A couple of months ago, I had the opportunity to visit two pharmacies from the same chain shortly before they closed on a Monday night. Both pharmacists looked horribly frazzled. One had filled 600 prescriptions in a 12 hour day with no overlap, the other 610, also no overlap. In describing their day, both used similar language: The day had been a disaster waiting to happen.
Though employers still claim that staffing is adequate for the work load, chain pharmacy no longer makes any attempt to deny that there have been substantial cuts in tech hours and pharmacist overlap while at the same time new and additional duties are being heaped upon their pharmacists. Immunizations, MTM, patient phone calls, Medicare, prescriber phone calls, etc, all of which have metrics by which the pharmacist (and continued employment) is evaluated. Despite the increased workload, most chains still only use one criteria for the amount of tech help provided: the number of prescriptions filled. The remainder of the workload is not considered worthy of tech help, even though these duties require significant portions of the pharmacist’s time.
This is occurring at a time when boards, legislatures, colleges of pharmacy, professional journals, et al, are all calling for provider status. While the concept of enlarging the role of the pharmacist in the overall health care environment is more than a good thing, currently the pharmacists in the trenches are more often than not thinking “Oh great, what are they going to throw at me now?” Currently, provider status in the front lines is desired only if it gets more help in the pharmacy.
Though often only anonymously or in speaking to each other, pharmacists are not quiet on this issue. While many do not complain to superiors for fear of losing their jobs, dissatisfaction is widespread and growing.
One of the outcries by pharmacists is to bring in unions—strength through numbers. A pharmacist union would force employers to provide adequate help. But there are down sides to unions. Union organizers are often non-professionals—will they truly understand the issues faced by the profession? Is joining going to be forced or voluntary. If the latter, how will the dues-paying members feel about others getting the benefits of unions for free? Also, union dues are usually a big chunk and chain pharmacy, with its spreadsheets showing the actual and undeniably shrinking reimbursement all pharmacies face, would force other concessions to absorb the cost of additional help in the pharmacy. Ready to trade your health insurance for more tech help?
Another call is for pharmacy boards to step in and save the day. So far, according to what material I can find, only Oregon has taken a step and pretty much all that the board there did was poll its pharmacists about working conditions, then pass a mediocre regulation.
Should the Board of Pharmacy intervene?
This is a question with strong and compelling reasons for either a “no” or “yes” answer.
The board of pharmacy is here to protect the public, not the profession. Bad working conditions (save issues like sanitation) are not the purview of the board.
One and perhaps the biggest argument against board action is that the profession allowed itself to be put in this position and the responsibility to make it right also falls upon us. Too many voices refuse to speak however because the pharmacist shortage has ended and we fear for our jobs and our livelihood; we can be replaced easily today. Even a decade ago, the shortage protected us. Corporate kowtowed and failed metrics were brushed aside more often than not.
It is not like we did not see the number of pharmacy schools opening and could not guess that the end of our reign was coming—this writer has been. Too many relied on the Pharmacy Manpower Report–which predicted a shortage until at least 2020–without reading said report, which predicated its premise of a continuing shortage on 1.5 new schools of pharmacy per decade instead of the 25+ we got. But the truth was out there for all to see and it was pretty much overlooked and/or ignored.
Pharmacy as a profession has failed to unite and become an organized profession in the sense of possessing political and bargaining power. We are a fractured profession with many types of associations and no binding force between them. Flush with our past domineering position and high salary, few of us thought we would ever have need of these associations, so we did not join nor did we seek to join them into one powerful force for pharmacy. That is our fault, not the board of pharmacy’s.
The solution to the overworked, understaffed and unfair situation in chain pharmacies is for the pharmacists themselves to step up and take action. Slow the workflow to an acceptable level, speak up, refuse to do part or all of the added responsibilities until the workflow is deemed safe. Beyond that, it is (way past) time for this profession to unite and organize as a profession, to become a strong political force that can protect the people in it, provide decent working conditions, and advance us in the health care environment.
Then look at what would be needed to ease the situation. A limit on the number of prescriptions a pharmacist could fill per day and a required number of tech hours based on prescription history. A pharmacist-to-tech ratio. Board action would meet substantial opposition. The chains would bring to bear their considerable influence. And once again, some pharmacists working for these companies are going to side with their employers, maybe because they want to protect their job, maybe for other reasons.
And what about independents? These restrictions would force many of these one-pharmacist pharmacies to hire unneeded help, possibly a pharmacist that would only be truly needed a couple of hours at the end of the day. For indies, the restrictions and limitations to protect overworked chain pharmacists could mean the difference between profit and no profit in these days of ridiculously low reimbursement. The difference will be, for some, keeping the doors open and being forced to close So make a law only for chains with metrics? The chains would justifiably fill the board offices with lawyers ready to file lawsuits claiming 14th Amendment Equal Protection violations. Most indies are not going to support board intervention, and the chains will fight new regulations aimed solely at them.
Another reason for no intervention is that the KY Board of Pharmacy has not done so yet. The KY board is innovative and inventive and willing to take on issues. I am a big fan. That it has not done so indicates that they see no reasonable basis for doing so, at least at this time.
(And remember that this is coming from a pharmacist-attorney who makes a good portion of his income defending pharmacists and pharmacies when the Board comes after them. A big fan, yes, but hardly a sycophant—just mention the board’s overzealous and wrong use of lifetime revocation of license as a punishment and I will get on my soapbox)
What reason is there for the board of pharmacy to intervene? Currently, it is generally recognized that these staffing cuts and added duties have resulted in an increase in the number of prescription errors. (EG, see the popular pharmacy magazine DRUG TOPICS, but today on social media there is a story—the second one I have seen—about a lawsuit where an error occurred and the pharmacist is claiming the misfill was due to over work and too little help). The health and well-being of our patients is being placed in peril by pharmacists, as above, having to be responsible for 600 prescriptions a day. The danger in this is as apparent as a slap in the face. Despite these articles, there have been no changes.
Should the board intervene? I will make my answer “Yes” the day pharmacists fail to get control of their work environment and I read or see where an error by an overworked pharmacist kills a child. When we fail on that level, the board should and will intervene and we will just have to adjust. Still, as with a union, I expect that any law dealing with overwork is going to have unwanted and unseen consequences as well as benefits.
OK. Weigh in, readers