Experts: The Hematology-Oncology Pharmacist Great Migration Is Caused by Issues Outside of Burnout That Could Be Quickly Addressed

Pharmacy Times interviewed Zahra Mahmoudjafari, PharmD, BCOP, DPLA; Alison Gulbis, PharmD, BCOP; and Kamakshi Rao, PharmD, BCOP, FASHP, on a 2022 ATOPP Summit session they will be co-presenting in addressing research they conducted assessing the underlying causes of the hematology-oncology pharmacist great migration.

Question: What is the hematology-oncology pharmacist great migration, and when did it start?

Zahra Mahmoudjafari: That's a great question. Honestly, I couldn't put a finger on when it exactly started. I think we all began understanding and recognizing it about a year ago when we met for a brief conference in June of 2021 and recognized that a lot of our colleagues and team members who have worked with us and alongside us in direct patient care roles, since transitioning to different roles, were doing different things.

This allowed us to start questioning why this was occurring and led us to ask those questions directly to our colleagues, and we got together at the end of that conference, and at the time phrased it, as “the great migration. There are other publications that are available for the general workforce, specifically looking at what is called the “great resignation.” But we chose to call it the “great migration” because our pharmacists are still working in the field of pharmacy in some capacity, just not necessarily in direct patient care role. So we were motivated to figure out why some of those reasons were occurring to motivate our team members to move on to non-direct patient facing roles.

Kamakshi Rao: I think I would only add to it to say that I think pharmacists have been migrating amongst clinical and other roles for a long time. So it's not new to have pharmacists moving around or changing roles. I think what we had talked about was, I think it was 2 things.

The first was the rate of change, like how quickly it seemed like every few days, every week, we were hearing about somebody who we were quite familiar with, and I think the 3 of us are pretty well connected at knowing oncology pharmacists throughout the country, and so it sort of startled us to see the pace of change.

Then, I think, there were probably for each of us a couple people that we knew that in our heads, you just never would have thought that would happen. They were someone who, when you met them, you're like, this is a person who is going to be in patient care for the duration, it's completely their zone. Then to watch those people making decisions to leave patient care—I think those 2 factors sort of piqued our ears as to something different is going on here, something has changed.

Question: How did the pandemic contribute to this migration?

Zahra Mahmoudjafari: Yeah, I think the pandemic maybe hastened what was already occurring and made it potentially even more painfully obvious, thinking it was a time where pharmacists really had to sit down and evaluate what mattered to them. So sometimes, what mattered to them was increased flexibility and their ability to work from home. What was what mattered in terms of their own mental health or career advancement—they took some time to really evaluate that specifically, and I think it just escalated it and really highlighted it and just really wiped the rug out from under us.

So I think it has really made me look at it in a more positive light and enabled us to really look at some of the things that are the root of the issue and allow us to have a lot more honest conversations. So, therefore, our patient-facing pharmacists can really have the time to spend with our patients and to take care of our patients, and we have more honest conversations now than we've ever had before. So I kind of like to think of it as a positive. But certainly it has been a tough couple of years, and I think for all of us in so many ways, just as you thought you got over one thing, the next problem came along.

Certainly what other facet of this is direct shortages that never went away, and it's only getting worse, it feels like, by the end. So again, I think the pandemic helped highlight it, but also helps us understand some of these core factors and core reasons it was already occurring, it just maybe hastened it.

Alison Gulbis: I think to add to what Zahra said about the whole work from home thing and flexibility that people realized was out there—a lot of institutions took these clinical pharmacy specialists who had direct patient facing roles and made them work from home. So it really started a realization that the flexibility is helpful for some, but, on the other hand, I think work from home also blurred the lines of when you stop working. Also, I think that made people reflect on their own personal time and what they needed, so I think that has been a contributor as well.

Question: What are the causes of the great migration, and is it primarily burnout?

Zahra Mahmoudjafari: Burnout is a big facet, but it is not the only reason. In fact, our research found a lot of emerging trends, some of which were more obvious than others. Some of them are kind of surprising things that we would call low-hanging fruit that institutions can implement pretty quickly to try to help retain staff.

One thing that came out pretty loud and clear was the team members want more support, and potentially better patient ratios. They're feeling lack of recognition, they're not feeling valued, necessarily.

One thing that came in loud and clear was just the number of administrative responsibilities that our pharmacists have taken on both in the military spending as well as a QA person. Another facet was flexibility in wanting to work from home potentially, and then there's other facets, including career advancement—I think our pharmacists are extremely high achievers, and they want to continue to work towards something. Some of them have different strengths that don't necessarily mean that they want to be in direct patient care, providing avenues for them to explore those opportunities are all facets of some of the trends that we identified in our research.

Again, there's some other, like I said, low hanging fruit, those include things like board certification support, the ability to attend conferences, and to network with other colleagues, which we consider to be something that could be easily achievable, if given the right resources, but it's not simply just burnout.

Kamakshi Rao: I would have to call attention to, I think, burnout and wellbeing are very important. And you consider that so many things intersect and contribute to someone's risk of burnout and wellbeing. Those things can include more than just workload. We did hear about from a lot of people who felt like their desires for advancement didn't fit the strict narrative of the position descriptions that they had, feeling like their time was being nickeled and dimed to things that really weren't utilizing their skillset, so when a pharmacist is spending inordinate amounts of their days on insurance authorizations on trying to navigate the system versus being able to actually provide care to patients.

We also heard from pharmacists within oncology that are also involved in so many different things—teaching, research, committee work, representation and service on local, regional, and national organizations, and most of them are doing that on their own time.

Also, just tying back to the discussion around the pandemic, our own time became more important than ever. So when things started to creep in, and the idea was all the achievement you want has to happen on your own time. It really changed people's level of satisfaction with how their professional advancement was not tied to the appropriate metrics. So I think we heard a very loud call for more appropriate metrics that drive clinical pharmacy practice and career ladders and advancement opportunities that are more than just pharmacy administration as 3 individuals who have made those transitions into administrative roles. I think 3 of us have had some really healthy discussions about how that was the only option for advancement, and we pursued those options. But if we could turn back the clock and consider advancement using different avenues, whether it was getting protected time for education research scholarship, that would have changed the course of many pharmacists who have chosen admin as a path that may have changed the choices they made.