Podcast

Pharmacy's Perspective On The Future Of Healthcare in Canada with Sam Lanctin

About the Event

Sam Lanctin, international pharmacy consultant and former Registrar for the New Brunswick College of Pharmacists on the Canadian healthcare workforce, explores the expanding role of pharmacists as primary care providers, collaborate team based care with physicians, and the role of the private sector in shaping healthcare.

Objectives and Discussions
  • Practitioner shortage in pharmacy
  • Pharmacists perspective on increasing scope
  • Change that needs to happen in pharmacy
  • Privatising healthcare?
  • Pros/cons of IMG
  • Pharmacy in Canada in comparison to other countries
  • Technological revolution in pharmacy
  • Dual roles in government regulation
More Resources:

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Instagram: @cherry.health

Twitter: @cherryhealthinc

Have questions? We want to hear them!

Transcript
Speaker Identification:

[Host]: Dr. Jordan Vollrath

[Speaker]: Sam Lanctin

Jordan (00:02.094)
All right, today we're joined by pharmacist and former registrar of the New Brunswick College of Pharmacists. Sam began his career in community pharmacy and operated multiple pharmacies over more than a decade ago. His experience also includes time in a drug formulary management role with Blue Cross, and since early in his career, Sam has been involved in a wide array of pharmacy community and volunteer organizations at all the local, provincial, national, and international levels.

His extensive participation on boards, committees, and task forces has helped develop a keen and lasting interest in organizational governance matters. Developing on more than 25 years of leadership experience, Sam is now an independent consultant, providing a variety of advisory services to professional regulatory authorities, associations, and other organizations, including governance, planning, strategy, board relations, policy development, and leadership.

Thanks Sam for joining us. Excited to have that pharmacy side of things on the podcast.

sam lanctin (01:00.988)
Hearing that intro at all sounds pretty exciting doesn't it? The governance, the governance side, regulatory governance.

Jordan (01:03.507)
It does, it does, it does.

Jordan (01:09.07)
That's the fun part. What have you been working on recently? What's life been looking like? You're no longer clinically practicing, right? What are you actually working on recently?

sam lanctin (01:16.664)
No, and I didn't hear it in that intro, so maybe it was my myth, but the last 10 years of my active career, I was employed with the College of Pharmacists, so the regulatory side of it. But the last few years now, I've been consulting since I left that role. Consulting mostly around regulatory matters, governance, all various health professionals, that type of stuff. But...

not just restricted to that. And the last project that I've been working on, that I worked on, was for the Canadian Pharmacists Association and it was about the recruitment and the registration of international pharmacy graduates. So how can we make their path easier to help meet the demand of the workforce? We're simply not producing enough pharmacists in Canada to keep up with the demand and just like the rest of the world, we're fighting for that same talent.

Jordan (02:06.998)
Mm-hmm.

sam lanctin (02:11.784)
and Canadian Pharmaceutical Association want a little bit of insight on what could be improved and how we could get there.

Jordan (02:17.638)
And what was kind of the outcome of that? What is the plan? Are we going to be making it easier to bring in the IMG pharmacists? Or what's the path look like?

sam lanctin (02:27.092)
Yeah, well, the path is very complicated, as I imagine it is for the physicians as well. We've got 10 different provinces with 10 very varied pathways to get the licensure. And, you know, they're ranging in costs, you know, from $6,000 to maybe a year to get licensed to the other extreme being almost three years and $20,000 to get licensed.

Jordan (02:53.132)
Oh well.

sam lanctin (02:54.533)
The IPGs, if they're paying attention and understand that there are different pathways, they'll take the road of least resistance and they'll just simply transfer to wherever they ultimately want to be. But that's not a great system. So I think there's opportunity there for improvement. You know, unfortunately, I say unfortunately, I mean, an association only has limited influence on how it can change the pathways. They're owned by the regulators, as I used to be part of that group.

Jordan (03:18.083)
Mm-hmm.

sam lanctin (03:22.236)
So really until the regulators are really ready to change the pathway, it becomes a little bit more complicated. So CPHA was really looking at how do we support perhaps the IPGs in trying to get them across the finish line, prepare them for the exams, prepare them for mentorship opportunities or perhaps, you know, find placements, what kind of support networking because, you know, they come to Canada, they don't necessarily know anybody and it is very much about

how do you get placed or how you get those opportunities is who you know and who you meet. So I think there's opportunity there for the associations to get involved in just plain support of these individuals. But I think there's also a need probably for some wholesale changes with respect to the pathways themselves. And, sorry, there seems to be openness amongst the regulators about, we need to revisit this. And again, there's competition and governments are starting to put pressure.

Jordan (03:54.347)
Yep, yep.

Jordan (04:07.391)
Welp.

sam lanctin (04:19.396)
on some of the regulators about, you know, how do we make things a little bit better? We've seen the movement with the physicians and the nurses already right across the country and I think it's just a matter of time until we see a little bit more movement with the

Jordan (04:25.932)
Yep.

Jordan (04:31.342)
What's the scope of the problem in the pharmacy world? Because in the medical space, this is like one of the biggest things that we're just constantly hearing about and talked the most about is just like the practitioner shortage. Is it the same thing on the pharmacy side? Like we live in our own little bubble world and don't hear often a lot about what's going on in the other professions.

sam lanctin (04:45.945)
Yeah.

sam lanctin (04:49.26)
Well, I mean, it is there's always, you know, discussion is it a shortage of workers or are we just not using the people that we have correctly? Well, you know, tomato tomato, I guess we're still we're still wanting more people. And the reality is that the pharmacist scope and their involvement in care is just keeps increasing. So we're asking we keep asking pharmacists to do way more and not

Jordan (05:01.795)
Mm-hmm.

sam lanctin (05:14.884)
really having the personnel to support them and being able to do that and not take anything off their plates. I mean, we just don't have enough bodies. Population is aging through the pandemic. Pharmacists, they maintain their stores open, their pharmacies open throughout the pandemic. And they were the first point of access for a lot of people during that time, while sometimes doctors were, sorry, but doctors were sometimes harder to get a hold of. And through that, I think there was a certain recognition that...

pharmacists could take on more from a primary health care perspective. So governments are now even looking for pharmacists. I know through this work that I've done, I heard that Quebec was looking to hire 200 pharmacists for government positions. They're looking to put them in clinics at community level. So it's creating an extra strain. But the WHO predicted that by, I think, 2030, we're going to be short 18 million health care workers.

