Friday, June 25, 2010

A Really Difficult Job

When my friends complain about their jobs, sometimes I want to tell them, "I don't care what you do. You're job is easier than mine." Of course, I've never said that, and I never will. It doesn't make it less true though. Working in a busy retail pharmacy is one of the most frustrating professions you can imagine.

There are so many things wrong with the idea of retail pharmacy that I almost don't know where to begin. I guess I'll just start by saying that pharmacists are always in a losing battle because the very nature of the business conflicts with the nature of the profession of pharmacy. We are in business to fill as many prescriptions as possible as quickly as possible with as little help as possible in order to maximize profits. That's how our employers make money. That's how our salaries get paid. The crazier and more stressful it gets, the more money we generate.

The nature of the profession is one of health care. We're supposed to be promoting health and well-being. We're trained to make clinical decisions and judgments about the medication therapy of our patients. We're supposed to not only know which drugs a patient should be on, but also which drugs they shouldn't be taking. We're supposed to be teaching these people how to take their medication correctly and which side effects to look out for. In fact, we're actually mandated to at least offer that kind of counseling on every new prescription.

Therein lies the problem... The things we learned in school that make up the profession of pharmacy don't actually generate money for the business of retail pharmacy. However, we're still expected to do them, which is in direct opposition of the goal of filling as many scripts as possible. Every time we tell a customer they might not actually need that acid reflux medication they've been on for the last 5 years ever since they were discharged from that one brief stint in the hospital, we might be making the correct clinical recommendation but making the wrong business recommendation. Every time we tell a patient that the best thing for that cold is rest and plenty of fluids in place of selling them on some OTC medication that probably won't really work, we're losing sales. For the pharmacist that cares at all about health care, this is really hard to reconcile.

Then there's the way we're supposed to treat our patients/customers. In pharmacy school, we're taught to think of these people as our patients. We're supposed to be making recommendations that will improve their health. We're supposed to teach and educate them. We're supposed to be assertive in getting our points across. However, the business of retail pharmacy tells us that "the customer is always right." We shouldn't say anything that customers might not like because they might get mad and take their business elsewhere. We're supposed to kiss ass and be apologetic at the slightest sign of a customer not being pleased.

How can we educate people and make health care decisions and recommendations if we're supposed to kiss everyone's ass? It's impossible to have a health care provider/patient relationship at the same time as having a employee/customer relationship. The two roles do not mesh. In the end, when it comes time to choose one or the other, most of us choose to bite our tongues and treat our patients like customers so as to not possibly piss them off and complain to management.

Even if we forget about the irreconcilable differences between the profession of pharmacy and business of pharmacy, we have the crazy work environment to contend with. Everyone hates being interrupted when they try to perform a task. Let me tell you, no professional in the world gets interrupted more than a pharmacist working at a busy retail pharmacy. Trust me, it's not even close. The phone rings all freaking day long. I have nightmares of the phone ringing. Depending on how good your technicians are at triaging phone calls, up to 60% of those phone calls require a pharmacist.

The law might differ slightly between states. In my state, if another pharmacy is calling to transfer a prescription, it has to be handled by a pharmacist. If a doctor is calling in a new prescription, you need a pharmacist. Checking the voice mail requires a pharmacist. Any customer question about medication or anything that might require some counseling needs a pharmacist. It seems like no matter what I am doing, I cannot finish a single task without being interrupted by a phone call.

If it's not a phone call, it's someone barging their way to the pharmacy counter to ask a question. Usually, this question has absolutely nothing to do with my pharmacy knowledge. Last week, I actually had to leave the pharmacy to go show an old man where the cereal was. At first, I told him which aisle it could be found, but two minutes later he returned saying he couldn't find it. Therefore, I, a pharmacist making nearly $60/hour who went to school for 6 years to be a drug expert, had to personally show someone where the cereal was. This type of shit happens all the time.

If it's not a phone call or a customer interrupting you, a lot of time your very own staff is the source of the interruption. Now, this isn't true of all pharmacies, but I'd say it probably is for the majority. The pharmacist is the smartest employee in the entire store. Often times, the pharmacist is MUCH MUCH smarter than anyone else in the store. Therefore, while we are inputting, filling, and checking scripts, we're always paying at least a little attention to what all our technicians and cashiers are doing in the pharmacy. I can tell you that I'm always on alert listening for any sign that my employees are making a mistake, telling a customer the wrong information, or not handling an irritated customer well. I'm always ready to step in to solve whatever problem comes up... while at the same time dealing with insurance companies, inputting scripts, checking scripts, and calling the doctor to make sure he really didn't want to give Cipro to that patient taking Coumadin.

