The Cost of Change if Pharmacists Unionize

To be quite literal, how much would it cost for real change?

As pharmacists continue to be frustrated about the current state of the industry, one of the common, immediate outbursts of frustration to help fix and protect our profession is a call to unionize. I see a lot of comments comparing our profession to other industries and how they wouldn’t allow this to happen to them. Comments like, “The AMA would never let (insert problem with the pharmacy industry) happen to physicians,” for example. 

Well, this article will not answer the question of whether we should or should not unionize, nor will it create the argument for OR against our profession unionizing. Instead, what I want to do is explore the financial cost of unionizing and provide some perspective on how current pharmacy organizations monetarily stack up against a powerhouse like the AMA. 

Show me the money!

What do Jerry Maguire and Lil Wayne have in common? They both have famous roles involving money. Jerry Maguire’s “show me the money” scene and Lil Wayne’s hook on the song “Make it Rain,” are two famous cultural moments involving money, depending on what generation you’re a part of. 

If you didn’t know, like every other normal organization, a union requires financial capital to operate. A union’s operating capital usually comes from its members. Money from your paycheck is what would cover those operating expenses. It’s the employees (Pharmacists in our case) part of the union that are usually required to pay dues. And in some cases you are FORCED to pay these dues. How much would these dues actually be, you ask? For nurses, according to the National Nurses United, the nation’s largest union of registered nurses, their dues are “2.2 hours of gross base salary every month with a $117 per month dues cap” for any nurse working over 12 hours per week. “Those who work in Right to Work states cannot be required to pay dues as a condition of employment.”

I also looked at the dues for Union of American Physicians and Dentists (UAPD),a union based out of California for physicians and dentists, and according to their website, the UAPD member dues appear to usually be 0.9% of your earnings every month. “Those who are not UAPD members are still required to pay fair share fees to the union. Those fees are deducted by your employer. Those who sign an application to become a UAPD member will pay dues, which are only 0.04% more than the fair share fees that everyone must pay.” The following example was provided on their website:

$5000 in earnings x 0.86% = $43 in Fair Share Fees for non-members
$5000 in earnings x 0.90% = $45 in Dues for members
Member dues are just $2 more.

0.9% of every paycheck.

If you work 40 hours a week, this translates into 1.44 hours of work per month. The math I did was 0.9% of 40 is .36 hours, times 4 weeks = 1.44 hours a month. Just about one work hour less than the nurse’s union I mentioned.

I did see that there was a local union in the Chicago area that represents pharmacists, but I could not find any information about dues listed on their website. Any who, let’s actually assume pharmacists would look at the above and we come to an agreement that we’ll only pay one hour of our salary per month. We’ll get back to this math later. 

To be clear, I’m no union expert or lawyer, I just tried to find the closest example to our profession and go by what they had listed as public information.

A Team Effort.

According to the Bureau of Labor Statistics, there were a little over 300,000 pharmacists in 2016, likely more now, but let’s say the number is still 300,000 today. If we say they make $50/hour according to the above standards, collectively, pharmacists would spend about $180 million per year in dues.

Plot twist…maybe it’s a little ambitious to ask all pharmacists to pay union fees. And what may be true (I have no evidence of this) is that most pharmacists calling for unionizing are community pharmacists, specifically in retail chains. So let’s look at the number of pharmacists at these chains and see what that would be like if they were forced to pay dues. I’ll try to be a bit conservative here too. Let’s say only pharmacists at CVS and Walgreens are the one’s that would be required to pay dues. According to Wikipedia, that’s a total of 34,000 pharmacists between the two. Again, using our one hour a month at $50/hour that’s $20 million per year. Expand that to the top 5 retail chains, with almost 50,000 pharmacists now contributing, that rises to $30 million in dues. Crazy!

Dun dun dun…another plot twist!!! Independent pharmacy owners want a piece of the action. With 20,000 independent pharmacies, let’s assume we were able to round up 50% of them to chip in, that would pull in another $6 million.

Total Yearly Dues required for chains and indy pharmacists: $36 million.

Total yearly dues required for all pharmacists: $180 million

So, assuming that unions were the action we wanted to take, the above shows what we’d collectively have to pay, actual amount varying on how many of us chip in.

Current Currency.

Seeing that we’d have to pay millions of dollars in dues, let’s take a look and compare that to what we’re currently providing organizations already in place that we’d expect to advocate and create change on our behalf. In doing some quick research on google, I was only able to find public financials from APhA. I was not able to find NACDS’s or NCPA’s, and then I just gave up on searching because discussing APhA’s financials should fit the needs of this discussion. But if you can find those other reports, please reach out to me! My contact info will be at the end of the article.

