Pharmacists respond: Kim, you are not alone

May 6, 2014

Hours after we posted Kim Ankenbruck's “A dose of pharmacy truth: Report from the front lines,” the responses started showing up. Here's a collection of the early returns.

Well, as Click and Clack have been heard to say, it’s happened again. After we posted Kim Ankenbruck’s second article, “A dose of pharmacy truth: Report from the front lines,” she started getting e-mails, Drug Topics started getting e-mails, and readers started posting comments at DrugTopics.com. You can read the online posts by clicking here.

We decided to present as many of the other messages as we could, on the assumption that every reader who wrote in is speaking for hundreds of others who did not or could not do the same.

Because the subject is so volatile and can result in repercussions for those who speak out, we are keeping all communications anonymous and eliminating any personal details that the writers might have mentioned.

Last item: Some of these e-mails are long. Rather than make extensive cuts, we decided to present them as completely as possible, and let our readers choose how much or how little to read.

Here’s what some folks have written to Kim:

 

Hey, that’s my story!

How did you know what a company did to me? I got written up because of poor performance. Then they terminated me. The DM pretended he was helping me when in reality they were filling out paperwork necessary to technically terminate me. I was one of those marked pharmacists.

What goes around comes around

Congrats on expressing what countless pharmacists are experiencing.

I would like to share one story. I worked for a small chain of under 100 stores. One evening a non-regular customer walked into our store. She pulled out an albuterol inhaler and asked for another. The one she presented was from a different chain and had no refills on it. I explained that I had to call the chain.

The chain pharmacist told me that she has no active Rx on file. I called her MD. He said he hasn't seen the patient in six months. No refill; make an appointment.

Meanwhile, the customer was freaking out. Twice I asked her whether she was having trouble breathing. I told her I would call an ambulance if she had shortness of breath. She replied, "No, I just want to carry it around in my purse."

If she had been a regular customer, I would have extended some sort of courtesy. Under these circumstances, she was still fuming.

I gave her my supervisor's phone number and said, "Since you don't understand me, please give him a call and he will explain why you cannot have this medication."

He called me the next morning. I explained the situation. He said, "We are trying to build business in this store. You should have extended courtesy."

I replied that since the doctor and the pharmacy had said no, I could not break the law. He said, "We will defend you in a court of law."

I said, "There is no defense. If anything happens to her, I will be sued and lose my license.”

Two weeks later, the chain fired about eight troublemaker pharmacists. I was out of work for three weeks.

I received a letter one year later from the state Department of Labor. It seems that some pharmacists had made a complaint about the way the chain paid us for overtime. I received a multi-thousand-dollar check.

Later, during the financial crisis, the chain went bankrupt, sold some stores to a bigger chain, and liquidated.

These white-collar criminals had wanted me to place my license under scrutiny for less than $10 profit on that inhaler. What goes around comes around.

 

The sacrifice is worth it

Thank you for your piece in Drug Topics.

I am the treasurer and on the negotiation committee of a union of several hundred pharmacists and interns in my part of the country. We do keep management in line.

They are always worried that one day we will all walk out and go to the media with our stories. We, in turn, want to keep our jobs and keep serving patients. We negotiate at the table.

Being a leader requires sacrifice. Management does treat you differently because of it, and it can cost you money. But the sacrifice is worth it when it comes to saving the profession.

Great article

Great article. It is amazing, the number of pharmacists who have their heads in the sand. I feel sorry for the new graduates.

Couldn’t agree more

I just wanted to say I couldn't agree more with your articles. Years ago, some of us said we needed a national pharmacists’ walk-out day to force change. That was in the ’90s, when there weren't enough pharmacists in retail, and still no one united.

We, as a profession, have caused a lot of this current mess. Every time we were asked to do more, we jumped through more and more hoops, always afraid to say no. Today, with competition fierce because of the pharmacistglut, we are expected to do even more with less. 

 

At some point you have to go home

I have operated independent retail pharmacies for more than 36 years. I have had seminars (at my cost) on cardiac, blood pressure, etc. I’ve done tons of diabetic testing and seminars, brown-bag days, etc.

Now I am informed that I am supposed to do more work for free to increase star ratings for insurance companies that have bullied me and paid me less every year. This is ridiculous. If they want a collaborative partnership, they should share the money. Doing more for less doesn't help me pay my employees. Cutting my tiny reimbursement doesn't help me do what I am already doing.  

At some point you have to go home from work and take care of your family.

Ain’t seen nothin’ yet

[Regarding the oversupply of pharmacists and the power of the chains to pick and choose] With 129 pharmacy schools and more on the way, the worst is yet to come …

It really wasn’t like this 20 years ago

My husband and I are both pharmacists, and we feel that what the insurance companies have done has brought pharmacy to its knees. It has turned a great career into a decision of regret every day of our lives.

