The Health Care System is Failing Its Providers, Too

By SAM URETSKY

The Bureau of Labor Statistics estimates that the growth rate for pharmacists will be about 2% over the next 10 years, and that this rate is slower than average for all occupations. That may not be a bad thing because a job that used to be fairly pleasant and reasonably remunerative has become stressful and unpleasant. The salary is pretty much okay, but that’s about the only thing that is. Drug Topics, a trade magazine, carried a report, “Retail Pharmacy Has Reached the Breaking Point,” with a subhead “Pharmacy workloads, corporate demands, and customer behavior have stretched an already thin pharmacy workforce to the breaking point.”

The shortage is not confined to pharmacists – it affects virtually all healthcare occupations ranging from physicians to home health aides and includes veterinarians, and extends from private practice to chain stores. The first occupational shortage was among nurses, and has not really been resolved. Hospitals send recruiters to Ireland and the Philippines to recruit nurses, and other hospitals use traveling nurse services, where nurses can work at interesting locations on a temporary basis. The practice of having pharmacists administer influenza and COVID-19 shots was a partial attempt to alleviate the nursing shortage. It didn’t.

Among physicians, many have turned to concierge medicine in order to improve their lives while maintaining their income. In this system, the patient pays an annual fee for the right to be able to get an appointment within 48 hours and to telephone the MD at any time. There is also a fee for each visit – concierge medicine isn’t insurance, just a promise of access. But while insurance companies press physicians to see more physicians at lower fees, concierge companies offer a second income stream that allows MDs to work at their own pace.

Precedence Research reported, “physician stress is one of the primary reasons that help the acceptance of the retainer care model. As per the survey of the Medscape National Physician Burnout & Suicide Report, in 2020, around 42% of the physicians claimed to be burned out. … Therefore, physicians are increasingly adopting the retainer model as they can earn a little extra from it and can easily maintain a work-life balance.” The problem is the obvious one. As MDs join these organizations, it cuts into the number of physicians treating lower-income families, let alone the uninsured.

There is nothing comparable for pharmacists, but it might seem that working in a rural, independent pharmacy would at least offer the benefits of a comfortable workload and even a personal relationship with the patients. That doesn’t work either. The few remaining independent drug stores can’t compete with the six figure signing bonuses offered by the national chains. At the same time, residents of rural towns are often older and sicker than the patients in metropolitan areas – they need more prescriptions filled so that the workload is still excessive. The burn-out rate is about the same as working for a chain, and leads to PharmDs looking for other ways to make a living.

In 2022, Walgreen’s, the nation’s second largest chain pharmacy, issued a press release saying “that it is eliminating ‘task-based metrics’ from performance evaluations to allow its pharmacy staffers to ‘place even greater focus on patient care.’ They will now be evaluated ‘solely on the behaviors that best support patient care and enhance the patient experience,’ Well yes, but while this won’t count against the performance evaluation, it will result in a lot of irate patients saying ‘all you have to do is take the pills from a big bottle and put them into a little bottle.’”

What some pharmacists are doing is leaving the retail environment where the chains are improving conditions by offering a half hour lunch break, and finding work from home jobs. These focus on some of the professional aspects of pharmacy practice without the pressures of direct patient contact. One job description from Florida Blue includes, “Collaborate with physicians and other prescribers by reviewing patients’ drug profiles to help safeguard against new prescriptions having unintended side effects and by working with prescribers to assure that the drugs prescribed are eligible for coverage; are low cost, high quality generic products when appropriate; and are projected to do no harm.” This, one of the most basic aspects of professional pharmacy practice, can be done from home, and limits some of the pressures, but means that the community pharmacist has lost the sense of professionalism and has less to do with patient care.

Tech solutions may resolve some of the causes of burn out, just as telemedicine helps physicians cope. None are solutions to the entire problem of a growing, aging population, but they’ll help.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.

From The Progressive Populist, March 1, 2023

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