The simple truth of retail chain pharmacy

The October 23, 2006 edition of

Drug Topics

published a Viewpoint article titled “Is pharmacy a trade or a profession?” that has generated mail ever since. Because of the wide interest readers have shown, and because the questions it addressed are more pertinent today than ever, the author has decided to take another look at some of the issues he raised in that first article.

Many years ago, before deciding to go to pharmacy school, I spent several semesters in industrial psychology. I remember one professor made the statement that the most destructive thing an employer can do to an employee is to assign tasks that are impossible to accomplish. I would like to add that the most destructive thing an industry can do to a profession is to require more from the professional than can possibly be accomplished.

Make it work, or else

One day at work, I was operating in total chaos, trying to verify, review, and fill prescriptions while three phone lines were ringing, the drive-thru bell was buzzing, the line in the lobby snaked halfway across the store, the floor was hidden under 15 totes filled with drugs that hadn’t been put up in days, control invoices were scattered across the countertop, three people waited to get flu shots, and one person wanted a zostavax shot.

I turned to the female pharmacy manager next to me and asked her how on earth she managed such a place. She looked me straight in the eye and said, “I don’t, because I can’t.”

Six weeks later she was demoted in disgrace because she just wasn’t doing her job. The company placed a recent graduate in that store to manage it, primarily because no one else would consider taking the position. Two weeks after he assumed the title of “manager,” we were in a similarly chaotic environment and he looked over at me and said, “Charles, why is it that I just feel like I can’t do this job?”

I laughed and said, “It’s real simple - because you can’t.” I explained to him that the woman who had held the position before him was one of the most qualified, most competent, most professional, and most knowledgeable pharmacists that I had ever known (and I’ve been doing this for 38 years). And she was constantly getting written up for incompetence.

When monkeys fly

You simply cannot do something that is impossible unless you live in the Land of Oz - which is where most of the decision-makers of retail pharmacy management dwell, along with pharmacy school academics, and where their expectations get created.

For years academia has been promoting and directing the profession into a setting that is oriented more toward clinical practice. And I think that that is great, except for one major problem - lack of support staff.

Someone needs to inform middle management that if you want us to appear professional, to have the self-confidence of true professionals, and to be true healthcare providers, you’re going to have to quit cutting the hours and start giving us more hours. You’re going to have to figure out that if we are to offer all these medical testing and monitoring services, you just might have to have more pharmacists on duty at the same time.

One right thing

While working for this company, I once had an 86-year-old woman come into the store in the middle of the late-afternoon rush hour. She requested a blood pressure evaluation that the chain promises to give anyone anytime.

Well, my computer dashboard showed that I had about 36 scripts to review, about 18 to verify, and another 37 to fill; I had about 8 people in the lobby and both lanes of the drive-thru were taken; the “wait-time” indicator on the computer screen was flashing the warning that “you’re in deep doo-doo, dude,” and I was the only pharmacist running this three-ring circus. I was trying to get somewhat caught up (never happens), and the elderly lady was getting a little impatient with us.

At that point I had an epiphany. Why not do one thing right? Why not do the right thing for once? Why not just follow my heart, my inner convictions about what I believe the profession of pharmacy is really about? Why not???

Why not “pretend” that I had one or even two other pharmacists helping me fight the battle on the Normandy beachhead, so that I could attend to one of the wounded, as I was trained to do?

That, my friends, is exactly what I did. I found myself “spending time” listening to the old lady, trying to understand her needs and health issues. (Can you imagine that?)

She told me some of her personal history, about being one of 13 kids raised during the Depression, about her father being a farmer who could provide very little for his family beyond love and acceptance. Her circumstances were almost identical to those of my own father: He was one of 13 children raised during the Depression by a farmer.

I found myself pouring out everything I had about hypertension, its causes, its effects, how one can make life-style changes that would help . . . It was wonderful. I felt like a “real” healthcare provider, a real pharmacist. Not a monkey with wings in the Land of Oz. And I wasn’t concerned in the least about the wait-time indicator on my computer screen and the negative report to my supervisor that it would generate the next day. I simply chose to do what was right.

None so blind as those who will not see

PLEASE NOTE: Most of the truly professional and caring pharmacists who work for the major chains are much more concerned about their patients than the middle management clones are, or the think-tank gurus are, or the policy-makers and the movers and shakers who make a feeble attempt to run companies with integrity.

