Amazon Pharmacy : Is It the End for Other Pharmacies?
Amazon is making its biggest push into the healthcare industry yet with the launch today of Amazon Pharmacy: a new service offering home delivery for prescription medication.
Customers can sign up to the new store by creating a ”secure pharmacy profile,” with the option of adding information about their health insurance, any outstanding medical issues like allergies, and any regular prescriptions. The store will offer a range of “generic and brand-name drugs,” reports CNBC, including “commonly prescribed drugs like insulin, triamcinolone steroid creams, metformin for controlling blood sugar, and sumatriptan for migraines.” Notably, the pharmacy will not sell Schedule II medications, which includes many common opioids like Oxycontin.
As usual for Amazon, Prime members will get a number of advantages over regular customers. These perks include free, two-day delivery on orders and discounts on medication. Amazon claims Prime members will be able to save “up to 80 percent off generic and 40 percent off brand name medications when paying without insurance.” Prime members will also be able to save on medication bought in person from over 50,000 pharmacies across the US, including Rite Aid, CVS, Walmart, and Walgreens.
Amazon Pharmacy will be available in 45 states this weeks, reports CNBC. States currently not covered include Hawaii, Illinois, Kentucky, Louisiana and Minnesota, though Amazon plans to expand to those areas in the future. Amazon says it accepts “most” insurance plans, and will give customers the option of speaking to a pharmacist for advice.
The launch of Amazon Pharmacy is a significant move from Amazon, but far from unexpected. The company has been steadily building up its position in the healthcare market for years now, with signs pointing to a launch into pharmaceutical services.
In 2018 it bought pharmaceutical delivery startup PillPack for just under $1 billion. The company later rebranded the service as PillPack by Amazon Pharmacy, and CNBC reports that PillPack’s infrastructure (including its fulfillment centers and relationships with healthcare providers) were used to create Amazon Pharmacy. Amazon says PillPack by Amazon Pharmacy will continue as a “distinct service,” aimed at customers “managing multiple daily medications for chronic conditions.”
According to Healthcare Weekly, the pharmacy industry is worth $312 billion in the US, with annual growth rates of 3 percent driven primarily by the rise of online stores and home delivery. Given Amazon’s prowess in logistics and its network of warehouses and drivers, entering this space seems logical. And at a time when more people are staying at home because of the pandemic, the prospect of delivering medication is even more attractive.
In a press statement, Amazon’s Senior Vice President of North American Consumer, Doug Herrington, suggested that this dynamic would work in the company’s favor. “As more and more people look to complete everyday errands from home, pharmacy is an important and needed addition to the Amazon online store,” said Herrington.
Even before the pandemic, independent physician practices were facing challenges.
Beyond safeguarding the health and welfare of their patients, independent physician practices play a critical role in the fabric of our health system. They’re also strong economic drivers tightly woven into their communities by the commerce and jobs they create—which generate taxes to support schools, housing, transportation, and other public services in local communities.
But modern private practice faces increasing economic challenges often driven by non-medical issues such as increasing administrative burdens; large fixed overhead for staff, equipment, and space; and the lack of time or resources to develop expertise in evolving technology, regulation, and payment/reimbursement models.
A rough situation made worse
These pressures have been mounting for some time. A study on physician practice arrangements updated in May 2019 found that, for the first time in the United States, employed physicians outnumbered self-employed physicians.
As far back as 2014, one study co-authored by the American Medical Association and Mayo Clinic, found 26.6% of physician respondents indicating it was likely or definite that they would leave their current practice in the next 2 years, with burnout, dissatisfaction with work-life integration, and dissatisfaction with the electronic health record noted as independent predictors of intent to reduce clinical work hours and leave current practice
The 2020 arrival of SARS-CoV-2 in the United States exacerbated the struggle with additional concerns and financial pressures. An August survey from the Larry A. Green Center and Primary Care Collaborative showed 2% of primary care practices had closed, and another 2% were considering bankruptcy. The survey further found 1 in 10 practices uncertain of their solvency for the coming month.
While telehealth expansion helped fill some revenue gap, physician personal protective equipment (PPE) shortages continue to be a serious problem for individual physician practices in many states, making in-person services difficult, and patients have deferred non-urgent or preventive care. Research from the Commonwealth Fund shows that “the number of visits to ambulatory practices fell nearly 60 percent by early April before rebounding through mid-June. From then through the end of July, weekly visits plateaued at 10 percent below the pre-pandemic baseline.” Independent physician practices “are being forced to make do with less revenue, some of which may never come back,” according to a recent Washington Post healthcare business exposé.
To be fair, it’s not just primary care, and it’s not just private practice. The pandemic has exposed questions that have rocked the entire healthcare industry in general. But for most specialties, if independent practices were struggling before, the pandemic probably made it worse.
Practicing possibilities post-pandemic
Physicians should be able to work in a healthcare system that provides opportunities for both employed and independent physicians. However, with many employee physicians facing furloughs and layoffs due to the pandemic’s impact on regional hospital and health system patient volumes and revenue, the old truism practicing medicine is recession-proof has given way to the reality that it isn’t pandemic-proof. Some physicians may have no choice but to pursue self-employment.