And that prediction was before the pandemic. So that number's probably gone up now.

Jordan (06:18.058)
So the expanding scope is not helping things. Like that's pulling pharmacists away from the duties where there's already an active shortage. Am I hearing that right?

sam lanctin (06:28.268)
Yeah, to a certain degree. I mean, part of it is because pharmacy maybe hasn't done a great job of backfilling, right? So moving the pharmacist a little bit more of the clinical stuff, perhaps, I think that increasing scope, but then getting the technical functions done either through technology or through, you know, pharmacy technicians or assistants. So I think there's part of that. So pharmacists often end up doing both roles. So I think there is a role to play. But even with just the, you know, the scope.

Jordan (06:33.902)
Mhm.

sam lanctin (06:56.24)
continue to expand, the more they offer, the more there's gonna be demand for those services, right? So typically right now we're going with lists of what we call minor ailments, while those lists keep getting bigger, right? So potentially seeing more patients and you need to have office space, you need to have appointments with these people, you need to have a structure, and that's not something that a lot of pharmacies are.

Jordan (07:10.626)
Mm-hmm.

sam lanctin (07:25.348)
They're getting there, but I think it's creating extra strain right now with all the extra demand.

Jordan (07:30.206)
What do the pharmacists think about that increasing scope? Like looking at it from the governance side of things, having a higher scope seems like a good budget decision, good business decision to try and get more people doing more stuff. I know like in the nursing world, there's been some pushback on the scope goes up, but the payment doesn't change, it stays the same. And so they're feeling squeezed to do more with less. Like is it, what are the pharmacists like? Like the more of that autonomy, is that seen as a-

positive thing or are they like this is just more added onto the pile already?

sam lanctin (08:03.068)
Well, I think the latter is probably true to a large degree because, you know, the staff pharmacist, the frontline pharmacist, they're going in and they're putting in hours. So, I mean, I think if they were allowed the opportunity to do it well and to really own it and not feel like, you know, well, I got to hurry up and finish this with you, Jordan, so I can go off and finish checking those six prescriptions and talking to the person about cough syrup in the aisle.

Jordan (08:13.646)
Mm-hmm.

sam lanctin (08:32.012)
and answering the three waiting phone calls, then perhaps they'd be happier about it. I think right now it's creating a lot of stress. I don't know that pharmacy, the community pharmacy right now feels like a great place to be because of all the pressures. When I was still in my role, a lot of these services were not covered by governments, right, they didn't pay pharmacists to do this. So there was limited demand because there was not much

profitability in it. So now the provincial government, many of them are now paying for these services and of course the corporates and the owners, they want to build off of that which just makes sense. So it's increasing demand but they've got the same people, the same amount of HR to try to complete these extra tasks and provide these services. So I think it's creating strain. When I was in my role...

Jordan (09:13.079)
Yeah.

sam lanctin (09:29.26)
It felt like not very firm, very many pharmacists were actually providing these services. There was a push to keep expanding it, but it's like, well, why would we keep expanding it when what's already enabled isn't really being used very much at the community level? But that's changed since, since government started to pay for it. And now it's really, I think everybody's on a whole hog. And I think, you know, and look, I think it's, I think it's good. I think pharmacists can be involved in this primary care. They're, they're an easy point of access most of the time.

But there needs to be a balance with, you know, what do we give up if we're going to do this if we don't have the extra bodies to do all this.

Jordan (10:05.314)
Well, it makes sense, right? Like having more of that availability, more of that scope to actually care for your patients, right? Especially in like underserved areas, rural communities. I mean, they might not even be a doctor in that town, right? The pharmacist might be like the entire primary care team out in certain locations. It's interesting though, that the pharmacists aren't looking fondly upon this. Like my picture of it was kind of the opposite. Like it was almost like, you have to let the...

sam lanctin (10:19.565)
Absolutely.

Jordan (10:33.734)
sentiment is kind of like a pharmacist or taking our jobs kind of thing, but that from the physician perspective, but they don't even want to be involved in taking over that primary care, it seems.

sam lanctin (10:44.888)
Well, I wouldn't go that far, Jordan. I think they want to do it, but they just want to be able to do it correctly and do it right and not feel like it's just another thing. I think they would gladly give up having to answer the phone five times every five minutes or having to check these prescriptions and do all these technical duties and structure this in a way that they can make appointments, they can take their time and talk with somebody. And it's health care and even more so for firms. But I think it's true.

Jordan (10:53.159)
Yeah, yeah.

sam lanctin (11:14.776)
in medicine as well. It's very transactional. They get paid for in and out quick. They get paid for each prescription that gets done. They get paid for every patient that they see or prescribe for or what have you. It's very transactional. There will always be a little bit of pressure there to do things to keep things moving. I think if they had a chance to do it right and to be independent in how they did it and manage the situation,

Jordan (11:17.559)
Mm-hmm.

sam lanctin (11:44.208)
their own workloads and all those things. I think pharmacists would absolutely love this. I think they just, I think there's a different kind of pressure right now and say, well, we have to do it because it's part of our duties, our boss expects that there might be certain targets or what have you. And it's creating extra pressure and there's nobody doing my job when I'm not behind the counter.

