Peter A. Kreckel practices pharmacy in Lemont Furnace, Pennsylvania.

Peter A. Kreckel, RPh

January 2022 has finally rolled around, and every pharmacist’s plate is full and—in most cases—running over. I use this plate analogy knowing full well that we are in the midst of “eating season,” which starts with Thanksgiving and ends with the Super Bowl. Having fought the “Battle of the Bulge” since elementary school, gaining weight is something I am an expert in. People can gain as much as 10 pounds during the eating season, often because they overload their plates.

Unless they are an owner, the average pharmacist doesn’t really have control over what is put on their plate. Unlike our university dining hall days, when students could take their fill and discard the rest, pharmacists must eat everything on their daily plate. It doesn’t matter how large the plate is, or how high it is piled, it is expected to be cleaned off by the end of the shift.

We might look around at our fellow pharmacists who have big plates piled high. Social media tells us of pharmacies providing upwards of 50,000 COVID-19 vaccines. I read about these amazing achievements with widening eyes. My wife Denise managed COVID-19 clinics in State College, Pennsylvania, immunizing thousands of patients on 1 Saturday. I was able to help her out by reconstituting and drawing up vaccines.

She had at least 24 volunteer immunizers, at least a dozen reconstituting and drawing vaccines, and at least 2 dozen more helping out with intake, monitoring, and tra. c control. It was a fun 8 hours, working with at least 60 health professionals and run-of-the-mill volunteers. Doing the math, Denise’s 8-hour clinic administered 2400 shots with 60 workers, coming out to 40 shots per person which equals 5 shots per person per hour. By the way, they did no billing whatsoever and only used the computer to enter data into the Statewide Immunization Information System.

Can we extrapolate these efforts down to the community pharmacy level, where you have 1 pharmacist to do the drawing up, administering, and monitoring? In the pharmacy where I work, we are required to use 3 different databases—all clunky at best—when we administer a COVID-19 vaccine. One database links to our federal health partner, our pharmacy software is used for billing, and another system is used to access the Statewide Immunization Information System.

There are, essentially, 3 different operations to fill 1 prescription, all before the shot can even be administered. And did I mention that we’re still filling prescriptions at a sometimes breakneck pace? We as pharmacists need to start looking at our own plate. No longer should our plate consist of liver, onions, and brussels sprouts day after day, but it should have an occasional filet mignon and baked potato. We need to go to the pharmacy cafeteria and fill our plates with well-balanced activities.

If we are to provide immunizations,then we must take something off our plates. If someone keeps piling up our plates, and insisting we clean off the plates, it is only a matter of time until something must give. Either a larger tray with more plates (technicians) or a smaller one with fewer plates (less responsibilities) is needed in exchange for pharmacists providing immunizations. In Malay, Indonesia there is a term used instead of the word “no,” which is too absolute.

The word belum means “not yet”—a response that reflects on the possibilities of uncertainty and a positive answer that needs to be considered more deeply. Belum is a word that I would like to see incorporated into every pharmacist’s vocabulary. When the district manager has another addition to an already busy schedule, we can avoid saying “no” and instead say “belum”—not just yet. Our plates are full and we can’t eat another bite.

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As pharmacists administer more immunizations than ever, managers must provide a larger tray (pharmacy technicians) or smaller plates (fewer responsibilities) to balance things out.

Pharmacists’ Plates Are Piled High

Last month I discussed pizza and the hashtag floating around social media—#PizzaIsNot-Working—that reflects the ways in which management needs to address salaries to help retain pharmacy technicians. 

I use social media infrequently-typically to read posts about pharmacy or my former student’s achievements and to keep up with extended family. I don’t have a Twitter account and am clueless about Snapchat. But if I did have a Twitter account, I’d start the hashtag to the effect of #PharmacistsAreNotScaredAnymore.

I am seeing a true revolution in this profession, especially in my observations of chain pharmacists. One year ago, my fellow pharmacists would refer to WalMart, Walgreens, and CVS as “Spark,” “Corner,” and “3-Letter,” respectively, to make it more difficult for regional managers to monitor derogatory comments. Now, however, pharmacists openly and blatantly criticize their managers, their staffing levels, and their salaries. Pharmacists are not scared anymore!

