Countdown Towards Retirement Around the Corner

Are you planning on retiring soon? I still remember a pharmacist I worked with who was ready to retire within a few months, and he had a countdown on his computer that counted down the days, minutes, seconds to retirement.  Are you doing that too? 🙂

Aside from getting excited, there are things (aside from your new retired life and evaluating your benefits) to start thinking about before the transition.

Here are 3 simple effective tips for making a smooth transition for the pharmacy you’re leaving behind:

1. Pass On Your Insider Secrets –

Start thinking about what items will need your specific training on to pass the ball after you retire. Sure, there are policies and procedures in place for the basic needs of the pharmacy or office, but what about those pharmacy-specific tidbits that you have picked up over the years?

Your next steps:

As you go about your regular work for a couple weeks, write down a list of things that would be good for your next-in-line to know about after you retire. Think about things like who the best contact person is for various common (or tough) issues that arise, who to call when you are short-staffed, or any other time-saving tips that you learned on your own.  Save your successor from having to discover it the hard way through trial and error like you did. They will thank you for it!

2. Introducing Your Heir –

There are a lot of people who are in contact with you on a regular basis and who count on you in their jobs. Instead of just sending out a mass announcement about your last date, take the time to give a personal call to all your important contacts.

It doesn’t have to take a lot of time.  You can even combine it into a call that you’ll be making to them anyway. When you talk to them, share:

  1. Who your replacement will be, how to reach them, and when the change takes place.
  2. Give them a chance to ask questions so they feel at ease about the transition.
  3. Send a general FYI email that reiterates what you covered on the phone, so they have that for reference.

Finally, send a quick reminder email during your last week to everyone involved. It will jog everyone’s memory about your last day, so they remember to switch gears.

3. Start Thinking About Your Post-Retirement Plans –

For the first few months after your official retirement, you will most likelywant to rest, relax, and enjoy your new-found free time.  Many times, retired pharmacy directors want to stay connected to the pharmacy and keep their skills in practice. A good flexible option for this is working as an IHS/Tribal Contract Pharmacist, so you can have both.

Did you know that 50% of our current contract pharmacists at RPh Temp Service are retired pharmacy directors? Doing travel assignments gives you the freedom to choose when and where you want to work.

Want to work just a few months out of the year? Or maybe you’d rather work a few weeks here and there over the course of the year. Contracting lets you stay in the pharmacy on your terms.

Start shopping around for an agency early. That way you know your options.  When you qualify to work for an agency that is well-connected, you’ll be kept in the loop for assignments that will be perfect for you. That way, when the right one arises, you can take it at a moment’s notice with no hassles.

An Overlooked Way for IHS/Tribal Pharmacies to Get Paid for MTM

As an IHS/tribal pharmacy, are you looking for ways to do more medication therapy management (MTM) AND create new revenue to support these clinical services?

If you have Medicaid patients coming to your pharmacy, this is something you can look at taking advantage of if your pharmacy isn’t already doing this. For a number of years, IHS has signed an agreement with CMS.  This agreement says that when there are clients (patients) who need to be seen through state Medicaid programs and are seen at tribal or federal clinics, instead of going through complicated billing procedures, the following can happen:  if a person who’s Medicaid eligible comes to the tribal facility, CMS would pay the clinic/hospital to cover the cost of that visit on a fixed rate.

What this can mean for the pharmacy: Pharmacy can get reimbursed around $300 (fixed rate) per medication therapy management visit.

How:  If a patient comes in on a Mon & sees a healthcare provider (ie, primary care provider) named under the CMS contract, the primary care provider can bill a flat fee for that visit as per the contract (ie, around $300).  If the primary care provider refers the patient to a pharmacist who can see the patient for medication therapy management (or other clinical encounter, ie: smoking cessation, etc) on a different day (ie, Wednesday), the pharmacist clinical visit can also be billed to CMS for that same flat fee (ie, $300).

NOTE:  In some states, pharmacists are noted as a direct provider on the CMS/IHS contract. Pharmacist may see patients for MTM services without a referral.  

In other states, pharmacists are not noted as a direct provider under the contract. If pharmacists are not specifically excluded from the contract, pharmacies may interpret the federal register.  Pharmacists can consider acting as an agent of the physician.  Pharmacist is referred a patient by a medical provider, provides the care & submits a report in EHR for example, noting to the referring physician the SOAP note & outcomes of visit, and include the referring physician as the provider of record for CMS.

What it is: This is a scheduled visit from a referral from a primary care physician (or direct appointment pharmacist books with patient) where a pharmacist offers medication therapy management for a patient.