Jordan (11:59.903)
Mmm.

Jordan (12:05.266)
Yeah, so they don't want to be like forced into doing things they feel ill prepared for. I guess that's part of the growing pains with systems reform.

sam lanctin (12:13.444)
Well, absolutely. And you know, part of this was just the demands of the pandemic, right? Like I said, the pharmacists stayed open. They continued to provide services. In a lot of cases, you know, there was extra strain on them and there was extra demand and extra precautions. And they came out of the pandemic pretty tired already, where they were already tired. And now this is building up at lightning speed. So it's just a lot to digest. They didn't have it. They haven't really had a chance to have a breather.

Jordan (12:31.864)
Mm-hmm.

sam lanctin (12:41.464)
and try to move things forward. And again, look, I'm speaking very general terms here. I would suggest and I would think that most pharmacists view this in a positive light, as far as a big picture, positive light, but how is it impacting me on my day to day and how I feel and the pressure and all those things might be a little different.

Jordan (13:02.782)
Yeah, like the actual changes themselves are viewed upon favorably, but then there's sort of that corporate pressure and like chasing metrics and the business case is getting pushed down. That seems to be where that friction comes from.

sam lanctin (13:15.512)
Absolutely. I think as far as recognition of the role that pharmacists can play and that they can contribute to primary health care and support their patients better and all, I think that all helps the professional identity. I think that's all positive, but it's that back end of it that's a little, the business side of it that's a little trickier.

Jordan (13:36.298)
Well, what's been the feedback, I guess, or what's been the reception like in the provinces where that scope has already expanded? Like I think here in Alberta, we have one of the broadest scopes for pharmacists. Like was it Ontario just recently made some more changes in that same direction as well?

sam lanctin (13:52.032)
Yeah, so Alberta is the leader in the country and they've got a broader scope. You know, it goes beyond just the minor ailments that most provinces have now ushered in. But even then, I think, you know, and look, I don't speak to pharmacists in Alberta very often. Even then, I wonder when I look at who's allowed to do it. And as far as a percentage of all the pharmacists, they're not all...

allowed to do it. I mean, you have to go through certain steps and get qualified for it and offered. So just the fact that, you know, not all of them have gone that way. Maybe, maybe they're already feel they've got enough on their plates or they just don't want to go down that path. It's hard to know. You know, I Ontario, you mentioned Ontario, they're actually one of the one of the last provinces to sort of jump on this on this increased scope for pharmacists. So New Brunswick was, you know, near the near the

the front of the line and we passed, I think, in early 2010s that we began with our list of minor ailments that were allowed and all those things. But again, these things pick up momentum when somebody starts paying for the service. Right? Yeah.

Jordan (15:06.198)
Mm-hmm. What needs to change, I guess, like in the ideal world, if you could wave your magic wand, like how would this be incorporated differently, or how would you make this smoother process with less friction?

sam lanctin (15:21.932)
Yeah, we're, I think we're starting to go down that path in some provinces, you know, with the implementation of clinics, where you've got, you know, your community clinics, or you might have a nurse practitioner or pharmacist and a GP or, or other or mix of those. And, you know, there's a little bit, there's a little bit of triaging, right. So it's a little bit more like a health center, like a health clinic, and not necessarily retail environment. And

I'm not saying that what's happening in the retail pharmacy is not being done right, but it is a little bit of a different environment with respect to the structure there. So I think we're starting to see more of that collaboration at the community level. And I think that's the right way to go now where exactly it's gonna go or where it needs to go. I don't know, but I think there's, in the past we've seen change where...

There was a focus on

sam lanctin (16:24.54)
community clinics with, you know, multidisciplinary. And then when you think they're starting to take root, they all, everybody's back in their offices after that and there's no collaboration anymore. And then we seem to be returning to that collaborative model at the community level, which I think is probably a better model. And I think will serve the community better. And I think is a better use of the various, the professional skills and talents.

Jordan (16:48.434)
So the College of Family Physicians of Canada and just like all of the associations, there's been a big push for the team-based care, the patient's medical home, where essentially everyone's working together in unison and the common thread there seems to be that it's quarterbacked by the patient's family doctor. They're sort of like leading the charge. And so it makes sense, but like the part of me that's like, just...

trying to be humble, like what's the vibe from the other side of the table? Like, do they see the family physicians as that team quarterback or are they wanting more of that like autonomy, more of that decision making? Like how do the pharmacists actually view that team-based care?

sam lanctin (17:33.656)
Yeah, I don't know that I can speak to that very much. I think everybody's open to that team-based care. I think it makes sense and I think they would value being part of that team with their opinions valued and their input and their talents put to good use. So I think, I don't know if it's about who's quarterbacking or who's not, that's important. I think if

people are truly working as a team and each recognize each other's strengths and opportunities. I think it can work and I think there's certainly openness to that.

Jordan (18:08.254)
And then that seems like it would be applicable not in that corporate setting, right? Like the pharmacists that are sort of like at the larger chains, they seem to kind of removed from that team-based care. Like, will that wind up being like the minority of pharmacists wind up practicing within that collaborative team model? Or is there a way to actually get people connected and together on the same page, even if they're in that bigger corporate environment?

sam lanctin (18:32.94)
Yeah, so that's an interesting question. You know, where government has the ability to drive it and bring people into a team-based clinic, you know, family health clinic of that type at the community level, and where those jobs and those roles continue to be attractive to pharmacists, right? I think they'll continue to be able to staff those and what'll happen at the retail level is hard to predict.

