some implications of value differentiation in pharmacy

Some Implications of Value Differentiation In Pharmacy* Edward Harvey Princeton University

Lanalyse des confets de r6les du professionnel et de l’homme d’affaires est faite du point de w e des valeurs auxquelles sousaivent les pharmaciens. La valorisation que les pharmaciens font de leur occupation influence la satisfaction qu’ils en derivent et le recnitment du personnel. LinterGt suscitk chez les pharmaciens par des questions politiques et ideologiques ayant trait B la profession repdsente un substitut institutionnel aux valeurs d’ordre professional. Lauteur suggere d’autres utilisations possibles du modele analytique qu’il a dkveloppb.

Theoretical Orientations : Value Analysis

Among the professions, pharmacy is notable in its combination of a professional service with a business enterprise. In this paper we shall attempt to explore some of the possibili- ties for conflict inherent in this combination, particularly in terms of occupational satisfaction and recruitment. We shall pursue this analysis first by ascertaining the occupational values held by pharmacists and then by proceeding to examine how these values “fit” with actual occupational contexts. Lastly, we shall investigate the extent to which groups holding different occupational values come to re- semble micropolitical interests1 seeking to m t r o l and direct change within the profession. Our data are derived from two sources. Firstly, a ques-

tionnaire was sent to all pharmacists registered as members of one provincial pharmaceutical association in Canada,2 the membership of which constitutes 95 per cent of all pharmacists practising in the province. The questionnaire and two follow-ups ultimately yielded a response of 86 per cent or 973 respondents. Secondly, supplementary interviews were carried out with a random sample of 100 pharmacists who had also answered the questionnaire. Un- less otherwise stipulated, all the findings presented in the paper are derived from the questionnaire and not from the interviews.

The major theoretical orientation which guided our re search into the profession of pharmacy was derived from the conceptual scheme developed by Morris Rosenberg in

*The criticism of an earlier version of this paper by Richard F. Hamilton of Princeton University and assistance in carrying out the research by Lorna R. Harvey is gratefully acknowledged. Any defects are the author‘s sole responsibility, however.

micropo political" derives from Tom Burns’ use and meaning of the term “micropolitics,” in “Micropolitics: Mechanisms of Institu- tional Change,” Administrative Science QuarterZy, VI, 1961-62. %Although our findings are derived from the study of pharmacists in one province in Canada, we believe them to have considerable generality in that the education of pharmacists and the practice of pharmacy varies little from province to province and not greatly, for that matter, throughout North America. In this connection, see the section on pharmacy in the Report of the Royal Commission on Health Services in Canada (Ottawa, 1964); also, Anthony Weinlein, “Pharmacy as a Profession with Special Reference to the State of Wisconsin,” unpublished M.A. thesis, University of Chicago, 1943; also, Isidor Thorner, “Pharmacy: The Functional Significance of an Institutional Pattern,” Soczal Forces, XX, 1921-42, 321-8. Much additional information is available from the United States such as the Canadian Pharmaceihcal Journal and the American Druggwt.

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his investigation of the factors involved in the making of occupational choices3 Rosenberg argues that “whenever an individual makes a selection from a given number of alternatives, it is likely that some value is behind the decision. An occupational choice is not a value, but it is made on the basis of values.”* Contending that the types of values held vary widely from person to person, he offers a general ordering in the form of three value-orientations relevant for occupational choice. These are, firstly, intrinsic reward orientation (e.g., “I want to be creative and original, to achieve self-expression”) ; secondly, people orientation (e.g., “I want to work with people and be helpful to others”); and, lastly, extrinsic reward orientation (e.g., “I want a chance to earn a good deal of money, to gain prestige and security”). Rosenberg suggests that just as these value-orientations will vary from person to person, so will they vary from one line of work to another. In this connection, he employs a weighted average to estimate the dominant value-orientation of a number of occupations.6 His data, for example, present journalism-drama, architec- ture, and art as occupations high in intrinsic reward orientation; m i a l work, medicine, and teaching are high in people orientation, and real estatefinance, hotel-food, and sales-promotion occupations are We most extrinsic reward oriented. Rosenberg’s concern was to show that persons with a certain value orientation would be more likely to choose an occupation characterized by such an orientation. We, however, are concerned with adapting the scheme to explore value differentiation within a particular occupation rather than across occupational p u p s .