What it is not: This is not just a visit for dispensing prescriptions.  Also, the visit must be medically justified.

What can be possible: Pharmacy can actually spend time with patients and offer more clinical intervention.  This can contribute to saving overall healthcare costs. The pharmacy can get reimbursed for providing these MTM services. Pharmacy can also justify hiring additional people to take care of people who are chronically ill.  Especially in areas where pharmacy services are not currently being offered to the tribe, this can be an opportunity to make MTM services available to your tribal or eligible members. Offering medication dispensing services is not required.

In the lower 48 states, the reimbursement is over $300.  In AK, it’s over $400.
Just 3 MTM visits in a day can cover pharmacist salary plus much more.

Where to look into this more: The contract is in the federal register which you can find online here.  It gives general guidelines & itemizes lower 48 & AK contract rates.

From an interview with Don Downing. Don Downing, RPh helped start up the nation’s first self-determination tribal clinic. He has 38 years of experience in tribal healthcare work and continues to work with a number of tribes to implement clinical pharmacy services.  He is a professor at the University of Washington School of Pharmacy.

Turning Around Negative Attitudes in the Pharmacy

You walk into work & see your staff doing their job. But if you were to observe closely, whether it’s working on the line with them or listening in to their conversations, you might start to notice negative attitudes.

Sometimes it comes across as complaining. Sometimes it comes across as a complaint through a joke. However insignificant a negative comment may seem, negative attitudes can breed more negativity. It can start off with one person, and then that person gets the buy-in of another person. And pretty soon your staff has an underlying current of negativity even though they may appear to be doing their job and getting along.

An abundance of negative energy or attitudes can evolve without a specific triggering reason. Other times, it can be linked to stressful work conditions (such as workload increases, or a focus on reasons why things can’t be done and what seems like a lack of hope that things will get better).

There’s a pharmacy I know of that lost a lot of staff in a short period of time. Assessments were done about the existing situation, and recommendations were made by the staff. Months later, the staff were complaining of not seeing much change. The new hires were starting to get “jaded” too.

What can you do about negative attitudes in situations like these? If negative attitudes come from frustration that’s related to lack of hope that things will get better, check in consistently about how people are feeling about the change as the change is implemented. Speak to people individually & as a group, re-assess, implement the decided plan, and check in.

Another way to diffuse negativity is to inspire by how you handle situations. Sometimes as leaders, we may not notice that even saying a side negative comment about how we don’t like how some event happened or point out something that someone did in a negative light (even if it’s not related to your staff or patients), can indirectly give your staff an example that it’s ok to be complaining.

Negative attitudes can permeate staff and even affect the employees that have positive outlooks. It can also affect new hires. New hires can pick up on it, and a culture of “we have no power to change the situation” can start happening.

Acknowledge the negativity. Acknowledge that someone feels upset or dissatisfied about something. Then ask for a solution. Ask what specifically their suggestion is for it. If you feel it’s not a viable solution, share your feelings, and ask for other solutions. This way the person doesn’t feel like you just don’t like their solutions. Of course, if nothing resonates, be honest that you appreciated them putting the thought into the solution, and that although it wouldn’t be used, you invite them to continue making suggestions.

Understandably, it’s not possible to please everyone on your staff…but do what you can to inspire true open communication and hearing them.

“The Pharmacist Caught in the Office” Cartoon

Do you often wish your pharmacy staff or direct report(s) would perform better? Wish you had the skills to manage them better?
The Pharmacist Caught in the Office by Chen Yen on GoAnimate

Find yourself feeling this way about your contract pharmacists? What if this didn’t have to happen to you so much? Click here for your options.

Sometimes less is more. So for this article, I’d like to leave you with a few powerful quotes about effective management to contemplate. Pick your favorite one to work on today:

“Leadership is a reciprocal process. In order for people to follow you, they must trust and believe in you. And in order for people to trust and believe in you, you must first trust and believe in them.” (Not just saying the words “I believe in you”, but the feeling of really believing in them)

The only way to systematically improve individual performance is to consistently give constructive coaching and developmental feedback.”

“Coaching is not merely something that you, as a manager, must do. A Coach is someone that you, as a leader, must become.”

To get your team to become coachable, you must first become coachable. To get your team to open up, you must first open up. To get your team to embrace developmental feedback, you must first embrace developmental feedback. As a coach, you set the standard for your team to follow. And your personal example is the most powerful leadership tool you have.”

Great coaches consistently get the most out of their people because they consistently put the most into their people.”

