER personnel did right away. Of course, when the vaccine came out and the federal pharmacy program emboldened pharmacists, the PREP Act Declaration really put pharmacists right out there, front and center. I think that they felt really good but now it’s gone on too long, and they didn’t get the help that they needed from management in terms of adequate numbers of personnel and PPP, they just had these expectations loaded on top of everything else they were already doing and didn’t get sufficiently reimbursed to do. The profession’s financial model has been broken and is now so severely broken that pharmacists, like other healthcare providers, are just done. And it’s heartbreaking, but it all comes down to the fact that we have not ever been paid for the care that we provide, and we are now abysmally reimbursed for the drugs that we make sure get to the right people in the right dose, safely.

A segment for PBS NewsHour had cameos of about a half a dozen pharmacists expressing their concerns because the situation has them afraid that they can’t keep their patients safe. It’s heartwarming but heartbreaking at same time. It really gives you a window into the heart and soul of pharmacists that very few other pieces I’ve ever read or seen adequately capture. The biggest challenges in the profession today stem from the financial models in which we practice. It is not that the profession has ignored that; we have not and we are making progress. It’s going to be easier to make this progress when we shift more from fee for service into value, because many of those entities that are operating for value know that they can’t achieve their objectives unless they have integrated pharmacists into their practices. That is just so magnificent to see. That’s what the AACP Transformation Center is all about: let’s agitate to move that faster, forward in the right direction. And then let’s make sure we have the academic innovation to prepare the current students to practice at the top of their license in that value-based care context. Let’s make sure that we have services to upscale the existing workforce so that no pharmacists are left behind.

Speaking of the Transformation Center, what transformations do you see happening in pharmacy education?

When people question whether the Pharm.D. program is of adequate quality, former ACPE Executive Director Pete Vlasses would always say that the graduates of our programs today outshine anybody who has come before them. We’re doing a good job of educating our graduates, we are just not consistently equipping them to get out and change practice. Now that might be an unrealistic expectation because many of them have gone out and ultimately changed practice, but too many of them get stuck in a rut and don’t think they can change practice, and that’s a tragedy. The magic of the Transformation Center is going to rest in, first of all, the passion for the possible, and then we are going to create synergies through alliances and coalitions. This is not something that AACP can do alone. One of my philosophies honed from 30 years of association management is that no important endeavor that has happened in the profession has happened with one organization’s wherewithal. It requires collaboration and the Transformation Center is all about collaboration with some of our existing partners and with partners we have not found yet.

A great example: I’ve gotten to know Susan Dentzer quite well, she was with PBS NewsHour early in her career, she’s ultimately a journalist but she has studied healthcare so much, she’s become a health policy expert. She recently became the president and CEO of America’s Physician Groups. What distinguishes this group, according to Susan, is that the members have all bought into value-based contracting, and I expect to learn that the vast majority of them have already drunk the Kool-Aid for clinical pharmacy integration into their practice. If not, we’re going to give them some Kool-Aid and use that as a new collaboration opportunity for the Transformation Center.

Where do you see the greatest opportunities for pharmacists today and in the future?

I see opportunities in making comprehensive medication management services ubiquitously available to people who need them the most. That can be done in every setting the profession is a part of, including telehealth. There are great examples of that already going on, but we are about to launch a project I am so excited about called the Pharmacy Opportunities Network (PharmON). This project is a collaboration between APhA and the American Foundation for Pharmaceutical Education (AFPE). It was actually Ellen Woods’ idea. She said, ‘I have over 700 people in my LinkedIn network who are all connected to AFPE in some way, brilliant people working in all different kinds of companies, including education, and these companies could host internships, fellowships and APPEs. We started talking about it several years ago. We thought we had to hire a software developer to develop the platform until one day last year, I said, ‘We have one. We already have the AACP career center,’ By 2023 we’re going to be cooking. That is going to let student pharmacists, residents, fellows and even practicing pharmacists appreciate the vast number of opportunities out there in the profession. Pharmacists in their foxholes can’t see it, so we’ve got to give them the visuals. PharmON is going to do just that. It’s also going to show these hosts, the people who are going to pay people to come and intern with them, how amazingly talented today’s student pharmacists are, and that’s going to create new opportunities.

