If you’ve had a prescription filled in the last year, you probably already know that the United States is facing a shortage of retail pharmacists. Across the nation, many customers are finding their local pharmacy closed, sometimes for newly specified lunch hours, sometimes for weeks, and sometimes forever.
Last year a full third of Walgreens’ 9,000 stores were operating at reduced hours because of staffing shortages.
While store closures, shuttered pharmacy counters, and longer wait times can be an inconvenience, the pharmacist shortage can have real life or death consequences. Stress among remaining overtasked pharmacists can lead to medication errors or near misses. A little over a year ago, the Board of Trustees of the American Pharmacists Association (APhA) sounded the alarm that “Pharmacist burnout (had) hit breaking point, impacting patient safety.”
Background
Of the approximately 323,500 pharmacists in the United States, the majority work in retail settings, including stand-alone pharmacies, grocery stores, and chain drug stores. According to the National Association of Chain Drug Stores (NACDS), which represents such companies as CVS and Walgreens, chains employ 155,000 pharmacists, who collectively fill more than 3 billion prescription each year.
The typical pharmacist’s workload involves much more than dispensing prescription medications. As in other healthcare fields, pharmacists face increasing administrative and regulatory burdens. Pharmacists may also be responsible for inventory management, patient counseling, and the provision of limited primary care services such as vaccinations and COVID testing.
Now hiring
The average salary for a pharmacist in the U.S. is currently $128,570 a year. Still, many retail pharmacy jobs are going begging. A recent search for full-time staff pharmacist positions on the CVS careers site, rendered more than 2,000 results across the United States, many designated as “Sign on bonus eligible.” And these bonuses can be significant. In August of last year, the Wall Street Journal reported that Walgreens was offering pharmacists sign on bonuses of up to $75,000.
Burnout
In study after study professional associations are finding pharmacists burnt out, with many considering or actively pursuing other fields. The U.S. Bureau of Labor Statistics predicts that openings for pharmacists will outpace industry growth as a result of the “need to replace workers who transfer to different occupations.”
For years, pharmacists working for chains including Walgreens and CVS have complained that performance metrics and quotas prevent them from delivering quality patient care and raise the risk for medication errors. In some instances, pharmacists are evaluated not only on the number of prescriptions they dispense daily, but also on the number of patients they can persuade to enroll in revenue-securing auto-refill programs.
Citing “feedback from pharmacy team members,” Walgreens announced the elimination of task-based metrics for its pharmacy staff performance in October. This was under increasing media scrutiny and more than a year after California passed a law specifying that a “chain community pharmacy… shall not establish a quota related to the duties for which a pharmacist or pharmacy technician license is required.”
That the state of California acted on pharmacists’ concerns about performance metrics before Walgreens, lends credence to APhA’s assertion that pharmacists confront a lack of “meaningful two-way communication channel(s)” with management.
Another stressor for pharmacist is reimbursement structure. In a 2021 statement, APhA characterized the “payment system for pharmacy services (as) fundamentally flawed,” pointing to the power of pharmacy benefit managers (PBMs) in setting drug prices. The organization accuses PBMs of forcing pharmacists to “depend upon unrealistically high transaction volumes with minimally viable staffing to stay in business.”
The leverage exerted by PBMs is a special problem for independent pharmacies. “Between rising costs and diminishing reimbursements, neighborhood pharmacies are really being squeezed,” according to Douglas Hoey, CEO of the National Community Pharmacist Association (NCPA).
COVID-19
Performance metrics and PMBs are longstanding issues for pharmacists. The pandemic added additional burdens. Pharmacists very quickly found themselves on the frontline of the nation’s COVID response.
Under the Federal Retail Pharmacy Program, pharmacists have delivered 296.9 million doses of COVID-19 vaccine at over 41,000 locations nationwide. Through a separate partnership with the federal government, Walgreens and CVS pharmacists were dispatched to administer COVID vaccinations in long-term care facilities. Thousands of other smaller or independent pharmacies participated in separate state vaccination programs.
Pharmacists battled misinformation as well as the COVID virus. They had to dispel rumors about the efficacy of hydroxychloroquine and chloroquine and negotiate requests for ivermectin, all while administering COVID tests.
The pandemic brought with it supply chain shortages, which persist. And it hasn’t been just masks and hand sanitizer. Last month the Food and Drug Administration (FDA) reported that amoxicillin, pediatric pain medicines, and albuterol were all in short supply.
Although not responsible for these shortages, pharmacists frequently incur the anger of patients stymied in their attempts to fill “routine” prescriptions. This is also prompting pharmacy technicians, the frontline assistants who answer phones and ring up sales, to quit, which, in turn, adds to pharmacists’ workloads.
The future
Addressing the shortage of pharmacists will require a multi-pronged approach that enhances job satisfaction among current pharmacists while ensuring there are new entrants in the pipeline.
To attract new candidates to the field, the American Association of Colleges of Pharmacy (AACP) reports that the Pharmacy College Admission Test (PCAT), previously a prerequisite for admission to all Doctor of Pharmacy (Pharm.D.) programs is being phased out after 2024. It is currently not required by any pharmacy program in the U.S.
Elimination of the PCAT may make the application process more “holistic” and lead to more diverse applicant pool. At a minimum, it should increase the number of applicants to pharmacy programs.
But systemic issues must be addressed, or new graduates will only follow their predecessors in abandoning the field for other options.
Scott Knoer, APhA executive vice president and CEO, observes that “Support of pharmacy team members and pharmacies is needed—especially now as the pandemic continues—from employers, insurers, lawmakers, and the public to ensure adequate resource availability, address patient safety issues, and reduce stress and increase satisfaction of pharmacy personnel both now and in the future.”