The first assumption underlying our research is that the structural diversity of pharmacy, comprising as it does both a professional service and a business enterprise, will be reflected in a diversity of value-orientations in the profession. In other words, pharmacy, unlike a number of occupations studied by Rosenberg, does not have a dominant value-orientation but rather recruits persons from all three value-orientations. To test this assumption, a list of job characteristics was provided in our questionnaire from which our respondents were requested to select, in order of importance, the three characteristics which they regarded a s most desirable for their ideal career.6 Three of these characteristics were thought to be representative of the extrinsic value-orientation in their emphasis upon such factors as money, prestige, and security: (1) a job that provides a very good salary and one in which you work regular hours and have regular holidays; (2) a career that is considered desirable and which has prestige and status

Wonis Rosenberg, Occupations and Values (Glencoe, 1957).

41bid., 6.

m i d . , 16-20.

GThe characteristics which are broken down into analytic categor- ies for discussion below were scrambled when appearing in the questionnaire.

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Representation of Value-Orientations in Pharmacy

in the community; (3) a career that provides security of employment in that work is always available. Another three characteristics were thought to be representative of the people value-orientation in their emphasis upon the opportunity to interact with others and to be of duwt benefit to people: (1) a career that is useful and important to society in general and in which you can directly benefit your fellow man; (2) a career where you will have asso- ciates or colleagues who have the same general interests and whose company you find extremely stimulating; (3) a job in which you can meet the public and deal directly with people. The intrinsic valueorientation was thought to be represented by the following characteristics which emphasize the possibilitie of self-development and self- fulfillment, the intrinsic satisfaction of having mastered a body of knowledge, and the opportunity to exercise personal initiative: (1) an occupation in which you can use aZ2 YSW knowledge, training, aptitudes and skills and one which allows you to develop and excel in these areas; (2) a career that requires a good knowledge of science and scientific method; (3) a job where you are pretty well “your own boss” in that you are not always under the guidance and supervision of someone else.

Also included in the list were three additional characteristics which, though unconnected With the three value- orientations, were thought to be highly descriptive of the profession as it is actuaUy pra~ t i sed :~ (1) a job which in- volves a considerable amount of merchandising or retail selling; (2) a job that is highly competitive; (3) a career that is both a profession and a commercial business. These characteristics were included with the others in an attempt to measure certain divergences between ideal values and actual conditions, a matter which will be discussed later. These last three characteristics will be termed the “test characteristics. ”

Tabulation of the responses to the question just outlined revealed a distinct clustering pattern which took the following form: respondents whose first choice was an extrinsic characteristic were much more likely to choose an extrinsic or “test” characteristic for their second and third choices than a “people” or intrinsic characteristic. This pattern also held for those choosing a test characteristic first. Those respondents who chose a people characteristic first were much more likely to select a people or intrinsic characteristic for their second or third choices than an extrinsic or test characteristic. Again, this pattern held for those respondents who chose an intrinsic characteristic first. Table

7Our judgment in this regard was subsequently confirmed by the response to the question, “List in the order of t h e best description three of the above characteristics which, in your opinion, best describe the profession of pharmacy as it is actually practiced today.” For each of the three choices, over 95 per cent of our respondents selected one of the test characteristics.

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~~

Table I Representation of Value-Orientations in Pharmacy

Percentage of Respondents

Extrinsic and test cluster 41

People and intrinsic cluster 50

Other arrangements of characteristics 9

-

Total 100 (N=973)

I s h 0 ~ 7 . 3 that 41 per cent of respondents made three of their three choices from either the extrinsic or the test characteristics; 50 per cent made three of their three choices from the intrinsic or people characteristics; and 9 per cent made less than three of their three choices from either the extrinsic- test or the intrinsic-people complexes.

