NCPA CEO: Three-Quarters of Community Pharmacists Say Filling Open Positions Remains Difficult

Pharmacy Times interviewed Douglas Hoey, PharmD, MBA, CEO of National Community Pharmacists Association (NCPA), to learn more about the results of an NCPA survey that showed over three-quarters of community pharmacists say they are having a difficult time filling open positions on their staff.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me is Douglas Hoey, PharmD, MBA, the CEO of National Community Pharmacists Association, or NCPA, who is here to discuss the results of a recent survey that showed over three-quarters of community pharmacists say they are having a difficult time filling open positions on their staff.

So Doug, what did the survey show exactly regarding the current staffing issues that are facing so many community pharmacists today?

B. Douglas Hoey: Well, Alana, great to be here. And I think the survey showed what a lot of our members are telling us and what they're feeling, and it quantified those things. As you mentioned, almost three fourths are experiencing some kind of labor shortage of some kind, particularly with technicians, front end staff, but also with pharmacists as well. I think that's coupled with demand for pharmacy services that’s greater than it's ever been before. So, we have this great demand and this shortage of people to do it coming at the same time.

Alana Hippensteele: What are some of the results of such widespread staffing openings remaining unfulfilled?

B. Douglas Hoey: Well, there's a lot of ripple effects when our members don't have the staff that they have to take care of the patients as timely as they would like. One of those things that we're seeing in a few pharmacies is that they're having to cut their hours a little bit. Anecdotally, what we're seeing that, with the independent is much, much, much less severe than what we've heard about with the mega chains. But we have had a number of members who say, Hey, I'm not going to be open on Sunday, or if I'm normally open till, say, 7 o'clock, I'm going to close at 7 o'clock. I have heard that from a number of members, and our survey supports some of those actions. Other things are, we're finding that our owner members and their pharmacy teams are working harder and longer than they had to in the past. And that's one of the characteristics of an independent community pharmacy is that our members are going to take care of that patient until the last one, to the very last one. We're not going to shut the door in someone's face when they're coming up for care. And so that results in, a lot of times, the owner themselves, he or she working longer hours. I hear about burnout and ‘man, I'm tired’ now over the last couple of years than I've heard throughout my career.

Alana Hippensteele: Right. What are some of the potential causes of the staffing and hiring difficulties community pharmacies are experiencing, based on the results of the survey?

B. Douglas Hoey: The results of the survey don't necessarily ask the why, so we have to speculate somewhat. I speculate—part of that speculation is the workforce pressures that other sectors in the industry or in the world are seeing, that there was the great retirement. A number of pharmacy technicians and salesclerks might have retired or want to cut back on their hours. Also, during the pandemic—well the pandemic is still going on—but when the pandemic was really raging at its peak, the reluctance of workers to be face to face with others. That has had some impact. I also think there's a growing trend of retail jobs, face to face with the consumer being less desirable, not just in pharmacy, but in other sectors as well. We can speculate, are consumers, is their behavior more boorish or more unacceptable? Or is there something else going on where there's other jobs pulling those people away? But our members are having a harder time to attract workers, again, as are other industries.

Alana Hippensteele: Right. How about NCPA? Does the association have any further information on what some of these staffing shortages’ causes may be and also some of the ongoing problems with hiring? What might be the source of that?

B. Douglas Hoey: Well, also with some of the cause, so a pharmacy technician, they don't have to be certified, but it's often helpful when they are. So there is a training, and either way they need to be—whether they're certified or not—they have to be trained in order to assist the pharmacist with his or her duties. That is, I wouldn't call it a huge barrier to entry, but there is some criteria to entry. You just can't come up off the street and all of a sudden be a pharmacy technician. There is some training involved. And that's somewhat true with some of the front-end positions as well. There's certainly some training that's unique to community pharmacies. That's different than say working at a grocery store or fast food place, especially in independent pharmacy, where that connection with the patient, that relationship with the patient is so important, whereas maybe in some other settings, it's not as important. Those are some of the, again, I'm reluctant to use the term barriers to entry, but it is at least an obstacle to entry. We're also seeing some of our members, from a salary standpoint or wages standpoint, that there's wage pressure, as well, to either pay higher wages or adjust compensation in some manner as well. So, all of those pressures are kind of coming together. The thing is, there are others, whether it's restaurant, grocery store or other retail industries have the same pressure. They're all trying to attract that same pool of workers, and there's only so many workers to go around right now.

Alana Hippensteele: Right. How might these staffing shortages affect community pharmacy closures, which have been a trend threatening community pharmacies throughout the pandemic?

B. Douglas Hoey: Yeah, the closures issue, we're seeing it a lot with the chains. We've heard a lot of it with chains, heard a lot of it from our members calling and saying that XYZ chain just put up a sign and said, “we're closed this weekend. Sorry, patients, do the best you can, or drive 25 miles to the next city to get your prescription where that pharmacy is slammed and doesn't have access.” We've heard a lot of our members, typical of independent community pharmacists trying to do whatever they can to serve that patient, calling the physician, trying to get a new prescription, trying to transfer the patient, which is almost impossible to do with some of these chains because you can't get through to them, they won't respond to faxes, electronic requests. The closures are a problem.

Part of the problem also is the economics. We're seeing some of those prescriptions being transferred over to the independent pharmacies, which are staying open by working harder and longer and being able to keep some of their staff, a lot of their staff. But because of the usually terrible reimbursement from the PBMs, just because they're filling more prescriptions, doesn't mean that economically they're doing better. Now the independent’s in a situation of, I’m filling more prescriptions, but I'm filling prescriptions for terrible reimbursement. What do I do? This patient needs to be served, but I'm losing money by serving this patient. I think that's going to come to a head in this industry, where at some point, pharmacies are going to say I can't serve this patient and continue to lose money or I'm not going to be in business. And that patient is going to find themselves in no man's land. They're going to not be able to get a prescription. I think when that comes to a head, the industry is going to have to see some changes from the payers.

Alana Hippensteele: Right, Absolutely. Walgreens has announced multimillion dollar investments in their pharmacy staff to support pharmacist retention over the past year. How might this level of financial investment at large chain retail pharmacies impact community pharmacies looking to address the same problem?

B. Douglas Hoey: I don't have any insight into Walgreens, their financial situation other than what's publicly reported and what I hear from members. When I do hear concerns from our members, it's usually about a Walgreens. That's number one, the one that's listed as far as not staffing. Those are anecdotal, so I don’t have that quantitatively. But number one, by far, is Walgreens. The recent news about them now offering bonuses, incentives, doesn't surprise me in that, whatever they're doing, they need to attract more people. I think it can have a ripple effect, but I also think that a number of pharmacists are going to look at not just Walgreens, but the working conditions in the big chains—and those are pretty well documented. I mean, you can go on social media, you can Google some of the concerns about the working conditions in the large chains. Some of the quantitative surveys that have been done show just pharmacist attitudes, especially in those big chains, have really fallen over the last 5 years. I think there's a lot of work to do there. The financial incentives will attract some people. But at some point, it's the quality of life that's got to change. And again, the economic conditions often lead to the businesses being able to affect the quality of life. So, something's got to change with the economic conditions, and that's not a newsflash for anyone in independent community pharmacy.

Alana Hippensteele: Right. What is your outlook on the future for community pharmacies?

B. Douglas Hoey: It's very bullish. One of the things causing this, and I think it's important that we keep in mind, that one of the driving factors of this labor shortage is that the demand for pharmacist services has never been higher. People are accepting, consumers have been slowly accepting pharmacists to fill in some of the primary care gaps that our healthcare system needs, starting with immunizations and increasingly, consumers have been getting their flu shot here. But then with COVID patients voted with their feet. Two-thirds of all consumers said, I want to get my COVID shot at a pharmacy by a pharmacist or someone from their pharmacy team. The opportunities for filling in some of these primary care gaps, whether it be immunizations, point of care testing, other public health needs, PEP and PrEP, contraception, smoking cessation, the list goes on and on. It's never been greater. It's some growing pains right now to get the labor to balance with the pharmacy demand. And again, not to be redundant, but having the economics to have the payment for those services balance out. So it makes sense for the pharmacist to be able to do those services and to be able to hire staff. So again, the demand for services is amazing progress for the profession. The economics have to catch up with it, and when the economics catch up, I think the labor force will also quickly catch up as well.