Most of the major chains have a dismal record when it comes to respecting the profession. And if by chance you are a supervisor for one of the major chains and doubt what I just stated, leave the Land of Oz, spend some time in reality, have a heart-to-heart with the people who bust their buns for you, and please don’t focus only on the ones wearing corporate rose-colored glasses, who envision themselves sitting at your desk at the home office. They will lie to you.

Your average John Doe doesn’t realize that we, as pharmacists, are expected to be Blue/Cross Blue/Shield specialists, Humana specialists, Tricare Federal Employee specialists, Medicare specialists, Medicaid specialists, Medicare Part B specialists, Medicare Part D specialists, Cobra specialists, Immunization/Vaccination specialists, Workers Comp specialists, Hypertension Management specialists, Glucose Level Monitoring and Intervention specialists, Medical Therapeutic Medication Monitoring specialists, Drive-Thru Window specialists, Cash Register Technical Support specialists, and finally the My Co-Pay is Too Damn High specialists. The more we, as professionals, attempt to wear that many hats without proper staffing, the more we project the image of being monkeys with wings. And everyone knows that monkeys can’t fly - unless, that is, you live in the Land of Oz.

Houston, we have a problem

Okay, Mr. Middle Management and Corporate Executive person, if you don’t believe me, let’s see if you can understand this. I’ll try and make it very simple. There are several obvious indicators that have been around for years, signs that point to the fact that “Houston, we have a problem.”

First (I’ll go real slow), try calling one of your stores after a holiday and see how long it takes you to get a pharmacist. Try calling on any Monday. Try calling any chain most anytime. I do it for a living. When calling for copies, many times we sit on hold for 15 to 20 minutes, hang up, and call again.

The very day I was writing this piece, I had a customer call me at home on Saturday, my day off, and ask me why it was that she couldn’t get a pharmacist on the line when she called the store. She said that she had called and was on hold for 40 minutes. Finally she just hung up.

It doesn’t matter how much you demand that we answer your phones on the third ring. Human beings tend to prioritize. And to be perfectly honest with you, most of the time answering the phone is at the very bottom of the priority list. Primarily this is because it is much less painful not to answer the phone than to get cussed out by an irate customer who expects a script, a flu shot, a shingles vaccination, a pneumonia vaccination, and a prostate exam (just kidding) within a 15-minute wait period.

“Houston, we have a problem.”

There they go

The second obvious indicator is turnover. I was with this chain for less than 2 years. In that short time I witnessed some of the best, most qualified, most professional, hardest-working technicians leave and go elsewhere because of stress resulting from workload.

I’ve seen extremely talented young pharmacists come to the realization that this is not at all what they expected when they decided to go to pharmacy school. They return to med school, nursing school, optometry school, or dental school and begin careers in other medical fields that allow them to work as professionals, get paid as professionals, and most of all be respected as professionals (i.e., actually get to stop to eat lunch).

When I was employed with this company, a fellow pharmacist informed me that a brilliant young supervisor had told him that the company hires only the “best and the brightest.” I responded, “Oh, how I wish he had told me that!”

I would have let him know that first off, it’s easy to attract the “best and the brightest” by throwing $100,000/year at them. The difficult thing is keeping them.

And that is something our company could not do - primarily because the best and the brightest never get to retail. They change their majors after a small taste of retail long before they graduate in pharmacy.

The second-best and the second-brightest change professions after two or three years of not getting lunch breaks; 12- to 14-hour workdays; working on Christmas, Easter, and Thanksgiving; and being expected to fill 675 scripts while giving 52 flu shots and 6 blood-pressure consultations (and of course maintaining a less than 15-minute wait time).

The next-best and next-brightest find practice settings that are much closer to their initial expectations of what the practice of pharmacy should be, such as small-town independents.

And sadly enough, the rest of us are left in the Land of Oz, which is run by a wizard who is in denial.

The simple truth

The simple truth is this: If you follow the yellow brick road of retail chain pharmacy practice, you will end up in the Land of Oz, with pink horses, flying monkeys, and the Wicked Witch of the West as your boss. The reason? Most of us, like the cowardly lion, don’t have the courage to simply say, Enough is enough … this just isn’t right.

Charles Duhon has been a community pharmacist in Tulsa Oklahoma for 38 years. He welcomes your feedback atcleod1@cox.net.