Their findings suggest that our assumption concerning the diverse nature of the value structure of the pharmaceutical profession is correct. They also suggest that a close alignment exists between the people and intrinsic orientations which sets them off, in combination, as a value group distinct from an extrinsic or test orientation.

As has been noted, over 95 per cent of the respondents confirmed that the test characteristics are in fact descriptive of the present actual practice of pharmacy. It can thus be seen that respondents characterized by an extrinsic orientation are much more likely to select the test characteristics for their ideal career than are those respondents characterized by people or intrinsic orientations. If we re-examine the wording of the test characteristics (with their emphasis on retail selling and competition) and the wording of the intrinsic and people characteristics (with their emphasis on scientific method, colleagues, and human- itarian service), it becomes apparent that the dichotomy of values we have encountered is an expression of the combination in pharmacy of a professional service with a business enterprise. Furthermore, the evident alignment between the test characteristics and extrinsic values is congruent with Rosenberg’s finding that the business-type occupations he studied tended more towards extrinsic orientation than towards people or intrinsic orientation.8 Our argument, then, is that the structural features of

pharmacy attract recruits from all three value-orientations outlined. The presence of these divergent value-orienta- tiom in the same occupation is crucial in examining a number of patterns of conflict and change in the occupa-

SRosenberg, Occidpatwns and Values, 16-18. Because of this evident alignment between the extrinsic and test characteristics, it was decided to make use of the latter in constructing the typology of respondents.

tioq9 for example, the differences in occupational satisfaction, preference for changing one’s field in pharmacy, the amount of informal and formal activity involved in recruiting for the profession, attitudes about the profession con- veyed in connection with recruiting (i.e., encoura,oing, discouraging etc.), and attitudes towards the entry of a son or daughter into the profession.

Clearly, value-orientations exercise an effect upon an occupation, especially in these areas of conflict and change. There is, in fact, considerable evidence to suggest that the occupational values held by pharmacists are ante- cedent to their entering the profession rather than the con- sequences of a structuring effect. in the occupation. A recent national study of pharmacy students, which also drew upon Rosenberg’s research, found a pattern of distribution in which were represented all three of the value- orientations discussed by that author.I0 In a study of pharmacy students some years ago, McCormack concluded that the socio-economic background of students would strongly influence whether they would have a “professional” or “business” orientation on entering the occupation. Our data show a similar direction of relationship between socio- economic background and “professional” or “business” or- ientati0n.l’

It is, of course, reasonable to inquire what effect the occupational milieu has upon value-orientations, especially because, as we shall see below, the division of labour in pharmacy is such that many pharmacists find themselves in sub-fields inconsistent with their value-orientations. Later in the paper we attempt to uncover possible “socializing influences” of the occupationlal milieu by controlling for the variables of age and the number of years spent in the subfield.

To facilitate the analysis we have combined the obviously congruent people and intrinsic orientations as one group, the extrinsic and test orientations as another, leaving out the small number of cases which contravene the general pattern (see Table I). This has reduced our analytical group by only 9 per cent and leaves 399 cases in the “extrinsic-test” group and 486 cases in the “people - intrinsic” group.

Th i s is not to suggest that the value groups we discuss will always be present in the profession. In fact, we shall be concerned later in the paper with changes which may occur within the occupation and which will have implications for its value structure.

1oAs yet unpublished research for the Royal Commission on Heal th Services in Canada, Ottawa, 1%.

