Understaffing: The cancer on our profession

The switch to the PharmD was ostensibly in response to some perceived need or deficiency in pharmacists’ ability to perform their job. But I don’t recall ever seeing a clear explanation of that need or deficiency.

Editor’s note: The Drug Topics blog is a place for pharmacists to share their opinions and does not necessarily reflect the views of the publication. We welcome any alternative viewpoints at David.Frabotta@ubm.com. 

Presumably, the idea was that more education would enable pharmacists to perform their jobs better. The tremendous energy expended on the switch to the PharmD could have been spent much more wisely by addressing the elephant in the room that everyone is afraid to discuss: the stranglehold that the big chains have on our profession and the resultant threat to the public safety by rampant understaffing.

The powers-that-be in our profession realized that requiring more pharmacist education is much easier than requiring more staffing in drug stores. Requiring adequate staffing results in tremendous resistance and push-back from chain drug stores-the biggest employer of pharmacists. So, the powers-that-be decided to focus their attention on pharmacist education levels rather than pharmacy staffing levels.

I realize that pharmacy schools can’t force the big chains to provide safe staffing levels. But the pharmacy schools, American Pharmacists Association (APhA), American Association of Colleges of Pharmacy (AACP), state boards of pharmacy, and National Association of Boards of Pharmacy (NABP) collectively have tremendous ability to shape a compelling narrative. All of these entities should have joined forces to inform state and national legislatures and the general public that the big chains are endangering public safety by using a business model based on understaffing.

The Benefits of PharmD

I think that most pharmacists would agree that our primary responsibility is to assure that the right drug is dispensed to the right person, in the right dose, with the proper directions, and with adequate screening for drug interactions and contraindications. Using these criteria, I don’t see how the switch to the PharmD has benefited patients/customers. The switch to the PharmD has benefited the occupational and intellectual interests of pharmacy faculty far more than it has retail pharmacists and the customers they serve.

I’m retired now, but as I look back on my long career, it seems to me that the primary causes of pharmacy mistakes belong in two main categories: 1) carelessness, not paying attention, not concentrating on the task at hand and 2) understaffing, (i.e., not having enough staff to allow pharmacists to perform their job properly).

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I can’t recall observing a single error during my career that was due to a deficiency in a pharmacist’s education. The nice thing about pharmacy computers is that they are capable of storing much more information about drug interactions, drug allergies, contraindications, high-low doses, etc., than even the most highly educated pharmacist can carry in his/her head. The problem is that understaffing does not allow us the time to address as many of these drug utilization review (DUR) alerts as we would like.

With more PharmD’s in the profession, why aren’t there fewer pharmacy mistakes?

Accurate statistics about pharmacy mistakes are hard to come by. The big chains aren’t willing to release internal data regarding the incidence of pharmacy mistakes that occur in their stores. Nevertheless, I think most pharmacists would agree that the number of pharmacy mistakes is not decreasing. With a higher percentage of PharmDs in the profession every year, why hasn’t there been a commensurate decrease in pharmacy mistakes? Is the PharmD degree irrelevant when it comes to preventing pharmacy mistakes?

Pharmacy Schools vs. the Real World

The core concept in pharmacy school is patient counseling. The problem is that the biggest employer of pharmacists is opposed to the core concept taught in pharmacy school. Thus, pharmacy faculty are not living in a real world.

A pharmacist sent me an e-mail relating a story of when he asked a pharmacy school dean how pharmacists are supposed to implement the patient counseling model in a workplace characterized by dangerously low staffing levels. The dean gave a very disappointing answer, responding something like, “We teach students to be drug experts and then it’s up to them to figure out how to implement the drug expert/patient counseling model in the real world.”

The big assumption in our profession is that more pharmacist education makes more competent pharmacists. If there is a direct relationship between pharmacist competence and years of education, are we to assume that requiring even more education would make even more competent pharmacists? Rather than requiring six years of college to become a pharmacist, aren’t we shortchanging the public by not requiring seven or eight or ten years of education? 

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The more logical assumption is that big chains have complete disdain for the product of today’s pharmacy schools: the PharmD graduate.

In order to do our jobs competently, we need adequate staffing in the pharmacy far more than we need more education. The switch to the PharmD degree was accompanied by tremendous fanfare-as if some critical problem had finally been fixed. What if the intense focus had instead been directed at addressing the real problem in the world of pharmacy: dangerously understaffed pharmacies? Would pharmacists be happier and would the public be better served?

Pharmacy schools self-servingly promote the false premise that pharmacist competence is directly proportional to the number of years of schooling. In my opinion, pharmacist competence has a much closer correlation to staffing levels than it does to education level. Requiring adequate staffing is far more important than requiring more education. Understaffing means that we don’t have the time to use the education we have.

Dennis Miller, RPh is a retired pharmacist living in Delray Beach, Florida. He welcomes feedback at dmiller1952@aol.com.