|Pharmacy working conditions
|Ended on 11/22/2023
The regulations, as proposed, are a good first step towards improving working conditions. However, even though these have already been in place as emergency regulations, there has been zero response from any of the large corporations to actually implement changes to improve the working conditions thus far. For example, one large chain still allows pharmacists a lunch break, but because the pharmacy remains open while the pharmacist is on lunch, the pharmacist is still required to address mandatory counseling blocks (such as generic "90 day refill" blocks). If their 30 minute lunch break turns into a 5 minute lunch break, so be it. Likewise, another large chain does close for lunch, but at a set time. Regardless of if the pharmacist is helping patients or not after 1:30, the pharmacist is required to return promptly at 2:00. If the pharmacist is administering immunizations, or is counseling a patient, and doesn't get to actually leave the pharmacy until 1:45, they still have to be back at 2:00. The technicians, on the other hand, are guaranteed a protected 30 minutes, whether they leave at 1:30, 1:45, or later. I have had a permit holder point blank state that "you have 30 minutes to eat somewhere in your 11 hour shift. Figure it out".
Large corporations will, quite simply, look at the proposed regulations and will pull out the policy manual that says "we already meet these regs". Because they do. Any pharmacist that challenges the corporate budget or corporate direction will not be termed or demoted because they challenged the actual work conditions, they'll be punished for "poor customer service". As an example, Walgreens very publicly announced that they "will no longer hold pharmacy teams accountable to performance metrics". That's true. They don't. Prior to my leaving the company they changed their performance evaluations to only focus on "leadership qualities". However, these "leadership qualities" are then tied more deeply to "did you're pharmacy meet goal script growth? Immunizations? MTM?" No? Then you must have poor leadership. It's easy for the board to put in regulation "Avoid the introduction of...quotas...", and it's just as easy for a corporation to hide those quotas behind the vague umbrella of "effective leadership skills".
My pharmacy did over 800 prescriptions in the span of 3 days with 1 pharmacist and 2 technicians. I went to the bathroom two times in 10 hours on the first day, one time the second day, and was unable to the third day because while I had 2 technicians, they were both acting as cashiers for the majority of that time. So 1 pharmacist entered scripts, reviewed them accuracy, filled a good chunk of those scripts, and verified for product correctness. In addition, about 25%-30% of those required mandatory patient counseling after checkout (dictated by the corporate software). This is after the emergency regulations were published. We did several dozen immunizations, and received constant pressure from our management to also complete additional MTM claims because "we were over 100 active claims". I could, very easily, have told my management "I'm sorry, but the volume we are attempting to fill with only 2 certified technicians is unsafe and we are unable to accommodate any additional services right now". However, I still need my job. I absolutely guarantee I would receive a very strong warning, if not lose my position. I could lodge a formal complaint, but it wouldn't do any good, the company would replace me with another pharmacist less vocal and say "I have poor customer service skills and am not respective of my patients needs".
No, without concrete minimums in writing that are black and white corporations will continue to use and abuse pharmacists. We're "highly compensated individuals" and as such, according to the corporations, deserve every bit of what they want to dish out. The Board needs to step up to protect both the patients and the pharmacists. Pharmacist walk-outs (of which I did not participate) only hurt the patients. They get publicity, but that's it. When CVS is posting over $320 billion in revenue for 2022, I seriously doubt 22 pharmacies closing for a few days because of a walkout will truly make an impact. At the end of the day, corporate pharmacy boards are ruled by non-pharmacists that will do everything to keep shareholders happy and profits as high as possible. I fully intend to exit pharmacy well before my retirement age, if possible. I have many friends that have exited retail completely, and in some cases pharmacy completely. What happens when retail pharmacies can't be staffed, not because of COVID, but because the pharmacists are not there to staff them? Pharmacy deserts. Mail order. I think everyone can agree its inconvenient for a patient to drive 30 to 40 minutes to find a pharmacy in rural areas. But Virginia is in large part rural. Nobody likes mail order. There's a reason mail order market share has never gotten above single digits since its conception.
Any regulatory movement should address working conditions in black and white.
Ultimately, legislatively the issue with DIR fees and PBMs needs to be addressed, as in my own personal opinion PBMs are the root of the problem. Pharmacy is the only business, to my knowledge, where we sell a product or service for less than its value, and have no guarantee to ever get paid for the full value of that product or service.
I believe the regulations as proposed are a good first step, but they don't go far enough. Simply because, by their interpretation, corporations can truthfully say "we meet these regulations" and continue pushing pharmacy teams to the breaking point at the expense of patient safety. The regulations to address working conditions should be clear, black-and-white standards much like the physical standards of pharmacies, that do not leave any room for interpretation. In summary: