Letters: March 2010

March 15, 2010

Pharmacists speak out about the pharmacist shortage and professional organizations.

Key Points

No shortage here

As the pharmacy recruiter for a major grocery chain in Southern California, I have seen a dramatic shift in pharmacist availability since I began in my position three years ago ["Is the pharmacist shortage over?" January 2010]. Initially, pharmacists were able to express their demands and the pool of available pharmacists was limited. For the past year, however, as David Trang mentioned, retired pharmacists have been reentering the workforce. In addition, many pharmacists are dissatisfied with their current positions and are willing to change employers (not so likely three years ago). Today my phone rings constantly with pharmacist candidates seeking a position with my company.

Marie Mackenroth
SAN BERNARDINO, CALIF.

Having been a pharmacist for more than 50 years, I have seen the ups and downs in employment. The schools have over-responded in cranking out new graduates, and we will very shortly be in an oversupply situation.

Don Becker, RPh
SANTA BARBARA, CALIF.

More scrips, less staff

I think that you can say the shortage is nearly over, but most people will read this article and wrongly assume that the level of staffing has remained the same, which is not true. A pharmacist shortage can disappear in two ways: Produce more pharmacists to fill needed positions, or decrease the number of needed positions. I believe the latter to be true in regard to the pharmacist shortage.

What has happened is that the large chains are just not hiring and filling needed positions, due to the economy and their own foolish pricing programs. It's not just a coincidence that the pharmacist shortage has ended just as we are experiencing one of the worst economic downturns in our country’s history. Companies are realizing that $4 generics do not provide the revenue to support the level of staffing they have maintained in the past, and they are no longer satisfied with allowing the pharmacy to exist in order to get people in the door.

Do the math. Let's say you get the $4 drugs for free. If you pay a retail pharmacist on the low end, $50 per hour for 12 hours, you have spent $600 (not including benefits). You have to fill 150 $4 prescriptions just to break even on the pharmacist! Couple that with the fact that the current economy makes getting retail sales as difficult as it has ever been, and employers will cut or choose not to replace dollars that they have always spent on staffing.

This has not been a gradual fall-off. In Ohio, there was a sharp decrease in hiring and temp pharmacist services in early 2008. Retail pharmacists really don't have much of an option to leave an employer for a better situation with someone else, because most of the major players always follow each other.

Simply put, retail pharmacies are now filling more prescriptions than they ever have done and with a smaller staff. This is probably why we are seeing a decrease in hospital openings; retail pharmacists are switching to hospitals in hopes of better work environments.

Fred Yingling, RPh
COLUMBUS, OHIO

Higher costs, fewer hires

In my opinion, there is no current shortage of pharmacists. That opinion is based upon the following:

1. The growth in the number of schools of pharmacy in the United States, along with the increase in class size, has outpaced the demand for practitioners.

2. Profitability, which is strongly determined by inadequate dispensing fees and unrealistic acquisition-cost formulas, has been diminished to the point that chains, hospitals, and independents are severely cutting staff at the expense of quality/safety.

3. Except in some institutional environments, MTM and practical clinical pharmacy have been severely cut back or totally scrapped to lower costs: Less time for fewer pharmacists, resulting in less care, but perhaps higher future costs.

Until the economy recovers and some type of insurance reform guarantees equitable reimbursement - or the schools reduce class sizes - there will be a glut of pharmacists in the marketplace. MTM and good pharmaceutical care require time and manpower, but no one is willing to support the cost at this time. This isn't rocket science - just elementary economics.

Richard Meadows, RPh
WARETOWN, N.J.

Send 'em south

I am currently working in Florida for a large big-box chain. Our district in Pinellas and Manatee counties is very short of pharmacists. My store, located in Palmetto, Fla., is currently waiting for a third pharmacist so that we can extend our 9 a.m.-9 p.m. hours to 8 a.m.-10 p.m. When my partner or I get a day off during the week, the other must work a 12-hour day without a meal break while giving flu shots on the fly. We now are expected to give Medicare patients 15-minute one-on-one drug-utilization reviews. We are filling 500 Rxs on a Monday with only about 20 hours of tech help. Please send some new grads south!

Eugene P. Harvey, RPh
PALMETTO, FLA.

Hazards in chains

[David Stanley is] spot on about the real issues facing retail pharmacists and the lack of understanding displayed by our state and national pharmacy organizations [“You talkin' for me?” January 2010]. In the same issue, the guest editorial by David Trang discussing the end of the pharmacist shortage was yet another telling sign that chain-store pharmacists' untenable and dangerous work environment is about to become even more hazardous to their pharmacy licenses and their patients (errors; counseling and MTM) as the corporate bean-counters apply new financial leverage against higher-paid long-term employees and the debt-ridden students coming out of the pharmacy schools. Add the PBM whims of the week, discount coupons, the audit craze, and the electronic-prescribing fiasco (no standards + 30% error rate), and you have a recipe for disaster and/or unionization of the retail-chain segment of the profession.

What a relief that I am an independent who only has to worry about PBM whims, the audit craze, the electronic-prescribing fiasco - and HIPAA training, SIGIS POS mandate, FWA training, Quality Assurance Program, origin codes, and our most daunting business challenge: the cost of our new laser-printer cartridges.

Bob Montemorano, RPh
CLYDE, N.Y.

It may be time

David Stanley is right on target. I have been a bench pharmacist for 35 years and frequently attend the Board of Pharmacy meetings here in New Hampshire. Neither the state organizations nor the boards of pharmacy want to get involved in working conditions.

The commercials for the major chains are a joke, talking about “asking your pharmacists” when they are clearly so busy they can't even answer the phone in a timely manner. I have never been an advocate of unions, but has the time come? We have no voices with employers, boards, or professional organizations. The practice of pharmacy as I got into it 35 years ago is becoming a lost art. No time.

Bob Stout, RPh
RAYMOND, N.H.

Nailed it

I read David Stanley's article during an abnormally quiet lull in the pill-counting action today and made all the other pharmacists I work with read it too. Every one of us was of the same opinion: David hit the nail on the head.

I was a member of APhA throughout pharmacy school, got my free NAPLEX review book, and then never renewed my membership. Other than the Geico discount, I can think of no reason to give those people my hard-earned money. Support for MTM? Sure, I have an MTM room in my pharmacy. We refer to it as the storage room.

Thanks for speaking what is known in the heart of every rational pharmacist. It's time for the APhA to live up to its name and stand for the pharmacists in this country.

Tom Michaels, RPh
PITTSBURGH, PA.

When all else fails

All I can say is “Amen, brother.” I have worked in retail all my pharmacy career and it has only gotten worse and worse. As much as I dislike unions, I sometimes think that a national pharmacy union would be a welcome choice.

Eric M. Moore, RPh
ROCK HILL, S.C.

Want to weigh in? Send your thoughts to drugtopics@advanstar.com. We will share as many as possible in the pages of upcoming issues.