11McCormack found that pharmacy students from lower income backgrounds were oriented more towards the “profes;iona!” than the “business” aspects of pharmacy, the reverse holding for pharmacy students from higher income backgrounds. Takinz thc “people-intrinsic” values and “extrinsic-tcxst” V R l u c l s as signs of professional and business orientations rcspectively, WP have :our,d a similar direction of relationship with :he srtcio (ywtlornic. ilaci<-

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Value-Orientation and Occupational Sub-Field

Pharmacy is differentiated into a number of occupational sub-fields, listed in the order of the percentage they constitute of our group of 885 cases: (1) independent retail, 67 per cent; (2) chain and department store retail, 17 per cent; (3) hospital pharmacy, 11 per cent; and (4) prescrip tion only stores, 5 per cent. Of these fields, the last two constitute the most purely “professional” practice of pharmacy in that they are completely divorced from the business of We familiar “drug store.” The number d jobs available in these fields is relatively small, however, and consequently a number of pharmacists oriented more or less towards a purely professional practice find themselves in the retail field. In that field, the chain and department store operations recently have developed as a large-scale business through introducing more and more varied non-medical merchandise, modern advertising methods, self-service and so on.”i2 The pharmacist becomes more of a clerk than a professional trained in the preparation of prescription medicinals. Independent retail practice remains the best example of the co-existence of professicmd and business functions, although even here competition from the chains is resulting in a diminishing of the professional element and a growing emphasis on the business enterprise.

Occupational subfield was found to vary significantly with value-orientation. As may be Seen from Table II, 96 per cent of hospital and “prescription only” pharmacists score in the people intrinsic value complex,l3 72 per cent of pharmacists in chain and department stores score in the extrinsic-test value complex, while in independent retail pharmacy the value-orientations are much more equally distrib- uted. The distribution of values gives additional support to the relationship suggested earlier between certain value groupings and professional or business orientation in pharmacy. For, as can be seen from the findings in Table 11, the most professional fields of pharmacy attract those respondents characterized by the people-intrinsic orientation, while the field most similar to large-scale business attracts respon-

grounds of our present respondents. It might be noted that Rosenberg’s general finding was that students from lower socio- economic backgrounds placed less emphasis on extrinsic values in occupational choice than did students from higher socio-economical background. See Thelma H. McCormack, “The Druggist’s Dilem- ma: Problems of a Marginal Occupation,” American Journal of Sociology, LXI, 4, 1955, 308-15; and Rosenberg, Occupations and Values, 53-9.

IzChanges during the last ten years in the structure of retail pharmacy and the implications these hold for the pharmacist’s occupational role have been developed more fully in the study of a large drug store chain in the author‘s M.A. thesis, “A Study of Decision Making in Four Complex Organizations” (unpublished), University of British Columbia, 1964.

13Hospital pharmacy and “prescription only” pharmacy are sum- ciently similar, in the sense of being the most purely professional form of pharmacy, to be combined for the purposes of our analysis.

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Table I1 Occupational Sub-Field and Value Group, in Percentages

Independent retail 54 46 100 ( N = 593)

Chain and department store 72 28 100

Hwpital and “prescription 4 96 100

retail (N = 150)

onIy” pharmacy ( N = 142)

dents characterized by the extrinsic-test orientation. The distribution of value groupings in the independent retail field k more equal because this field is still the most diversified in terms of the representation of profesional and business functions and is the largest employer of pharmacists, consequently involving many perscms from both value groups unable to obtain work in the other fields. Finally, the six cases in hospital and “prescription only” pharmacy which scored in the extrinsic-test complex were omitted from the analysis because they ccmstitute too small a number with which to make meaningful comparisons within that sub-field.

Value-Orientations and Our next concern was to measure occupaticmal satisfac- Occupational Satisfaction tion within the profession. Respondents were asked to

rate their satkfaction with their present job in pharmacy on the five-point scale: “very satisfkd,” “fairly satisfied,” “neither satisfied no dissatisfied,” “somewhat dissatisfied,” and “very dissatisfied.” As may be seen from Table Ill, respondents characterized by the extrinsic-test value-orientation are much more likely to be satisfied with their jobs in independent, chain, and department store retail pharmacy than are those respondents characterized by the people-

Table III Occupational Satisfaction and Occupation-Value Group, Percentages

Extrinsi:-test 76 15 3 3 -- 100

People-intrinsic 9 18 12 41 20 100

Extrinsic-test 88 10 2 -~

People-intrinsic - 5 10 50 35 100

( N = 320) _ _ ~

( N = 273)

100 ( N = 1088)

