'We Need to Educate': NABP Seeks to Address Pharmacy Workforce Burnout Through Collaboration, Education

Al Carter, executive director of the National Association of Boards of Pharmacy (NABP), sat down for an interview with Pharmacy Times® to discuss the state of working conditions in pharmacies as they continuously report feeling stressed and burnt-out. Carter discusses the relationship forged between the NABP, the American Pharmacists Association (APhA), and the American Society of Health-System Pharmacists (ASHP) to tackle the issue, and the "Implementing Solutions" report recently released by the group that provides a roadmap to addressing the burnout epidemic among pharmacists.

Pharmacy Times: Can you describe the challenges that the pharmacy workforce has been facing with high stress levels and occupational burnout?

Al Carter: Yeah, that's a very good question. This isn’t something that's new, this is something that's been ongoing. I think what we saw is with COVID, it escalated it, and it just escalated it significantly, I would say x times in comparison to what you saw as far as working conditions or workforce challenges or what have you before the pandemic. First, you have a lack of resources. So, you don't have enough pharmacists that practice in some of these community settings, you have technicians, or a lack of technicians in this community setting as well, partly because they can go to do other jobs that are less stressful, making the same amount of pay or what have you, and just the environment and conditions were very challenging. The other challenge you have with this, and this isn't something that is an issue that NABP is focusing on, but it's hard to bring in those resources, such as pharmacy technicians and that additional help if you can't pay them. The way the reimbursement structure is currently in pharmacy is very challenging and very limiting in many ways, and so that contributes to that factor as well. One of the things I will say is that what we're seeing in pharmacy is: we're not alone. You see a huge shortage of nurses. There's a shortage of physicians as well. To have the burnout—everyone’s dealing with it—where you have more and more people that need pharmacy assistance, partly because they can't go to a primary care physician because it's a 6-month wait, or they can't go to see a specific doctor, so they're coming to the pharmacist, because that's their primary access point. You see pharmacies that are a lot busier, and if you remove that staff and that support, it's going to lead to more stressful environments dealing with all the requirements that pharmacists have to do, some of those being administrative in nature in addition to their clinical responsibilities. It just becomes very challenging and very stressful for the pharmacists and for the staff that are there.

Pharmacy Times: How was the relationship forged between NABP, the American Pharmacists Association (APhA), and the American Society of Health-System Pharmacists (ASHP) to tackle this issue?

Carter: It was interesting, because we were all doing our own things to look at working conditions, workforce challenges, burnout and what have you. We were at the meeting, I can't remember which meeting we were at, and it was kind of like a sidebar conversation where I and Ilisa Bernstein, who was the interim CEO for APhA at the time, were like, “Hey, instead of doing this separately, why don't we get a group together of regulators, industry leaders, of pharmacists, to tackle this all together.” And once we started having those conversations, ASHP asked if they could join and participate as well, because health system pharmacists were dealing with some of the same things, as far as burnout and stress levels and what have you. So, we forged this group together to plan out this meeting that we eventually call the summit in June 2023; really it was implementing solutions, building a sustainable, healthy pharmacy workforce and workplace. We all had specific topics that we wanted to address. So, we wanted to address workforce and workforce challenges, not only in community setting, but also in health systems setting, and looking at all settings where there were some workforce challenges. We also wanted to look at it from a standpoint of well-being and the individual well-being of the pharmacist and pharmacy staff and making sure that was a component of this summit that we put together. We got this group together, and one of the initial objectives in charge of this group was that we must implement solutions. We can't continue to talk about this and not have ideas or solutions for some of the challenges and problems that we're discussing. So, the goal was for this group to come together, and we each would have our own responsibility and own tasks that we have to take back, and it was to make sure that we implement solutions to address this and continue to address this moving forward.

Pharmacy Times: What are some of the key takeaways from the “Implementing Solutions” report?

Carter: Some of the big things, and I'm going to read through some of them, one of the big things that we noticed was that we need to educate the public. We need to educate the payers, and we need to educate health systems and other community pharmacy executives. We needed to educate mainly the public, because if you look at some of the workforce studies and data, one of the largest complaints they had was that unruly and aggressive or abusive behavior from some of the patients and the public that were coming into some of these settings. It was really understanding what a pharmacist really does, and understanding the value of the pharmacy services that are provided in these locations and kind of talk about some of the success stories to create some type of sustainable collaboration of what care would look like with a team. One of the other things was, how do we leverage pharmacy technicians more? How do we leverage their capabilities? How do we provide them with more responsibilities and give them opportunity to take on some of these more administrative tasks? As you know from COVID, many states moved in the direction of allowing pharmacy technicians to administer vaccines. What are some of these other tasks and responsibilities that are administrative in nature and don't necessarily need the clinical judgment of a pharmacist that a pharmacy technician can't provide?

Part of that also was, how can we implement technology? How can we look at new efficiencies, utilizing technology that will help to enable pharmacists to focus more on the patient and focus more on what those services are that they can provide without trying to cut labor and other resources or what have you. So, enhancing technicians and put the technician on a higher platform, and then also utilize technology and the technological resources that are out there to be able to do more. And then one of the other big things was, how do we talk to the payers, and how do we talk to the health plans, and how do we begin to establish ways for pharmacists to become credentialed so that pharmacists can start getting paid for some of the services that they're providing. Because pharmacists are being asked to do more and more and more within the space. As we talk about some of the gaps in care, and specifically with pharmacists, in many situations, being the only health care professional that a patient has within a 3-to-5-mile radius that they have access to real time and pretty much every day. How do we recognize pharmacists’ free services that they're providing, and be able to pay them? Those were some of the things that we looked at. But there's other things that we talked about. How do we look at addressing the mental well-being of pharmacists and pharmacy technicians? How do we look at peer-to-peer support groups? How do we create awareness for some of these types of stressors? What are some things that we can do to remove regulatory hurdles or burn unnecessary burdens that are challenging to the workplace? What are some of the things that employers can do? So, what can employers do to help with addressing these working challenges? How do we establish closer partnerships? How do we give more leadership roles into some of these things?

So, there were a lot of topics that were discussed during this 2-day summit that we're looking at many of those types of actionable items. At the end of the day, one of the things that was clear if I was to summarize this, is that we need to educate. We need to educate the public. We need to educate health care professionals. We need to educate payers. Two, we need to utilize technology, and we need to expand upon the responsibilities of pharmacy technicians, to allow them to do more and recognize them for that. And then 3 is, how do we continue to elevate the pharmacist where they're practicing at the top of their education and getting paid for those services that they're providing and recognize them in a different way than how they're currently being recognized.