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 This is Over the Counter, a podcast from 

. I'm Gabrielle Ientile. In this episode we'll be talking about professional burnout in the pharmacy, the many factors that lead to and intensify burnout, and what impact the COVID-19 pandemic might be having on rates of pharmacist burnout.

What is professional burnout? Experts generally define burnout from 3 aspects: 1, physical and emotional exhaustion; 2, depersonalization; and 3, one’s sense of autonomy and personal accomplishment.

 It's typically measured along those lines and individuals who are feeling a lot of exhaustion and a lot of disengagement tend to have higher burnout scores.

 That's Caroline Gaither, a professor in the department of pharmaceutical care and health systems at University of Minnesota College of Pharmacy. Dr. Gaither is coauthor of a national survey of pharmacist burnout and engagement, which was presented at the Midwest Pharmacists Workforce Consortium. Here's Dr. Gaither again to explain the results of that survey.

 They're telling you that the workloads have gotten higher and the staffing has decreased, and that has increased their feeling of job stress and also influence their satisfaction levels. So that has been another thing that we think has also contributed to some of these levels of exhaustion we've seen with the workforce study.

 Jon Schommer, a study coauthor and a professor in the department of pharmaceutical care and health systems at the University of Minnesota College of Pharmacy, explained that making sure pharmacists avoid burnout isn't enough. Pharmacists should be able to grow and thrive in their professional environment too.

 And then in addition to burnout, which is something that you would like to avoid, we also do research in the area of what's called well-being. That's being able to have constructive conditions at work and beyond even in your personal life that enable workers to thrive and achieve their full potential. So we're looking at: let's avoid burnout and some of the dimensions of that, but let's also look at our healthcare professionals able to thrive and achieve full potential.

 Matthew Witry, coauthor of the survey and an assistant professor in the department of pharmacy practice and science, division of health sciences research at the University of Iowa College of Pharmacy, said to keep in mind the complexity of these factors, individual and systemic.

 It's hard to disentangle these elements. If you're incredibly exhausted, because of a setting issue that's leading to exhaustion, that might prevent some of that personal accomplishment ability. A lot of these things are going to interact. Depersonalization, you might see more of that if you're already emotionally exhausted, so all these things are interacting with each other.

 Here's Dr. Gaither to shed some more light on these interconnected factors.

 National Academies of Science, Engineering and Medicine have been focusing on this issue of clinician burnout, and they've developed this model that I really do like. It talks about how you have frontline workers, and then you have these frontline workers, the health providers, who work for a particular health care organization who has different policies and procedures. Then there's also the external environment - so the things that are happening outside - and all of those things influence the provider who is providing care. They've talked about these work system factors which are things like job demands: so, what is your workload? How many hours are you working?

There's this idea of resources, and 1 of the things they talk about in terms of resources is how much control you have in your job. Those kinds of things are really influenced by the workplace and the system that you're working in. If there's a good balance there, then the health provider is able to really thrive but when the job demands become too high, then that's where you can get into some of the more negative consequences.

The other piece of that is, they say that these work system factors are also influenced by kind of the individual: so how much resilience that person has, and their ability to cope with adversity, and also how much their work and life are integrated. That can also influence burnout or the fulfillment that the health provider feels. I really I like the model because they've started to talk about the system factors that are beyond what the individual provider is able to contribute, and talk about the fact that burnout is not necessarily related to some kind of individual failure, but it's really related to kind of the way the work environment is structured.

 Dr. Gaither mentioned that corporate-owned chain pharmacy environments, where business decisions are out of pharmacists hands and workloads are increasing, those large companies are at risk for potentially burning out their pharmacists. But what about community pharmacies?

We’re seeing in community pharmacy practice that there's this great stress to conveniently and quickly and efficiently distribute medications, and that whole business model is changing.

 Improving pharmacy business models are vital for keeping pharmacists from burning out and staying in business. An estimated 2000 pharmacies have closed since 2018, many located in regions of the United States that are home to vulnerable populations, where their first point of care is often in their local pharmacy. Another non-negotiable way to minimize burnout and help pharmacists find fulfilment at their place of work is to address the system factors at play. 

As Dr. Gaither, Dr. Witry, and Dr. Schommer all mentioned, burnout is mainly a product of the health care system factors that get in the way of true fulfillment for medical professionals. Dr. Schommer explained that pharmacists are experiencing increasing pressure not just to be fast and efficient, but to be faster and more efficient in an increasingly competitive and instant-delivery world.

