“Mistakes will happen sooner or later, and you only want to hope that you don’t make a deadly mistake,” he says. “For the past 10 ten years, I’ve been filling on average about 100,000 prescriptions per year—that’s a million prescriptions. So, if the margin of error is 0.0001%, that’s 10 prescriptions every year you’re making a mistake and that mistake could result in a deadly scenario.”
The majority of stress in an independent pharmacy, he says, comes mainly from three different sources: The first is business related; running an independent business is a challenge by itself, let alone running an independent pharmacy in the age of low reimbursements and Direct and Indirect Remuneration (DIR) fees.
“One of the biggest stressors for a pharmacy owner is cash flow and profitability, which is the only way a pharmacy door can stay open,” El-Khatib says. “With what’s going on in the industry right now, you have to innovate, invest in the future and adapt to the new model of care that is being put together by the CMS.”
The second obstacle is effective patient communication. While independent pharmacy patients are very pleasant for the most part, and you can build a great rapport with them, El-Khatib says they can get upset for a lot of reasons that normally have nothing to do with the pharmacy.
For example, a medication may not be covered by insurance, covered with high co-pay, needs a prior authorization or early fills, or any other of a host of factors outside of a pharmacy’s control.
“Patients may not understand the rules and regulations surrounding controlled versus non-controlled substances or why we can’t fill a cash prescription when it was just filled a week ago,” he says. “Complaints and competition can cause patients to seek to transfer out of your pharmacy.”
The third obstacle is finding good technicians. Quality and experienced techs are very hard to find and train.
“If you own a long-term care pharmacy and pick up a huge account, you can go from filling zero prescriptions to 5,000-7,000 that need blister packaging on a monthly basis, in a matter of a week,” El-Khatib says. “You can’t let such opportunities pass by and if you can’t find good staff or if you didn’t prepare beforehand to train someone, then you might experience difficulties that cause stress.”
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Inna Lukyanovsky, PharmD, started her career in the early ’90s working in a family pharmacy, and she’s worked for a big retail chain in Brooklyn, NY for more than 20 years.
She says a lot of stressful situations fall on the shoulders of retail pharmacists, such as the hours pharmacists put in, the lack of opportunity to take bathroom breaks, angry customers, paperwork, deadlines, unpredictable prescription flow, insufficient amount of help like techs and cashiers, poor working locations that lack natural light, and many more.
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