Pharmacy Workload Standards... What's the Solution?

As the pharmacist’s scope of practice continues to expand, excessive workload is a major concern for pharmacists in all practice settings.

Perhaps the problem is worse today than in previous years, but I have heard employee pharmacists complain about excessive workload for most of my career. As the third-party reimbursement rate for filling a prescription declined, pharmacist employers have had to manage their employee hours more tightly. This has been going on for years in most pharmacy settings, but it does seem as if I am hearing more pharmacists complain about unsafe working conditions as they fill prescription orders.

The problem seems to be inadequate staffing. Some suggest that the problem has become worse as pharmacists are being asked to add immunization administration into their workload, operate under a 15-minute guarantee to complete filling a new prescription order, or obey a stoplight arrangement on the pharmacy computer system. Pharmacy Times received this letter, which sheds some light on these issues:

This “Letter to the Editor” letter is written by the wife of a pharmacist. Today we have listed our home for sale because my husband has lost his pharmacy position because of the corporate strategies and age discrimination practices that have become rampant in the corporate pharmacy mentality that presently exists in America. He has systematically been written up…to make room for new graduates who will be paid far less than his present salary.

The shame of these tactics does not only rest with the chain pharmacy corporations, but also with the pharmacy boards and pharmacy associations that have let the chains systematically change a vocation that was considered one of the most highly respected professions. As the chains began to grow in the early seventies, the independent pharmacies began to struggle and be choked out of the business community.

Where were the voices of our associations and boards of pharmacy to protect these small businesses? They remained unheard and resulted in the general demise of the independent pharmacies. Now we have reached another era in our economic history where economic times have affected the wealth of these corporations. We find that the older pharmacists are now becoming extinct too. They are being walked out of drug stores by district managers after years of providing high-quality services to their customers….

Where are the voices and protection from our pharmacy boards and associations today? Are they not listening or just uncaring? As I pack the boxes of our family home where we have raised and educated our children, I think of the pride I once held for my husband’s profession that now has been changed forever.

Although this pharmacist’s wife doesn’t state the reasons her husband has been written up by a district manager, one can surmise that it might be related to getting prescription orders filled in a timely manner. That would be consistent with reports I have received personally. Like many pharmacists, she wants to put the blame on boards of pharmacy and pharmacy associations.

What is interesting is that when these pharmacists complain to the state board of pharmacy they often refuse to give their names, so the board is unable to really do any kind of follow-up. It raises this question for me: Why are employee pharmacists so reluctant to advocate for themselves with their employers? Of course, boards of pharmacy are not advocates for pharmacists, but are in place to assure public health and safety. Trying to show a link between staffing patterns and workload is very difficult because so many factors can influence how long it takes to fill a prescription. Thus, it is very difficult at best for a board of pharmacy rule to be able to show that it contributes to reducing medication errors, the reason why such a rule should be promulgated.

What is the role of the pharmacy association to assure good working arrangements for pharmacists? With the majority of pharmacists not even being members of their state pharmacy associations, most associations operate with limited staffs and funds. Most associations have not seen their role to be a collective bargaining unit for pharmacists either, although they should be interested in developing professional practice standards. Such standards can only help if employers agree with them and implement them voluntarily.

The fact is that pharmacy associations are not in a position to enforce their implementation. I am not aware of any successful effort at the state or national level to address this perceived longstanding problem of adequate staffing in the dispensing arena. In the end, unless pharmacists are willing to make public their situations after raising concerns with their employers about the situation, there is not much an association can do.

I am positive that boards of pharmacy want to assure safe practices and would follow up if complaints were made by name and location. Pharmacy associations want to serve the needs of member pharmacists, too, but more employee pharmacists need to become members—and bring their ideas on how to address this problem to the leadership.

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.