 In community pharmacy, practice, the distribution of pharmaceuticals is so vital and you have to have that pressure on you all day long to be as efficient as possible. At the same time, community pharmacies are being recognized by the public, by government agencies such as CDC, etc., as health care access points, that you can get vaccinations and immunizations and screening and point-of-care testing. There's a lot of patient care and public health services that are being provided. When you put those two goals together, work systems get very complicated, and it's very difficult to do both within the same space.

While pharmacists might be willing to take on these additional responsibilities to support their patients and provide the best care they can, these burnout factors - exhaustion, depersonalization and lack of a sense of autonomy and personal accomplishment - as well as the system constraints, can make it possible, especially during a pandemic.

They’re talking about this idea of moral injury, where the health providers want to be able to do certain things, but they're not able to because of other kind of constraints with within the organization, and that really affects how they can work to the best of their ability. Some of the things that I've heard about in pharmacy, is whether pharmacists get PPE and because they need them as well if they're going to be giving vaccinations and doing some of the services that the pharmacists typically do. What happens if your staff in the pharmacy gets ill with COVID-19?

The other thing that I think a lot about is, you're also serving people who have chronic illnesses, and whether they can get their medications. Are they afraid to come to the pharmacy? Are they still being taken care of in this situation?

I think there's a lot of things that this pandemic is revealing about the holes or disparities in the system. The other thing is some of the pharmacy benefit managers cutting some of the reimbursements. This is not the time to cut reimbursements, or do things that can inhibit the abilities of the pharmacist to do different tasks. That is something to that I'm hoping; I hope that these reimbursements and the way that pharmacists and other health providers are reimbursed does not get short shrift.

 Dr. Witry gave us an example of just how complex burnout factors can be, especially during a pandemic. He explains that while pharmacists may be emotionally and physically exhausted from working longer and more frequent ships, and my experience depersonalization from having to provide care to patients from behind a mask, and a plexiglass guard, they might also feel elevated levels of personal accomplishment for being able to assist the patients when they need them most.

 If someone feels that their employer isn't providing a safe environment, or you're interacting with patients who aren't taking this seriously, I would imagine that that's going to be a significant source of anxiety. On the other hand, a lot of pharmacists are probably feeling really appreciated. They're making a difference. They’re getting that getting that care to people, being that access point, answering important questions, being a source of care when people aren't going to their primary care physician appointments. They can still call their pharmacist or they can still talk to the pharmacist across the Plexiglas. The pharmacists are still in that position, especially in the community setting.

 There are also other potential issues that the COVID-19 epidemic can bring to the surface too, like hoarding medications and administering vaccines.

 As we move forward in the future, there will be new things. There's some evidence that patients are becoming very acutely aware that there could be drug shortages due to the pandemic and the effect on manufacturing around the world and are starting to consider hoarding and stop taking medications so that if it runs out, they would have a supply There's a lot of anxiety for our patients that we that we help. Also, what kind of role from a public health standpoint would pharmacists play? When a vaccine is discovered and developed or there's treatments being provided, there's a whole new set of things that pharmacists will be looked to provide and that requires change and updating our work systems and our processes of care. That all creates the opportunity, or the possibility, that pharmacists will experience stress and burnout.

 Experts are hopeful that the COVID-19 pandemic will open up the opportunity for improving pharmacist care and addressing health care system shortfalls.

 It opens up new opportunities for pharmacists to do really what we're called to do, which is to take care of our patients.

 We've recognized how fragmented our care system is, so being able to better communicate across different health providers and across different health systems. You have the pharmacists in the community, you have the pharmacist in the health system, pharmacists in long term care, and the ability to better communicate, I think across the different pharmacists, but also with other health providers would be very, very important.

Also, do the pharmacists feel that the employers kind of have their backs? Do they feel supported? I would say that in some places, they may not feel as supported as they could. Our employers really stepping up to take care of their health providers, I think is something that also probably needs to change. And then this idea of, I'm not exactly sure how to say this, but the profit motive in health care. There’s a lot of things that we could do better with if we had more resources and more reimbursements and those kinds of things to really provide patient care.

 So with the task as big as the United States health care system, what are the next steps?

 We like to use a certain quote. We look at the financial pressures in health care system, all the burden of documentation that we that we do in healthcare, the pressure to meet production metrics are places of practice, and this constant specter of litigation that's over us, really distract us from patient centered care, and it can even lead to conflicts of interest. If it happens once in a while, that's 1 thing, but it's in incessant, intensely routine, drip, drip, drip that we experience and again, as we talked before, really improving the systems in which we work, and that can be everything from personnel staff, processes of care, computer systems and technology needing to be updated, so they interact and provide information that we need when we need it. That is really an important next step for us to improve and to develop good work environments that we can thrive in.

We always go back to those quotes. It's not just pharmacy that's saying this, but all healthcare professions are saying pretty much the same thing. Moving forward, I would echo what Caroline Gaither said, in really focusing on our systems of care and employees, knowing that their workplace is there to as she put it, “I've got your back. I am here to really help you thrive so we can do what we're called to do.”

 That's all for this episode of Over the Counter. Check back next week for another expert interview covering the latest news trends and innovations in pharmacy. And don't forget to subscribe and share with your pharmacy friends. Thanks for listening.

In the newest episode of Over the Counter, 3 experts on professional burnout discuss the factors at play, and the impact the COVID-19 pandemic may be having on rates of pharmacist burnout. 

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Best of the Best Pharmacy Awards generated thousands of nominations from SingleCare customers across the United States. 

 sat down with Sidrah Alam, a pharmacy student at Shenandoah Unviersity and winner of the 2021 Best Up-and-Coming Pharmacist award, to discuss the road that took her to pharmacy school.

 Hi, everyone. I'm Lauren Biscaldi, managing editor of Drug Topics

. I'm sitting down today with Sidrah Alam, 1 of 25 winners of the third annual SingleCare: Best of the Best Pharmacy Awards. Sidrah is pursuing her Doctor of Pharmacy and Master of Science in pharmacogenomics and is the winner of the 2021 Best Up and Coming Pharmacist Award.

Thank you so much for joining us tonight, Sidrah. Can you introduce yourself to our viewers and tell us a little bit about the journey and family history that led you to pharmacy school?

: Thank you so much for having me. I really appreciate knowing that we always get 

 in our pharmacy. It's really exciting to be here today.

My name is Sidrah Alam. I am a final year student pharmacist at Shenandoah University, located in Virginia. I attend the Fairfax campus a little bit closer to Washington, DC. I graduate in May 2022 with both my Doctor of Pharmacy, as well as my Master of Science in pharmacogenomics. I am pursuing a dual degree currently at Deloitte University.

So, in terms of my pharmacy journey it's been a little bit interesting. I traditionally did not want to do pharmacy, which is actually a fun story to tell everyone. I had decided when I was younger that I would be a doctor since around the age of 2 or 3.

My parents had bought me the fake stethoscopes and my little doctor bag, and I used to take it around and try to fix everybody. And my mother has been working in pharmacy. She does still work in pharmacy and so for some reason, I knew that pharmacy was never going to be the career for me.

Additionally, my grandfather was diagnosed with cancer many years back, and I remember seeing [a pharmacist] on his team (which was new to me) because I always believe that pharmacists only worked in a community, you know, retail setting but you only see pharmacy, its CVS or Walgreens or a pharmacy like that.

But he had pharmacists on his treatment team, and they were helping figure out what treatment was best, how to manage all the different side effects of all the chemotherapy he was on. They were working right alongside with the medical doctors and nurses and everyone else on his treatment team.

So, that was kind of an introduction to how pharmacy wasn't just about community pharmacy and seeing my mom in the field, you know, it was in the back of my head, but I never thought I was going to go into it. I went to Virginia Commonwealth University for undergraduate and I was still premed all throughout college.

I was mostly premed during the last year [of college]. I took a little bit of time off and decided to work at a pharmacy. I started working at Wegmans pharmacy, and Wegmans is a northeast grocery store…mostly in the Northeast. And so, I started working there as a technician. And I realized the impact that community pharmacists have in their communities. And I kind of realized that maybe pharmacy was more for me to have the direct patient care. They're kind of helping every single person—everyone knew their pharmacists names. So, then I decided to pursue pharmacy and looked into different programs and now here I am, a pharmacist.