There are also a lot of physicians who simply prefer the autonomy afforded by self-employment. A 2019 McKinsey survey reported 79% of small independent practitioners and 67% of large independent practitioners cited autonomy as a top factor in selecting their current practice model. In that same survey, 84% of all independent physicians who did not proceed with an employment opportunity in previous years, and 59% who had returned to independent practice after employment, indicated autonomy was a primary influencer in their decision.
And physician self-employment as a model can produce positive outcomes. A seminal 2016 paper in the Annals of Family Medicine showed that “small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates” than larger or hospital-owned practices.
Fostering independent practice sustainability
Independent physician practice represents an invaluable thread in the fabric of American healthcare delivery that should be preserved. But even without the pandemic continued viability of independent practice business models is long-overdue for redress.
Safeguarding its future requires rethinking operational models to deliver long-term sustainability. Look for credible resources for increasing physician professional satisfaction and supporting practice sustainability. These include is a wealth of information on contemporary financial strategies and new federal programs available to physician practices to help address the challenges brought on by Covid-19; as well as guidance on overall practice transformation, effective change management, interventions and workflows that improve practice efficiency and shared best practices from exemplary healthcare organizations to improve both professional well-being and patient safety.
But the greatest issue that must be addressed is also the elephant in the room: reducing administrative burden on physicians. Regardless of specialty, in today’s world, there is simply no sustainable way for an individual to practice medicine and run their own business while also serving as facility manager, head of procurement, accountant, IT support, EHR administrator, regulatory compliance expert, marketing professional, HR and payroll specialist, coding and billing expert, and the man or woman who fixes the fax machine. Yet most independent practice requires some or all of those roles to be filled by medical doctors, and the proportion of a doctor’s time devoted to the simple joy of practicing medicine is increasingly encroached upon.
Changing that is going to require innovation in business support, as well as new ways to increase purchasing power, new types of practice networks, new revenue models, enhanced access to innovation, efforts to democratize patient access, and a significant reduction in government and payer administrative burdens. That may include permanent integration of telehealth and virtualized patient-physician interactions and appropriate billing coding to support it, as well as applying models from other industries to eliminate administrative overhead. These might take the form of new professional employer organization (PEO) services akin to JustWorks or TriNet, which could be customized to the unique requirements of healthcare practice to offload and aggregate administrative necessities and create services that help independent practices leverage the economies of scale that large healthcare organizations normally enjoy. Or they could iterate off concepts like the Amazon Seller Central example, which offers a turnkey online sales service so businesses can focus on making their product, much like offering turnkey back-office services to an independent physician who can then focus on practicing medicine. In addition, government regulators and public and private payers should minimize the administrative burdens placed on physicians, realizing the primary role and major driver of professional satisfaction of physicians is to care for patients.
Facing great challenges also presents great opportunities for positive change. But all of that transformation and reinvention shouldn’t fall on the physician’s shoulders alone. There are lots of interesting new services and technologies for supporting and streamlining businesses of all sizes, but applying them to healthcare practice should not become one more chore left for independent practitioners to figure out on their own.
Historically, innovation in healthcare has not always driven efficiencies and savings. But physicians are supportive of innovation if it works, provides cost savings or receives proper payment, is not an added liability, and fits into the practice workflow. This is where innovators and big thinkers and bright business minds beyond the healthcare realm can lend support in taking up both advocacy and solution development to ensure that not only do independent physician practices survive, but these physicians thrive well into the future.
It doesn’t make sense, right?
Unfortunately it’s hard to put ourselves in someone else’s shoes until we walk in them too.
Here’s one point of view from a recently trained surgeon:
. I feel like a pawn in a moneymaking game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade.”
I have been practicing actively for 10 years. I hate this job and the whole medical world. I never felt as though I belonged. Most of the “successful” doctors in the community are arrogant BS artists who viciously attack other doctors to make themselves look better to administrators.
To be considered good at your job in this world, you have to work 80 hours a week, take care of inpatients, outpatients, be on call, put up with phone calls and visits to your home. I am done. I have had it up to here, and I am done.
- I don’t have any clue what to do after this.
- I have no training for anything else.
- I’m not qualified to be anything else.
I have been criticized (unfairly) so heavily by other doctors in the community that I know I mentally and physically cannot do this job. I am good at certain aspects of my job, and I enjoy procedures (working with my hands, minor office surgery, etc). I hate people. They all LOVE me because I can listen (basically I have nothing to say to them, and have very little skill at manipulating a social interaction – which is required in my profession).
I am expected to spend the time listening, then relive it all when documenting the visit. My documentation takes twice as long as anyone else. I have anxiety about documenting every detail to prove that what I have done is appropriate.
