For Maryland pharmacists and their staffs, COVID has been a prescription for stress and burnout

One pharmacist stopped offering COVID vaccines when he couldn’t hire enough staff to administer them. Another grew so overwhelmed by the workload he couldn’t sleep at night.

And then there are the customers, who post misinformation about the pandemic on the pharmacy’s social media sites, demand their ivermectin prescriptions be filled or when asked if they’d like a COVID vaccine, respond with an unprintable curse.

Nearly two years into a public health crisis in which they’ve played a central role in combating, many pharmacists and their staffs are stressed, fatigued and burned out by both the amount of extra work and the ensuing conflict surrounding the coronavirus.

“We don’t get recognized as front-line workers,” said Ashley Moody, a pharmacist and assistant professor at Notre Dame of Maryland University. “But we’ve been here all along.”

As with doctors, nurses and other health care workers, pharmacists are straining under soaring demands on their time and energy — particularly now, with flu season drawing many people through their doors for shots and remedies, along with those seeking COVID boosters for themselves or vaccines for their newly eligible children.

A third of pharmacists who used a self-assessment tool developed by the Mayo Clinic were at risk for “high distress” as of June, according to the American Pharmacists Association, leaving them potentially vulnerable to making mistakes on the job, burning out or considering quitting.

Pharmacists groups have long been concerned about their members’ well-being, with those in the retail sector facing ever tighter profit margins and competition. The addition of COVID testing and vaccinations to the mix has only increased their duties.

“There’s so much work involved,” said Surinder Singal, a pharmacist who owns Deale Pharmacy on the Western Shore of the Chesapeake Bay. “More work, more paperwork — it’s not worth increasing your workload.”

Recently, when one of the two part-time pharmacists he employed at his shop left for another job, he discontinued offering COVID vaccines while searching for a replacement.

Pharmacies have not been immune to the so-called Great Resignation, in which many have left the workforce. According to the U.S. Bureau of Labor Statistics, employment is down in industries in which pharmacists work, such as health care and retail, from pre-pandemic levels.

But demand for their services remains high. With some public and private employers and venues mandating proof of COVID shots, and many of the mass vaccination sites closed, those who previously held out are heading to pharmacies. The need for COVID tests, either on site or to take home, continues to draw traffic to stores or their drive-through lanes.

“It is what it is,” Matt Smithmyer said, with a sigh.

A pharmacist on the Eastern Shore, he said he’s been through a “pretty crazy” year in which his store at one point was administering more than 100 vaccines a day. He said the resulting anxiety and sleep loss prompted him to start taking medication for the stress.

“Lunch breaks were scarce, overtime was common,” Smithmyer said.

Pharmacies small and large, independent and chain are trying various measures to alleviate the burden.

For Tom Wieland, who owns Ritchie Pharmacy in Brooklyn Park, it’s a matter of controlling the amount of work that he and two pharmacy techs can handle, and hiring an extra pharmacist on occasion. He doesn’t offer testing or children’s COVID vaccines and, after some 40 years in the business, he’s fine if customers go to a higher-volume pharmacy for that.

“I have worked for chains — they’re torture,” Wieland said. “I don’t need that.”

The major chains say they’re upping recruiting and retention efforts and in some cases shortening hours to ease high workloads.

Citing “supply chain issues and labor shortages” as it seeks to immunize customers against COVID and the flu, Rite Aid recently began temporarily closing most of its stores an hour early Monday through Friday “to allow our pharmacy teams to catch up from the day and prep for the next,” said spokesman Jeff Olson. Additionally, it’s limiting walk-in immunizations to between 2 p.m. and 3 p.m.

“COVID-19 testing and vaccinations — on top of traditional responsibilities to keep our communities healthy — has led to some of the busiest times we’ve ever seen,” Olson said.

CVS Health has launched “a nationwide hiring push,” spokeswoman Tara Burk said, to accommodate the expected rise in flu cases and continuing demand for COVID services.

Walgreens officials said they have, on occasion, shortened hours at some stores and are focused on hiring and retaining staff. The chain has offered $1,250 signing bonus for pharmacy technicians, said spokesman Fraser Engerman, and incentives for them to become certified in administering vaccines.

Throughout the pandemic, staff members “have fulfilled even greater responsibility, whether it’s administering lifesaving vaccines or helping patients keep up with prescriptions and health screenings,” he said.

