California legislative committee examines pharmacy workplace issues

Impossible workloads. Inadequate staffing. No time for legally mandated counseling of patients, much less a break from the constant pressure of quickly and accurately filling a steady flood of prescriptions.

For those in retail pharmacy, this is not an unusual story. It seems to many that working conditions have deteriorated over time, and in California, there is an emerging consensus that things need to change.

“We were recently contacted by some worker and consumer advocates who expressed concern about some of the current developments in the retail pharmacy industry, specifically ‘speed incentives’ and other workload issues that jeopardize consumer safety and impact the working conditions of pharmacists,” said Bill Monning, chairman of the California State Assembly Committee on Labor and Employment, which recently held an informational hearing on the subject of workplace conditions in retail pharmacies.

During the hearing, the committee heard testimony from pharmacists, academics, students, consumer advocates, and representatives of the California Retailers Association describing how today’s retail pharmacy working environment hampers the practice of the profession and puts patients at risk.

Two retail pharmacists told the committee similar tales of stores staffed so sparsely that taking care of routine but essential tasks left little time for professional responsibilities such as patient counseling. One, a CVS pharmacist who testified anonymously, expressed concern over prescription quotas linked to employee bonuses, creating pressure on pharmacists to work faster, and also mentioned company policies that discourage breaks.

“I was surprised by testimony indicating that in the retail setting the emphasis has apparently shifted from patient care and counseling to performance standards - how many prescriptions you are filling and how quickly,” Monning said. “There seems to have been a ‘corporatization’ of the pharmacy industry to emphasize things in terms of commodities and profits, rather than in the traditional pharmacist-patient relationship that I think so many have valued and cherished over the years.”

Bill Dombrowski, president and CEO of the California Retailers Association, acknowledged there is a need to free pharmacists to deal with “core pharmacist issues,” but called the matter a management problem that pharmacy chains should handle themselves. However, Nancy Gomez of the healthcare consumer advocacy group Health Access California said that the problems patients have obtaining adequate service and counseling are such that legislative solutions are required. That sentiment was echoed by Francine Harris of the Santa Ana Senior Center, who proposed a limit on the number of prescriptions pharmacists can fill per shift.

The retail industry opposes any sort of “prescription cap” or similar effort. Aside from the “cap” issue, a number of matters were discussed during the hearing, including staff shortage issues, pharmacists’ need to concentrate on “core” pharmacy tasks, and innovative ways to provide more time for patient counseling.

As for the California Board of Pharmacy, Monning said, “From the discussions that my staff and I have had with the CBP, I sense that they view this problem as primarily an enforcement issue. If there is an error made, they investigate, ask the appropriate questions, and cite the pharmacy and pharmacist if necessary. I would like to see the board be more proactive than that and look for ways to address some of the workload issues to prevent such errors from occurring in the first place.”

The California Pharmacists Association did not send a representative to the hearing.

David Stanley is a community pharmacist in California. He can be reached at drugmonkeyrph@gmail.com