Don’t think a weekly coaching conversation is possible in the pharmacy? Think again. Read the book and decide for yourself. It’s a short read:

How often do you feel like this in the pharmacy? Comment below on your challenges and solutions to this problem. Share what you’ve found to be most helpful with motivating your pharmacy staff to their best performance.

Pharmacy Directors: A New Way to Interview

Do you ever get tired of asking the same interview questions and wish they were more insightful? Often when interviewing a new candidate the same type of answers are given over and over again: “I’m a good team player,” “I work hard,” etc. Sound familiar? Do you often think to yourself, “I’ve heard all this before.” It can be difficult getting people to truthfully talk about their weaknesses. What if you could find out things that were more revealing about who you are considering?

A friend of mine who runs a successful business kept telling me I need to check out the book, “Who.” At first I thought to myself, “I’ve heard lots of other interview questions before, so what could be so helpful about these?” After checking out the book I was pleasantly surprised and am now using some of these interview questions myself when interviewing people.

Here are a couple of the interview questions adapted from the book for you to get started with:

1. During the actual interview, ask this multi-part question, “What are the names of the last three people who supervised you?
When I call them, what are they going to say about your performance?
How would they rate it on a scale of 1-10 with 10 being the highest?
What would cause them to give you that rating?
What would they say about the areas you needed improvement in back then?”

These questions put them on the spot and get them answering from the perspective of honesty because it tells them that you are going to be contacting them and that their answers will be verified.

2. Later, when you talk to the actual references, ask questions like, “What were the person’s biggest areas of improvement back then?” Framing the question that way takes the guard down and encourages the person to open up about things they probably would be more hesitant to answer.

Another question to ask would be, “XXXX mentioned they struggled with XXXX during their time there. What can you tell me about that?”

I encourage you to read the rest of this book. You’ll get other great tips and interview questions to ask for getting more honest answers from your candidates and their references.

Comment below on what you think about these interview/reference questions. Share the most effective interview question that you ask below.

How Will the Healthcare Reform (Affordable Care Act) Affect Pharmacists?

Ever since early discussions of how a healthcare reform could affect pharmacists, the overall predictions were that it would be favorable for pharmacy practice. This is because pharmacists are considered valuable in a healthcare model that values cost-savings.  For example, the American Pharmacists Association, National Community Pharmacists Association, and the National Association of Chain Drug Stores are working on encouraging payment structures that allow pharmacists to receive provider status.  Pharmacists would receive reimbursement for MTM and alternative patient care models such as medical homes.

Although that sounds good, there is a problem. Currently the pharmacy practice acts in the 50 states are not all in line with making expanded reimbursable pharmacy services possible.  What is allowed under collaborative practice agreements differ in each state.  Collaborative practice agreements allow pharmacists to work collaboratively with a physician through a defined protocol and provide patient assessments; choose appropriate medication, order related lab tests; administer drugs; start, continue, and stop medications.

According to an article by Krstalyn Weaver, PharmD written for APhA, as of earlier this year, 33 states plus the District of Columbia allow for pharmacists to initiate drug therapy; many allow for discontinuation; and nearly all allow for modification of drug therapy.  In 8 states, collaborative practice agreements are restricted to certain practice sites only—and they all exclude community pharmacies.  31 states allow for pharmacists to order and interpret laboratory tests.

Some laws place extra requirements on which pharmacists are authorized to enter into a collaborative practice agreement. This varies.  For example, in California, a clinical residency is required, whereas in Arkansas, a PharmD is considered a minimum requirement.

What can we do as pharmacists so that we can actually take advantage of being reimbursed for our services? One thing you can do is join your state’s pharmacy association.  With proper funding, voice, and lobbying, there can be more favorable laws for pharmacists that allow us to appropriately get reimbursed for our clinical services.  Encouraging collaborative practice  agreements in our states that support our pharmacy practice is one aspect.  Don’t underestimate your power–each pharmacist’s membership and voice counts.

No matter what practice setting you’re in (whether you own a pharmacy or work for the federal government), giving our profession a voice can contribute to our own job security.  As a pharmacist to another pharmacist, join your state’s association now.

What do you think about all this?  Comment below on how you think the healthcare reform will affect your practice.

Never Say Never

Never say never.  I still remember when I looked at the pharmacy director in the eye & said “I will never work for the IHS.”