It depends again on the bodies, right? I mean, if you just, if the good jobs, if the good jobs, right, are at the family clinic level, those are attractive because you're either working, you know, nine to five, or, you know, you're working collaboratively and there's not somebody timing you as far as how long it takes for each appointment, that kind of stuff, and you're getting paid equally or maybe better or what have you, then you might be in retail, then you're gonna continue to fill those positions first, in my opinion.

and then the retail is going to be where it suffers a little bit. So that's sort of what you see when there's a crunch on the workforce. The good jobs, they get filled quicker and there's movement and people migrate to whatever they think is a good employer or a good situation. And then it's the ones that are the most stressful or the most strenuous or the most, I don't know.

I don't know what adjective I want to put in there, but those are the ones that end up with it with really having the most difficulty to stay staffed.

Jordan (20:06.13)
What are those levers that the government and the regulatory bodies have to pull in order to enact these changes? Like the billing codes and the compensation structure seem like that would be a big influence, especially, I mean, across the board, not even on the bigger corporate places, but just how they actually structure that payment. Do they have any influence over the actual education side of things as well and then reforming like the actual programs?

sam lanctin (20:23.685)
Yeah.

sam lanctin (20:31.4)
I mean, there is and there isn't. I mean, we have, as the regulator, we like to think when I was in that role that everything starts with the regulator. But the reality is there just continues to be a progression, right? And everybody's sort of trying to work in concert and the regulators adjust to what the educators are doing and vice versa, and the exam people, you know, the competency assessors, they adjust. And so it's a multi-stakeholder kind of dance. And...

who's leading is not always very clear. I think it sometimes depends on the issue, even if we as regulators like to think that we ran the show or think that we should, I don't know if that's true or not. But as far as creating that environment, I think the education and the scope of knowledge of pharmacists is already pretty high if you compare it to what's happening globally with pharmacy.

So I think there's a lot that pharmacists can offer already. I don't know that much has to change for the education. As far as the regulatory environment, that's moving pretty quickly to adapt to what governments want, which is more access to that primary healthcare offered through the pharmacy or through the pharmacist, I should say. So I think that doesn't really have to change. I think the supporting structure.

of how that works in the community, you know, how government is going to compensate, how they're going to set up the billing numbers or whatever, however they decide to do it. I think that's the part that maybe still needs some work. But the reality is, I mean, look, there's some stuff through the pandemic that we, you know, you work on for 10 or 15 years and you think we'll never get an answer to this and then like two weeks into the pandemic, like you've got a solution because it's critical. So at some point somebody's going to decide it's critical enough and figure things out.

Jordan (22:21.65)
How much influence do those larger corporate entities have? Like it's all very foreign again, compared to medicine, right? Like the medical clinics, we've got the odd, you know, 10, 12, maybe in Ontario, there's some with 20 or more facilities, but here in Alberta, it's largely one, maybe two, the odd three, four different facilities. Everything's very independent, small mom and pop. And then it seems as if like,

the actual lobbying side of things or the medical association's influence on the government is a little bit at odds. Like even here in Alberta, it's very antagonistic between the government and the Alberta Medical Association and our like agreement and contract getting ripped up. So it seems like the influence in the medical sphere is more on the lower end. What's it like in the pharmacy space?

sam lanctin (23:14.064)
Well, I think the influence may not come from the associations all the time, at least what I know here in New Brunswick and from some of the smaller provinces, and it may be different in Ontario. So I'm not suggesting that the associations do not have influence, but what I am suggesting is some of the corporates are so big and they create so much employment and so much revenue for the provinces that I think they sometimes...

they bypass, they may bypass the association, right? So the link is directly between some corporates and government perhaps, and there's influence there. And, you know, I mean, it's, if that helps to develop the practice to a certain degree, that might be okay. But then when we've got conflicting perhaps goals or objectives, then I don't know how that plays out.

Jordan (23:52.194)
Guys.

Jordan (24:07.246)
We would blow on that up a little bit higher. What are your thoughts on privatizing healthcare? I mean, your pharmacy space, it's largely privately delivered already versus medicine is mostly publicly delivered. Like how has that played out in the pharmacy world? Do you think you guys are more up to speed, more up to date, further advanced? Like...

sam lanctin (24:28.868)
Well, you know, I don't know that we're further advanced, but certainly, you know, I spoke earlier about governments not paying in Ubranchuk for some of the services that were being offered. Well, pharmacists were still charging for it, right? If there was somebody willing to pay for it, they'd charge cash for it. So there was already, I guess, a certain degree of privatization there. Some insurance coverage is, you know, some of the private insurances will pay for some of these services. So I, yeah, I don't know. It's...

sam lanctin (24:57.884)
Pharmacy is an interesting beast, right? It's a profession with a cash register and a profit-driven bottom line. And I think the tension between the profession and the business side of it is sometimes a little bit out of balance and hard to see where things are gonna go or where they should go. But I think the return or the institution maybe or the ability to have these family health clinics might help.

solve some of that to a certain degree. But I mean, it's a good question, but the privatization, how does that work? I think right now it's not an issue because government's agreeing to pay for most of these services.

Jordan (25:39.246)
Did those bigger corporate entities just like on the account of the topic of like accountability and metrics and KPIs, because you mentioned earlier that they have their targets and things that they're trying to hit for like prescriptions filled per day. Like in medicine, there's not a whole ton of that like KPI driven accountability, right? Like every year I'll get a report on like where I stand on the bell curve for opiates prescribed and some things like that. But

versus if you look in the US, like Kaiser Permanente, for example, right? The bigger entities, they have more of a standardized framework where they're actually looking at like, what are the admission rates of the family medicine patients to hospitals and ER visits and things like that? Like, does that bigger organization, the pharmacy, like, do they have health KPIs and metrics that they're looking at or is it generally business-focused things?

sam lanctin (26:34.26)
I think a lot of them are, they're really business focused, right? Because I mean, we don't have an ability, I mean, where the HMOs in the states, they have data on all the access points and all those things and all parts of the care. We don't really have that here in Canada. And I don't know that we have the ability to really go that route. So whenever we, as pharmacy...

want to show the value of the service. I mean, we've got to launch research projects and really try to bring economists in and you try to figure stuff out, but the data is not readily available to just sort of on an ongoing basis, be able to measure all the time, well, what does having pharmacists offering the service and the outcomes of it, what is it saving the healthcare system or is it successful? What are the outcomes and all those things?