I am seeing pharmacists inundated with COVID-19 and flu shot administration with no increase in either help or salary, and these pharmacists are mad as hell and not taking it anymore. CVS reported significant profits  at the beginning of November thanks to COVID-19 vaccinations and testing, but only the shareholders are benefiting.


Meanwhile, the rank-and-file grunts seem to be left out…again. Every COVID-19 vaccine generates $40. Every COVID-19 and flu shot administered takes time away from dispensing, leaving the pharmacist and staying  further behind. Sorry big guys, but a 5-cent an hour raise doesn’t cut it.

I am 63 years old and have achieved all that I ever hope to in this amazing profession. I have a wall full of awards and have had a satisfying career dispensing medications, educating my patients, teaching, and precepting nearly 70 pharmacy students. My advocacy is not self-serving, but my concern is for the future pharmacists in this profession.

Many pharmacy schools are accepting virtually any student just to fill seats in the classroom.We continually see smaller enrollments with students who are less than qualified. The average pharmacy school acceptance rate for 2017 through 2018 was 82.7%.

During the 2003 through 2004 application cycle, the average acceptance rate was 34.1%.

Compare that with the current acceptance rate for medical school, which was approximately 42% for 2017 through 2018.

When I applied to the University of Pittsburgh School of Pharmacy in 1977, we were told that we had a less than a 1 in 5 chance of getting in and that if our grade point average was less than 3.35—well, don’t waste the paper and stamp applying. Although the “legacy schools” still have robust qualifications for entrance, such is not the case at many other schools.

Today, at least half of student pharmacists apply for residencies to position themselves for a job that is not community-pharmacy related. Many of the students I interact with have not only a lack of interest in practicing community pharmacy, but also a real disdain for this area of practice. 

It’s too bad, because there is not a health care professional anywhere who can have a more direct influence on patient care—if working conditions allow for it. The level of practice most community pharmacists wish to attain can only be attained through sufficient staffing, competent pharmacists, and salaries that are adequate.

Pharmacists should be doing patient care, not typing on computers, running cash registers, or counting pills. Any of those tasks can be easily accomplished by a technician. Pharmacists should be doing patient care. Instead, community pharmacists are leaving this profession in droves. 

When I took my Boy Scout troop camping, I would tell them to leave the environment better than they found it. Such is not the case in this profession: Pharmacists have had enough and are letting the world know that pizza is not working and that pharmacists are not scared anymore.

Overwhelmed pharmacists are no longer scared of speaking up to managers.

Profits Soar, But Pay Stays the Same: Chain Pharmacists Are Ready to Speak Up

Editors note: In our November issue of Drug Topics, we neglected to credit Bled Marchall Tanoe, PharmD, as the creator of the #PizzaIsNotWorking hashtag. We sincerely apologize for this oversight.

Authors note: We pharmacists are frequently overlooked with our efforts in providing excellent patient care. I would also want to make sure that the efforts of Bled Marchall Tanoe, PharmD—the creator of #PizzaIsNotWorking—gets all credit due for her leadership in promoting the profession of pharmacists and their technicians. Our profession needs more pharmacists like Bled to direct the causes of our profession.
—P. Kreckel

As a kid, growing up, my mom always baked bread, usually on Mondays. The smell wafted through the house as we enjoyed her handiwork fresh out of the oven.

The only way we could be more excited was when she took the leftover dough and made us pizza with Velveeta cheese and pepperoni. We had pizza at home, long before the first pizza shop opened in our town in the late 1960s. One of my clerks—an Italian woman—had another view of pizza.

Antonia hated pizza because it reminded her of her childhood in the 1930s. Antonia said that when they had pizza at her house, it meant things were bad. Her mom would roll out the leftover bread dough and top it with tomatoes and leftover cheese, or maybe some pepperoni, salami, or soppressata—anything she could scrounge up in the refrigerator. Not a good day at Antonia’s home when pizza was served.

