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Impact of Pharmacy Conglomerates on Patients and Pharmacists

We are all aware of the hundreds of articles, studies, and blogs written about specialty pharmacies and their impact on access and cost; no repetition should be expected from me! I have observations that strike a chord, observations that have not been addressed.




Annual ratings of professions as viewed by the public are published every year based on surveys by Medscape and other organizations. Historically, pharmacists rank on the top in trustworthiness by patients. They have been viewed by the public as the legitimate arbitrator for caring, honesty, and integrity. Usually, nurses rank second, followed by physicians. Funny enough but tragic, politicians only beat prison inmates in trustworthiness.

Decades ago, physicians were on the top of the list, but that has changed, a change that paralleled the shift from self-employment to being employed by hospitals and other large institutions. I can argue that the paperwork and insurance mandates have distanced physicians from the face-to-face patient interactions, hence viewed less caring about patient needs and concerns. In fact, nurses have been dropping in the trust hierarchy, which in my view can be attributed to the shift of nursing care from the bedside to paperwork and computers coupled with more administrative duties replacing actual patient care, which has been increasingly delegated to State Tested nursing Assistants (STNA’s).


We at Gabrail Cancer Center are trying to recruit a second pharmacist to handle the pharmacy aspect of research. One Indeed advertisement we posted resulted in more than 30 highly qualified applicants; I had no choice but to interview most of them. Not only was I shocked by the sheer number of applicants, but their responses to our questions were also telling. Most of the applicants currently work for the mega pharmacy conglomerates. They find little professional satisfaction in what they do. They complain that they miss patient interactions. The pharmacy technician is the one who talks to the patient, while the pharmacist deals with inventory management, spreadsheets, and revenue analysis. They all seem to have given up on reversing the trend. It is more than a trend; it is a new paradigm that policymakers, including the FTC, seem to ignore.


These desperate, highly educated pharmacists, all Pharm.D, see clinical research as a vent to their professional frustration and oppression - an intellectual stimulant that will feed their scientific and professional hunger. What is curious to me is the number of applicants we have encountered, yes, we have several pharmacy schools, but I don’t think we have a surplus. After all, all applicants do have a job that pays well monetarily but little to show in satisfying the professional zeal and instincts.


Independent community oncology is a narrow vent for these highly educated professionals; we need to work with them. One way of widening that venting window is through expanding our scope of operations at our practices via opening retail pharmacies and expanding our clinical research programs. That is exactly what ICOP is doing. Pharmacists have demonstrated their usefulness in clinical research both at Pharma R&D divisions and at community oncology research sites.

Nash Gabrail M.D.

Gabrail Cancer Center



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Innovative Community Oncology Practices “ICOP” was established in 2021 as an association of small and medium-sized community oncology practices with the aim of promoting our survival in the face of me