Number One No Longer

Lack of staff is forcing chain drugstores to close. I’ve seen pharmacies with so few professional staff that they are closing early, not opening on weekends, and sometimes closing for an entire weekday because they cannot get enough pharmacists to work. Recently, a pharmacist friend of mine became sick during his shift and went home, closing the pharmacy behind him at 1 PM.

So what has gone wrong? When I graduated in 1981, there were 72 schools of pharmacy in the United States; today there are 142 US-based colleges and schools of pharmacy—just 2 schools shy of double the amount of pharmacy schools over a 40-year period. Some years back, many of those schools greatly expanded their enrollment as well. Pharmacists—especially those of us who graduated in the 1980s and 1990s—were in very competitive programs and could easily be described as overachievers. We studied relentlessly to get into our programs, as well as to keep our seat once we were there. Most programs turned away 3 to 6 applicants for every seat they had available.

With this many schools of pharmacy producing a higher number of graduates, why do we have stores that cannot meet their staffing needs? The answer is simple: No one wants to work in community pharmacy practice. I have been working in independent pharmacy practice for 42 years, so let me share some insight.

Readers who follow this column know the issues I have elucidated over the past 6 years. Inadequate staffing, constantly ringing phones, irate customers, and lack of support from upper-level management all make this job a challenge. And don’t forget opioid dispensing, drive-through windows, and COVID-19 vaccines.

My son Phil works as a data analyst for a major bank. He called me recently to congratulate me on my retirement. He said, “Dad, I don’t know how you did that job for 42 years. I worked with you for 3 summers in high school and still have nightmares about the potential to harm someone. I never have bad dreams about my job in data analytics, but still have nightmares about working as a pharmacy tech.” Phil has not worked in a drugstore in 15 years, but still gets anxious thinking about the job.

Now we are seeing the demise of pharmacy schools. Enrollment is down, thanks to a significant decrease in applicants. Back in the 1990s, pharmacists were the most respected health care professionals; today, we are lucky to break the top 20. As a matter of fact, we are No. 22, according to 2023 rankings by U.S. News & World Report.¹ Despite the fact that our salary is double that of respiratory therapists, dietitians, and nurses, we are ranked well below those professions.

Another reason for the drastic fall from No. 1 to No. 22 is that the management of the chains are always demanding more of their pharmacists. They want more prescriptions filled with significantly less help, and the metrics they use are unattainable. Pharmacists are hardworking on both the clinical and technical side of the profession, but every metric says “Close, but not good enough.” They are told they did not do enough comprehensive medication reviews, administer enough influenza shots and COVID-19 vaccines, or fill enough prescriptions for another store. Pharmacists have had enough of unfulfilling careers in community and hospital settings. Most pharmacists have outstanding clinical skills that seldom get used. Because of staffing, chain pharmacists are relegated to entering data, answering phones, counting pills, ringing registers, and dealing with insurance companies. Despite the pharmacists’ Herculean efforts, they are not appreciated by supervisors and upper-level management; the boss just wants more.

With double the number of schools—and easier admission requirements—how can we blame anyone other than the massive hospital systems and the big chains for the demise of this once-wonderful profession? We’ve fallen from the No. 1 health care profession to No. 22 in 25 years. Is it any wonder that $75,000 sign-on bonuses are not enough to attract graduates into the world of chain pharmacy practice?

Peter A. Kreckel, RPh still practices pharmacy in Lemont Furnace, Pennsylvania.