Episode 2: A Pandemic's Effect on Pharmacist Burnout

Drug Topics®: This is Over the Counter, a podcast from Drug Topics®. I'm Gabrielle Ientile. In this episode we'll be talking about professional burnout in the pharmacy, the many factors that lead to and intensify burnout, and what impact the COVID-19 pandemic might be having on rates of pharmacist burnout.

What is professional burnout? Experts generally define burnout from 3 aspects: 1, physical and emotional exhaustion; 2, depersonalization; and 3, one’s sense of autonomy and personal accomplishment.

Caroline Gaither: It's typically measured along those lines and individuals who are feeling a lot of exhaustion and a lot of disengagement tend to have higher burnout scores.

Drug Topics®: That's Caroline Gaither, a professor in the department of pharmaceutical care and health systems at University of Minnesota College of Pharmacy. Dr. Gaither is coauthor of a national survey of pharmacist burnout and engagement, which was presented at the Midwest Pharmacists Workforce Consortium. Here's Dr. Gaither again to explain the results of that survey.

Gaither: They're telling you that the workloads have gotten higher and the staffing has decreased, and that has increased their feeling of job stress and also influence their satisfaction levels. So that has been another thing that we think has also contributed to some of these levels of exhaustion we've seen with the workforce study.

Drug Topics®: Jon Schommer, a study coauthor and a professor in the department of pharmaceutical care and health systems at the University of Minnesota College of Pharmacy, explained that making sure pharmacists avoid burnout isn't enough. Pharmacists should be able to grow and thrive in their professional environment too.

Schommer: And then in addition to burnout, which is something that you would like to avoid, we also do research in the area of what's called well-being. That's being able to have constructive conditions at work and beyond even in your personal life that enable workers to thrive and achieve their full potential. So we're looking at: let's avoid burnout and some of the dimensions of that, but let's also look at our healthcare professionals able to thrive and achieve full potential.

Drug Topics®: Matthew Witry, coauthor of the survey and an assistant professor in the department of pharmacy practice and science, division of health sciences research at the University of Iowa College of Pharmacy, said to keep in mind the complexity of these factors, individual and systemic.

Witry: It's hard to disentangle these elements. If you're incredibly exhausted, because of a setting issue that's leading to exhaustion, that might prevent some of that personal accomplishment ability. A lot of these things are going to interact. Depersonalization, you might see more of that if you're already emotionally exhausted, so all these things are interacting with each other.

Drug Topics®: Here's Dr. Gaither to shed some more light on these interconnected factors.

Gaither: National Academies of Science, Engineering and Medicine have been focusing on this issue of clinician burnout, and they've developed this model that I really do like. It talks about how you have frontline workers, and then you have these frontline workers, the health providers, who work for a particular health care organization who has different policies and procedures. Then there's also the external environment - so the things that are happening outside - and all of those things influence the provider who is providing care. They've talked about these work system factors which are things like job demands: so, what is your workload? How many hours are you working?

There's this idea of resources, and 1 of the things they talk about in terms of resources is how much control you have in your job. Those kinds of things are really influenced by the workplace and the system that you're working in. If there's a good balance there, then the health provider is able to really thrive but when the job demands become too high, then that's where you can get into some of the more negative consequences.

The other piece of that is, they say that these work system factors are also influenced by kind of the individual: so how much resilience that person has, and their ability to cope with adversity, and also how much their work and life are integrated. That can also influence burnout or the fulfillment that the health provider feels. I really I like the model because they've started to talk about the system factors that are beyond what the individual provider is able to contribute, and talk about the fact that burnout is not necessarily related to some kind of individual failure, but it's really related to kind of the way the work environment is structured.

Drug Topics®: Dr. Gaither mentioned that corporate-owned chain pharmacy environments, where business decisions are out of pharmacists hands and workloads are increasing, those large companies are at risk for potentially burning out their pharmacists. But what about community pharmacies?

Schommer: We’re seeing in community pharmacy practice that there's this great stress to conveniently and quickly and efficiently distribute medications, and that whole business model is changing.

Drug Topics®: Improving pharmacy business models are vital for keeping pharmacists from burning out and staying in business. An estimated 2000 pharmacies have closed since 2018, many located in regions of the United States that are home to vulnerable populations, where their first point of care is often in their local pharmacy. Another non-negotiable way to minimize burnout and help pharmacists find fulfilment at their place of work is to address the system factors at play.

As Dr. Gaither, Dr. Witry, and Dr. Schommer all mentioned, burnout is mainly a product of the health care system factors that get in the way of true fulfillment for medical professionals. Dr. Schommer explained that pharmacists are experiencing increasing pressure not just to be fast and efficient, but to be faster and more efficient in an increasingly competitive and instant-delivery world.

Schommer: In community pharmacy, practice, the distribution of pharmaceuticals is so vital and you have to have that pressure on you all day long to be as efficient as possible. At the same time, community pharmacies are being recognized by the public, by government agencies such as CDC, etc., as health care access points, that you can get vaccinations and immunizations and screening and point-of-care testing. There's a lot of patient care and public health services that are being provided. When you put those two goals together, work systems get very complicated, and it's very difficult to do both within the same space.

