More Pharmacist Layoffs. What Now?

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It’s been one week now since the latest round of retail pharmacy and pharmacist layoffs and cuts, this time at the retail giant Walmart.

I’ve seen a number of pharmacists jump in to discuss this trend, but there is a dialogue that I see missing in the conversations that are going on right now:

What now?

We have an immediate and pressing situation of pharmacist layoffs to deal with and what are we going to do about it?

I think everyone agrees that pharmacy isn’t what it used to be. I also think that, outside of pure nostalgia, we all know that it shouldn’t and won’t ever go back to what it was.

Past fears are finally coming true.

I talked with an older pharmacist I know who remembered the fears that existed in the professional world when mail order was coming out. They said, “everyone said there won’t be any jobs, but you know what I saw, an opportunity and a job at the new mail order company.” I don’t think pharmacist layoffs were a concern, but lack of finding jobs was.

To which I replied, “sure… and it turned out all those worries were hypothetical right? Everyone didn’t lose their jobs. In fact, salaries could still be negotiated. There were even extremely generous sign on bonuses to be had.”

Today, people are literally losing their jobs without notice and pharmacist layoffs are happening in large numbers. Of those who aren’t losing their jobs, I can’t think of a single retail pharmacist who hasn’t already been impacted by loss of hours or wage freezes. Impact may not mean it’s happened to them, but the fear of pharmacist layoffs is very real and tangible and it’s keeping people up at night. I addressed this growing problem when I wrote “Are You Prepared for Underemployment?” some 8 months ago.

The times, and the markets, they are a-changin’.

So, fine, we can talk about the fact that technology is rapidly changing things. It’s true. But we don’t know how things are going to shake out in ten years. Just because things will change doesn’t mean that we don’t have a very clear problem of ongoing pharmacist layoffs to tackle right now.

Remote and tech – those are the buzzwords of this era. But where are the jobs? Pharmacists are still so closely tied to a product in most respects and establishing niches for ourselves in remote work, especially remote work that allows you to work as self employed or as an independent contractor are few and far between. Unless you want to do remote order entry for rural hospitals at 2 am and still be tied to production quotas.

We still have a lot of public education to do to change our image of being tied to a product. And our value is eroding in the public eye as they plan for a future where Amazon drop ships that product by drone on their back garden table while they take their morning coffee and then they ask Alexa(tm) what the side effects of their drug are. For a positive take on where these types of technology could go as well as where we’re at currently, check out this podcast from RxRadio and Richard Waithe.

Niche down and carve out a new market.

Sure, we can say people need to find their niche or be an entrepreneur. But seriously, we can’t all have a niche and not everyone is cut out for entrepreneurship.

A vast majority of pharmacists entered retail because it allowed for relatively steady work at good pay. It offered a chance for people to have some work life balance. For women especially, it offered the possibility of being the primary source of income for the family and having a family and being able to take time off. So, suggestions of niche down or go get more education don’t work for everyone.

We’ve all got the same degree.

And for those in non retail environments, I hope you’re not naive enough to think that the collapsing retail pharmacist market won’t effect you.

It’s simple economics folks – supply and demand. Though there are a portion of pharmacists who will just exit the workforce when faced with more pharmacist layoffs, some of the best and brightest retail minds are more than equipped to transition into other roles. Especially if they’re motivated and willing to take a pay cut to do it.

What I can foresee is an exodus from retail that will dilute all the other pharmacist pools and begin to cause wage drops and wage stagnation there. And any gaps in retail will be filled by hungry new grads with no choices and bills to pay.

The point is, this is a problem for all of us.

And what is lacking and has always been lacking in the profession of pharmacy? Solidarity.

I’m not going to explore all the reasons we have this problem. But we do. And, it’s probably a large part of the reason that we have still not achieved provider status.

The other problem is minimal advocacy, in my opinion, compared to other professions, on the part of pharmacists.

Maybe the lack of advocacy isn’t entirely our faults either. With the massive shortages that existed for so many years, there wasn’t much of a need to ensure we advocated for our jobs. But, that made us lazy, and we stopped highly advocating for our profession, which is something we should never do. We should have taken better advantage of the market where we controlled the shots as highly in demand professionals.

Lack of solidarity and minimal advocacy are a recipe for a tenuous future in a profession in the face of rapid changes.

Is a union the answer?

Is a union the answer as so many are calling for? I don’t know. Should it be explored more? Yes.

Anyone who says that unions solve all the problems is also being naive. They definitely come with their own issues.

Or call it a professional guild. Or a collective. But, we’ve got to start looking out for each other and be willing to make some personal sacrifices for the greater good.