I dread telling anyone, especially my fiancé and my family. They are constantly saying how they are proud of me for my accomplishments (for what that’s worth), and I dread losing value in their eyes. I have approached the subject of changing professions with friends and family, and I get encouragement (“you are just having a bad day”) and disappointed looks and statements. They say “we will love you no matter what you do, but you should be strong and keep on trying.”
I have no pride in myself other than their acceptance and pride in my career. If they knew the things I was thinking about doing, they would be shocked, disappointed, and disgusted.
I am clueless and stuck.
I hope and pray that someone, no matter their profession, seek help immediately if they’re having thoughts like this.
Now there were several posts that disliked being a doctor but others that loved it. With any job or career choice there’s going to be the good and the bad.
As a periodontist, I went through four years of undergrad, four years of dental school, one year of hospital training at the Biloxi, MS VA Hospital and 3 years of a surgical residency at LSU. Geaux Tigers!
I acquired close to $300K in student loan debt during the process. The problem we ran into was my job offer fell through only two weeks before I completed training and I had no clue how to start a practice (they forget to teach us that even thought it’s the MOST important).
For me personally, there was no way I could even consider to give up my career due to the MONEY owed.
Doctor Burnout Is On The Rise
Unfortunately, too many doctors are burning out early in their careers.
In a survey of 12,000 physicians, only 6% described their morale as positive.
A 2019 Medscape Physician Burnout and Depression survey showed that 45% of physicians are burned out with three specialties (urology, neurology, and physical medicine and rehabilitation) having burnout rates that exceed 50%.
Their top three contributors were:
- Too many “bureaucratic tasks” (records, charting, paperwork, etc)
- Overworked contributing to a poor work-life balance
- Electronic Medical Records
Many are citing that despite the thousands and thousands of hours spent training, it’s the lack of autonomy that’s causing this undue stress.
Doctor Suicide Rate
What’s even worse is the increase in the amount of doctors taking their lives each year.
In the U.S., it’s estimated that 300- 400 doctors commit suicide each year. (I personally know two that have)
Those figures equate to a doctor per day – the highest suicide rate of any profession.
Newer research shows that the number of doctor suicides are 28 to 40 per 100,000 which is more than twice the number than the general population (12.3 per 100,000).
Many attribute this to their “greater knowledge of and easier access to lethal means”.
Suicide is the second-leading cause of death in the 24–34 age range (Accidents are the first).
In a 2017 study published in Academic Medicine, suicide was the leading cause of death among male resident physicians and the second leading cause of death among all residents.
Look, I’m not trying to be a Debbie Downer. I simply want to point out that:
- burnout is a REAL issue
- there are several top reasons doctors hate their careers
- you don’t have to continue saying “I hate being a doctor” to yourself (It’s a BIG world out there!)
Top 3 Reasons Doctors Hate Their Job
The top 3 reasons why doctors think, “I hate being a doctor” are:
I completed training two months before Hurricane Katrina hit New Orleans (where we were living) in 2005. As previously stated, I had close to $300K in student loan debt. We also purchased a home (interest-only because we were broke) then I lost my job offer. Not fun.
I realize that tuition has been climbing each year with no end in sight.
It’s not uncommon to pay between $40,000 to $70,000+ a year.
If a student decides during their third year that they hate medicine or dentistry, they’d already be more than $80,000 to $140,000+ in debt not even factoring in living costs and undergraduate student loan debt.
Now I understand that if this person completes training, then typically they can deal with their debt.
But the question remains: Who can leave medicine/dentistry?
Few of us are raised with a silver spoon in our mouths and our parents aren’t in the position to help us dig out of the debt hole.
If we decide to quit during school and go into a different field, as a failed medical/dental student, how would you ever make enough money to pay off the debt already acquired?
Leaving school early is a recipe for lifelong financial insecurity.
Unfortunately, doctor’s salaries haven’t kept pace with their expectations.
A general practitioner back in 1970 was making $185,000 a year (average inflation adjusted) vs making only $161,000 a year in 2015.
Don’t forget to add in the fact that doctors are having to see double the number of patients now than they did in the 70’s.
We’re now starting to see an increase in the number of physicians moving to a “Concierge” model as most patients are paying more for their care but less of that money is going to the providers.
How about this:
According to a 2002 article in the journal Academic Medicine, the return on educational investment for primary-care physicians, adjusted for differences in number of hours worked, is just under $6 per hour, as compared with $11 for lawyers.
#3 Rise of Bureaucracy
I remember my time spent as a resident at a VA hospital when the changes were made to go from paper to electronic records.
For a semi-literate computer person, it didn’t affect me as much as it did those older docs that had been writing notes in charts for years.
This small change began the BIG wave of those guys calling it quits, not wanting to continue spending countless hours of clinic time spent documenting care rather than providing it.
To them it wasn’t worth it. Could you blame them?
Studies estimate that doctors spend almost an hour on average each day, and $83,000 a year dealing with the paperwork for insurance companies.
Their office staffs spend more than seven hours a day.
Is it any reason why so many physicians view themselves as pawns in a battle between insurers and the government?