Gender Equality, Professional Pharmacist Equality and All Health Equality – Same problem, different label

Today, I randomly tuned in to an ABC program that marked the United Nations (UN) International Women’s Day.
It marked the 20th anniversary of the first forum that was held in Beijing.
The forum lamented that women had not advanced their cause (gender equality) since that first forum and still lagged behind in salary and wage payments, representation on business boards and in politics.
Norway, the country most complimented because it had mandated for these types of change and appeared to be a “shining light” had failed, because a mandated culture change could not be sustained in reality.

In Australia today (04/03/15), it was commented on by the discussion panel that many links had to be dealt with simultaneously before equality could emerge, particularly in areas of childcare – currently not affordable with inadequate facilities to service the demand, even if all mothers could pay full price.

It was also pointed out to government representatives that the impetus to Australia’s economy by having greater female workforce participation, that the cost would not be an economic loss or even an economic neutral position – bit it would be a substantial economic gain overall.

Concurrently, the culture within the business community had to shift significantly to actually accommodate the real needs to support the participation of women in the workplace.

Even with all the various lobby groups and support groups, from local levels to international levels, women had failed to achieve the various objectives established at the original UN forum in Beijing, even though all member governments had adopted the principles of gender equality, it still remained elusively out of sight.

I then reflected on the feminisation of pharmacy and whether the same issues had followed them into the profession.
Certainly there does not appear any specific barrier for women wishing to take on the profession of pharmacy and in many instances, they have won the right to have flexible working hours.
I am uncertain as to pay rates and whether male pharmacists attract a premium over females. I would not think that this is happening in pharmacy.

In fact, working mothers have changed the very long working days that often intruded into the weekends to a type of job-sharing model, with many male pharmacists also finding shorter working weeks also to their liking.
I can also remember some of the disadvantages of women owning a business, with no childcare support, and early entrants by women setting up business as a partnership with their own crèches within the pharmacy, where one partner managed the business, while the other partner provided support through baby sitting and other supportive processes.

These pioneer women proprietors solved a social and management problem that did not exist prior to their entry to business – because ownership was overwhelmingly male.
But it had to come with a complete change in culture that may not have always been male-friendly.
However it was an innovative solution.

The conclusions arrived at by this current UN forum was that a complete change in culture was needed which embraced other areas of disadvantage such as abuse- sexual and physical, childcare, industrial issues of wage disparity with the most important support from government having a willingness to fund a culture change and bring all the elements together.
Recognition of all the elements of business life that created equality, was a step forward.

Taking a step back from the issues promoted at this forum I could not but think that gender inequality issues were almost identical to some of the issues in health for both male and female pharmacists, where we do comparable work to the medical profession, but are paid far less.
This was the subject for a recent discussion regarding a vaccine program where a pharmacy was offering a doctor around $100 per hour to participate in the program.
An accredited pharmacist would have been paid a lesser amount, suggested at $40 per hour.
Simply because of the culture that pharmacy has evolved to.

While pharmacists are funded by government to provide a range of services there is no uniformity of purpose attached to them.
The funding also cannot be relied upon, as evidenced by the budget reduction for HMR activities.

Pharmacists around the world have been battling to be recognised as providers to fill in the gaps that have been created by the medical profession.
The medical profession, on the other hand, deny that any gaps exist.
But a recent program on SBS that focused on health issues, exposed that not only were doctors not listening to patients (who simply wanted an efficient medical record online for all their medical contacts to access), but they were not talking one to the other with the patient forced to maintain their own record and relay their version of the professional dialogue to each medical practitioner.
They readily admitted that a costly mess existed but they blamed it on their culture. This was offered as an explanation but with no qualifying detail as to how they would be rectifying cultural deficiencies.

Recently I came across an article written about US pharmacist culture and what had to happen before they could achieve provider status.
The telling point made was that all pharmacy leadership organisations had to unite under a single voice that could truly be representative of pharmacy.
A copy of the article can be found here:   Political Advocacy in Pharmacy

Health is unsustainable because it relies on a faulty culture from most of its constituent individuals.
For example, we know that pharmacists should (and have previously) been fully engaged with patients, educating them and creating knowledge transfers. Over time, the quality of this offering has declined due to PBS dispensing.
Some pharmacists are looking at the prospect of working in GP environments in “collaboration”.

This may work where the participants are genuinely patient-centric and put them genuinely at the centre of the collaboration. Such a relationship would develop with mutual respect.
However, the AMA version does not seem to respect pharmacists and seeks collaboration as a form of control.
It also wants clinical nurse practitioners in the same subservient situation.

If pharmacists go it alone be warned that the time investment with a patient is significant, because it involves mentoring, knowledge transfers and continual education to fill the gaps created by the medical profession.
They no longer do this work and hence you see patients falling through the cracks.
A proper pharmacist service would provide a qualitative better service than a GP, and that would be necessary to win the market.
It is also necessary to have a “primary care home” (rather than a patient centred home medical model) in competition with the GP version to create an alternative patient proposition, located in a pharmacy.

Patient choice and quality of service will win out eventually.
Patient compliance or product recommendations for simple conditions would prevent a patient’s health from deteriorating, or even entering hospital.
At each level of health care – self care; primary health care; intermediate health care; secondary health care – there is an increase in cost per patient.

Pharmacists, and pharmacists in collaboration with clinical nurse practitioners could resolve many of these care issues, and that would make the health system more sustainable.

So why can’t pharmacy as a whole support the following suggestions?

1. Form up a pharmacy council for all leadership organisations, that is bipartisan in nature and able to defuse any internal issue e.g. PBS negotiations.
Government should be part of that council providing funds and acknowledging the resolutions of that organisation in the form of supporting legislation. Other community health organisations e.g. Consumer Health Forum, may also be part of this council to create a greater momentum with government.
Affiliate this body with a global pharmacy equivalent with the view of adopting best global practices and advocate for government adoption in Australia.

2. Do the same for all of health. We have long needed a forum to resolve disputes and create professional boundaries.
Also, to reduce inequalities and prejudice that exists within each health profession’s culture.
Health is now simply too big for one profession to claim leadership over all of its components.

With government participation and funding, we could produce a complete health system that would be the envy of the world.
This cultural change would be massive, but unless we do something along those lines and create mutual respect for the type of work each health discipline performs, then we will always see high cost and fragmentation of care services.

The women’s movement is a great model for this type of restructure.
They have been waiting over 20 years since the formation of their peak international body and still remain frustrated as to fulfillment of objectives.
But each year they meet and advance the cause and it will happen eventually.

I hope these comments fall on fertile ground.
I have grave reservations for pharmacy survival if we can’t rise above the petty squabbles within existing pharmacy leadership organisations.
I have never made that type of statement before, preferring to remain optimistic.
There are grounds for optimism, but it will not be sustained without a willingness to adjust and improve our culture.

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