Heck, we could all at least begin to be actively involved with our state pharmacy associations and advocate to make things happen at our state boards of pharmacy! I know, most retail pharmacists are exhausted after working 14 hour days… but if your hours got cut: boom, you’ve got a new job in advocacy.

What do I see going on right now? A race to the bottom.

While everyone is angrily demanding that wages don’t drop and retail pharmacists deserve more pay than they get (with which I agree) the profession is further eroding.

I’ve seen discussions and arguments about retail pharmacists being “glorified cashiers.” And while I do not agree with that, I also think you’d be hard pressed to find a pharmacist who doesn’t feel like this from time to time. There’s a reason it’s somewhat of an ongoing joke when a retail pharmacist tries to use the title they so fully earned and call themselves “Dr.”

Here’s where the issue with solidarity comes in:

Do we want to be glorified cashiers? Heck no.

Do you think there’s a single retail pharmacist out there who is proud to say how little of their clinical education they use on a daily basis? Heck no. We earned these degrees and we want to use them and be paid appropriately.

Market forces and lack of solidarity have created a situation that has allowed this to happen.

I think back to the mock up models of retail pharmacies I saw nearly ten years ago when MTM was the big buzzword and community practice residencies were just beginning to pop up.

The plan didn’t pan out.

Walmart showed a pharmacist, at a desk, at a consultation window, front and to the right or left of the cash register. If I remember right, the model said basically, there would be someone there “all the time” to provide thorough and comprehensive counseling services and clinical services in the pharmacy. The rest of the pharmacy staff, and pharmacists would still be in the back making sure operations run as usual.

Would this be a higher class of retail pharmacist? The clinical retail pharmacist? Or would the staff pharmacists just swap out who provided this role? That I don’t know. But, there was supposed to be a dedicated pharmacist providing all of the many services that have since come to be basic parts of retail pharmacy and are only growing.

Other pharmacies built what effectively looked like a small doctor’s office next door and connected to the pharmacy. So far, I’ve only ever seen them vacant.

What actually happened?

That clinical desk never got filled. Instead, the burden has shifted back to the pharmacists filling prescriptions as just another item in their queue. Just another box to check, button to click.

I alluded to some of my concerns here when I wrote “Deep Work and Why My job Sucks.”

So, now, in addition to ensuring that prescriptions are filled safely and accurately, pharmacists are typically supposed to just “build in” to their already overloaded schedules time to complete immunizations, perform MTM and CMRs, prescribe birth control, smoking cessation, and, as is developing in some states, prescribe a whole host of maintenance meds and even rapid strep tests and antibiotics.

We’re performing health screenings, monitoring for opioid misuse. And then, we’re trying to have honest, human conversations with customers about their concerns and tackle deep and important problems when we know there are 400 other items waiting for us.

It’s kind of a joke. And, it makes a mockery of what we should be doing.

Therapeutic interchange, evidence based medicine and current best practice guidelines? Ha! We barely have time to make sure the tech typed the prescription correctly and pretend that we did a CMR by reading back a prescription drug file and asking the customer if they had any questions and if everything is accurate. All while they’re glaring at us from the register because they really just wanted to pick up their atorvastatin and already had to wait too long, in their mind, to do so.

No one wants it this way.

Don’t get me wrong- I don’t think anyone wants it to be this way. I think we try our damndest to do our best and serve our customers, but the cards are not stacked in our favor.

And sometimes, we have the time. But, that’s the exception, not the norm.

Argue with me all you want. But, for the most part, it’s true. Perhaps I’ve embellished a bit. But, please, anyone, tell me that this is really what you thought you’d be doing when you set out on the course to earn that PharmD? How much does one meaningful interaction stand out in your day, or week or month? Shouldn’t they all be?

Opportunity

We talk about showing that we have value and moving away from a commodity to offering a service.

Well, perhaps, we can take this opportunity to turn a sinking ship into another opportunity. If we’re all willing to give up a little.

How do I think we can make this work to our advantage?

I think we can demand more pharmacist hours, not less. But I don’t know how that’s going to happen without the effective bargaining power of the bulk of pharmacy standing behind it.

I think that model I described earlier, with a solid, available pharmacist presence was the right idea. And, I think we should be aiming to provide all the services we tell the public we do. We shouldn’t be sighing and wondering how we’re going to fit it in to our day.

And, we should be finding ways to take our services out into the community. Into the homes of patients. In ways that we are paid for it without being tied to the NCPDP number of a pharmacy. We have NPI numbers – we should be able to use them.

So, pharmacists in retail here’s what I pose to you:

More pharmacists. Less pay.

IT SUCKS.