 That's such a great story. And I think that that's really impactful. I didn't realize until I started working with pharmacists that they were so involved in different care teams. My association was going to the pharmacy and picking up a prescription when I wasn't feeling well. So, I think that's interesting that that was how you really got started on this journey.

So, you mentioned, you're pursuing a dual degree right now. Do you have any advice for student pharmacist who are looking to specialize in a specific area of pharmacy?

 I'm really fortunate that my school does offer a dual degree program. Many universities have other dual degrees, whether it's in, you know, a Master of Public Health or something along those lines.

So, with my master's, it is in pharmacogenomics, and I think that that's a really growing field and the future of medicine. In general, really, it’s going to be genetics and personalizing everyone's treatment. So, the theory behind my masters and pharmacogenomics in general, is that the best treatment for patients is something that's individualized. What's more personalized than using someone's own genetic DNA to figure out what works best for them?

In terms of pharmacogenomics, specifically, a lot of what we do is really focusing on the different enzymes that people have and their genetic makeup. For example, if someone metabolizes a medication a certain way, that medication may not work best for them. It's really interesting to see how the population metabolizes things and the different genes that are involved in things like that.

And so, this master's program is really focused on you know, individualizing that treatment, and I think that's kind of how we are going to best treat our patients is when we treat every single person, as a person and as an individual.

But in terms of advice for someone specializing, there's so many different fields of pharmacy, which honestly, I've learned more in pharmacy school, how vast the field really is, kind of like a buffet in my opinion, where you have a little bit of everything. You can honestly get whatever you want from the field. So, I personally want to pursue clinical pharmacy, which involves [further] training after I graduate, so that's kind of the field I'm going towards. Even within clinical pharmacy, you can specialize in so many things.

So, whether that's more pharmacogenomic related, oncology, pediatrics, really anything that you're interested in and have a passionate about, like has a place for that. So, I think for me, the biggest thing was staying kind of keeping an open mind. When I first started pharmacy school, I didn't realize about the different programs and the different specializations. But when I saw that my school offered it that was kind of a pulling factor for me to even attend this university. 

I think for student pharmacists, the biggest thing is to keep an open mind, be passionate and be involved throughout pharmacy school. I have been super involved in many organizations. I actually serve on the national executive board for the American Pharmacists Association and have been involved at my school in many other student organizations. So being involved kind of helped me realize what I love what I'm passionate about and how I can best serve patients in the future.

I really think that being involved advocating for yourself, your patients, the profession, is what's really going to help people kind of figure out their place in pharmacy. The more you're involved and active you'll learn like where you want to specialize and if you want to specialize.

Some people love community pharmacy and that's the best place for them. Others prefer working in the industry in the hospital in a clinic. So, for me personally being involved and kind of seeing everything out there [helps one] decide what to specialize in.

 That's such an interesting journey that you took to clinical pharmacy and [finding] what specifically you wanted to study. And I think that was my next question. You know, as an up-and-coming pharmacist, what does it mean to you to win the 2021 Up and Coming Pharmacist Award?

: I just wanted to start off [that] it was such an honor. I honestly was shocked when I heard that I had won. It's really amazing to be recognized for something and realize that everything I'm doing is not going unnoticed.

So, at the end of the day, you know, I'm not doing things for awards or any recognition, but it's still nice to know that people are seeing what you're doing.

And I think this pandemic really has kind of made it more worth it winning the award, because a lot of time pharmacists are considered a little bit on the sidelines. And this pandemic has really shown us that we really are on the frontlines, and we are an integral part of that healthcare team and that we're working with everybody to best serve you know, the best patient care.

This award just kind of shows that we have been working hard and that my impact on patient care hasn't gone unnoticed. Interestingly, at Wegmans our motto is: “Every Day You Get our Best,” so this award kind of exemplifies that, where every day I have been giving my best. I've been at Wegmans for about five years.

You know, pharmacy school is four years long. So, I've been doing that direct patient care, helping people. But that's really just for my profession and for pharmacy. That's what pharmacists really do. So, it's been nice to just have that award and have something that shows that I've been working hard and that my patient care hasn't gone unnoticed. I hope to continue to deliver the best patient care as a pharmacist.

 That's great. I've just been saying to all the other pharmacists I've spoken to through this interview series that the stories that I've heard have been so impactful and so powerful. And you guys really are an integral part of the healthcare community. I don't think that patients could receive the care that they receive without the pharmacy teams. So, with that said, Would you be able to share a story of a customer or patient that had a really profound impact on, during your time at Wegmans or prior?

