Retail Pharmacy Has Reached the Breaking Point

"Breaks were nonexistent. I would have to try to use the bathroom at the most convenient time to step away from the pharmacy. Often I would find myself saying, ‘I’m going to the bathroom,’ and 2 hours later still needing to go.” This is the story that one former employee at a major retail pharmacy chain told Drug Topics®.

The lack of breaks, hiring of new staff, organization of staff schedules, and managerial support was a problem at the pharmacy even before the COVID-19 pandemic began, the pharmacist said.

After community pharmacists began administering COVID-19 vaccines, pharmacy staff workloads increased, but help was not available “due to staff quitting and not being replaced,” the pharmacist added.
She is now working for an independent pharmacy and said her work experience is “much better.”

But that former retail pharmacist is not alone. Many pharmacists and pharmacy staff have told Drug Topics® and other national news outlets that they are leaving retail pharmacy or have plans to make a change.
“Community pharmacy is hemorrhaging pharmacists currently,” said another PharmD who recently left their role another retail pharmacy chain at after 11 years.

The lack of well-trained staff was the pharmacist’s biggest challenge. “I had not had enough staff for 7 months. Having to do the work of multiple people for so long really took its toll,” she said.

“People come and go because they get overwhelmed without adequate training,” she added. “The job does not pay enough for the level of stress that technicians endure.”

Stress and burnout among pharmacists and pharmacy technicians are not new issues, nor are they limited to retail pharmacy. Some pharmacists and technicians are leaving the profession and encouraging high school graduates not to go into pharmacy, said Lucinda L. Maine, PhD, RPh, executive vice president and CEO of the American Association of Colleges of Pharmacy (AACP).

Still, chain pharmacy practices have the highest percentage of pharmacists whose scores indicate the risk of high distress in the American Pharmacists Association’s (APhA) Well-Being Index for pharmacy personnel,¹ an online self-assessment tool measuring well-being and suicidal ideation, and other factors. Last July, the national distress percentage for pharmacists had reached 33.68%.

Initial findings from APhA and the National Alliance of State Pharmacy Association’s (NASPA) 2022 National Pharmacy Workplace Survey2 “validate the many anecdotal stories heard through national and state pharmacy association members and pharmacy-specific social media,” the organizations said in a news release.³

“The responses to this survey indicate that work environment factors contribute to pharmacy personnel’s difficulty in performing their clinical and nonclinical duties effectively,” the organizations said.³ “There is no open mechanism for pharmacists and pharmacy personnel to discuss workplace issues with supervisors and management; if they try, the discussion is not welcomed or heard. This is concerning because feelings of not being listened to or valued are risk factors that can cause stress leading to occupational burnout.”

The APhA/NASPA survey identified a number of factors that contribute to stress—and may lead to medication errors or near misses—a list that includes increased demands on pharmacy staff; harassment, and bullying by patients/consumers; insufficient and ill-trained staff; employer focus on production results; constant interruptions or calls to insurance companies; and the addition of services with inadequate support for these services.³ Additional comments from pharmacy staff included complaints about management’s focus on metrics. “Quotas always increase,” said one commenter.² “This year, our region’s flu shot goal is 500% larger than last year. It’s ridiculous.”

According to survey respondents, other issues that impact the ability of pharmacy staff to provide optimal patient care include the following²:

• “Not caring that employees are at their breaking points mentally and emotionally while still asking for us to
  do more.”
• “Imposing unrealistic workload by increasing COVID-19 vaccines while we try to maintain good and safe service to our customers.”
• “Employers are solely focused on the bottom line. Eliminating technician hours and pushing salaried pharmacists to work 60 to 80 hours weekly without paying overtime. The money is not what matters, but the detriment to patient care and well-being of the pharmacist is evident for every pharmacy you walk into."
• “Conflicting messaging: Go as slow as you need to avoid errors/get the prescriptions done and out faster, you slow down the discharge process.”