Pharmacists say they were contending with high stress even before the pandemic: Changes in how they’re reimbursed have shrunk profit margins and led in some cases to smaller staffs. The continuing opioid crisis added demands, from dispensing naloxone to extra monitoring of prescriptions for the highly addictive drugs to guarding against potential robberies.

“It’s opioids. It’s the politicization of vaccines and mask mandates,” said Aliyah Horton, president of the Maryland Pharmacists Association.

Just how highly charged the environment around the COVID vaccine can get became clear in Maryland when pharmacist Brian Robinette, and his wife, Kelly Sue Robinette, were shot to death Sept. 30 in their Ellicott City home. Police arrested Robinette’s half brother, who according to charging documents had previously said Brian Robinette was “killing people with the COVID shot.”

That shocked pharmacists, who are dedicated to protecting their patients and communities from COVID, Horton said.

“For him to be killed for that reason,” she said, “is painful.”

Cherokee Layson-Wolf, a pharmacist who lives in Ellicott City herself, said the killings brought “so close to home” what her colleagues face these days.

“You never know where those challenges are going to come from,” said Layson-Wolf, an associate dean and associate professor at the University of Maryland Baltimore School of Pharmacy.

From the start, the pandemic wreaked havoc on pharmacies. As other businesses closed, they remained open. There were difficulties getting adequate supplies and safety concerns that necessitated protective gear. When vaccines became available, they were deluged with, at least initially, more demand than supply.

“I remember compounding hand sanitizer when we could get ingredients and then working with a local distillery to provide it when the market dried up,” said Brian Hose, owner of Sharpsburg Pharmacy in Western Maryland. “I remember sourcing homemade masks from my mother and others who had the time and resources to make them so that my staff could work safer.”

Hose sees two groups emerging during the pandemic, “the ones that will do anything to protect themselves, and those that believe the entire pandemic is a conspiracy to further a political agenda.”

The latter will sometimes respond to public health messages or notifications of COVID services on the pharmacy’s Facebook page with angry comments or bad information, which he tries to take down immediately.

“We found the smartest way to combat them was to simply remove their comments from public view, rather than engage or block them,” he said. “So far, this has ended the stream of misinformation and avoided further conflict, but it does require a constant awareness of what people are posting.”

Hose said it’s stressful for pharmacists, who polls have long shown to be among the most trusted professionals, to have patients refuse to believe them on the subject of vaccines.

“I’m proud of the work that myself and my fellow pharmacists have done during COVID-19. The profession has stepped up in every way possible to help our communities navigate a very challenging time,” he said.

“The toughest thing has been seeing that we were the best positioned country to vaccinate our way out of COVID-19,” Hose said, “only to fall short as members of our community continue to die.”

Richard DeBenedetto, an assistant professor at the University of Maryland Eastern Shore Pharmacy School, said pharmacists have “jumped at the opportunity” to play a vital public health role during the pandemic.

Pharmacists say that they’ve had to deal with agitation over COVID vaccines just as have others in public-facing roles, be they flight attendants having to enforce mask wearing, school board members weighing COVID precautions for students and teachers, or nurses, doctors and other workers in hospitals and clinics.

“Everyone in the medical profession is burned out now,” DeBenedetto said.

Moody, who brings Notre Dame students into stores like Empire Professional Pharmacy in Glen Burnie for the clinical component of the program, said the aspiring pharmacists are getting an eyeful. While pharmacists are used to seeing sick and worried people, these days “people have been extra emotional.”

Wieland, of Ritchie Pharmacy, said he doesn’t engage in arguments about the vaccines or press them on the reluctant because that’s only one aspect of what he offers at the store.

“I’ll talk to patients about other conditions, like diabetes: ‘You didn’t get your insulin on time,’” he said. “I don’t want to ruin the relationship I have with them.”

Singal said this kind of one-on-one service is increasingly under threat of vanishing as pharmacists face higher workloads and smaller profit margins.

He’s particularly concerned about trends in the business, such as patients being encouraged to fill prescriptions online rather than at community pharmacies. Amazon’s entry into the field last year sent shivers through many who have seen how the online giant overwhelmed other brick-and-mortar businesses.

As it is, Singal said he regularly fields calls from people asking about a particular drug, even though when he looks them up in his system, he finds they aren’t customers. They’ll concede they get their pills online or at a chain, but say that when they have questions about them, they can’t get through on the phone.

Still, at 74, he says it’s still a pleasure to come to work.

“I get to meet my customers, I’m able to find out what going on,” Singal said. “All my customers know me personally, and I’m a service to the community.”

Baltimore Sun reporter Alex Mann contributed to this article.