 I actually have 2 stories, I think, that really kind of define like what being a student pharmacist and having that patient care has meant to me. The first was at work so at Wegmans and it was more actually directly with cost. So, everyone's as everyone knows, medications are super expensive. I actually, I think the other day had one that costs $10,000. You have to pay out of pocket.

So, this I remember: a mom came in getting some medications for two of her children. They were pretty expensive with inhalers and different specialized medications. And for me because I've worked in retail for so long, I'm used to all the different coupons and the different companies and what savings I could look for.

For me, it was just another day where I was just trying to save another patient, you know, a couple of dollars. I looked for different coupons. I tried to see which would be cheapest for this person, because their insurance wasn't covering as much.

I ended up saving this mom, I think it was close to eight to $900 on their total medication bill, which that was no big deal for anybody but what I didn't know was when she came to pick up her medication, crying, she literally started crying, and it was just so sweet. Then she told me how her mother had just passed away, and her husband had just lost his job. So, trying to afford these medications was really difficult for their family. But they were lifesaving medications for her children so, she didn't really have a choice.

So, just hearing that was so powerful and impactful. I was honestly just another day for me, and I was just doing my job and trying to like help somebody there. But it was just really powerful to see her cry, and it just made me so emotional. That was just from work and that helped me realize the impact that pharmacists can have in the retail setting which we've seen with people giving vaccinations and everyone's going through their booster shots.

The other story was actually from a rotation. So, with hospital and inpatient care, pharmacists actually are rounding with the medical team. People don't realize that we are making those medication recommendations or helping with dosing—everything that is related.

We actually had a child, a baby, who was born, but delivered early, and so the child was probably not ready to make it. He ended up on life support and it was just up to the parents to decide when to take the baby off of life support, which is a difficult decision for anybody. They finally decided on a date. When that day came in the morning, the parents unfortunately were not there. Just because they couldn't emotionally take it.

And so, they took the baby off of the ventilator. And the way that that works is after a few hours, the heart was slowly just decline on its own. The team that I was on was called because we were kind of working with end-of-life care and things like that. We were called to make sure that the pain medications were correctly dosed and enough to make sure that the baby was comfortable throughout that process.

We made sure that the medication was enough to make sure that the baby was comfortable, and we weren't necessarily hastening that process either. And the nurses were holding the baby since the parents weren't there.

And everybody was taking turns to make sure that the baby you know, felt comfortable regardless of whether we thought that the baby could feel heard or not. I held the baby. And after about 15 to 20 minutes, his heart started to stop beating as much and baby literally passed away in my arms.

And my first instinct was put [the child] on the table and give it to HR because we need to revive its heart. But unfortunately, it's not what we were supposed to be doing. We just held this baby, but it was just realizing that the impact that we had, and it was coming up and dosing those medications to make sure that that baby wasn't in pain when he did pass. And it was just amazing to see how we have that impact no matter what setting we're in.

 A lot of people don't realize that all of health care is important that we're all part of this team to make sure again, that all of our patients are comfortable and getting their best health care. Both of those stories very different and very different impacts but they really kind of defined my pharmacy journey so far and what I hope for it to be that I have chills right now. And I don't say that to sound trite or anything, but that those are powerful stories, and I really appreciate you taking the time to share those.

I hope that any student pharmacists who are watching this or anyone who's considering going into the profession, you know, realizes the impact that you guys have and the potential there. So, thank you. And it sounds like you know, this is a very well-deserved award. So, with that, are there any final thoughts or words of wisdom? That you'd like to leave our viewers with?

I guess [my] advice is keep an open mind. Never really know where your pharmacy journey will end up and just stay involved and be active and kind of follow your heart because you will find what you're passionate about. Regardless of if you think that's the best pathway or not. If you're passionate about it, you'll find a way.

So just stay involved, be active, and continue to advocate for the profession. And again, we've seen in the pandemic that we have been helping so many people. And that's why I feel so proud about being a up and coming pharmacist. It's an exciting time for pharmacy and I just hope everyone realizes that.

 Awesome. Great, thank you so much for joining us tonight. I appreciate it.

Click here to learn more about the SingleCare 2021 Best of the Best Pharmacy Awards.

Alam joined Drug Topics® to discuss her time as a student pharmacist.

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