Pharmacists Raise the Alarm About Staffing, Workload

With walkouts across the country and other efforts to raise public awareness, pharmacists are working to find solutions to understaffing and workload challenges. In an interview with Pharmacy Times, Sarah Oprinovich, PharmD, BCACP, a clinical associate professor at the University of Missouri-Kansas City School of Pharmacy, discussed these efforts and what they mean for the future of pharmacy.

Q: Can you give some background on these problems?

Sarah Oprinovich, PharmD, BCACP: Yeah, so in the time since I've been practicing, I've really seen a lot of shifts. Reimbursements for prescription products are decreasing, so that's putting a lot of increased pressure on other parts of the business operations to be more efficient and lower costs. Frankly, pharmacies don't have the ability to set most of their prices, they don't know what they're going to get reimbursed, they aren't allowed to fully be in control of that. So, they have to work on what they can control, and what they can control is labor and inventory and things like that. So, with that, you know, you've seen a reduction in the workforce just to make that leaner, and I think we hit a place where the friction was too great. But I've also seen some places where they're being very successful. You know, ideas like Flip the Pharmacy, where those places are improving efficiencies in the workflow without necessarily reducing the workforce, and they are maintaining their clinical services. And so, I think what we need to really bring light to is where it's going well and how we can expand those practices to other places.

Q: What are the key concerns?

Sarah Oprinovich, PharmD, BCACP: Yeah, I think the biggest thing here is patient safety. Pharmacists are afraid that they're going to be too rushed or too overloaded to give the care that they would like to provide, and that they're going to make a mistake, they're going to hurt a patient. I think that is the driving fear. I also think that pharmacists are, in general, a high performing kind of person and they are used to being able to provide a certain level of service. We have trained them to provide a certain level of service. And it's really extremely distressing when you can't do that because you don't have enough resources, you don't have the staff. And so, I think the concern there is sort of, in a way, a good thing, because it demonstrates how much pharmacists really want to push to provide that better service. And so, I think the other reason we're hearing so much about this is that pharmacists haven't given up. Complacence is silence. So, we're hearing a lot about this. It's because pharmacists are engaged, and they're activated and they're ready to be able to do more.

Q: How did the COVID-19 pandemic exacerbate these issues, and has there been any improvement post-pandemic?

Sarah Oprinovich, PharmD, BCACP: Yeah, I think COVID-19 definitely threw us challenges that we didn't see coming. But I think it showed us where we can step up, it showed us how long we can step up. You know, we got out and vaccinated like crazy and that showed us, like, we can do that, to a point. We can in an emergency, we can step up. But there is also a point at which rest needs to happen. And so now that we're in this more maintenance phase, I think what I'm seeing is there's expanded scope of practice, there's expanded realization of what community pharmacists can do and what kind of health care they provide to their communities, and I think we're just waiting on the staff availability to meet that need as well. So, again, I think there are places that are doing well here, and I think we need to highlight those bright spots and figure out what is it that these guys are doing and how are they making it function well, and how do we expand that?

Q: Is this specific to community pharmacies, or do these issues affect pharmacists in all working environments?

Sarah Oprinovich, PharmD, BCACP: Yes, I think these issues really go across all aspects of pharmacies. I've been hearing from students in other types of locations that their workload has increased, their scope of practice has increased. You know, when I was graduating pharmacy school, there was this concern that there were too many pharmacy schools and there were going to be too many pharmacists. But at the same time, I was also hearing that pharmacists are going to be able to do all these new things. They're going to need to be in all these places, and we're going to need that many more pharmacies or pharmacists to take on this workload. And I think there was a delay there. And now I think we've caught up; we've gotten to that place where we need more pharmacists in more places, and now we need to crank out more. And that expansion happened. So, again, I think those are those are good things. Pharmacists are doing newer, cooler, better things. But we just need to expand the number of pharmacists that are ready to do that.

Q: How do burnout and workload affect patients?