-

Ind-ndent retail

( N = 42)

Chain and department store retail

pharmacy - 29

intrinsic value orientation. The latter group express much more occupational satisfaction in the field of hospital or “presrription only” pharmacy. These findings further support the earlier suggestion that,

as the largest field of pharmacy, retail practice becomes the work of many whose value-orientations would ideally place them elsewhere in the profession. This is made very clear in the response to the question in which we asked pharmacists in which field of pharmacy they would prefer to work. (An “other” category was provided for those respondents for whom no field of pharmacy was accept- able.) Table IV shows that respondents characterized by the extrinsic-test value-orientation are much more likely

Table IV Preferred Field of Pharmacy and Occupation-Value Group, in Percentages

5;

- (d +I

Exhinsic-Test fj4 34 - 2 100

PtmplSIntrinsic 22 - 69 9 100

( N = 320)

( N = 273)

Mependent retail

ESrtrinsicTest 1 96 - 3 100

store l-ehil PeopleIntrinslc 22 3 71 4 100

( N = 108) deparfment

( N = 42)

People-Intrinsic 2 -~ 91 7 100 (N = 136)

Hospital and

Pharmacy

to prefer a field in retail practice than those respondents characterized by the people-intrinsic value-orientation The latter group, when found in retail practice, show a strong propensity to prefer a field outside. When they are found in hospital or “prescription only” pharmacy, however, they show a marked tendency to prefer that field.

Value-Orientations and The last set of findings we shall present relate to certain Participation in Recruiting variations in a number of attitudes and actions of, respon- Activity dents which affect recruitment into the profession. Our

questions related to four specific areas: (1) The number of formal recruitment talks our respondents had given to student groups or other groups during the year preceding receipt of the questionnaire. (2) The number of informal tallrs our respondents had with individuals seeking information about the occupation during the year preceding receipt of the questionnaire. (3) The impression of pharmacy as

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a career our respondents had given in reply to informal requests for information (in tmns of the scale “very encouraging,” “fairly encouraging,” “neither encouraging nor discouraging,” “somewhat discouraging,” “very discour%g- ing”) . (4) The attitude which our respondents held regarding the prospective entry of a son or daughter into the profession of pharmacy. The range of response was “very pleased,” “fairly plea.wd,” “indifferent,” “somewhat displeased,” “very displeased.”

In Tables V, VI, VII, Vm and Lx, it can be seen that in contrast to the independent, chain, and department store retailers characterized by the extrinsic-test orientation or hospital or “prescription only” pharmacists characterized by the people-intrinsic orientation, in each of the areas specified above, independent, chain, and department store retailers characterized by the peopleintrinsic orientation give fewer formal recruitment talks, give informal advice

Table V Number of Formal Recruitment Talks and Occupation-Value Group in Percentages

(ExtrinsicTest 18 37 35 5 2 3 100 (N=3201

100 People-Intrinsic 53 44 3 - - - Independent retail

(N=Z73)

Extrinsic-Test 12 25 39 17 5 2 100 -__ ____

Chain and ( N = 108)

People-Intrinsic 20 26 19 30 5 - 100 (N= 136)

Hospital and “prescription only” pharmacy

Table VI Number of Informal Recruitment Talks and Occupation-Value Group, in Percentages

1-2 34 5-6 7-8 9-10 10f Total

Extrinsic-Test 7 30 41 14 5 3 100

People-Intrinsic 61 37 2 - -

Extrinsic-Test 4 25 52 12 7 -- 100

People-Intrinsic 55 31 14 _ _

(N=320)

- 100 (N=273)

( N = l W )

100 (N=42)

-

Independent retail

100 (N-136)

{ Chain and department store retail

People-Intrinsic 39 47 14 Hospital and

only”

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less frequently,l* convey a less favourable impression of the profession when they do, and are more negatively disposed towards the prospect of a son or daughter entering pharm-

Table VII Impression of the Profession and Occupation-Value Group, in Percentages