Jordan (27:58.214)
I mean, switching gears a little bit back to the IMGs thing, like where does that then fall in terms of pros, in terms of cons? Like, is that looked at favorably across the board as a solution to getting the workforce back up to snuff? Or are there like some pitfalls that we go to avoid or framework that we need to put in place there?

sam lanctin (28:03.498)
Sorry, I'm your first.

sam lanctin (28:30.108)
Well, a few considerations. I think for a lot of the pharmacists that we would get from the countries that they're coming from, they're not necessarily countries where practice is equivalent to what it is here in Canada. So there's not always the client centricity, right? The patient centricity that we have, even the conversation with patients. Some of it's more technical in some of these countries. So it's trying to...

Yes, they're qualified to a certain degree as far as their knowledge, but how do they apply it and providing care and having that interaction. So I think that's a little bit of a concern to a certain degree. I think there's a realization as well that you're not going to be able to fill all your needs through the IPG pipeline. It's just not realistic. But we're also not producing enough pharmacists in Canada. So ultimately, I think there's a realization that...

that things are gonna get worse and how we're gonna deal with it. So I think there needs to be a little bit, we need to look at other solutions, either opening new schools, new seats at the existing schools, more technology, we're still using fax machines in pharmacies, right? Yeah, it's you guys faxing us. So I mean, I think there's opportunity for, and look, some...

Jordan (29:47.091)
Same.

sam lanctin (29:56.052)
retailers are going down that path of technology, automation, that kind of stuff. But I think using technology has been slow in pharmacy, so I think there needs to be a greater push more quickly that way.

Jordan (30:10.658)
Where does Canada stack up in terms of that education for the pharmacists? Like in other countries or most places around the world, is it like a full degree on top of another degree or is it quite a bit different?

sam lanctin (30:24.164)
No, it's often a full degree. Now in Canada, it's not necessarily on top of another degree either. So I mean, it's usually with a few years of science. I think every school now in Canada has gone to a firm D. So it's not even a bachelor's degree. So it's an advanced degree. But I think not just the education, but the practice is different. And in my research,

I get the sense that Canada feels and I'm not an academic and I haven't really delved into that level, but there's a sense that pharmacy is more advanced in Canada than in most other countries or at least in a lot of other countries. And I get the sense that medicine feels the same way about medicine in Canada as well. So whether that's true or not, I don't know.

Jordan (31:16.738)
We're up on our little podium thinking we're pretty cool. I think we are pretty cool though. That's...

sam lanctin (31:19.5)
Well, and that's the premises thing too, that we're pretty cool. But I don't know enough to know if that's true or not. I think we're probably fairly similar to a lot of the light countries, Australia, the UK, Ireland, those kinds of places. But I think there's probably a gap with a lot of the other countries where we're getting most of the IPGs from. So I think, I forget the question

Jordan (31:48.677)
pitfalls and the IPG route, yeah.

sam lanctin (31:51.94)
Yeah, well, I don't, I think it's just the fact that we're competing with everybody else. Right, and we have one system, right, sorry, we have 10 pathways, but each pathway has only one system. So regardless of where you're from, if you're coming to New Brunswick, you're going to go through all the same paces. Right, so I don't care if you're from India, from Egypt, from the United States, from the UK, or from Zimbabwe. If you're an ITG from one of those countries.

the requirements are all the same. There's no individualization, there's no alternative pathway, there's no fast tracking for people from the UK or anything like that. We're treating everybody the same.

Jordan (32:21.758)
Yep. Good.

Jordan (32:32.97)
Well, and then you mentioned something interesting with the Pharm D degree. What role has that played in the change over the last few years? Like talking to a pharmacist here at the U of A in Alberta, when this first rolled out, it sounds like it was somewhat arbitrary. They kind of just like picked a cut off and certain percent of the top performers in the class got denoted with this Pharm D degree versus everyone else had their same pharmacy degree. Like what's the

sam lanctin (32:57.68)
So, I hadn't heard that, that seems a little sketchy. That seems a little strange, but I mean, they're all officially now offering firm D degrees, right? So it's the same for everybody. So, you know, we talked earlier about the regulators and the educators and everybody sort of getting along and trying to move. This seems to be an evolution, I think,

Jordan (33:05.514)
Maybe that's not 100% accurate as well, but that's what I was relayed.

sam lanctin (33:27.408)
that's really likely been driven by the educators more than anybody else. I don't know that, and I'm not saying it's not good or it's not a natural evolution. I think just the knowledge and scholarship, the pharmacy keeps increasing and then to a point where it became affirmed yet. The entry requirements in every province are still a bachelor's degree.

Jordan (33:48.546)
So what's the intent of the new PharmD degree then versus their standard pharmacy degree? Is it just like a modernized curriculum and the idea is that everybody does that same thing? Or is it like an actual different trajectory that you can go on?

sam lanctin (33:59.129)
Yep.

sam lanctin (34:03.136)
No, it's a modernized curriculum and I mean that's eventually it's so I mean it'll be the only pharmacy degree available in Canada. So it's not while their legislation doesn't require a firm degree that's essentially all you're going to be able to get in Canada anyway, right? So that'll become the standard. I mean it is becoming the standard and that's what it is. I think you know there's a there's a greater emphasis on you know internships.