Here’s a quote from the APhA 2018 annual report:

“The APhA Political Action Committee (APhA–PAC) is an important tool in APhA’s efforts to advocate on behalf of the pharmacy profession before the federal government. The APhA–PAC raised more than $110,000 in 2018 — the first time we have raised six figures in one year, and an increase of over $30,000 from 2017 and over $60,000 from 2016.”

So, they received $100k for the APhA-PAC. What about membership dues? Membership dues were $4,146,349 in 2018 and $4,142,736 in 2017. Yup, that’s right, a whole $3,613 dollar difference from one year to the next. But, that’s a whole other conversation. Looking at the rest of their financials, turns out their total total revenue is $34,989,119 with total expenses of $34,565,617. For simplicity, let’s assume it will cost the organization $40 million to operate. 

Remember what I kicked off the article with? How some will compare our actions, or lack thereof, to the AMA? Comments like, “Why can’t we be more the AMA and get things done with legislation?” Well, I hope you’re sitting down.

You know how I mentioned above our PAC only raised about $100k, the AMA’s PAC, called AMPAC, “raised a combined $2.2 million dollars during the 2018 election cycle.” Any math will show you that’s WAY more than us. 

What about the AMA’s dues? “The number of dues paying members increased 3.4 percent in 2018, and total membership increased 2.8 percent in 2018 as compared to 1.2 percent in 2017.” APhA dues increased by like .08%, these numbers aren’t exactly apples to apples to compare but I think it is quite telling. More importantly, “gross dues revenue was $36.5 million,” compared to APhA’s $4.1 million. 

As a side note, I’d encourage you to go to the AMPAC website to read more about how the organization operates and drives political change for their profession. Because I think a lot of what PACs can do for our profession are not usually clear, its good to get an idea of what they are doing. Here’s an excerpt:

“AMPAC incorporated valuable feedback from state medical society PACs and local physicians from around the country as it worked to identify candidates that would fit this mold and make for sound investments on behalf of organized medicine. In all, AMPAC contributed $1.4 million in the 2018 cycle that included direct contributions to 291 physician-friendly candidates for the U.S. House and Senate from both political parties (51% to Republicans and 49% to Democrats). These contributions provided more than 600 strategic opportunities for AMA lobbyists, physician leaders and local doctors to attend events and have important one-to-one interactions discussing issues critical to medicine. As the cost of elections continues to spiral ever higher, AMPAC is finding its value-add is our ability to create these opportunities.”

This all makes sense as AMA’s slogan is “Membership Moves Medicine.”

The reason I’m pointing out these financials is because we’re trying to compare ourselves to the AMA when frankly, they have WAY more pull than we do because of the cash they’re able to operate with.

Lesson here is, if you’re going to want action to happen, we’re likely going to have to pay for it. 

And before you email me and say, BS, we need a lot more than just money, we need blah blah blah… I get that. But to execute on everything else we need, we need the capital to execute.

To wrap up…

The Call to Action:

With an understanding that to see change, we’re going to have to pay for it, should we work through the process of unionizing? Or should we try to use what we already have in place? Again, I’m not going to present or argue reasons for one or the other, I’m just hoping to paint a clear picture of the expectations and our current reality. I do, however, want to create a call to ACTION. I think every pharmacist that wants to see change should pick one of the following:

1. Pick an existing organization that either has a plan, or you think can formulate a plan to execute on how you want to change/protect the profession, and donate 1 hour’s worth of your paycheck per month (half of what a union would cost) or
2. Start doing some research on how unions work and learn both the positives AND the negatives of unionizing. See how that may compare to what an organization could do. Maybe hop on reddit, since it is anonymous and find people who are trying to start one. Just be careful because if you work for a large retail chain, they will NOT be happy and you could risk your reputation and maybe even your job. Also, if you’re choosing this option, start contributing to a savings account that will eventually go to operating costs of said union. 

Excited to see what you’ll do.

Thanks for reading.

Take care,

Richard

UPDATE: I was able to find some financials from tax documents via https://www.guidestar.org/ on NCPA and ASHP. Here’s what I found…In 2018, ASHP had $52 million in total revenue and $56 million in operating expenses. Only $6 million of the revenue came from membership dues. NCPA on the other hand, had only about $13 million in revenue in 2017 and $12.9 million in operating expenses, only $3.7 million in revenue from membership dues. 

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Connect with me on any of your favorite social media platforms, I’d love to hear your thoughts on the article and wether you agree or disagree with my comments.

Richard Waithe, PharmD | Richard@vucahealth.com

President | VUCA Health

Host | Rx Radio Podcast

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