100 (Extrinsic-Test 71 26 3 - - (N=320) I People-Intrinsic 11 12 18 45 14 100

Independent retail

100 (N=108)

Extrinsic-Test 92 7 1 - -

- 3 8 62 27 100 (N=42)

.Chain and department store retail

People-In~nsic 97 3 -- - 100 -_ (‘N=136)

Hospital and

O n l y ” pharmacy

Table VIII Attitude Towards Entry of Son Into Profession and Occupation-Value Groups, in Percentages

3 G

hdependent retail

E M i C - T W t 69 21 8 2 - 100

People-Intrinsic - 7 n 4 6 2 6 100

(N=320)

(N=!Z73) ~ ~~ ~

100 - Extrinsic-Test 7l 23 6 -- Chain and “=la)

People-Lntrinsic - 6 1 2 4 7 3 5 zoo (N=42)

department store retail

85 9 - 6 -- 100 (N=l36)

Hospital and

only” pharmacy

14A control for city size revealed here that as population in- creases so does the amount of formal and informal recruitment acti-vity by pharmacists. However, there was no significant varia-

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Table IX Attitude Towards Entry of Daughter .Into Profession and Occupation-Value Group, in Percentages

Hospital and “prescription

p-aw only” 4

Independent retail

100 (N=l36)

_- P e o p l e I n m c 89 9 2 - -

100 Extrinsic-Test (N=320)

People-Inmic 5 39 2l 30 5 100 (N=Z73)

75 19 6 - -

Chain and department store retail

~~ ~

- 100 ’Extrinsic-Test 87 13 - ._

People-Intrinsic 4 42 18 16 20 100

(N=lCB)

(N=42)

The Influence of the By breaking down the occlrpational sub-fields by value Occupational Milieu on Values group and then controlling for the variables of age and the

number of years spent in the sub-field, we have attempted to investigate whether or not the occupational milieu has a “socializing effect” on the value-orientations held by pharmacists.

It was found that controlling for age and We number of years spent in a subfield revealed no signiScant variations in the distribution of valutwrientations h each of the sub fields. This finding is contrary to the oommon-sense expec- tation - especially for people-intrinsic oriented pharmacists employed in independent, chain, and department stores - that a conflict between values and job would lead to a change in one or the other. However, we now believe that certain ideological forces are operating in pharmacy which serve to sustain the people-intrinsic values in the face of this conflict.

Discussion We have attempted to show that We structural diversity of pharmacy attracts recruits with different mlue-orientations. Our approach has also facilitated the Iucation of the

tion in the distribution of values by city size and we therefore suggest that the basic relationship posited between values and recruitment activity holds. It might be noted that hospital and “prescription only” phannarists are considerably higher in the area of formal recruitment talks than in the area of informal recruitment contacts, largely because their work in hospitals and laboratories affords them fewer opportunities for informal inter- action with the public than a retail pharmacist

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most pronounced area of conflict in the profession, the people-intrinsic value group in independent, chain, and department store retail practice. In a number of areas, such as occupational satisfaction and recruitment activity, this group has consistently proven to be the most dissatisfied. Our findings suggest that this is a result of the present nature of the division of labour in pharmacy whereby many respondents characterized by the essentially professional people-intrinsic value-orientation find themselves in a field of pharmacy where the professional function is subordinate and dimini~hing.’~ This was further confirmed throwh fifty interviews (supplementary to the questionnaire) with a random sample of respondents classified in the people- intrinsic value group and practising in independent, chain, and department stores. Over 90 per cent stated, in one form or another, that they felt that although trained as professionals they had little or no opportunity to realize adequately or utilize their special training in retail pharmacy. Another set of fifty interviews carried out with respondents classified in the extrinsic-test group and practising in chain and department stores revealed that these pharmacists, though much more satisfied with their jobs, also fe l t that their pharmaceutical training was unsuitable for their work.16 In their case, however, it was the absence of ade- quate business training that was lamented rather than the absence of an opportunity to make use of pharmaceutical howledge and techniques.

