What Pharmacy School Doesn't Teach You About Business

The University of Toronto gave me a world-class clinical education. It taught me almost nothing about how to actually run a pharmacy.

I graduated with a Doctor of Pharmacy and could counsel a patient on the pharmacokinetics of any drug in the formulary. I could identify drug interactions, manage chronic disease states, and interpret lab values. What I could not do was read a balance sheet, negotiate a commercial lease, price a service for profit, or manage an employee.

That gap between clinical competence and business competence is where most pharmacy graduates fall into one of two paths. Either they become excellent employees who work for someone else's pharmacy for their entire career, or they open their own pharmacy and learn business the hard way — through expensive, avoidable mistakes. I took the second path. The tuition was steep.

Financial Literacy: The Missing Course

Pharmacy school at U of T did not include a single meaningful course on business finance. Not one class on reading a profit and loss statement. Not one lecture on cash flow management. Not one discussion of how corporate tax structures work in Canada or why incorporating matters.

When I opened Cloud Pharmacy, I had to learn all of this in real time while simultaneously running a clinical practice. I taught myself double-entry accounting. I learned what HST input tax credits were after I had been failing to claim them for months. I figured out the difference between a salary and a dividend — and the wildly different tax implications of each — from an accountant who looked at me like I should have known.

Every pharmacy owner I know has a version of this story. We all arrived at business ownership with deep clinical knowledge and shallow financial knowledge. Some caught up quickly. Others burned through their capital before they figured it out. The ones who failed were not bad pharmacists. They were good pharmacists who nobody taught to read a P&L.

Negotiation Is Not in the Curriculum

Pharmacists negotiate every day without realizing it — with patients on adherence, with physicians on therapy changes, with insurance companies on coverage. But the formal skill of business negotiation — supplier contracts, lease terms, partnership agreements, employee compensation — is never addressed in pharmacy education.

When I negotiated my first commercial lease for Cloud Pharmacy, I did not know what "triple net" meant. I did not know I could negotiate the tenant improvement allowance. I did not know that the first offer from a landlord is a starting position, not a final number. I signed terms that a more experienced negotiator would have improved significantly.

At Canadian Web Designs, negotiation is a core business function. Every client contract, every vendor agreement, every partnership proposal involves negotiation. The skill I eventually developed came from repetition and a few painful losses, not from any formal education. Pharmacy schools could save their graduates years of learning by spending even a few hours on basic negotiation principles.

People Management Is a Blind Spot

Managing pharmacy technicians, assistants, and eventually other pharmacists requires a skill set that pharmacy school does not acknowledge exists. The assumption in pharmacy education is that management is intuitive — you are a competent clinician, so leading a team of clinicians should come naturally. It does not.

The first time I had to give critical feedback to a pharmacy technician, I handled it poorly. I was either too indirect, which meant the message was not received, or too blunt, which created resentment. Finding the balance between directness and diplomacy took years of trial and error across all four of my businesses.

Performance reviews, firing decisions, conflict resolution between team members, motivating people who are having a bad month — these are daily realities of owning a pharmacy, and not one of them was covered in my education. I have had to learn management from books, from mentors, from making mistakes, and from watching what happens when you get it wrong.

Marketing Your Practice

Pharmacy students are taught that good clinical care markets itself. Patients will find you because you are competent. This is false.

In the GTA alone there are thousands of pharmacies. Competence is a baseline expectation, not a differentiator. The pharmacies that thrive — including Cloud Pharmacy — are the ones that actively market their specialization, build a referral network, and maintain a visible presence in their community.

Building Cloud Pharmacy's reputation as the number one HIV and PrEP pharmacy in Toronto required intentional marketing: building relationships with specialist physicians, establishing a presence in community health organizations, maintaining strong Google reviews, and creating content that helps patients find me before they find a competitor.

None of this was taught. In pharmacy school, marketing was vaguely associated with pharmaceutical company sales reps — something to be skeptical of, not something to learn. The result is a generation of pharmacy graduates who are excellent at clinical care and invisible to the market.

What Should Change

I am not advocating for pharmacy schools to become business schools. The clinical training at U of T is rigorous and necessary, and I would not trade a single pharmacology lecture for a marketing class. But the profession needs to acknowledge that a significant percentage of graduates will become business owners, and those graduates deserve at least a foundational understanding of finance, negotiation, people management, and marketing.

A single elective course — one semester of practical business skills for healthcare professionals — would prevent thousands of dollars in avoidable mistakes for every pharmacy graduate who decides to own instead of just practice.

Until that course exists, the education happens on the job. It is more expensive and less efficient than it needs to be. But if you are a pharmacist reading this who is considering ownership, know that the learning curve is real but survivable. You just need to accept that your clinical degree is the beginning of your education, not the end of it.

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Related reading:

• Why Pharmacists Make Great Entrepreneurs — The skills pharmacy school does give you
• The Real Cost of Running a Small Business in Canada — The financial literacy gap in action
• Hiring Your First Employee: Lessons From Four Businesses — The people management gap