Jordan (34:10.708)
Okay, okay.

sam lanctin (34:32.016)
you know, during the program versus just, you know, through summer employment, through summer placements and those things. So I think there's greater clinical focus. Again, that's where pharmacy is going, it's offering that clinical care. And I think there's, we're gonna continue to go that way. And I guess eat more of the doctor's lunches, right?

Jordan (34:51.694)
Well, it makes sense, right? Like changing and revitalizing the education. Like in medicine, there's a lot of rumbling going on about moving family medicine to a three-year residency program. And that's obviously been met with a lot of mixed reviews, but just in terms of catching up with the world and technology and like the new kind of team-based primary care model, it does make sense. Obviously it's gonna be a little bit of a growing pain there, but it's good to see that the pharmacy space is already on top of this. And yeah.

modernizing their education system across the board, which is really cool to see.

sam lanctin (35:23.996)
Yeah, it's evolving. It's evolving. I mean, for me, what I find interesting is the balance or the discrepancy that you have throughout. You might walk into a pharmacy and have three different pharmacists with three totally different educational backgrounds. Right? So maybe somebody was educated in Egypt and you've got somebody mid-career like me, perhaps, who would have a Bachelor of Science.

and then you've got a brand new graduate that would have a firm D. So I mean, you've got quite a range there of what's there. And I suppose it's the same for any profession as you continue to evolve. There's always some people that are, have the more up on the newer knowledge and technology and all those things.

Jordan (36:10.31)
What has been the technical revolution in the pharmacy world? Like, is there a lot of things happening? It sounds like you guys are still on the same fax machines, like the info way, Canada Health info way. What do you know about their prescribed IT system or prescribe it, sorry, I'm probably saying it wrong there. Has that been a big hit with the pharmacy community? Is it making everyone's lives easier and been wonderful?

sam lanctin (36:22.352)
Yep.

sam lanctin (36:25.802)
Well, that's, yeah. Well, yeah.

sam lanctin (36:33.852)
So I don't know firsthand what the experience is. It took a long time to get going, honestly. And I was in my previous role when that sort of started and there was resistance and there was a lot of stuff. And it just, I think it's moving forward. I don't think that all pharmacies and all physicians are in this yet, right? So until you have everybody through these systems, it's, I mean, there's

there's benefit and there's not. There was issue back then with some of the pharmacies not wanting to do it because they had to pay for the transaction. Or the transmission of the prescriptions. Like, well, why is pharmacy always paying for these things? Why don't doctors pay for the trans? It's like, well, and it wasn't our decision anyway, but you think really if I'm a business owner and I can get something, the data entry right into my system for a nickel versus having to pay.

to pay a fan to do it in five minutes, I'm probably better off just paying a transmission fee and getting into my system and safe there. So I think some of that reluctance to really get onto the technology and sort of embrace it, I think it's hurting pharmacy a little bit, but I think there's also progress being made with some centralization. So I think there's some central fill. I don't know if you're familiar with that term, but you might have.

Jordan (38:01.792)
No, what was that?

sam lanctin (38:03.16)
Yeah, so you might have a central firm, so a retailer that might have, I'm going to pick it on Ontario because Ontario's got lots of stores. So let's say Ontario's got 100 stores under the same retail banner or corporate banner, what have you. You could have central fill where there's a central location where there's through robotics and hardware.

technicians or assistants, you might fill a lot of the standard prescriptions that are filled at the stores and then they're just sort of shipped to the stores for pickup. Right. So, right. And I think exactly, and I think, so that's, I think it's even gone beyond that now where the prescriptions sometimes are fed directly from the store, the store to the central field place perhaps, and they're actually labeled there and they're shipped to the store automatically. You know, so.

Jordan (38:40.766)
Oh, you just put a name and a label on it at that point. Is that the idea?

Jordan (38:57.627)
Oh, it's like the Jeff Bezos model then almost like just with a really fancy supply chain.

sam lanctin (39:00.736)
almost. And you know what, Amazon, Amazon pharmacy, if it ever gets here, is going to be interesting as well. I know they've been in the States for a little bit. I don't know how well it's working, but I know they've been there. So.

Jordan (39:12.378)
I heard a lot of buzz about that. That was what, maybe a year or two ago. And then they spent a hundred million dollars or something acquiring a chain of pharmacies. And then I didn't really hear much after that. I don't know if it's I'm assuming it's going well. It's Amazon. They're taking over the whole world.

sam lanctin (39:23.512)
What, what, you know what, what I've heard since then, it's just in bits and spurts, what I've heard seems to be, you know, they've laid off people or they've, you know, they've shut down this branch of it or whatever, so you think, oh, maybe it's not really picking up as much as I thought, but anyway.

Jordan (39:41.238)
But yeah, the prescribed IT thing, it's, I mean, it's basically growing a two-sided network. Same thing we're doing here with Cherry Health, trying to get all the clinics and all the healthcare practitioners on there, right? It's like a really difficult problem to solve and the local regional effects, the interplay. And so like I've, myself, I've never used the system because it's not compatible with the EMR that we're using at the clinic. But the idea of it in general, that sounds like progress, right?

sam lanctin (40:08.208)
Well, the idea is good, but the execution is difficult. And it's not just because pharmacists aren't embracing technology. I mean, there's a struggle with physicians embracing technology. I know when I go see my physician, everything's still paper. I don't know that he does a whole lot on a computer or tablet or anything, right? So I don't know if he's got an EMR. He's using the fax machine. He's doing those things. He's got a file about that thick or whatever, and that's what it is. So...

Jordan (40:23.65)
Hehehe

Jordan (40:32.066)
Yeah.

sam lanctin (40:38.644)
And when they do make a decision to have an EMR, they're not all the same throughout the province. And so they're not all compatible with whatever prescribed IP is trying to do. So it's, you know, it is complicated. When I had my pharmacies, and this was a long time ago, you know, you had some physicians that thought that they were being modern and they had an EMR and they thought they were transmitting secure prescriptions to my fax machine from their EMR. It's like, well.

