Pharmacists are burning out. Patients are feeling the effects.
When Christopher Duke's frail, elderly patient needed her blood pressure prescription refilled last year, she did what she always does - she called Duke, a physician in Chevy Chase, Md.
No problem, Duke told her, he would call it in to a nearby pharmacy.
But there was a problem - because Duke couldn't get anyone to answer his calls. Instead, he ran up against a frustrating new reality at many drugstores, especially those in big chains: As essential jobs at retail outlets go unfilled, and hours are reduced at many chains, the likelihood of spotty service and potential mistakes at pharmacies has grown.
When Duke called the pharmacy, its phone mailbox was full. He called the pharmacy again and requested the direct line for doctors, and the phone rang. And rang. It rang for more than 40 minutes unanswered, Duke said. The next day, the woman made her way into Duke's office to get a paper prescription. It marked the second time in a short period that Duke's efforts to call in a prescription had failed, he said; the other also forced an elderly patient to come to his office to pick up a paper script.
It was "aggravating and time consuming," Duke said. While most of his prescription calls ultimately get through, enough don't that it has become a problem.
Growing workloads and resulting stresses on pharmacists have led to well-documented burnout and subsequent staffing shortages. Reflecting new demands on pharmacies, the Centers for Disease Control and Prevention reports that 301 million coronavirus vaccinations had been administered in pharmacies as of March 9, roughly half of all such shots given nationally.
But while the pandemic slammed pharmacists, as it did many other health-care workers, pharmacy groups say working conditions are generally more stressful and demanding now than they were before the pandemic.
In 2021, the National State-Based Pharmacy Workplace Study reported that 75 percent of the pharmacists in a survey disagreed with the statement, "Sufficient time is allocated for me to safely perform patient care/clinical duties." Additionally, 71 percent said there were not enough pharmacists working to "meet patient care/clinical duties," and 65 percent said "payment for pharmacy services" did not support their "ability to meet clinical and nonclinical duties." About 6,400 pharmacists in a variety of workplaces - large and small retail chains, independent stores and hospitals - participated in the survey.
"Workplace conditions have pushed many pharmacists and pharmacy teams to the brink of despair," the board of trustees of the American Pharmacists Association (APhA) said in December 2021, citing stress from the pandemic. "Pharmacy burnout is a significant patient safety issue. It is impacting patients today with delayed prescription fulfillment, unacceptable waits for vaccines and testing, and potential errors due to high volume, long hours and pressure to meet performance metrics."
APhA interim chief executive Ilisa Bernstein said in late February that little has improved since the 2021 survey. While some pharmacies have made changes, such as closing for a 30-minute staff lunch and instituting signing bonuses, when it comes to pharmacist burnout "we're not seeing much improvement at all," Bernstein said.
Excerpts of an upcoming National Pharmacist Workforce Study - sponsored by a broad coalition of pharmacy organizations - were presented last week at the APhA annual meeting in Phoenix.
The new findings support Bernstein's conclusion, said David Mott, a professor in the University of Wisconsin-Madison School of Pharmacy and the principal investigator on the new survey, which gathered almost 5,000 responses.
The full survey, which will be released in May, documents that self-reported workplace conditions have broadly worsened since 2019 for many pharmacists, he said.
For instance, Mott said, more than 60 percent of the community pharmacists who responded said they don't have enough time to perform their work activities. Pharmacists also reported more feelings of burnout in the new survey - which was conducted in 2022, when the pandemic had started to wane - than they did in 2019.
"Pharmacists' responses in our survey show that many are struggling to get things done, and that has to have an effect on the quality of their work and their care," Mott said. "It's a scary situation; not healthy."
How did pharmacy problems start?
Although groups representing pharmacists and chain retailers agree that they have a serious problem, they disagree about its immediate causes.
Retailers and the trade group representing them have complained that there aren't enough trained pharmacists and pharmacy technicians available. They also say rules governing how pharmacies operate should be updated and loosened, including allowing pharmacy technicians to perform a broader range of tasks, some of which only pharmacists can fulfill today.
These changes and more "will go a long way in addressing pharmacy staffing issues," said Kathleen Bashur, senior manager of media relations for the National Association of Chain Drug Stores.
Organizations representing pharmacists counter that there is not a shortage of trained pharmacists, and that the upcoming National Pharmacist Workplace Study has data to support this view. Rather, pharmacist organizations said, there is a shortage of pharmacists and pharmacy technicians willing to work under the hothouse conditions at many retail pharmacies.
Pharmacy groups, as well as members of Congress and federal officials, blame pharmacy benefit management (PBM) companies, which negotiate with manufacturers, insurers and pharmacies on drug prices. Critics say PBMs carve out too-low pharmacy reimbursements, leading to shortfalls and staffing cuts. PBMs say they help deliver discounts to patients and point to the prices charged by drug manufacturers as the driver of high drug costs.
One visible way that retail pharmacy chains have responded is by cutting pharmacy hours at many stores. CVS and Walgreens - the nation's two largest retail pharmacy chains - reduced hours in recent months.
Aliyah Horton, executive director of the Maryland Pharmacists Association, said it isn't clear whether pharmacists and pharmacy technicians will have to fill the same number of prescriptions they did before, just in a shorter workday.
If pharmacy staff must fulfill the same volume of prescriptions in fewer work hours and without additional staff, she said, the existing problems with service will inevitably grow.
A spokeswoman for CVS, the largest national pharmacy chain, declined to comment on pharmacy burnout and workload.
Kris Lathan, a spokeswoman for Walgreens, said, "We've continued to take proactive steps to address staffing needs, including hiring thousands of pharmacists and other team members, increasing compensation and other measures to reduce workload."
Charles, a pharmacist in Madison, Wis., worked for more than two decades as a pharmacist and pharmacy manager at several big-box retail outlets. The Post agreed not to publish his full name to allow him to speak freely.
Over the years, he said, his workload continued to grow. As new tasks were added, many of his colleagues were let go, quit or were reassigned. "The straw that broke the camel's back" for Charles was an error he almost committed.
One day in late 2021, Charles was preparing to vaccinate a child for covid-19 as increasingly impatient customers waited in line and a large number of prescriptions from a phone order remained to be filled.
With too much on his mind, Charles said, he grabbed a syringe and headed to the child awaiting his shot. It was only as he prepared the injection that Charles realized he had picked up an adult syringe with the adult vaccine dosage, not a child's.
"I almost made a mistake that could have been harmful," he said. "That worried and scared me, and that's when it hit home that I had to leave."
Now he works at a rural clinical pharmacy where the salary is about the same, but the pressures are much reduced. And he said he can be the patient-centered pharmacist he trained to be.
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