How The Chaos in Chain Pharmacies is a Side Effect of a Bigger Problem

Those who are dedicated to a life of wisdom understand that the impulse to blame something or someone is foolishness, that there is nothing to be gained in blaming, whether it be others or oneself

Epictetus 

What I Remember About Pharmacy School

I still remember the conversations, conversations that I heard when I was a pharmacy student and when I was working as a technician. The conversations about the working conditions in retail pharmacy. Most newly graduated pharmacist, including my former classmates, end up working in retail pharmacy. Those who decide on doing residency or any other form of post graduate training do so for several reasons, one of which is that it’s the best option to avoid working in retail pharmacy. 

The Problem

The problem with difficult working conditions in America’s pharmacies took a more central stage thanks in part to two New York Times articles that were published early in 2020 by Ellen Gabler: The first article, titled, How Chaos at Chain Pharmacies Is Putting Patients at Risk was published on January 31st of 2020. The Second article, titled, At Walgreens,Complaints of Medication Errors Go Missing was published on February 21st of 2020. 

Both of those articles discuss how understaffed pharmacists are and how the chaotic workplace conditions harm pharmacist and ultimately harm patients because they potentially lead to an increase in medication errors (no causation here just correlation- although I would say that correlation is an indication to dive deeper and conduct more research and analysis). My purpose in writing this article is not to further elaborate on The New York Times articles. I think the author does a good job of investigating and writing about the working conditions and how that potentially leads to medications errors. 

The Chaos in retail pharmacy working conditions is a byproduct and a side effect of a bigger problem, the problem of a system that focuses overwhelming on using medications as the #1 resources for treating chronic disease. In other words, it is an extension of the problems inherent in the conventional medicine system. It’s a system that values speed because time is money, volume is money. In the world of retail pharmacy volume is more prescriptions in and more prescription dispensed. According to a 2019 Drug Channels Institute report that was cited in The New York Times article, the big retail chains dispense 70% of prescriptions in America. Furthermore, according to the first article, CVS controls a quarter of the U.S.’s total prescription revenue and dispenses more than a billion prescriptions per year while Walgreens controls 20% of the total prescription revenue.

The Numbers

What exactly do I mean by chaos in retail pharmacy work conditions is a side effect of a bigger problem? It’s a side effect of the chronic disease epidemic and the problems inherent in conventional medicine for treating those chronic conditions. 

You see, retail pharmacies don’t exist in silos, they exist to serve a market and that market is those individuals with chronic disease who have been prescribed medications for those conditions. Here are the statistics about chronic diseases in the U.S.

  • “Six in ten adults in the US have a chronic disease and four in ten adults have two or more”1
  • “Chronic disease like heart disease, cancer and diabetes are the leading causes of death and disability in the US. They are also the leading drivers of the US’s $3.6 trillion in health care cost”1
  • 90% of the U.S.’s $3.6 trillion in annual health care spending are for people with chronic and mental health conditions1
  • 9% of the national health spending is for prescription drugs.
  • The average number of prescriptions filled annually based on the number of chronic conditions a person has are the following.
    • People with 1-2 chronic conditions: fill 9 prescriptions annually
    • People with 3-4 chronic conditions: fill 24 prescriptions annually 
    • People with 5+ chronic conditions: fill 50 prescriptions annually 
  • As of 2018 retail prescription drug spending was at $335 billion2

In pharmacy, much like the rest of conventional medicine speed and volume = money! The financial incentives are around speed, time, and volume and therefore it becomes about getting the most out of every pharmacist to maximize those financial rewards. 

Does this bigger problem I’m describing give the right for retail pharmacies to unfairly treat their pharmacist and the rest of their employees? Does this mean that its okay for pharmacist to be in unfavorable working conditions? Does this mean it’s okay for pharmacist to be overworked, understaffed, under-appreciated and under-valued? NO, absolutely not and that’s not what I’m suggesting, this sort of treatment of employees stems from a leadership problem in retail pharmacy (more on that in another article). 

Start Small

My focus and goal are to empower pharmacist! 

I remember the advice I got several months ago when I was attending a conference about residential assisted living facilities. They had a speaker, Dr. Bill Thomas, a geriatric doctor and an expert on nursing homes and senior living communities and how those institutions are designed to isolate our elderly. I caught up with him after his talk to chat, he had mentioned something that I related to. He said in reference to nursing homes “what the management does onto the staff, the staff will do onto patients”. I shared with him my frustrations with the profession of pharmacy (more specifically retail pharmacy) and he gave me a simple advice for creating change, “start small”. 