Somewhere between my childhood and adulthood, pizza became not only a treat but also a reward. Little League teams had a pizza party if they won a big game. Kids who won fundraising competitions at their schools had a pizza party. Cub Scouts celebrated a successful Pinewood Derby with a pizza. Even an occasional drug sales rep might drop o. a box of pizza to his pharmacies for hustling his vaccines.

So, what’s a 100% German guy doing writing about pizza?

All over social media, we are seeing the hashtag #PizzaIsNotWorking, created by Bled Marchall Tanoe, PharmD, an Oklahoma pharmacist. It’s a catchphrase to show that pharmacy staff is not motivated by an occasional pizza. At one time in my career, pharmacy technicians were just a step up from a clerk. Most pharmacy techs did the mundane jobs: counting pills or filling out the occasional third-party triplicate claim form. After a couple months of training, a pharmacy tech in the early 1980s was fully trained and capable.

In the 40 years since I kicked o. my career, the pharmacy technician profession has changed—possibly even more than the pharmacist profession. Today, technicians may do the data entry for the pharmacist, as well as the preparation of the prescription. Today, the pharmacy technician might do everything from receiving the prescription (either on paper or electronically) to bagging the completed prescription.

The pharmacist needs to be onsite to do the verification, but other tasks fall on the technicians. Today, it takes at least a year of intensive training to create a proficient technician.

For all these tasks and duties assigned to technicians, their pay has in no way kept up with their workload. Pharmacy technicians, especially in retail, have the most stressful job in the service industry. I’ve seen local convenience stores offering salaries $3 to $5 more than our techs are offered to operate a cash register, make sandwiches, and stock shelves—with significantly less stress and significantly more pay. Is it any wonder that our community pharmacy techs are leaving in droves?

Handing them a pizza once a year on Pharmacy Technician Day hardly makes up for the belligerent customers, insurance issues, and—yes—stressed-out pharmacists.

There is not one topic I have addressed more often than staffing issues in the pharmacy. I’ve been called a staffing guru by a hospital pharmacist who read my comments as he was researching how to staff his hospital’s outpatient pharmacy. I’ve always said that the difference between a good day on the bench and a miserable day is the quality and quantity of staffing.

The big chains have made massive amounts of money with vaccinations. They got almost $40 for each COVID-19 shot given, along with all the other vaccines we administer. All this money has been made on the backs of the pharmacist and their technicians. The chains need to give at least a $5 per hour increase to everyone in their pharmacies. The money is there—we’ll be glad to order our own pizzas.

Peter A. Kreckel, RPh, practices community pharmacy in Altoona, Pennsylvania.

This occasional “reward” hardly makes up for the belligerent customers,
insurance issues, and—yes—stressed-out pharmacists.

The #PizzaIsNotWorking: It’s Time to Rethink Pay for Pharmacy Technicians

The year 1981 was a special one for my wife, Denise, and me. We graduated from the University of Pittsburgh School of Pharmacy in April. We got married on the Fourth of July and took our first jobs as licensed pharmacists in August. Like all new graduates, we were ready to apply our new knowledge and patient counseling skills to help our patients. It didn’t take long to realize that the dream was becoming a nightmare.

After a couple months working with a major chain, I came home one night and told my new wife, “If this is retail pharmacy, I made a serious mistake choosing this profession.” When I begged for more tech help, my district manager said, “I’ve watched you work, Pete, and if you stop talking to those customers, you will have [a lot] of time to get my paperwork done.” As good fortune would have it, we later found 2 great jobs for an independent pharmacy chain. As I always tell my student pharmacists: “Your license hangs on the wall by a nail. If you are unhappy in your current position, find a new nail.” My license hung on that independent pharmacy chain’s nail for 26 years until I realized the chain was going to be sold to a major chain.