The material from these interviews as well as the findings reported earlier are evidence of a wide discrepancy between the nature of professional education in phannacy and the a c t d practice of the profession. The present situation is perhaps best understood in terms of Bucher and Strauss’ model of professions in process which “posits the existence of a number of groups, called segments, within a profession, which tend to take on the character of social movements. Segments develop distinctive identities and a sense of the past and goals for the future, and they organize activities which will secure an instiMonal position and implement their distinctive mis- sions. In the competition and conflict of segments in movement the organization of the profession shift~.’’~7 In pharmacy we may identify two mlajor “segments” which

15See discussion of the Elton Chain Operation in Edward Harvey, “A Study of Decision Making in Four Complex Organizations.” The line of business diversification and development followed by the Elton Chain was inspired by innovations carried out by chain operations in the United States. The types of change carried out by the Elton Chain have now been widely copied by smaller chain operations in Canada.

16For other examples of role strains arising from professional education 5ee Marshall Sklare, Conservative Judaism, An Amer- ican Religious Movement (Glenme, 1955); R. G. Corwin, “The Professional Employee: A Study of Conflict in Nursing Roles,” American Journal of Sociology, LXVI, 6, 1961, 604-15.

17Rue Bucher and Anselm Strauss, “Professions in Process,” American Journal of Sociology, LXVI, 4, l961, 325.

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~

are, in fact, the institutionalized punterparts of the two major value groupings outlined in the course of this analysis. One segment is composed of the pharmaceutical training schools and professional associations which are primarily cmcerned, substantively and ideologically, with maintaining pharmacy as a profession. For example, our recent examina- tion of over 85 per cent of the curricula available from all pharmacy colleges in Canada and the United States disclosed that, on the average, courses in pharmaceutical business or merchandising comprised less than 8 per cent of the curri- culum. The ideology of professionalism is discussed in detail in a forthcoming paper.l8 The second segment com- prises the increasingly powerful chain and department store interests which are concerned primarily with the diversification of merchandise and the general development of retail pharmacy as a business enterprise.lg Some interviewees in independent retail (people-intrinsic value group) suggested that chain and department store interests used the professional function of filling precripticms as a “loss leader,” offering to fill “any prescription for $1.00 while you wait” to attract customers and thereby increase sales of non-medicinal merchandise. In any event, chain and department store pharmacies continue to expand and take over independent retail operations which find the problem of remaining economically viable increasingly difEdteO

Pharmaceutical educators face the dilemma that though commercial expansion threatens the professional function, that function has lost most of its significance because of a number of technological changes, in particular the large- scale manufacturing and pre-packaging of drugs by drug houses which has all but eIiminated the pharmacists’ main professional function, of filling prescriptions. The ideology of pharmacy as a profession prevails among pharmaceutical educators, but there is now doubt and disagreement about

18For relevant material see, for example, The Gaeral Report of the Pharmaceutical Survey 19469, ed. E. C. Elliot, Director, Amer- ican Council on Education, Washington, D.C.; Joyce Nemeth, “A Code of Ethics for Pharmacists,” Canudhn Pharmaceutical Journ- al, XCVI, 8, 3425; Keith Lawton, “A Year of Outstanding Pro- gress for Canadian Pharmacy,” Canadian Pharmaceutical Journ- al, X W I , 9, 36870; “Canadian Pharmaceutical Association Con- vention Resolutions,” Canadian Pharmaceutical Journal, XCVII, 9, 382-3.

19For further development of this point see Edward Harvey, “A Study of Decision Making in Four Complex Organizations.“

zoNo exact statistics are presently available on the decline of independent retail and the expansion of the chains. However, when present a t a national meeting of pharmacists recently, the writer received the impression that independent retailers were finding it increasingly difficult to remain competitive with the chains and that some had been forced out of business. In this connection, see the comments regarding the taking over of independent retail operations by the Elton chain in “A Study of Decision Making Processes in Four Complex Organizations.”

what the profession will or should be.21 Though pharmaceutical educators are attempting to decide such issues they are subjected to pressures from the top management of chain and department store interests who desire that more business courses (e.g., merchandising, management, etc.) be introduced into the training programme. In an inter- view with the director of one of the largest chain oprations in Canada the writer was told that, “We lose money on a newly graduated pharmacist. It takes about two years to make a good manager of him. He doesn’t learn that at university. Yes, we’d like to see the university training changed to include a lot more business and managerial background.”22 A number of large chain operations have developed what might be referred to as their own re-training programmes for the newly graduated phannacists they employ.

