Turbulence can be used to describe a state of change or uncertainty that can make it difficult to predict outcomes and can lead to significant disruptions and challenges - this certainly applies to the current state of the pharmacy profession, particularly in large, community, retail-chain settings such as CVS, Rite Aid, and Walgreens.
Over the last year, several major news outlets, including USA Today, Forbes, and CNN, have reported on a shortage of pharmacists and pharmacy technicians. While this is partially true,1 the reality is that the news coverage has failed to capture the working conditions and healthcare landscape that have created and sustained the turbulence retail pharmacists and their staff are experiencing. These conditions are particularly concerning given that 1) approximately 90% of the US population resides within 5 miles of a community pharmacy2 and 2) that 70% of prescriptions are dispensed by retail chain pharmacies.3 As a result, workforce conditions in the retail pharmacy setting have significant potential to impact public health and compromise the healthcare of populations that heavily rely on their accessibility, including the elderly, low-income patients, and underrepresented communities.
The turbulence within the retail pharmacy practice setting relative to other practice settings has been amplified, as aggressive volume-based metrics of dispensing rather than quality patient outcomes continue to be the focus. Although community practitioners have always and continue to prioritize medication safety, the retail pharmacy business model in which pharmacists operate relentlessly tests and compromises their ability to execute their provider role safely, putting patients at risk of potentially catastrophic medication errors.4 A quick jaunt to any large retail-chain pharmacy reveals teams of pharmacists and technicians who are often understaffed, working through frenetic working conditions to dispense any of the 1.9 billion prescriptions delivered electronically each year,5 managing a relentless flow of patients through the drive-through, administering walk-in vaccinations, answering phones, working the register, counseling patients, and calling doctors and insurance companies to answer questions and better advocate for their patients. As a result, the retail pharmacy workflow places a heavy burden on pharmacists hitting volume-based targets while managing areas they cannot control.
Over time, this business model has created and sustained punishing workloads for retail pharmacists who often stand on their feet all day, missing lunch and bathroom breaks in order to meet the demands of patients and corporate quotas of dispensing. A recent workload survey of over 15,000 Ohio pharmacists affirms practitioners’ concerns with insufficient staffing and pressures from their employers to meet metrics. Perhaps even more startling is that retail pharmacists indicate that inadequate staffing and the current work environment result in delays in patients receiving medications and their ability to provide safe patient care.6 The perceptions and concerns of retail pharmacists are further supported by independent studies demonstrating that high volumes and inadequate pharmacist staffing do indeed contribute to medication dispensing errors.7-9
As one might imagine, the pressures of the COVID pandemic have only added to the turbulence experienced by practitioners. During the past three years, pharmacists administered over 300 million doses of COVID-19 vaccines (largely in retail pharmacy settings) and were empowered by several states to furnish the anti-viral medication, Paxlovid, and counsel patients on its complex drug-drug interactions—all while the demands of their responsibilities continued unabated.10 The pandemic also created chronic supply chain issues that forced pharmacists to navigate drug shortages and provide patients with alternatives for common medications. It should be noted that there have been efforts by retail chains, some state boards of pharmacy and legislatures to mitigate the turbulence experienced by pharmacists. These efforts include the adoption of measures mandating specific staffing ratios and lunch breaks for pharmacists along with increased signing bonuses. However, such laws have proven difficult to follow and enforce in practice. Although increased signing bonuses may help alleviate staffing shortages in the short-term, they fail to address the working conditions and burnout that create and sustain them.
Despite this turbulence, the pharmacy profession remains an essential part of the healthcare system. Pharmacists are trusted healthcare providers who play a critical role in ensuring that patients receive safe and effective medications. However, our current retail pharmacy workplace environments are not structured to maximize practitioner efforts to provide safe patient care. Retail pharmacists have, for too long, been asked to do more with less and the breaking point is here. Accordingly, state/federal workplace pharmacist staffing regulations and enforcement, improved whistleblower protections, and a workflow that emphasizes patient outcomes versus dispensing metrics are needed to mitigate turbulence within the profession and improve patient safety.
Kyle M. Sousa, PhD
Dr. Sousa is an Associate Professor and the Associate Dean of Academic Affairs at the School of Pharmacy. His research interests include pharmacy program/policy evaluation, and pharmacy workforce sustainability.
- 1Pharmacists Occupational Outlook. US Bureau of Labor Statistics. January 18, 2023. Accessed February 12, 2023. https://www.bls.gov/ooh/healthcare/pharmacists.htm
- 2Berenbrok, LA., Tang, S., Gabriel, N. et al., Access to community pharmacists: A nationwide geographic information systems cross-sectional analysis. 2022. Journal of the American Pharmacists Association. 62(6):1816-1822
- California Department of Health Ccare Services (2023) CalAIM Behavioral Health Initiative. https://www.dhcs.ca.gov/Pages/BH-CalAIM-Webpage.aspx
- 3Parasrampuria, S., and Murphy, S. Trends in Prescription Drug Spending, 2016-2021. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. September 2022
- 4Gabler, E., How Chaos at Chain Pharmacies Is Putting Patients at Risk. New York Times. January 31, 2020. https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html
- 5Surescripts Network Alliance. 2020 National Progress Report. https://surescripts.com/news-center/national-progress-report-2020
- 6Francis, SG., Pharmacists’ Perceptions About the Effect of Work Environment Factors on Patient Safety in Large-Chain Retail Pharmacies. 2022. Journal of Pharmacy Technology. 38(6):376-378
- 7Pervanas, HC., Revell, N., and Alotaibi, AF. Evaluation of Medication Errors in Community Pharmacy Settings: A Retrospective Report. Journal of Pharmacy Technology. 2016. 32(2) 71–74
- 8Malone, DC., Abarca, J., Skrepnek, GH., et al. Pharmacist Workload and Pharmacy Characteristics Associated With the Dispensing of Potentially Clinically Important Drug-Drug Interactions. 2007. Medical Care 45(5):p 456-462
- 9Ashcroft, DM., Quinlan, P., and Blenkinsopp, A. Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies. 2005. Pharmacoepidemiol Drug Saf.14(5):327-32
- 10The Federal Retail Pharmacy Program for COVID-19 Vaccination. National Center for Immunization and Respiratory Diseases and Center for Disease Control and Prevention. https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html