Sarah Oprinovich, PharmD, BCACP: Yeah, and I think that this is a phenomenon seen all across health care, where, you know, when health care staff is burned out, mistakes happen. And even for those that are patient-facing, it can result in just not being able to provide the services that they would normally provide, or maybe even an extreme cases being less kind than they would normally be. And so that's going to affect the patient and the trust and what they pursue from the pharmacy. I think one of the examples I've seen, especially with the drug shortages is, normally you would be able to call other pharmacies and find this drug. But when you have to juggle all these other tasks and you have less help than you would have normally had, then you can't provide that service, you're putting it back on the patient. And I think that's distressing to both the pharmacy staff and the patient. So, I think that's one thing that has been really impactful on patients.

Q: What are some recent efforts to bring attention to these issues?

Sarah Oprinovich, PharmD, BCACP: Yeah, there are some huge grassroots efforts going on among pharmacists, and these go all the way from just social media all the way up through the national organizations. In my backyard in Kansas City, we had several pharmacists come together and walk out. And what I've seen come from that is that there is now a more open dialogue, they are having these conversations with employers and with regulators, and our state pharmacy association has weighed in, and our Board of Pharmacy has weighed in. And so, everyone has brought this focus on patient safety and how do we maintain that to the utmost that we would like to provide? So, you know, I've seen more policies and rules be put in place because of these things that will hopefully contribute to patient safety. That's their intention, anyway. I think, also, the national organizations are really working hard to move toward changing the incentive structure in community pharmacy, which has been rewarding volume over quality for a lot of years. And so, that big push is going to be able to affect how pharmacy runs in the future.

Q: Have you seen real shifts or movement on these issues?

Sarah Oprinovich, PharmD, BCACP: Yeah, I mean, I've seen employers and regulators take on some new things, even, you know, adding lunches and so on. And I think those are great first steps. I think, also, one of the things that I've seen is the advent of CPESN—Community Pharmacy Enhanced Services Network—that brought together independent pharmacists and pharmacies from all over the country for more information sharing, more collaboration, spreading of these procedures and policies in pharmacies that can improve the efficiency, free up time for more enhanced services, other revenue-generating tape of things. I've seen more unification and mobilization of those working to distribute the work of those great innovators and trailblazers, particularly in academia. There’s the Community Pharmacy Transformation Collaborative, working with the Community Pharmacy Foundation and the Flip the Pharmacy efforts, and I think that's really been instrumental in trying to expand those efforts beyond the innovators.

Q: How can pharmacists advocate for the profession and bring attention to these problems?

Sarah Oprinovich, PharmD, BCACP: So, I think the very first step is working with and communicating openly between employers and pharmacy staff, and making sure that people with ideas have a way to get them to people that can implement them. For example, I've had students bring me really good ideas that would be low cost, potentially have a really high impact, but they don't know where to go with it. So, I think making those lines of communication more obvious and accessible would give away for people to say, ‘I have an idea here and think I could make this better. Let's figure out how to do it together.’ I think, also, pharmacists really need to get involved in their local and state and national organizations. These are organizations that are trying to serve as advocates for pharmacists, but they really need to hear from pharmacists on the front lines working—what is it you need? What do we need to advocate for, what are your ideas? And even outside of advocacy, it gives a really nice network of other colleagues that can provide support, other ideas, sharing of information, things like that.

Q: Is there anything you’d like to add?

Sarah Oprinovich, PharmD, BCACP: So, with the CPESN pharmacies, I'm seeing that information sharing, that spreading of things. So, for example, the appointment-based model, that was a big push with Flip the Pharmacy and pharmacies were figuring out how to use medication synchronization and planned patient interactions to improve their efficiency, but then also add on other services for the patients. And so, when you have that, it works. And I've seen that already expanding out. When it started, it was just a few independent pharmacies, and now I've seen it, in some variety, go to every corner of community pharmacy. So, I think that is one real highlight. You know, I have seen some independent pharmacies that are very successful with their vaccine campaigns that are using it very intentionally. So, they're making very specific set limits on how many people can get a vaccine in a day, they are giving very clear policies and procedures, automating things like the consent form that can help the pharmacy staff out—less paperwork to fill out, less things to do. They don't have to fill out the address, things like that. It seems very simple, but at the same time, it saves a lot of time, and it eases the process. And just simple things like that, where the pharmacist feels supported and knows, ‘Okay, this piece or this task that is time consuming, that doesn't really require any clinical expertise, there is a way to get it done without me having to do it every time.’