Thus we have a situation where the Occupation is divided into two segments which are in conflict over who shall dire& and control change in the occupation and what form this change will take. Both segments will continue to gain supporters as long as the structure of pharmacy is such as to attract some recruits who are oriented towards a profession and some who are oriented towards a business.

The questions now arise of how long this conflict will prevail and what the outcome will be. We would suggest that much depends on the extent to which the professional educator and associations are able to obtain material support for their ideology of professionalism. For example, a strong theme in the ideology of professionalism is that the phamacist must seek to establish “a new professional role” as a consultant on drugs to the physi~ian.~3 But there is much evidence to indicate that this particular function is already monopolized by the “detail men” of the large drug Should the ideology of professionalism fail to realize its aspirations - as seems likely - it is doubtful if pharmaceutical educators and associations will be able to resist the pressures by the pharmaceutical bus- inessmen for a change in the MtUre of the professional education.

Reference was made earlier to technological innovations, in particular to the large-scole manufacture and pre-packaging of drugs, which have had a profound effect on the professional functions of pharmacy and have made a direct

2lSome feel, for example, that the pharmacist must find his “new professional role” as consultant on drugs to the physician; others feel the pharmacist should become consultant on drugs to ‘he public.

22Edward Harvey, “A Study of Decision Making in Four Complex Organizations,” 32-3. The growing control over pharmacy by the large outlets is similar to William !Miller‘s account of publishing in The Book Industry (New York, 1949).

23See Joyce Nemeth, “A Code of Ethics for Pharmacists.”

24For a guide to much of the literature in this area, see Everett M. Rogers, Diffusion of Innovations (Glencoe, 19621, 46-51.

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contribution to the development of the business aspeds of the occupation in that these innovations have become the major s o m e of income. In this sense they may be seen as the basis or beginning of the conflicts discussed here. But change is inevitable in any occupation. Indeed, a number of earlier contributions to the literature have ex- plored such processes of occupational change as b u r e a r n - tization, professionalizatim, the contingencies of speclaliza- tion, and the transition from craft to manipulative skills.25 We believe that the identification and analysis of the gen- eric features of such change in several Occupational groups may usefully be pursued by focussing on the relationships obtaining between occupation& values and occupational contexts.26

Z S S e e , for example, Harvey L. Smith, “Contingencies of Profes- sional Differentiation,” Amerkam Journal of Sociology, LXIII, 4, 1958, 410-14; Harvey L. Smith, “Psychiatry: A Social Institution in Process,” Social Forces, XXXIII, 4,1955,31&16; Walter L, Ward- well, “Social Integration, Bureaucratization, and the Professions,” Social Forces, XXXIII, 4, 1955, 356-9; Harold L. Wilensliy, “The Professionalization of Everyone?” American Jozlrnal of Sociology, LXX, 2, 1964. 137-58; Howard M. Vollmer and Donald L. Mills. “Nuclear Technology and the Professionalization of Labor,” American Journal of Sociology, LXVII, 6, 1962, 6W6; Oswald Hall, “The Salaried Doctor: Half Medical Man, Half Ad- ministrator,” mimeo, Ottawa, Canada; Joseph Ben-David, “The Social Structure of the Professions in Israel,” unpublished, Hebrew University, Jerusalem; David Riesman, The Lonely Crowd (New Haven, 19501, especially 1 S 5 , on the transition from craft skill to manipulative skill.

zl6The implications of the present paper are developed in more general form in Edward Harvey, “Some Implications of Contextu- al Dissonance in Changing Professions” (forthcoming).

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some implications of value differentiation in pharmacy

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