Those were the days when my commute was walking down the hill to the Whiteriver hospital from the government trailers just 2 minutes away. The thing I looked forward to the most was walking back up the hill at the end of the day.  I had just finished an FDA rotation and couldn’t imagine myself working anywhere else.
I couldn’t wait to start my job there.  I wanted to work there after I graduated from pharmacy school, and they were excited about hiring me.  I was ready to just be finished & moved to D.C., but I had to go to Whiteriver first for another rotation.  Prior to being in D.C., I had just started to fall in love with having adventures and traveling while studying at Oxford University, and could not imagine living in the middle of nowhere where people thought I was a foreign exchange student  (On a softball field after a day at the Whiteriver hospital, I was asked if I was a foreign exchange student).

Whiteriver Indian Hospital: My first IHS home…would it be my last?

And then there was the pharmacy director at Whiteriver. He used to grill me.  I thought about how much I didn’t know, and that I really didn’t want to be working in a pharmacy anyway.  As much as I liked working with the patients at Whiteriver, talking on the phone all day long at the FDA Drug Information Branch was a much better fit for me.  At least I’d be able to look things up when people had questions.  I remember saying adamantly to the pharmacy director at Whiteriver, “I will never work for the IHS…I’m going to work for the FDA.”

He said to me, “Never say never” and I rolled my eyes to myself.

But my path took an unexpected turn when I was offered to cover an Indian Health Service travel assignment the summer before starting at the FDA. I thought what a great opportunity that was.  I could go have an adventure at a less remote IHS site and make money to travel in Europe.

Ok, I admit it.  It grew on me.  I ended up liking it. And I unexpectedly ended up meeting my now husband in Europe after that IHS travel assignment, and the rest is something I wish I didn’t have to admit to the pharmacy director at Whiteriver–he was right.  Never say never.  I ended up working at IHS/tribal sites instead of working for the FDA, because it allowed me the flexibility of doing my external PharmD and travel to see my now husband who was living in Europe at the time.

After contracting at IHS sites for a few years, I decided to start & grow RPh Temp Service because I noticed pharmacy directors would complain about being sent just a “warm body” by temp agencies. I wanted to raise the bar of of contract pharmacists available to the IHS, so pharmacy directors didn’t have to settle for warm bodies.

I wanted the pharmacy directors to feel as if their temp staff seemed like part of their permanent staff— pharmacists who would jump in wherever needed, knew what they were doing, had strong work ethic, and who appreciated Native American culture.

RPh Temp Service started out by connecting recently retired IHS pharmacists (and people who made IHS contracting a career) with IHS travel assignments. It evolved to include pharmacists with IHS experience who were in-between job situations, including those who recently finished residencies.  It gave them the opportunity to travel and have time off when they wanted to, while they figured out their next career move.

It’s been very rewarding to offer IHS-experienced pharmacists access to assignments they aren’t able to access through other agencies.

Now, are you ready to hear the kicker to the “Never say never”? Now the previous pharmacy director at Whiteriver where I did my rotation works with our company.  Who would have thought?

3 Simple Ways to Combat the Long Pharmacy Wait Times

What do you do in your pharmacy to keep the wait time down?

While working at different IHS pharmacies, I’ve noticed a range of wait times and patience levels of patients.

I’ve worked at IHS/tribal pharmacies where the provider would instruct the patient to go to the pharmacy and their medications would be ready. Then the patient shows up and is disappointed that the wait time quoted by pharmacy staff is significantly longer.  I’ve also worked at sites where patients have a lot of patience –they’re used to waiting a long time for their prescriptions.  The pharmacists do their best to fill the prescriptions as soon as possible, and patients seem very understanding.

What can you do when you can’t help the long wait time because of staffing constraints? Increase patient satisfaction in one of these 3 simple ways:

1. One way is give assurance that the pharmacy is working on their Rxs as quickly as possible. Instead of just having your staff tell people that the wait can be 1 hr long, for example, let them know “we are working on your prescriptions as quickly as we can.  Although there is a bit of a line right now, when we receive it, we’ll start working on it right away.”

2. Something else your staff can do is let people know how the process works & invite them to come back later. For example, “the way it works is that the Dr. enters the prescription in after seeing you, then as soon as pharmacy receives the Rx, we process it.  It may take 15 min after your visit before we receive the prescription to start working on it.  Feel free to eat lunch & come back to pick up your Rxs.”
3. A 3rd way to improve patient satisfaction is to help patients understand why it takes time to fill their prescriptions appropriately. It’s amazing how much we take for granted that we think people know what pharmacists do.  Just try asking your next few patients whether they know what pharmacy does, and chances are that they will tell you we count pills.

One thing you can do is hand out a sheet of paper answering FAQs about the pharmacy & expectations while patients are either waiting to see their physicians or waiting to receive their prescriptions.