At my pharmacy, this is perhaps the most frustrating thing of all. We have employees that have worked in the pharmacy for years, but they still don't understand what certain insurance rejections mean. They don't know the best way to explain things to customers. Hell, most of my technicians and cashiers have only very basic knowledge of how to use our pharmacy software. They make the same mistakes over and over again inputting prescriptions. They ask me the same questions over and over again but seemingly tune out my explanations. Some of them work so slowly that I almost wish they'd just stand in the corner and not do anything because all they're doing is getting in my way.

Moreover, despite being much more intelligent and more educated than pretty much everyone in the entire store, I ultimately have to answer to and follow the asinine rules made up by "head cashiers." Once again, I went through 6 years of college to get a doctorate in pharmacy. I graduated in the top 10% of my class. I'm looked upon as a drug expert. However, when it comes to the business end of things, I ultimately am outranked by people that never went to college, barely graduated high school, and make less than half the money I do.

I'm sure this situation is familiar to most pharmacists. The reason we have so many problems with management is often that we're much much smarter than management, and we realize just how stupid and illogical most of the store policies are.

Even if you're somehow not bothered with the disconnect between the profession of pharmacy and the business of retail pharmacy. Even if you're the world's greatest multi-tasker and are able to effectively tune out the perpetually ringing phone. Even if you have the patience of a saint and have no problem dealing with the intellectual short comings of your staff and store management, there's still the whole issue that we're often so busy that we don't have time to take a break.

I have a buddy that complained to me about how hard it is for him to work 12 hour days and how tired he is when he gets home. He's a car salesman. He actually works at the dealership where I bought my car. The last time I took my car in for service, we stood around talking for about 10 minutes. During that time, he didn't have a single customer walk through the door. The phone never rang once. No one asked him to do anything. He had all the time in the world to have a conversation with me while he was at work. Most of his day is usually spent sitting down in his office. However, he says his 12 hour days are so tiring that he doesn't have the energy to do anything when he gets home.

My 12 hour days at work involve me working like a mad man for 12 hours straight. The phone never stops ringing. Customers never stop coming. I get, if I'm lucky, maybe 10 minutes to scarf down my lunch, and that's the only break I'll get in those 12 hours. The rest of the time is spent on my feet working.

The craziest part is that my store is actually one of the better retail pharmacy situations you can be in. We're busy, but not insanely busy, and at least for now, we get a pretty decent amount of pharmacist overlap and tech help. There are pharmacies that are much worse than mine is. When standing on your feet for 12 hours with only maybe a 10 minute break in the entire day is a good retail pharmacy situation, trust me when I say that the average person can't even fathom how it feels to work in a bad situation. I used to work in a bad situation. It was quite literally the worst time of my entire life.

In light of all this, I keep thinking about how pharmacists are up in arms with a lot of the changes the big chains are proposing and trying out. Pharmacists are nervous about centralized filling because they fear it will take away jobs. Pharmacists are pretty much universally scoffing at the idea of increasing the role of pharmacy technicians in the filling process. We're all fighting against any change that could possibly take away jobs.

However, the more I think about it, the closer I am to coming to the conclusion that maybe that's not a bad thing. Maybe pharmacy has to fundamentally change. Maybe pharmacists can't and shouldn't get paid $60/hr to count by 5. Maybe big box drug stores are not the best future for all of us highly educated drug experts. I think a new business model might not be a bad thing. Sure, a lot of pharmacists as we know them would lose their jobs if the role of the pharmacy technician was expanded. It's probably necessary though. Right now, retail pharmacy is really kind of a broken profession. It's not serving the best needs of our patients, and it's certainly not serving the best interests of the pharmacists who practice in these settings.

Change like that is really scary, but maybe in the long run, it's what we need.


Anonymous said...

Did you get a chance to read the commentary from Dr. Anna Garrett posted in April 2010 in Drug Topics ("Reality: Have it your way")

Do you think she has a point, or do you think her tough stance of "like it or leave it, but stop complaining" is unrealistic?