I found another great nail at a different independent pharmacy and had 12 great years of community practice there. I staffed the bench, and later on, I staffed a physician’s office 2 days per week. By most pharmacists’ standards, this was a dream job. However, I left that job to fill a position as director of clinical services at Nickman’s Drug store in Lemont Furnace, Pennsylvania. I chose this nail not only because of the owner’s interest in providing clinical services, but most importantly, the nail would be closer to my family. I had landed another dream job.

Did you notice that all 3 times I left a job, money had nothing to do with my career move? It was all about conditions outside the paycheck. The major chains have yet to learn this. Wave the big bucks in front of the newbies and get them signed up. After a short time, the joy of the big paycheck is overshadowed by lack of staffing, unattainable metrics, and long hours. As a result, these experienced pharmacists move on to lower-paying jobs with much more opportunity.

Brenda, a pharmacist who lives just up the lane from us, left her chain job for a pay decrease to be part of the West Virginia University community. She now gets to be a mom as well as a pharmacist. Mike, another neighbor of mine, left his job with a major chain shortly after he got married. He took a job with an insurance company doing medication therapy management for a few years and also became a member of the university community. He is now on the national circuit discussing opioid therapy and pain management. Like Brenda’s, Mike’s career moves involved a salary decrease for better conditions and opportunities.

I often compare the big chains to my beloved Pittsburgh Pirates. The Pirates develop players like Andrew McCutchen, Gerrit Cole, Josh Bell, and Josh Harrison, who move on to bigger and better opportunities. The New York Yankees, Washington Nationals, and Los Angeles Angels are grateful to the Pirates for developing the future stars of our profession. By providing better working conditions, staffing, and opportunities, the chains could keep these future stars for their own benefit.

As I celebrate my 40th year in this amazing profession, I’m sure that nail No. 4 will be my last. My extended family is always asking me, “When are you going to retire?” My answer is simple: “When [I’m] darn good and ready.” I love this profession and get great satisfaction going to work every day. My best advice to students and new pharmacists: “Keep looking for your nail.”

Money isn’t everything in this profession. 


What I Learned From 40 Years in Pharmacy

In the late 1970s, I worked at a paper mill for 3 summers while I was in pharmacy school. Of all my lessons learned running jackhammers in steel tanks, shoveling bark in the woodyard, and muscling cast iron boiler parts, I can still see a sign in the personnel director’s office. It was a sheet of paper that read, “Don’t start vast projects with half-vast ideas.” Say it quickly and it really makes sense.

I can’t think of a more lucid example of a vast project that has been implemented with “half-vast” ideas and implementation than the COVID-19 vaccine rollout. There isn’t a community pharmacist whose day-to-day activities has not been altered by this historic event. Patients call incessantly asking when it is their turn to get their dose of the precious vaccine. Even the leadership in Washington and our state capitals see the community pharmacist as the answer.

The news, whether on the internet or television or in your local newspaper, is chock-full of vaccine stories. Patients read the headlines and pick up the phone and call the pharmacy for information. Small community pharmacies can field 100 phone calls or more a day for patients to be put on the “list.” Forget the internet; most patients, especially the elderly, want to speak to a human, a human who can get them this life-preserving shot in the arm.

We’ve all seen the colossal success in West Virginia, one of the few states to use independent pharmacists to administer vaccines in the nursing homes. In my home state of Pennsylvania, we were ranked in the very bottom of percentage of shots administered versus received in the initial rollout. West Virginia, early on under the leadership of Gov James “Big Jim” Justice, deployed small, independent pharmacies as the best option. My daughter Gretchen Garofoli, PharmD, BCACP, CTTS, and her team of pharmacists, Krista Capehart, Pharm D, MSPharm, BCACP, AE-C; Betsy Elswick, PharmD; Ashleigh Barrickman, PharmD, BCACP; Heather Johnson, PharmD; Ashlee McMillan, PharmD; and Angela Goodhart, PharmD, are mostly responsible for West Virginia’s success. Gretchen was featured on local news channels, NPR, PBS, and even the British Broadcasting Corporation’s (BBC) World News. Capehart has been featured on many news outlets as well and was featured giving Justice his vaccine.