I have been a pharmacist for over 20 years, but now I am trying everything in my power to get out. I am/was a retail pharmacist, and I feel that my job has changed from helping people, serving the public, and educating patients into trying to do anything to make a profit...like flog vaccinations.  

The big bosses don't have a choice because they can't make a dime; the insurance companies refuse to pay and then they turn around and take back the rest of the money from audits. Unfortunately, the pharmacists can't change that; it's the big corporations that need to step up and refuse these ridiculous contracts. I just don't understand why all the big corporations don't just band together and refuse the contracts.

It really wasn't like this 20 years ago. I actually liked my job and loved the customer service. The pharmacy was always the most profitable department. We can probably thank some business major for this, someone who had a great idea that would make the insurance and drug companies millions or billions of dollars while stomping all over pharmacy.

My husband has changed to a career in acute-care clinical pharmacy, but I am ecstatic that I don't have any more student loans or a mortgage or a car payment. I'd rather have fewer material things than sell out - or sell my soul to the devil.  

I feel sorry for all the new graduates who come out with a quarter-million in loans and then are unable even to find a job.  More pharmacy schools, pharmacists of lesser quality, and cutbacks do not equal jobs.

 

The quiet lull

As saddening and disheartening as that was to read, I must agree. I think the problem is that as a group, most of us have settled into a quiet lull because of the $116,000 average salaries.

I thought speaking out about the situation would reeducate our society into appreciating what we mean to society. That is why I left my comfy job to start my business seven years ago; I even wrote a book to make a statement about my profession.

My father’s dream was to see me mature and become self-sufficient. Opening a pharmacy is not going to make someone rich, but it should be something that one should be able to survive on. If American culture could reflect on what is essential, perhaps we could focus on bringing down the cost of living instead of looking for a raise. Greed has hurt our country.

During these seven years, many of the patients I serve have expressed their appreciation of my profession, but unfortunately, not enough when I look at it retrospectively.

Recently, in the Georgia Congress, there has been some acknowledgement of what we do, but I think we need to keep the focus on what insurance companies have done to us.

Buddy Carter, a pharmacist in Georgia, is running for Congress. I think this is newsworthy.

Our knowledge seems cheap because it’s free

I was reading your article. I agree entirely.

We are the most accessible healthcare professionals. The general public constantly walks in and approaches us with questions. We are always willing to help them and answer their questions.

Unfortunately, a zero-dollar price tag has been put on our professional knowledge. We are not appreciated because we give it away. Someone can randomly walk in, ask questions, take 20 minutes of your time, and never expect to pay for any counseling services that were given. They simply walk out without paying a penny. The average person will think subconsciously that if the pharmacist’s time and knowledge cost them nothing, then our knowledge must be cheap and isn’t worth much.

It's sad to see that a physician assistant with two years of theoretical academic training and a semester of pharmacology can have the power to deny or authorize the refills I'm calling in, when I have had numerous semesters of pharmacology and medicinal chemistry. I am more than qualified to teach that PA about medications. Yet I have no prescribing power to authorize the Plavix that a patient has been taking for ages and will continue to take probably as long as he lives.

Do you think we will ever be granted prescription-writing power?

 

“I thought I was the only one”

Every now and then when I'm listening to the radio in the car and I hear a female singer lamenting something or other, I think to myself, "That girl is singing my song."

When I read your blog post titled “A dose of pharmacy truth: Report from the front lines,” I almost fell out of my chair, because you were singing my song. I have been that marked pharmacist, except I call it PTFD ([pharmacist targeted for destruction). I didn't coin that term until after I'd already been fired.

This is my story:

I started at a critical access hospital in a rural area about five years ago. Three years into my stint at Hospital X, the CEO of 28 years retired and was replaced by a new CEO with a reputation for slashing and burning. The CEO is best described as a hybrid between the store manager and the DM that you describe in your blog post, except that this guy had absolute power.

Soon into his tenure, he had replaced, fired, or force-retired about 30% of the hospital staff, brought in his own people from his previous job, and required all remaining employees to sign a document stating that they support and agree to comply 100% with the decisions of the organization and to conform to its stipulated standards of behavior.

The director of pharmacy, a non-PharmD with two kids in college and a long history of doing exactly what she was told, always and without regard to the welfare of patients, immediately signed it and was completely disgusted with me when I balked. My degree is a PharmD. None of the physicians were required to sign this document, which made me the only holder of a clinical doctorate at the hospital who would be required to sign this in order to keep their job. To me, there were approximately 100 reasons not to sign and only one reason to sign (keeping my job).

I sent the document to my former law professor from pharmacy school for some advice, and he agreed with me that the document was an attempt by my employer to usurp the board of pharmacy's regulations as the employer saw fit, which is illegal.

My professor advised me that since I lived in a right-to-work state, I most certainly could be fired for not signing the document, and the easier lawsuit to win would be the one where I signed it and was subsequently fired for violating some aspect of it.

So that I could sleep at night and still keep my job, I added a small addendum to the document stating that my primary obligation was to my patients and the board of pharmacy that licenses me to care for them, and that my secondary obligation was with my employer, but that I would comply with the new standards of behavior, provided that they didn't require me to break any state or federal laws or my profession's code of ethics. I thought this was a fair and suitable compromise. I was wrong, and in hindsight, this is when I became a marked pharmacist.

The aforementioned director of pharmacy was furious with me and told me that the CEO was "not amused by my antics," and that if I didn't sign the form with no addendum I would be terminated immediately. (I was not surprised by the director's response, as she once instructed me to go ahead and verify a potentially lethal order for a pediatric seizure medication and just write on the order: "I did not agree with dose, but doctor insisted." Obviously, I declined to do this: I refused to verify the order or dispense the medication, and the physician transferred the patient to a pediatric ICU.)

So I signed the stupid form, because I have a teenager who needs to go to college, and given the rural nature of where I live, there are no jobs to be had and I needed time to get my ducks in a row.

Unfortunately, it was too late.

 

I became the target of all those things that employers do when they are trying to get an employee to leave: last-minute shift changes, schedule upheavals, fictitious annual reviews, etc. I mistakenly thought my director was doing this just to get back at me for somehow making her look bad in front of the CEO, and that I could just ride it out. I was wrong. I suspect now that she was acting under direction from the CEO. 

One Saturday evening, after about four months of not being able to make plans because I never knew when my schedule would be changed, I was alone in the pharmacy with my technician, with the door shut, after the pharmacy had closed.

She asked me why I was there so late on a Saturday when the other weekend pharmacist usually left hours earlier. All of the anger and frustration I had been so careful to keep in check bubbled to the surface and I vented to the tech, saying that director was trying to get rid of me but that she had another think coming, because she had no idea just how stubborn I could be.

I made the poor choice to use language prohibited by the new standards of behavior and mentioned something about wanting to burn the director's house down and kick her teeth in. Obviously, these were idle statements made in the heat of anger, the intent of which was no different from that of one of my techs when she shook her fist at me and said, "I'm gonna beat you," when I made a silly mistake that caused them extra work.

I was venting to a technician I considered a friend. She was the only co-worker who has ever been to my house. And I thought the conversation was private. I was extremely incorrect.

To this day, I don't know whether the technician randomly relayed my comments to the director, or whether there was illegal audiotaping in the pharmacy (I suspect the later). Several weeks ago, I was fired for "communicating threats."

When the CNO terminated me, she delivered the news with a mix of barely concealed triumph and completely unnecessary cruelty. She smugly repeated the comments I had made, verbatim but completely out of context, complete with theatrical distaste while she repeated some choice four-letter words.

I was given no chance to defend myself or speak at all, and I was treated as a common criminal. I was escorted out by security and have had no contact with any of my former co-workers from the pharmacy.

 

After five years of dedicated service, thousands of unpaid hours, and dozens of clinical programs initiated that will outlive me by many years, I was not even afforded the courtesy of being paid out the 180 hours of vacation I had rightfully earned. My firing felt like the most painful and soul-crushing of divorces, except worse, because at least in my actual divorce I got to keep a shred of my dignity.

The shame and the guilt associated with being fired is indescribable. The injustice of the circumstances of my termination was completely overshadowed by thoughts of worthlessness and the fear of not being able to secure another job. I couldn't shake the idea that I had somehow let evil win and that I had completely let my family down, just because I couldn't keep my temper in check long enough to find another job.  

I kept my termination from most of my immediate family and started grocery-shopping out of town so that I wouldn't run into any of my former co-workers. I found myself in a downward spiral of shame.

I struggled with how to explain my sudden departure to prospective employers during interviews, because I thought no one would believe my story. I thought that something like this could only happen to me. I thought I was the only one.

Your blog post gave me an incredible sense of peace, just knowing that I was not alone. I sent your blog to my mom and told her to pass it along to my grandmother and aunt and tell them the news that yes, I had been fired.

My story does have somewhat of a happy ending. I managed to land a PRN job at a hospital an hour from the house. It's only one day a week, but it's a start, and its "character trait of the month" this month is courage. I took this as a sign from the universe that I had found the right place for right now, because courage is obviously a character trait I can get behind.