Corporations are difficult to change; I don’t mean to sound like a pessimist, but I think that’s the reality. It doesn’t mean that they won’t change, it just means that it takes time and a big shift in the incentives for them to change. 

You can’t begin to take steps towards change if you don’t accept that a problem exists and if you don’t take responsibility for the problem. 

That is exactly what you see in some of the big retail chain’s response, a failure to admit that a problem even exists. Just read for yourself what CVS response’ was to The New York Times article. 

“We fundamentally disagree with the recent assertion in The New York Times that patient safety is at risk in America’s pharmacies…”

CVS

How can a company to begin to make positive change if they don’t admit that a problem in their employees’ working conditions exists? (Again, more on this in another article focused on leadership in pharmacy) 

Solution

What can pharmacists do? What power do they have? What do they have control over? There are two options, two possible solutions. The first is hope for more journalists and pharmacist to continue to speak out and bring awareness to the problem in the hopes that it will help companies change. As I’ve alluded to earlier, I’m less hopeful that change will happen this way but it’s worth a shot. 

The second option is for pharmacist to begin on the individual level, for them to begin to empower themselves by finding ways to deal with the stress and finding creative and entrepreneurial ways to use their skills and influence as pharmacist to help patients change their health through nutrition, exercise and lifestyle behavior change and by focusing less on using medications for treating chronic conditions. This will ultimately help pharmacist to better serve their patients and to help them achieve better levels of health. 

I’m not suggesting that pharmacist ignore the problems they are facing at work! I’m, however suggesting that they find better ways to respond to their circumstances. As Epictetus, the stoic philosopher said:

“We cannot choose our external circumstances, but we can always choose how we respond to them”

How will you choose to respond to those challenges you face as a pharmacist? Will it be by focusing on things out of your influence; leadership and management decisions at your company, work hours, staff to workload ratio and hoping that the big corporations you work for will suddenly change overnight? Or will you focus on things within your influence; your physical and mental health, your skills and abilities and how you can use them to help patients outside the confines of retail pharmacy? I’m not saying it’s easy but it’s possible, I’m not saying things will change overnight for you and I’m also not saying that I’ve got it figured out because I don’t. I’m still finding and navigating my own path. 

Tips and Strategies for Better Physical and Mental Health 

I can’t understand and appreciate enough the stress that pharmacist feel from their jobs. I haven’t worked in retail pharmacy as a pharmacist, but I have as a technician. I can’t give you answers on how you can begin to creatively find ways out of retail pharmacy. I can, however, offer some tips and strategies for how to begin living a healthier life (if you aren’t already doing it) as a pharmacist, I can offer you tips and strategies for how to manage your stress and how to find ways to thrive. Here are some simple strategies to help you begin: 

  1. Deep breathing exercises
  2. Develop techniques to better deal with stress
  3. Exercising 
  4. Getting quality sleep 
  5. Eating nutritious food– I fully understand that the difficult working conditions prevent most if not all pharmacist from getting a break (although that is beginning to change in most states). This doesn’t mean that it’s not possible to eat healthy and to snack healthy. Most pharmacist snack because that’s all they have time for. As I have seen from my own experience, pharmacists are not usually choosing wisely when it comes to snacks. Most of the time, (again speaking from experience from what I saw as technician) pharmacist are snacking on things that negatively affects their biochemistry and physiology and therefore how they feel. It is possible to eat healthier and snack healthier, there are after all fit pharmacist, there are pharmacist that have done it (google fit pharmacist and you will see what I am talking about) 
  6. Practice Mindfulness (via meditation) 
  7. Condition your mind so that you can achieve better mental and physical health

For more information and more details about each of those tips mentioned above consider downloading the Wheel of Health Workbook, I go even deeper on mindset, sleep, exercise, nutrition, energy and stress management. 

Change happens internally first before you can begin to change and influence your patients. To begin to influence others and having impact on your outside environment you must first begin by learning to influence yourself. 

References

  1. National Center for Chronic Disease Prevention and Health Promotion. https://www.cdc.gov/chronicdisease/index.htm.
  2. National Health Expenditures 2018 Highlights. https://www.cms.gov/files/document/highlights.pdf
  3. Buttorff,C., Bauman, M., Ruder, T. “Multiple Chronic Conditions in the United States” Rand Corporation. 2017.https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf
  4. https://cvshealth.com/newsroom/press-releases/cvs-health-responds-recent-news-pharmacy-workplace-concerns

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