Notice that all 7 leaders from the West Virginia’s School of Pharmacy are women. At the end of the day, they go home and manage their households and take care of Ethan, Luke, Gwyn, Ainslee, Connor, Macy, Lila, and Ava. These amazing women saw a vast project and used their leadership skills and connections to implement the rollout of vaccines to the long-term care facility residents.

Two other women I’m familiar with are Pennsylvania residents and pharmacists. Molly Beimel, PharmD, from my birthplace of St. Marys, Pennsylvania, spearheaded her independent pharmacy’s efforts and pulled off a 1200-dose clinic at the local Catholic high school. Even closer to me is my wife, Denise Kreckel, RPh, who, along with her colleagues at Centre Volunteers in Medicine in State College, Pennsylvania, conducted the same 1200-dose clinic, however, with the Pfizer vaccine. With such precision, my wife handled the numerous storage requirements of this delicate vaccine from dry ice to thawing, reconstitution, and administration. I was amazed to see this 5-foot, 2-inch powerhouse impact the lives of so many in our community. 

Women make up about a quarter of Congress and of Pennsylvania’s state representatives in Harrisburg. On the national and state levels, the rollout of the vaccine has been abysmal. Is there any wonder the amazing success of West Virginia and the clinic success in Pennsylvania are led by women pharmacists? There is no doubt their vast ideas are making up for the “half-vast” vaccine rollout on the federal level. 

In an opinion piece, pharmacist Pete Kreckel highlights the ways that women have been leading the COVID-19 vaccination effort.

Women Pharmacists Are Leading Successful COVID-19 Vaccination Programs

Ronald Reagan was the most quotable president of my lifetime. The above quote truly resonates with me, especially when dealing with patients. I never use the term “customer” when they are at the prescription counter. They are here for health care, not just for making purchases.

Readers have heard me sing the praises of pharmacy technicians I’ve worked with. These technicians have allowed me to provide optimal patient care and ensure that the pharmacy is run efficiently. 

For example, Darlene worked as my technician for 24 years. She is highly organized, efficient, and a pharmacist’s best friend. Brad was my technician for the past 12 years. He started while in high school and learned the ever-cumbersome pharmacy software we used. He was a rock star at processing prescriptions and allowing me time to handle patient consultations, comprehensive medication reviews, and interventions that proved financially beneficial for my employer. The efficiency of the store didn’t depend on the pharmacist, but on whether Brad was there.

I currently have 2 excellent technicians, Hunter and George. I’ve been on the new job for only 4 months so I can’t take credit for their hiring or training. Both are whizzes with the operations of the system. Doing the paperwork and processing orders are their greatest strengths. Both are very capable data entry technicians as well. They are guiding me, the 62-year-old “new kid” on the block, through the challenges of working for a new employer.

What frustrates me is when I go to several general merchandise stores and I see signs saying, “The CUSTOMER is always right.” If the customer is always right, then who is always wrong? Talk about throwing your employees under the bus. If they are always right, my staff and I are always wrong. If I were an employee for that organization, I’d feel insulted every time I walked past such a sign. If patients tell me their physicians said there are refills on an oxycodone prescription, are they always right?

Of all the giants in the grocery store business, none shines as brightly as Wegmans. Their employees are always happy and helpful. They greet you with a genuine smile and a most caring attitude. Their attitude is their highly trained employees are always right. “Our employees are our No. 1 asset, period,” Kevin Stickles, the company’s senior vice president for human resources, told 

 in 2012. “The first question you ask is: ‘Is this the best thing for the employee?’ That’s a totally different model.”

I can assure Hunter and George that I will use my 40 years’ experience on the bench to guide them so they can have fulfilling careers like Darlene and Brad. As the sun begins to set on my career, I can assure my staff I will never “feed them to the crocodile.” We owe it to our pharmacy technicians to be their strongest advocates.

“If some among you fear taking a stand because you are afraid of reprisals from customers, clients, or even government, recognize that you are just feeding the crocodile hoping he’ll eat you last.” – Ronald Reagan