With those possibilities in mind, what advice would you give to a young person who might be considering pharmacy?

First of all, I’d say, don’t pass go, just do it, and here’s the reason why. Everything that I’ve seen change in my 50 years since I entered pharmacy as a pre-pharmacy student—the things that have progressively, albeit too slowly for my taste, changed this profession that I adore—are going to come to fruition sooner rather than later as the world begins to understand that medication use is complicated and it can be dangerous. You’ve seen that statistic that $528 billion a year is cost incurred unnecessarily because medication is not managed optimally, and the only people who know enough about medications to do something about that are the people we graduate. The opportunities are just going to become manifold and some of them will continue to be platformed on the most accessible healthcare destination, which is of course community pharmacy, but even that’s going to change. I just hope it happens fast enough that we don’t lose so many people in the profession. In 2019, incoming AACP President Todd Sorensen stated the bold aim that by 2025 the majority of primary care clinicians are going to have a formal relationship with a pharmacist focused on medication management. I said that was going to create the next national shortage of pharmacists. Well, Covid is doing that, unfortunately, but we will be able to tell the story again that there is a future in pharmacy. It breaks my heart to hear students tell me that pharmacists are discouraging them from coming into profession. That’s just so wrong-headed. It’s an epidemic of egregious proportions, and everything we’re doing to try and fix the pipeline is for naught because of one or more pharmacists telling a prospective student not to study pharmacy.

How do you counter that? If you could speak with that one potential pharmacist, what would you say?

I would share with them the stories of the pharmacists who are doing important work and are incredibly fulfilled. I would tell them in their first year of pharmacy school, if not before, to come to an APhA meeting and meet the passion-filled pharmacists who are making good things happen in their practice for their patients and for the profession. As I often say, I use a Safeway pharmacy and it’s quite close to the milk at the back of store. I know that if I ask my sons, who are now in their 20s, to go pick up some milk and they walk by that pharmacy and see that pharmacist kind of scowling at the computer, it would be the last thing they would want to do, but I actually happen to know those pharmacists care profoundly about me and my needs. It’s more than what meets the eye. That’s why the stories that we tell in Academic Pharmacy Now are so important, because we’re telling the stories of the people who are making a difference. I believe in the power of storytelling to attract more pharmacists.

What would you say to a student who is interested in the health professions but not considering pharmacy?

I would tell them no matter what branch of care they elect to go into, they just need to make sure that there’s a pharmacist nearby. I’ve done a lot of work in interprofessional education and sometimes I’ll be asked, ‘why does it seem like the pharmacists and pharmacy faculty are so often the leaders of IPE and their university’s program?’ and I smile and say, ‘Oh, that’s really simple. We know that medication use is a team sport.’ All we want others to understand is that there has to be a pharmacist on that team to make it work.

What are your plans for the future?

I didn’t coin this term but I have adopted it and use it liberally: I am transitioning to my preferment era. That’s different from retirement, but there are a whole bunch of transitions afoot. People who have retired before me have said to be careful about accepting too much before you retire. I’m not done with pharmacy yet, I just don’t have to do it full time. I took August of 2018 off and it was the first time I’ve ever had four weeks off. I was really able to unplug. I did a lot of driving during that time and I began the process of musing, ‘If you’re not doing what you’re doing now, what would you be doing?’ This was obviously two years before the tragedy of George Floyd’s death, but the way I answered that was, wherever I’m living I am going to spend more of my time addressing unmet social justice issues. I’ve got some writing projects that I want to do that will be pharmacy related, but largely I think I am going to volunteer locally in some capacity that’s yet to be defined. I hope not to be one of those people who says, ‘I’m so busy in my retirement, I don’t know how I ever had time to work,’ because I’ve worked at that pace for 50 years, and there are roses to smell, so I’m just going to create my preferment and really live a good after-full-time life.

I know that this is the right time for me. And knowing that Lee Vermeulen will be my successor, this is the right time for AACP. Lee has characteristics honed by his strategic leadership positions in academic health centers, he is an optimizer, he is more adept at business planning than I am, and AACP really needs that right now. Talk about the right person with the right skillset at the right time. That’s the other thing that leaves me completely at peace, that turning this over to him is the very best thing for AACP and for pharmacy right now. To my AACP family, I love you. You are the best.

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.