No, not really, it doesn't work that way. So, and these wouldn't be signed, so you have to sort of track back and try to make them understand that it didn't meet the requirement.

Jordan (41:17.934)
How does, I thought the fax machine was the God's gift to humanity, like it was secure and perfect. You're saying that it's not in fact, like a secure system?

sam lanctin (41:29.824)
No, it's not a secure system you know if I'm getting a fax prescription from you that's fully handwritten with your signature and I'm Familiar with your signature and I know that you know There's the likelihood that it's that it's that it's a valid prescription that is good and it's coming from you It's probably pretty hot right and if it's for something like alt-8 or whatever I mean as I'm probably not an issue with it if it's for like if they're like six hundred dial-out of eight I might ask a couple questions or am I?

Jordan (41:52.658)
Yeah, no red flags blinking.

Yeah.

sam lanctin (41:57.908)
or might circle back if it's just signed with the next or something. But the issue is that you've got an EMR that it's not meant to interact with the fact machine. There's no real technology in the fact machine to interact with that kind of secure system to really validate something. And EMRs don't provide a real signature. So most of them, sorry, I shouldn't say they don't, most of them don't or at least didn't at that time. And so they would have fixed a picture of a signature. Right? Well, that's...

Jordan (42:26.508)
Mmm.

sam lanctin (42:26.948)
That's like a stamp, right? When it comes through a fax machine, it doesn't, it's not valid. If I get a petition with the, for 600 dialed at eight milligrams from Jordan with your, with the stamp of your signature, I'm not filling that.

Jordan (42:38.558)
Yeah, now you got some authenticity on it.

That's funny. Well, we're pooping on the fax machine. That just reminds me like back when we were, they had probably like 10, I wanna say, maybe seven. My mom had a fax machine and this thing would, I don't know, routinely every week get inbounds from the local medical clinic, just like that had been wrongly addressed. Like I think her fax number was one off from whatever the clinic down the street was. And so, I mean, Antisystems only as good as its users, I guess, right?

sam lanctin (42:58.574)
I

Jordan (43:13.854)
Yeah, so beforehand you were mentioning you've been working on or privy to some information, you know, the governments and the regulatory bodies are now looking at people with dual roles, people that are both on the advocacy side of things and on the regulatory side of things. It sounds like they're trying to put in more umbrella framework about kind of like separating the church and the state, you know, for what roles an individual can have, is that correct?

sam lanctin (43:39.98)
Yeah, I'm not sure where I mentioned that. Certainly there are some provinces that are actively trying to separate the regulator from the advocacy body. And I think, you know, from a governance perspective, I think that's the best practice. And I think it's, you know, most of the world, most of our world that we know tries to follow that. But there are still a lot of organizations that, there are still some organizations that still have to do a role.

of advocacy and regulation. And it's a little bit, you know, the interest of the professional and of the public don't always conflict. Often they're the same, but there's likely gonna be some occasion where they do conflict. And when you've got a dual role, it becomes difficult to fulfill both interests very well. Right?

Jordan (44:19.394)
Mm-hmm.

Jordan (44:31.362)
So that's not on the individual person. That's on like the organizational level.

sam lanctin (44:36.12)
Yeah, yeah, I'm from a governance perspective, right? So I know in Alberta, that's where you were, I think it was only last year, perhaps that government dictated that colleges or regulatory bodies could no longer hold the advocacy role either. So you're, I know, it's familiar. I think the College of Nurses in Alberta previously, it was a nurse's association, but they, you know, they did the regulatory and the advocacy and they were forced to separate. So yeah.

Jordan (45:03.786)
Oh, so that's not standard in all professions. Cause like I figured that was pretty common across the board. Like we've got the college and then that's like the regulatory body, right? They're there, not the doctor's friend. They're there to protect the public and make sure we're behaving. And then we've got the medical association, you know, that's more of like the, the interest group trying to advocate. And so that's not how all the different health care professions or how pharmacies work.

sam lanctin (45:10.576)
Yep.

Yes.

Right.

sam lanctin (45:28.344)
Well, that's the trend and in pharmacy, throughout Canada, it's all separate. But there are some professions, and sometimes it's just because the group is so small. The group is so small and they really can't staff both an association and the regulator. And traditionally, we all used to be joined. So as pharmacists, when I graduated, I think we were just separating at that time, and I'm not gonna say how long ago that was.

Jordan (45:34.039)
Mhm.

sam lanctin (45:58.084)
But there's still some small organizations that came to being with an association mandate and then evolved into having the regulatory mandate but never really let go of the association mandate too. So they've got both and there's probably not enough, a big enough body of registrants to actually sustain both an association and a regulator. So.

Jordan (46:11.394)
Mm-hmm.

sam lanctin (46:26.044)
In your province in Alberta, the government mandated that, you know what, you can't do both roles well. We certainly don't want our regulators trying to promote professions or the professionals. You know, in negotiation, all that stuff is difficult as well. So they mandated separation of church and state there.

Jordan (46:45.158)
I mean, just looking at it at the face value, it makes sense. Apart from the, you know, just size limitations and having the manpower and the cash to support Heaven 2 organizations, is there any other like good reasons to not have them split up? It seems reasonable.

sam lanctin (47:03.18)
Yeah, I think it seems very reasonable. I think it's the right thing to do. And I think a profession is well served by having both a strong regulator and both a strong association. And I don't think you can have a super strong association when your primary role is that of the regulator. Because it's a really fine line to walk.

Jordan (47:22.766)
Gotcha, and...