Many pharmacy organizations are supporting the Pharmacist’s Fundamental Responsibilities and Rights,⁴ developed by APhA and NASPA, which outlines the fundamental principles enabling pharmacists to fulfill their professional obligations to patients.

The National Association of Boards of Pharmacy (NABP) recently pledged its support5 of the document. “NABP recognizes that pharmacists have a primary role in the protection of public health and the provision of quality health care,” NABP said in a statement⁵ adding that “In support of this role, pharmacists must be given the opportunity to understand their rights and responsibilities and preserve patient safety without fear of intimidation or retaliation.”

Retail Responds

“We greatly appreciate and value our pharmacists and technicians who have been working diligently on the front lines during the pandemic,” said a spokesperson for Albertsons Companies. “[We are] committed to supporting their work and well-being, and we have several initiatives in place to provide additional staff, reduce workload, and provide access to training.”

Meanwhile, spokespersons for Walgreens—another retail chain at the center of the movement to improve pharmacist working conditions—and CVS told Drug Topics® that their organizations are committed to hiring additional staff and improving working conditions.

“We are taking several steps to mitigate current pharmacy staffing pressures, including hiring thousands of new pharmacy team members, offering bonuses for vaccination certifications, and adjusting our appointment availability and store hours as needed,” Fraser Engerman, senior director of external relations at Walgreens, told Drug Topics®.
The company also increased shift breaks for team members to “provide needed rest,” Engerman said.

Walgreens has “continued to offer new roles to allow our pharmacists more time to spend with our patients,” Engerman added. For example, the company created a pharmacy operations manager position to reduce the administrative burden on the retail chain’s pharmacy managers.
In May 2021, Walgreens gave a bonus of $1000 to full-time pharmacists and $700 to part-time pharmacists. In September 2021, the company gave additional bonuses of $1250 to full-time pharmacists and $1000 to part-time pharmacists.

As of October 2021, all Walgreens pharmacy technicians receive a starting salary of $15 per hour, which will be increased to $16 per hour later this year. In addition, new pharmacy technician hires receive a $1250 signing bonus.

At CVS, many stores have teams dedicated to administering vaccines and are not filling prescriptions or counseling patients, Matt Blanchette, manager of retail communications for CVS Pharmacy, told Drug Topics®.

“At pharmacies without vaccination teams, we’ve adjusted workflows, processes, and vaccine scheduling to provide pharmacists and other vaccinators with predictability and structure for their day-to-day activities,” Blanchette said. “Also, we’re rolling out an additional prescheduled daily break time to create a predictable and consistent daily pause while minimizing disruption to our patients.”

References

1. Well-being during COVID-19. American Pharmacists Association. Accessed January 17, 2022. https://www.pharmacist.com/Practice/COVID-19/Well-being
2. APhA/NASPA National state-based pharmacy workplace survey. Report of initial findings. American Pharmacists Association. December 2021. Accessed January 17, 2022. https://www.pharmacist.com/DNNGlobalStorageRedirector.ashx?egsfid=Zofb6PIvYhs=
3. APhA and NASPA release initial findings from the 2022 National Pharmacy Workplace Survey. News release. American Pharmacists Association. January 13, 2022. Accessed January 17, 2022. https://www.pharmacist.com/APhA-Press-Releases/apha-and-naspa-release-initial-findings-from-the-2022-national-pharmacy-workplace-survey
4. Pharmacist’s fundamental responsibilities and rights. American Pharmacists Association. Accessed January 17, 2021. https://www.pharmacist.com/pharmacistsresponsibilities
5. NABP supports efforts to improve pharmacist workplace safety and well-being. National Association of Boards of Pharmacy. January 13, 2022. Accessed January 17, 2022. https://nabp.pharmacy/wp-content/uploads/2022/01/NABP-Statement-Workplace-Safety-and-Well-Being-2022.pdf