Navigating the AI Wave in Pharmacy: Challenges, Opportunities, and the Future Landscape
The past few months have been quiet on my end with posts on The Digital Apothecary but for a good reason. I have been traveling around the country, meeting a lot of different stakeholders (academics, professional organizations, local leaders, digital health companies, pharma), and invited as an SME/KOL to speak on the potential impact of AI for the pharmacy profession.
It's a given that OpenAI and Google LLMs have caused consternation in the pharmacy profession. For some time, the specter of AI and automation playing a threat to some of the roles of pharmacists and technicians has been simmering. But... out of sight, out of mind. That it would be a problem eventually, but that eventuality came sooner than many thought is my conclusion. Many pharmacists have been caught off guard by how decent generative AI can be and are wondering about the implications of what other AI systems are out there, what their capabilities are, and what that may mean for us.
I find myself having similar discussions, no matter what stakeholder, and I think I can sum them up as the following questions and thoughts brought up:
What does this mean for pharmacy jobs? Is this an opportunity or a threat?
What is the current and future regulation going to be like?
What is the issue of bias in the use of AI and its implication for clinical service?
And how do we protect patient data and privacy?
Who is going to make AI services for pharmacy?
How do we educate current and future pharmacists on how to use AI?
Is something lost if pharmacists use AI for their work?
Two clashing themes:
AI cannot replace the relationship between patient and pharmacist.
AI can replace a lot of the work done between a patient and a pharmacist.
My personal thoughts surrounding AI have been mixed. It's no surprise, given that I have been a fan of sci-fi for quite some time, which has influenced my views regarding implementing technology into health care. The concept of digitalizing health care services seems inevitable from my point of view. Digital health just becomes health care. AI and related power that transformation. Current health practitioners will fit into this changing dynamic.
At one point, I was resistant to what AI could do. I remember in the early 2010s seeing early iterations of AI/ML health products and not being impressed. Several years later, I saw their 2.0 versions, and I walked away from those meetings reflecting that if they had made that much progress in several years, what would have happened if they had had more time? Was it an exponential growth of development? And if so, how soon will we have to deal with it?
So, when everyone started talking about ChatGPT, I think I had fleshed out my approach and thoughts on the implications. I've had some time. I've seen the possibilities and heard what people envision as a possible 'end-game.'
I'll say this much: We have time, but less time than most would want to figure this out.
We stand on the razor's edge of seizing an opportunity or being hammered for our indecision. It's a chance to rethink what we do. Coming off the pandemic, where, for all intents and purposes, the profession was squeezed to the breaking point and beyond, now a time of reflection on where health care is going and where we fit into it needs to be discussed.
The automation of the dispensing of medications is inevitable. I cannot be convinced that in 10-20 years, people will want to drive to a pharmacy, go into a building, get their medication, or even use the drive-thru. Not when we look around and see how many industries of commodity delivery have shifted and the consumerism aspects that most industries have tapped into and addressed. Pharmacy is no different, as far as I can tell, despite what some may hope. Maybe this moves from brick-and-mortar to click-and-mortar. Maybe medications delivered by drones take on a large business. No matter. We know what is coming downstream, and this is our chance to act.
The starting line has been redrawn, and many health professionals, including pharmacists, are now seeing the race being reset. I think that this is where we decide what we want, what policies need enacting, and what we need to fight for and preserve, sideline, or explore as better business opportunities for current and future pharmacists to develop their future careers around.
For pharmacists looking to retire in the next decade, I think this won't be a big issue. I think business as normal will proceed, but with more community pharmacy closures and adjustments that hit dispensing roles and logistics. If a pharmacist looks to be working for more than 10+ years, I think then there will be an issue. We likely will hit a point of a 'great retraining' where pharmacists who have been in the workforce for more than 10 years will need a new skill set development. I think this may come from academic institutes developing those degrees, credentials, or certs. Maybe it'll be professional orgs or other third parties. But I think that is going to come when we see a training aspect to identify what new roles tech develops and move pharmacists into them.
This is nothing new. Historically, we see this in every industrial revolution. We see it in changes in health advancements.
One of my favorite examples of this is the movement from linotype to electronic printing. For the longest time, newspapers would use linotype to create and print newspapers. This was an intense, noisy business. However, the rise of computers and new printing mechanics eventually led to a shift due to the economic and logistical benefits. I highly recommend watching this 30-minute video, I think it really highlights the aspects of how industrial revolutions shift the thoughts and the culture and how change is difficult.
But again, health care has seen some of this trepidation as well, which I think is worth highlighting.
One health profession that always stood out to me is dentistry. In the 1980s, around 10% of their dental schools closed. Lack of enrollment, lowering needs, and different business issues in their profession cropped up. For the longest time, dentists 'drilled, filled, billed.' You got a cavity, saw the dentist, and they fixed it. But, in the 1950s, we put fluoride and encouraged more dental public health initiatives. 30 years later, the volume of cavities diminished. You had dentists that, for decades, knew one thing, and when that demand dried up, they sold their practices or quit the business. The money wasn't there. So what did their profession do? They redeveloped. It took a long time. They went towards preventative dental services, added more services, expanded what they could do, and made the dental experience completely different.
So, where does that stand for pharmacy? The business of pharmacy is fine, I believe. We'll always need pharmacies to process medications, but how that works will change rapidly. Pharmacists won't go away, but it will be a workforce shift we should anticipate to a significant degree. We need to prepare for that and determine how to take that on. We can either face that now or deal with the ramifications sooner than later.
We need more research. I'm tired of our data showing what we can do. I know we can provide a lot of clinical benefits, but demonstrating financial value is the hard part. We need to focus that work to demonstrate to CMS, payers, etc, that pharmacists can provide more services to help either reduce costs, provide better care, enable more outcomes, or whatever as far as I am concerned, that is worth paying for and building a business models we can take on. Because that is what we will need. Technology, whether digital health or AI enabling this should be embraced. I feel we can leverage this technology by providing more scalable services and collecting more objective data points to demonstrate value. I'd like to see more funding for this work and a drive to push it.
The next few years are going to be tough, I realize. I've been a champion of using technology to facilitate the work of pharmacists and expand our prospects. I think the pressure just shot up on how to get things moving. These are interesting times, for good or for bad. We have no idea what can and cannot be done, and that can be both exciting and horrifying. Seeing how some pharmacists are already taking this on and building new technologies and services leveraging AI demonstrates to me the capability of pharmacists to take on new roles and responsibilities. These will be the leaders of the profession in the coming decade, and I admire them for their tenacity and risk.
I do not have the answers for what is going to happen to the profession or how to fix current and future problems. I know it. But, I'd like to help if I can or help any of you wanting to take this on further. I don't see any one solution coming into being that will address our needs at this time. It's going to be multifaceted, at the least, and with a lot of failures and pushback. But we need to do this or face ignominy because no one else is going to do it for us.