Jordan (47:27.482)
And so what is the standard with the College of Pharmacies and professional pharmacy associations right now? Are all the provinces currently split up with that structure then? Okay, gotcha, gotcha.

sam lanctin (47:35.908)
We are, yeah, we are. Yeah, yeah, most of the bigger professions are, although that said, I mean, the nurses have just started splitting, like nurses associations and they were big. I mean, if you wanna talk about manpower, they've got the resources to have well staffed and well stocked associations and regulators and they still in many cases were joint, but they've separated. I know here in New Brunswick, I think they just separated not that long ago. I think Alberta just separated. So I think there are other places, but it's...

Jordan (47:47.891)
Oh yeah.

sam lanctin (48:05.944)
You know, sometimes when I talk about some of the other colleges I might have worked with, so say massage therapists or dietitians or dental hygienists, they may not have a whole lot and they may not have even existed for that long as far as a profession or as far as even a regulatory body. So they often have a dual role.

Jordan (48:29.278)
It makes total sense, I guess, right? Especially on the nurses side of things, right? There's what half a million or not? Yeah. 600,000 of them. Like, yeah, that's a force to be reckoned with that union for sure.

sam lanctin (48:36.394)
There's a lot. There are a lot. Yeah. They don't need to be together. Yeah.

Jordan (48:42.598)
Yeah. What else is going on in the pharmacy space? Like what other kind of like challenges or hot button issues is everyone facing that like we with our blinders on in the medical world might be oblivious to? What's been...

sam lanctin (48:57.184)
I don't know that, you know, you've covered a lot of ground in this conversation and we've talked about some of those things. You know, I think, yeah, I think, you know, what's going to be interesting going forward is seeing how the professions work together. Now, I know that the doctors, they're not always in a great position either, right? Where and I've had conversations with doctors, with some of the, you know, the family practitioners where I've become a...

becoming a GP now, our family practitioners almost become a dirty, where everybody wants to go and become a specialist. Uh, and if you are a GP, and again, it's very transactional and get paid for visits. And so you're losing the easier visits to the pharmacist or the nurse practitioners. How do you sustain a practice where all your, all your patients are complex? So I think, I don't think the system is working super well right now with respect to trying to reconcile some of these things. Uh, I think there needs to be changed. And I don't, I don't know what the

the system is like, we tend to treat sickness or illness and we get paid for that, but are we really looking at trying to keep people healthy? So I don't know, I think there's room for growth in our healthcare system. I don't know what the solution is, but sometimes I feel like it should be just imploded and started over and no government, and well, no government.

Jordan (50:20.952)
Revolution! Burn it down, start again.

sam lanctin (50:23.757)
No government's gonna do that though, right?

Jordan (50:25.646)
No, well, I mean, we're seeing a shift now towards precision medicine, right? So more genomics-based. It's still like pretty early on. We don't really see a whole lot of it actually within our like medical education, but it's really picking up and taking off in the States now. And so Canada's starting to follow suit. We were talking with a few doctors last night, actually, really good conversation just on that future of precision medicine and that exact point of like.

sam lanctin (50:32.476)
Hmm.

Jordan (50:54.446)
promoting health as opposed to that. We're very in Western medicine reactive treating disease as opposed to promoting health and making that shift. And then to your other point about just needing to play nicely with all the different providers. I mean, the issue of that we've had an internal debate on this, right? Even within the medical field, right? Like the walk-in clinics, creaming off the less complex, more simple patients, medication refills, the quicker things.

virtual care, obviously not being like a big hot button topic in terms of, you know, are they just at scale doing more of the same? And then of course, that's been one of the concerns then is that like, you know, is pharmacists and then that new prescribing power, is that going to be challenging things? And so I was talking to Dr. Lawrence Lowe again from the CFPC the other day.

And so that's one of the big pushes that they're making is for reform to those billing codes and that compensation structure, just to incentivize people to have those more complex patients, right? Like trying to get doctors practicing at the top of their scope, because now there's a financial reason to be doing so.

sam lanctin (52:01.388)
Yeah, it's interesting, right? Because I mean, you pay for it here in New Brunswick, some of the experiences, you know, you pay the physicians per visit, and you know, some of them, you decide on the patient load that you want to have, right? And then you're compensated as a result of that, and how often you see them. But then when you think, well, no, that's not good, let's put physicians on a salary, then there's a lot more time spent with

patients which sometimes is needed, sometimes is warranted, but there's less patients being seen, right? And it's easier to take a Friday off or Wednesday afternoon, right? So I don't know that the whole compensation structure is something on its own to grapple with. And how do we make sure we get the most of this so that we get the best care and also efficient care, right?

Jordan (52:32.664)
Mm-hmm.

Jordan (52:57.022)
I mean, is there any incentive on the government side of things, you know, if you're fairly plugged in and working with them? Like what are their thoughts on changing and reforming the compensation and the billing structure? It seems like it's somewhat slow going. Like why do you think that may be?

sam lanctin (53:08.228)
Yeah.

sam lanctin (53:12.516)
I, you got me on that one. I don't know. I mean, governments looking in your Brunswick here, government's happy to be touting, you know, big surpluses for several years in a row. But once you look at all our social programs and, you know, health and education and all those things, I mean, they're crappy. So, you know, they're happier to show, yeah, we're fiscally responsible, but the rest of us are, you know, the rest of society is not doing that well. So it's, anyway, that's.

As far as I'll go with government. You're going down. Skip. Get me in the next podcast. It'll get me going then.

Jordan (53:43.402)
Yeah, we could probably sit here and complain about government all day. Maybe, maybe we should just cut it there. We're coming up on our hour here. Okay, awesome. Well, Sam, thank you so much for joining me today. I really appreciate it. I learned a lot. Thank you so much. Awesome.

sam lanctin (53:59.996)
That was a pleasure. Thanks, Jordan.


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