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Malcolm E. Brown is a pharmacist and sociologist
from Beccles, Suffolk
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Nationwide, the portion of independently owned pharmacies has declined.
In 1977, in my district in East Anglia, of about 40 pharmacies, roughly
85 per cent were independently owned. Now only approximately 15 per cent
remain independent.
Mega business has purchased the little people; few profitable smaller
pharmacies remain for purchase by a new generation of independently minded
pharmacists wanting to gain the prestige of being their own bosses. That
mirrors the fencing off of “the commons” in the 18th century.
Poorer people could no longer fatten their cows and geese there.
In order to eat, pharmacists sell their knowledge, skills and caring
attitude. Increasingly, they must do so as employees of others, but being
an employer or a self-employed person remains possible. Each offers a
certain type of freedom.
Pros and cons of being an employee
First, consider being an employee. Advantages include those identified
by the sociologist Weber (1864–1920). His (bureaucratic) organisation
has rules, limits of authority and documentation so employees know
where they are. Today’s employees benefit from leisure, study
and sick leave and paid pension contributions. Potentially, systems
are splendid, colleagues are interesting and managers are inspirational.
Employees’ appraisals for performance and training with their
boss spoonfeeds some of their mandatory continuing professional development.
The salary is substantial. He or she might progress to become a big
cheese with collossal perquisites. Personal financial risk generally
remains low.
Disadvantages include the risk of catastrophic change imposed from
outside: witness regrading, restructuring, redundancy and takeovers — or
just being fired. Moreover, although individual managers may demonstrate
genuine concern, that of the organisation may be perceived as but a gloss.
The impression of caring is just another managerial strategy: the organisation
may care nothing about its employees. Its motives are utilitarian: an
employee is a resource that must generate maximum profit at minimum cost.
Organisations inflict humiliating practices, such as staff searches,
that reduce pharmacists’ status.
Machiavelli (1469–1527) argued that the successful mountaineers
of organisational pyramids were flatterers, negotiators, covert aggressors
and masters of the black arts. Occasionally, conflict becomes more public;
a recent illustration is the tiff between pharmacists and pharmacy technicians
through letters published in this journal.
Basically, there is always a certain awkwardness about working for another.
Such work, by definition, lowers one’s status. One strategy to
raise it is to become self-sufficient: work one’s own land, however
humble. Then, one would be beholden to no person. Pros and cons of self-employment
So consider, secondly, self-employment. Many pharmacists remain self-employed
as locums. They represent about a quarter of all pharmacists and 38
per cent of community pharmacists.
Self-employment has disadvantages. Those who are self-employed always
look over a precipice. If no one wants them, they will “starve”.
They must look after their clients and endeavour to give cost-effective
service to be invited back. They are the marginal men and women. They
may miss out on staff discounts. Days may be long and income low: £20
an hour compares unfavourably with about £100 an hour for an accountant
and they will probably need to hire one to help them avoid paying tax.
They must fix their own crashed computer and everything else.
But advantages exist. Self-employed people are quick to react to new
opportunities. They skip the spin of team briefings. They are insulated
from pressure to work when they have important family commitments, such
as Christmas. They may choose never to return to sweat-shop dispensing
factories where they are expected to labour furiously during their lunch
break. They are privileged to hear the gossip about employers from employees
who feel downtrodden; employees know that the self-employed person, an “outsider”,
will respect confidences.
The self-employed may possess an unusual, marketable attribute. Then
they can go upmarket and sell their skills in a consultancy at enhanced
fees. They could mix and match methods of earning. For example, last
month I practised as a community locum, certified ectoparasiticides for
goats, rabbits and sheep and medical gases for humans, and wrote.
Purchasing their own pharmacy remains possible. Commercial success may
require long, hard hours, stamina, entrepreneurial flair — and
luck. There are risks. But to some personalities, life without risk is
a flabby thing like a glycerin suppository formulated with insufficient
gelatin. If pharmacists do not take some risks, such as developing “new” roles,
arguably nurses may eat their lunch and doctors their dinner.
Imagine that you are the locum-in-charge during the last day of the last
independent, community pharmacy in Great Britain. The last proprietor
pharmacist has sold out to Wal-Mart because it offered most money.
It is a lovely pharmacy. You have worked there for years. It smells of
peppermint and beeswax, as pharmacies used to smell. You feel at home.
The pharmacy technicians are diligent, skilful and friendly. The manner
of the closing has gutted them. The proprietor was forbidden in the contract
to discuss the closure; staff have been sold with the fixtures, fittings
and medicine stocks.
Medicine stocks are being transferred box by box into the superstore.
Ever and again the empty boxes return and are filled from shelves.
“Look at that,” says a pharmacy technician pointing with
a trembling finger. Contempt, tears and laughter mingle in her voice.
Rolling around in the returned box is a potato. The grocers are losing
no time in marking their new land. So the last independent pharmacy died
and you witnessed the whimper. Do you care?
Germans have words for the soulful, fugitive feeling for old stones:
the words Ruinenempfindsamkeit, Ruinensehnsucht, and Ruinenlust describe
a visit to see overgrown mounds within a once proud city.1
From history into legend?
Maybe it is too late. Maybe we are in love with the independent pharmacy
that was but can be no more.
Many pharmacists, I suspect, secretly dream of being sole proprietors.
A few of those aristocrats among independents do remain and the knowledge
of their romantic presence fortifies all pharmacists. But the sole
proprietors are struggling and may slip into nostalgic history and
eventually into
legend.
Pharmacists who care about such changes may be able to do something.
They can practise for themselves if their personality fits; they do
not want to become the proverbial square peg in a round hole. Initially
I
worked for others. Later I worked for myself and I still do. The latter,
is, for me, better.
If other pharmacists join me it will make little difference to the
freedom and status position of pharmacists as a group. However, if
thousands
of our colleagues also go independent, maybe, just maybe, we could
change our future.
Reference
1. De Botton A. Status Anxiety. London: Penguin; 2005. |
The
Pharmaceutical Journal