Drug Topics®: While pharmacists might be willing to take on these additional responsibilities to support their patients and provide the best care they can, these burnout factors - exhaustion, depersonalization and lack of a sense of autonomy and personal accomplishment - as well as the system constraints, can make it possible, especially during a pandemic.

Gaither: They’re talking about this idea of moral injury, where the health providers want to be able to do certain things, but they're not able to because of other kind of constraints with within the organization, and that really affects how they can work to the best of their ability. Some of the things that I've heard about in pharmacy, is whether pharmacists get PPE and because they need them as well if they're going to be giving vaccinations and doing some of the services that the pharmacists typically do. What happens if your staff in the pharmacy gets ill with COVID-19?

The other thing that I think a lot about is, you're also serving people who have chronic illnesses, and whether they can get their medications. Are they afraid to come to the pharmacy? Are they still being taken care of in this situation?

I think there's a lot of things that this pandemic is revealing about the holes or disparities in the system. The other thing is some of the pharmacy benefit managers cutting some of the reimbursements. This is not the time to cut reimbursements, or do things that can inhibit the abilities of the pharmacist to do different tasks. That is something to that I'm hoping; I hope that these reimbursements and the way that pharmacists and other health providers are reimbursed does not get short shrift.

Drug Topics®: Dr. Witry gave us an example of just how complex burnout factors can be, especially during a pandemic. He explains that while pharmacists may be emotionally and physically exhausted from working longer and more frequent ships, and my experience depersonalization from having to provide care to patients from behind a mask, and a plexiglass guard, they might also feel elevated levels of personal accomplishment for being able to assist the patients when they need them most.

Witry: If someone feels that their employer isn't providing a safe environment, or you're interacting with patients who aren't taking this seriously, I would imagine that that's going to be a significant source of anxiety. On the other hand, a lot of pharmacists are probably feeling really appreciated. They're making a difference. They’re getting that getting that care to people, being that access point, answering important questions, being a source of care when people aren't going to their primary care physician appointments. They can still call their pharmacist or they can still talk to the pharmacist across the Plexiglas. The pharmacists are still in that position, especially in the community setting.

Drug Topics®: There are also other potential issues that the COVID-19 epidemic can bring to the surface too, like hoarding medications and administering vaccines.

Schommer: As we move forward in the future, there will be new things. There's some evidence that patients are becoming very acutely aware that there could be drug shortages due to the pandemic and the effect on manufacturing around the world and are starting to consider hoarding and stop taking medications so that if it runs out, they would have a supply There's a lot of anxiety for our patients that we that we help. Also, what kind of role from a public health standpoint would pharmacists play? When a vaccine is discovered and developed or there's treatments being provided, there's a whole new set of things that pharmacists will be looked to provide and that requires change and updating our work systems and our processes of care. That all creates the opportunity, or the possibility, that pharmacists will experience stress and burnout.

Drug Topics®: Experts are hopeful that the COVID-19 pandemic will open up the opportunity for improving pharmacist care and addressing health care system shortfalls.

Schommer: It opens up new opportunities for pharmacists to do really what we're called to do, which is to take care of our patients.

Gaither: We've recognized how fragmented our care system is, so being able to better communicate across different health providers and across different health systems. You have the pharmacists in the community, you have the pharmacist in the health system, pharmacists in long term care, and the ability to better communicate, I think across the different pharmacists, but also with other health providers would be very, very important.

Also, do the pharmacists feel that the employers kind of have their backs? Do they feel supported? I would say that in some places, they may not feel as supported as they could. Our employers really stepping up to take care of their health providers, I think is something that also probably needs to change. And then this idea of, I'm not exactly sure how to say this, but the profit motive in health care. There’s a lot of things that we could do better with if we had more resources and more reimbursements and those kinds of things to really provide patient care.

Drug Topics®: So with the task as big as the United States health care system, what are the next steps?

Schommer: We like to use a certain quote. We look at the financial pressures in health care system, all the burden of documentation that we that we do in healthcare, the pressure to meet production metrics are places of practice, and this constant specter of litigation that's over us, really distract us from patient centered care, and it can even lead to conflicts of interest. If it happens once in a while, that's 1 thing, but it's in incessant, intensely routine, drip, drip, drip that we experience and again, as we talked before, really improving the systems in which we work, and that can be everything from personnel staff, processes of care, computer systems and technology needing to be updated, so they interact and provide information that we need when we need it. That is really an important next step for us to improve and to develop good work environments that we can thrive in.

We always go back to those quotes. It's not just pharmacy that's saying this, but all healthcare professions are saying pretty much the same thing. Moving forward, I would echo what Caroline Gaither said, in really focusing on our systems of care and employees, knowing that their workplace is there to as she put it, “I've got your back. I am here to really help you thrive so we can do what we're called to do.”

Drug Topics®: That's all for this episode of Over the Counter. Check back next week for another expert interview covering the latest news trends and innovations in pharmacy. And don't forget to subscribe and share with your pharmacy friends. Thanks for listening.