Pharmacy Mike said...

I read the article before. I don't think her stance is a tough one exactly. I don't think she's saying, "quit your whining." It's more like she's offering a different, more optimistic perspective.

She's partially correct. It is our choice to stay in retail pharmacy. However, to say that the experience I depicted applies strictly to my own situation is incorrect. Retail pharmacy IS, for the majority, exactly how I described it. It's draining. It's frustrating. Often, it doesn't make a whole lot of sense.

Most retail pharmacists really aren't THAT happy with their jobs. Some might deal better than others. Some may work in slower pharmacies and not feel the same stress level. However, what I and a lot of other pharmacy bloggers write about is an accurate portrayal of the profession.

Here's the question then: If most of us dislike the state of that profession, does that mean that we ALL drop what we're doing and find new jobs. The marketplace wouldn't be able to handle it. As a lot of pharmacists have found out, there aren't a helluva lot of hospital or clinical jobs out there. There's certainly not enough for ALL the pharmacists who dislike the state of their retail jobs.

Moreover, if the experience I describe is so universal, isn't it in our best interests (not to mention the patients') to try to change it for the better? Why should we put up with ridiculous business expectations and poor patient care? Our attitudes aren't what's wrong with retail pharmacy. Retail pharmacy, in itself, is the problem.

We fight for what we think are the necessary changes. We want more pharmacist help. We want more technicians. We want to be able to take a break without falling behind. However, we want to keep our $120,000/yr salaries. It's unrealistic. Our employers will not give us more pharmacist help when pharmacist help is the biggest thing standing in the way of profits. They don't care that we go home burned out. All they care is if it's feasible to fill even more scripts per week with even less help.

That's just the nature of business. As I described, the business aspect of retail pharmacy in it's current form, will ALWAYS be in opposition with the professional side. That's why I'm starting to think that just maybe the solution is to somehow change the model so that the business end of simply filling scripts can be separated from the business end of practicing pharmacy. As much as I hate to admit it, you don't need 6 years of college and $120,000/yr to count by 5. Maybe, despite taking current retail pharmacists' jobs away, centralized filling and expanded technician roles is what we need to finally start practicing pharmacy the way we know we should.

Anonymous said...

I am really considering going into pharmacy. I am 30 years old with an MBA and BS in Computer Science. I have been working for the same company, first as a programmer and then as an internet project manager, for 10 years and I hate it. Not because it is hard or stressful, for the most part, but because I am tired on not being listened to and dealing with ignorant marketers and marketing managers all day who have no idea what they are talking about. I am trying to look for something completely different, outside of IT or project management, because I feel even if I get a new job that it would be more of the same anywhere I go.
I do understand all jobs, no matter what they are or where they are, will have stress and will have ignorant and dumb people you work with.
I read your post and it does kind of depress me, however I know that is just the adult world. It is called a job for a reason and being fun and easy isn't one of them. However, would you still recommend pharmacy to people as a decent career path? Is there any direction you would go this early on in the process (maybe take different classes or try some other internship while in pharmacy school) to put yourself on a path away from retail pharmacy and towards a more rewarding area of the business?
Thanks for your input.

Anonymous said...

So I don't want to say I have a stressful job, but I wanted to comment on doing something just diametrically opposed to what you studied in school.

I'm an accountant by profession. In accounting classes you learn, in a big picture way, how do write financial statements and perform consolidations and so forth. In real life, I tell callers a hundred times a day which form to use and which account code they should write on the form. Never covered in my academic coursework and has nothing to do with what I studied in school. Oh yeah, and a trained monkey could do it just as well without a license and a master's degree.

I think that's true of many professions.

Anonymous said...

Mike, I couldn't agree more. The current model, and the interruptions that are built into it, SUCKS. Would any other professional tolerate this on a day to day basis? And still maintain a calm and pleasant demeanor for the next patient? Is a retail pharmacy a pill mill or a site for providing health care services? Can't have both.

I don't think many of my patients have any clue of the many tasks we are juggling right before their eyes. They wave me away when I approach for refill consults, just want to get their pills and get outta there. They seem to feel that I am holding them up by making some sort of sales pitch, doing them a disservice, when offering them consultation. I can say what I want, they aren't listening, make them wait 10 seconds and they are already distracted, texting away. "Is what you just said all printed on the label (cause I wasn't listening)"

It is agonizing because we work so hard for those few customers every day who seek our help, find the answers they need, and value our time.