What is one thing you will start implementing to improve patient satisfaction and decrease wait time for patients? Comment below and commit to the postive change.

3 Simple Ways to Prevent High Pharmacist Turnover at Your IHS Facility

An Indian Health Service site called us recently & requested an experienced IHS contract pharmacist because their permanent pharmacist left unexpectedly. They’ve had trouble keeping the last 2 pharmacists they’ve hired. Each time they went to look for a pharmacist, they were in a crunch. Have you been in that place before, when you had to hire someone because you had a need, and then your new hire didn’t end up staying for long?

What can you do to prevent hires from not working out?

Here are a few things to keep in mind:

1. The best time to look for a new hire is when you don’t need one. That way, you can be making connections without that sense of urgency clouding your judgment. Network with pharmacists you meet at different conferences & trainings –ones that you feel could be a great addition to your team . Talk to them proactively about the possibility of working at your IHS/tribal facility (whether now, or down the road).

2. Ask interview questions that are a little off-beat and give you more insight about what drives your potential pharmacist hire. I went to my first interview last week since I was in pharmacy school (was asked to be a Board member of an organization), and was amazed that I guessed each question they asked me ahead of time. None of the questions offered any element of surprise to test me to answer in a non-prepared, spontaneous way (of course, I do have an unfair advantage from knowing what hiring managers typically ask, compared to other candidates). An example of an off-beat question is “What gets you excited about going to work every day?” or “What do you like to do as a pharmacist where you feel like you are really using your skills & interests?” (well, the latter one may not be as off-beat, but you get the picture…something different than the typical “why do you think you’re good for this position?”)

Aside from a couple of off-beat questions, ask questions that give you more than typical insight about your candidate. Want access to the top 10 pharmacist interview questions to ask, so you can prevent hires who don’t last? Click here now to get instant access to our insider’s interview cheat sheet:

3. Depending on your own goals of how long you want people to stay working at your pharmacy & what roles you need someone for, evaluate them with your needs in mind.

Sometimes you may want someone to work at your pharmacy more than they actually want to. Find out why they are applying—is there a good reason why they are interested in your facility?

Take the person’s own career path into consideration. Are they at a point in their career where this role you’re hiring for fits in well, or do things not really match up? One thing I see is pharmacy directors hiring a pharmacist based on fit and overlooking past behavior, and then being disappointed by their hire leaving within a short time frame.

One example of this is when a candidate seems to be a great fit, but tends to move every few years. If you’re looking for someone to grow longer-term than that with your pharmacy, then put your antennas out for how past behaviors don’t really match up with your needs.

While you’re hiring, if you want access to IHS-experienced temp pharmacists so that your pharmacy doesn’t feel the burden of being short-staffed, click here for your options.

Pharmacy Plans Not Coming True?

Can you believe January is almost over? Do you ever make resolutions & forget them by the 3rd week? There’s nothing more frustrating than making the same resolutions over & over again, and not seeing them come true.

Tired of making plans for your pharmacy or department that don’t come true?

Here are the first 3 steps that most pharmacy directors or leaders overlook when creating a plan for the year. Doing these 3 steps BEFORE planning for action steps will juice up your vision & allow it to come true more naturally this year. It will not only inspire you, but your pharmacy staff also.

Download the simple worksheet here.

Write on one sheet the following:

1. Why you are doing what you are doing
Example: “I am a ________________ (ie, pharmacy director/contract specialist) because ____________(your “why”)
(I am a pharmacy manager because I want to run a pharmacy where patients are well-cared for & can count on us for getting the best mediation options they can get)

2. Your vision for your pharmacy/department by the end of the year.
Example: “We are helping # patients/mo by helping them quit smoking & breathe easier.”

3. Write down the things that worked well & didn’t work well last year. This is a great opportunity for you to reflect on all the things that went well & acknowledge yourself (and others) for. Then write down what you choose to maximize or minimize doing.

Maximize things that worked well, or contributed to your team getting along well with each other. Minimize things that didn’t support your vision. It can include habits like procrastinating, not keeping your word (however small), coming in late, or complaining. It’s small leaks in every individual (including yourself) that contribute to a bigger problem of things not working well in your pharmacy. You set an important example for your pharmacy with your actions, whether you realize the extent of it or not.

This 3-step process is very effective to write down, before you break your vision down into next action steps.

Fill out the worksheet this for yourself and ask your staff to do it also.

**Now don’t miss this final step (ok, so it’s actually 4 steps 🙂 ): Post this up on your wall. This is the key between you having trouble with reaching your vision, vs. it coming true faster.

Enter your name and email below to get instant access to the worksheet download: