Opinion: Why your chain-store pharmacist is so unhappy

Opinion by David Mott, William Doucette, Jon Schommer and Caroline A. Gaither

(CNN) — Pharmacists swear an oath upon entering the profession to “assure optimal outcomes for all patients.” But current working conditions are making it nearly impossible to live up to this oath.

Using data from the 2022 National Pharmacist Workforce Study (NPWS), a survey of 96,000 licensed pharmacists in the US, we calculated that more than 60% of chain pharmacist respondents reported high levels of work exhaustion and nearly 80% reported low levels of job satisfaction. In contrast, only 15% of community pharmacist respondents practicing in independently-owned pharmacies reported high levels of work exhaustion, and less than 40% reported low levels of job satisfaction.

Recently, pharmacists staged walkouts at chains like Walgreens and CVS across the country — desperate attempts to draw attention to the poor working conditions and resulting burnout that have been ignored for far too long. Their work situation is particularly concerning given the cold and flu season and the role that retail chain pharmacists play as patient access points for medications, flu and Covid-19 vaccinations, and advisers to manage symptoms and use medications safely.

Now, chain organizations have no choice but to invest in their current workplace and workforce to improve working conditions, starting with the immediate need to hire additional pharmacists and technicians. Without significant investment in the chain pharmacy workforce, it is likely that outlets will continue to reduce operating hours or close (also due to competition and the opioid settlements), impacting patient access to pharmacy goods and services.

A primary driver of pharmacists’ unhappiness with their work at chain locations is the assembly line-like environment, where highly trained pharmacists barely have enough time to complete dispensing tasks within the limits chain corporations set, designed primarily to improve efficiency.

According to the 2022 NPWS data, we calculated that more than 80% of chain pharmacists agreed that the number of work activities that they perform in their job extends beyond what they were originally hired to do and that their work environments are chronically understaffed. Also, more than 80% agree that their employer’s focus on meeting workload metrics like dispensed prescription quotas leads to unsafe pharmacy practice, and that leadership consistently overlooks and underappreciates pharmacists.

Particularly concerning, we calculated that more than 91% of chain pharmacist respondents in the 2022 NPWS reported that insufficient pharmacist staffing and expansion of their work activities reduce patient medication safety. More than 82% of these chain pharmacists said that their lack of autonomy also hurts medication safety.

Pharmacists are more than capable of providing a high level of patient care. They just need more suitable work environments to do it.

Why are chain pharmacy work environments so bad? The business of dispensing prescriptions is not as profitable as it once was, leading to fewer dollars available to invest in their pharmacist and pharmacy technician workforce.

Profit margins on dispensed prescriptions are dangerously low due to the ever-increasing power of pharmacy benefit managers (PBMs) in prescription drug distribution. PBMs administer the prescription drug benefit plan, a common part of health benefits for employees. PBMs essentially dictate to pharmacies the amount of payment the pharmacy will receive for prescription drugs that the pharmacy dispenses to patients. If your insurance covers prescription drugs, chances are that a PBM pays the pharmacy after your cost sharing (copayment or coinsurance amount) amount. Often, PBM payments to pharmacies do not cover a pharmacy’s costs to dispense the drug.

The pharmacy chains responded by reducing staffing and increasing quotas for dispensing. In addition, the Covid pandemic often made pharmacies across the country a primary location for vaccinations. The additional vaccination administration tasks added to an already overburdened workforce made pharmacy working conditions worse. Consumers will walk into this perfect storm during the height of this fall’s cold and flu season.

Strong action is needed to rein in the predatory practices of the PBMs, which have been poorly regulated for too many years. Congress should pass legislation that re-establishes fair payments for pharmacy services and removes fees that PBMs impose. This would allow chain organizations to invest in improving pharmacy working conditions and restore patient medication safety. Quotas drive volume of work and may prevent pharmacists from spending a sufficient amount of time checking for the appropriateness of prescribed medication therapy.

Help also needs to come at the state level. Boards of pharmacy are state agencies focused on regulating pharmacy practice to ensure public health, safety and welfare. Some boards have developed and adopted rules and regulations related to workload limits and/or pharmacist and technician staffing ratios designed to allow pharmacists to spend adequate time assessing the appropriateness of prescribed medication and counseling patients to ensure patient medication safety. More regulatory boards need to consider pharmacy workload limits and/or staffing ratios for public safety.

Chain pharmacists need help now to weather the current storm they are experiencing. Without immediate action, heightened concerns about patient medication safety, more pharmacist walkouts, pharmacy closings and potentially long delays in consumer access to needed medications and vaccinations are imminent. The rumble of angered and anxious patients is on the horizon. The storm is not yet over.

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