PharmJam said...

I think you make a good argument Mike. I am still in school so I do not think I have the right to say 'you don't need a 6 year degree to practice in retail pharmacy' but when I graduate I am sure I will still find that to be the case. When I first entered pharmacy school, I loved the idea of retail pharmacy but now after interning in it, it is just not for me, I respect those who stay in it and strive to better retail pharmacy. No privacy, idiot store managers, constant interruptions, poor staffing, insurance, and the struggle to battle business vs pharmacy is a tough game.
I agree with you that not all unhappy retail pharmacists can just walk away but that has nothing to do with you trying to walk away. Finding another position may require moving but it is a option. When I think about it, I try to imagine practicing retail pharmacy for the next 25-30 years and I just can not see myself doing it...
Trying to herd up pharmacists to make a change is like herding cats. Maybe I am a pessimist but in the end I see the corporations winning out, more and more schools are opening, we have not even seen the bulk of the effect that all these graduates will have in this recession, things are going to get worse before they can get better.

I say get out while you can or at least try to get out, especially if you are not happy.
On a side note, there are 2 retail pharmacies in my area where the pharmacist applied for grants to fund an ambulatory care center at the pharmacy at it is pretty sweet. She is able to staff and offer several coaching classes, screenings, BP checks, and one of them has just began a collaborative drug therapy management protocol with a local physician group for a smoking cessation class. If it goes well, the physician group is interested in possibility of doing an anti-coag clinic as well. They took the initiative to apply for the grants and go meet with the prescribers and they are very happy with their careers as a result. Retail can be better but it takes a lot of work.
Whatever you decide, good luck and I love reading your blog.

Mrs MRPharmS said...

excellent post. The UK tried to move towards this. Rather than getting paid or volume of dispensing, we now get paid or volume + additional services. You may have read about MUR's. Basically we get paid for a comprehensive patient counselling session. It has been an huge challenge for the profession, especially with a LOT of bullying fromm middle management. But my friends & I are at a stage now where it is all good. Proper payment (£28) for a proper consultation and customers recognising YOUR contribution rather than all the interventions going on unpaid & out of sight. Still a way to go though...

melachrino said...

I'm finishing up school, working on starting the process to establish an independent pharmacy where I can spend more time working directly with patients rather than counting by 5's. Only time will tell, as always, but if this profession is ever going to change we'll have to change it.

Anonymous said...

Hospital pharmacy is no picnic either. The interruptions are also constant, pagers, phones, emails, etc. I, too am constantly listening to what my techs are doing all the time to make sure they are giving nurses the correct information and handling situations appropriately. And the techs have no idea what we do all day. When a lot of your work goes on by thinking about things that nobody can see, techs think our job is easy.

Anonymous said...

That's why you get paid almost $60/hr. It's a high stress job that needs a lot education. The pay matches the stress.

Anonymous said...

Yes, maybe it doesn't require 6 years to become a pharmacist and no need for pharamcy schools to teach you all the information that you don't get to use on the job. Then anyone could become a pharmacist and take your job away. The reason why US made a switch from BPham to D.Pham was to prevent having too many pharmacists and too many people going to pharmacy school. Remember when the IT world was booming, everyone went to study IT, and then what happened, people couldn't get jobs after graduation. But I think pharmacy is slowly heading toward that direction with the number of new pharmacy schools opening each year. Reality is always different from what we learn in school.

Anonymous said...

I work at an independent in a town of about 4000 people. We fill 1600 rxs/week with one pharmacist and four techs at a time. All the cashiers are trained techs, and can step in at anytime and help w/ overflow. We have a HUGE, way more than adequate, inventory - we average maybe 2 or 3 owes a WEEK. Our phone system is an IVRS and the patients USE it. The phone rings about four times an hour.

Do I make "chain money"? Not quite - I pull in about $108-110k/year. I also wear jeans and a t-shirt (clean one) to work, I have NO insurance premiums or deductibles, we have take-out lunch EVERY day (out of the petty cash, per the owner's instructions), we close at 6pm SHARP, and I work 39 hours a week. I spend most of those 39 hours on the sales floor/in FRONT of the counter talking to patients. They're not intimidated by a white coat, a shirt and tie, or a name tag that says "Dr. So-and-so, PharmD." They know that they're talking to a friend who is familiar with their medical history, their medication usage, and the names of their kids and favorite sports team. In all my time there, I have had about (literally) 4 or 5 "stressful" moments.

Also, a 401(k) with 6% match and a profit-sharing plan that you wouldn't believe if I told you about it.

Why am I bragging about my job? Because I work for an independent - maybe I don't get a company car, and I haven't reached the prestigious $60 an hour level, but I've never been so happy in my career - shit, in my LIFE.

And before you ask, yeah, we're viable. There's a Rite Aid that I can see right out the front door, and the next town over (much bigger) has about nine pharmacies total. We kick every one of their asses (number-wise and sales-wise) every week.

Anonymous said...

Mike,I dunno where you work, but I'm forever haunted by a retail pharmacy award hanging on their wall saying, #1 pharmacy for highest dispensed Rx's. Heck, it wasn't cuz of quality service, but cuz it was in an ideal location.

Anonymous said...

I just saw the UCSF PharmD program syllabus, and I guess many were complaining. It is now split into 3 specialties so that someone going into research won't complain of endless clinical classes, and someone in the business side won't have to take heavy research classes.

Anonymous said...

Hi Mike good to see you again. I hope someday you are considering that trainer gig when you I guess accumulate your nest egg.

Anonymous said...

You didn't talk about the drive thrus. My company wants Pharmacist to ring up the medication at the register so that the pharmacist can counsel the patient. I feel like I am a cashier more than a pharmacist. I already hate retail pharmacy job and can't wait to go back to hospital where I can at least use most of my time doing pharmacist job.

Anonymous said...

I totally agree with everything you said. Imagine doing all of that and being pregnant. Not an easy thing...

Anonymous said...

There are parts I agree with in your blog and parts I do not agree with.

Let's start with opposing opinions and then I'll state was opinions I share with you.

First, let me give you some background information

- I am a 20 yr old female college student, in school full time and working roughly 25 hrs/week part-time at a retail pharmacy. (no school this summer so I'm working more hours but you get the picture). I have worked at this retail pharmacy for 10 months.

I don't get why you give so little respect to your technicians? How long have they been working for you? Also, it's good to have them ask you questions in my opinion. Would you rather them shut up, make a mistake, you not catch up, and serious repercussions arise from this incident or spending 10 seconds out of your hectic schedule to answer their question? Are these certified/senior techs or what? In that case I could understand some but otherwise no.

Another thing is your arrogance is seemingly obvious. Let me quote you

"Moreover, despite being much more intelligent and more educated than pretty much everyone in the entire store, I ultimately have to answer to and follow the asinine rules made up by "head cashiers." Once again, I went through 6 years of college to get a doctorate in pharmacy. I graduated in the top 10% of my class."

Are you serious, sir?

Okay here are the parts I DO agree with you on.

- I think consultation is a messed up process. I feel really bad for the pharmacists. You have a customer yelling in your ear because they wanted a 30 day supply instead of 90, they can't get their hydrocodone, some doctor's assistant is bitching because she is on hold trying to call in a prescription, and then you counsel a patient in drive thru who won't listen to you but you have to do it because it is the law. I definitely see your frustration.

No lunch break and no potty break? It's seriously a nightmare.

I cannot fathom the degree of stress pharmacists face on an every day basis. My major was pre-pharmacy but now it is dental hygiene. I would not be able to handle the stress of others.

It's not fair, to be honest. If you are stressed and rushed, you're more likely to make an accident. I think there should be a patient education class on the pharmacy. It's just ridiculous.

I called 8 different pharmacies today trying to see if someone had Oxycontin. What does the customer do? Gets pissed off because I won't have her Hydrocodone ready before she leaves. The lines are long and I never got a thank you. It's so disrespectful.

Anonymous said...

This blog is a great insight to the pro's and con's of pharmacy work. I'm 17 years of age and contemplating pharmacology and reading this blog has answered a heap of questions. You have a really nice style of writing as well, so much that I've been reading your blog for well over 3 hours.

Thanks, and good luck on your future endeavours!