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Extra revenues we depend on are lost to large corporate pharmacy chains.
Until recently, the coming of the flu season was a boon to my practice's bottom line. Indeed, beginning in October, my waiting room would fill with patients who'd made appointments to be vaccinated against that season's strain.
Then, in 2004, the national vaccine shortage hit, and I administered decidedly fewer shots. This past October, the same thing happened-very few patients came in seeking flu shots. The problem wasn't a shortage of flu vaccine, but a move by local pharmacists, and the corporate entities that employ them, to administer flu shots themselves, thereby siphoning off extra revenues that primary care doctors like me have come to depend on.
Consider the actions of my local Tom Thumb Food & Pharmacy, a division of Safeway, headquartered in Pleasanton, CA. This pharmacy employs two pharmacists who've become qualified to administer injections, including but not limited to the influenza vaccine. In fact, within less than a month last fall, I understand, they'd administered more than 1,000 flu shots. If one assumes a $25 charge per immunization, that comes to a staggering $25,000 in extra revenue-revenue that would've otherwise gone into the pockets of the area's primary care doctors.
What can we do to remedy the situation? Certainly, we could recommend that our patients fill as many of their scripts as they can by mail order, thereby cutting into pharmacists' revenues in the same way they're cutting into ours. We could also ask patients not to patronize pharmacies that offer flu injections.
But these are piecemeal, perhaps even spiteful efforts, likely to have little real impact.
The better route, I think, is to work with our local, state, and national associations to call attention to the problem-and work to effect some change, legislative or otherwise. It's probably too late in the year at this point to do much about the upcoming flu season. But, at the least, we should make a concerted effort this October, November, and December to observe and record what's going on in our individual neighborhoods, forward what we learn to our societies and associations, and push for real change by next flu season.
Clearly, there are some pharmacists out there on our side. They believe that what their companies have asked them to do is hurting doctors, and they've decided to buck the corporate line.
One of these used to work at my local Tom Thumb branch. In my first year of solo practice, as I learned the ins and outs of managing a medical practice in his community, this kindly middle-aged man helped me immeasurably. Not only did he assist me in navigating the maze of managed care, but he also made sure that one prescription I might write for a patient didn't interact badly with another.
When the corporate mandate came down, he resisted cutting into the revenues of the local doctors on whom his business depended.
But in November, Tom Thumb replaced him with one of the two pharmacists who now administer flu and other shots.
I will miss my friend. And I will miss practicing medicine in his community if the corporate policy that he bucked isn't changed.
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