But things suck right now, and, to stop the blood from flowing, we have to make some decisions. We can’t demand our way to higher pay. Can’t demand our way in to everyone getting a job. We can’t demand that those who lost their jobs get them back.

But, we can demand, through state and national levels, and perhaps through a guild or union, that we have the ability and staffing to do the jobs that we are supposed to be doing and that we are able to do them safely.

We can demand that working conditions allow us to model patient centric behaviors and allow us some time to provide the clinical services that are further adding to our workload each day, and that we desperately want the ability to do and to do well.

Also, we can demand that conditions are put in place that allow us to be a Doctor of Pharmacy in the retail setting, with all the weight and responsibilities that go with it.

We can demand that all pharmacists get respect for the knowledge the have and the services we offer.

But to demand the respect of the public we have to demonstrate the results.

To do that we need more pharmacists in the pharmacy.

But, I think, sad and hard to deal with as it may be, one of the few ways it’s going to happen is if, for the time being, we accept less pay.

The other option is we continue to do what we’re doing, heads in the sand, ignoring those who have already lost jobs and hoping like hell it won’t happen to us.

More people will lose jobs. Pay will go down.

Eventually the displaced pharmacists will find work again.

And it will, as the rules of economics apply, mean that it will be at reduced pay. So, it’s not like we’re really losing anything by considering my suggestion.

But, if those pharmacists come back at reduced pay, hurting and desperate, we, as a profession, have lost the upper hand on how to dictate any terms of what pharmacy in the retail setting should look like.

We’ll still have people working alone. Working 10 to 14 hours a day, without a break. The job will still demand that all of the work and clinical items get completed. We’ll still be wondering how we’re going to get it all done and if we can do it safely. We’ll be making a lot less money doing it.

Let’s be a little more proactive.

Can we think a little bit more about our fellow pharmacists and the new grads coming out? Let’s think about how we can prevent more pharmacist layoffs.

And, indeed, because I’m a fan of talking economics, let’s follow this thought train a bit more. Yes, word will get out that pharmacy isn’t what it used to be. People will most definitely begin to asses the cost value of this education. They will reconsider becoming a pharmacy technician, who’s wages are likely to increase. Things will even out again… how long that will take? That I don’t know.

But we will have lost an interesting opportunity to turn things around a bit and empower our profession.

We can use these pharmacist layoffs to our advantage.

And, in time, when we’ve begun to demonstrate true value, because we finally have the time to do the jobs we thought we were signing up for, we can demand the pay we deserve as we will have demonstrated outcomes.

Hopefully, we will have regained many of the personal relationships that we have lost with our customers. Lost, because we simply do not have the time for meaningful engagement right now.

When the public sees our value again, because the relationships are there, and when corporations and private sectors see our value because we have re-demonstrated it, then perhaps, we can begin to shift ourselves into all of the new applications and sectors where we know we would be of value.

One of our biggest challenges currently is making other industries and the public really understand what a wonderful resource we can be when given the opportunity to perform effectively.

Is there a more business minded clinician out there? Or, as one colleague coined on The Pharmacist’s Slack, for you techies, something more well rounded than a “full-stack pharmacist?”

Let’s demand we have the opportunity to show them.

Would we not all like to feel confident in introducing ourselves as Dr. Pharmacist?

Sounds like a dismal outlook?

I agree.

More pharmacist layoffs and pay cuts seem somewhat inevitable with the current track that we are on. Unless there is some willingness to sacrifice now and some solidarity in the profession, I’m not sure how something along these lines can be avoided.

We’ve already seen wages stagnant across the retail industry. And there’s been a more troubling marker; female pharmacist wages which were nearing that of male pharmacists at a rate of making $0.92 to every male $1.00 in 2013, are now down to $0.82 per male $1.00 in 2018, despite the fact that women may be in the majority of graduating pharmacists (see below).

It’s not all “our” fault.

Here’s the thing; ultimately, we have already shown our worth when allowed to operate in appropriate conditions. Things like The Asheville Project made that clear.

Perhaps we should be looking more to the current leadership, like APhA, NCPA and ASHP. We should demand they work together more. Ask that they speak up more on pharmacy benefit manager (PBM) abuses. A large part of our current retail climate ultimately, following the money trail, leads back to the PBMs. But have we really seen any of them speaking, as representatives of the profession, about pharmacist layoffs?

Some, more so than others, namely NCPA, are trying to fight that fight. They are trying to protect their independent pharmacy owner members. If these groups can’t act in the best interest of all their members – meaning pharmacists as a collective group, maybe it’s time for members to take their money elsewhere. Members should be spending perhaps, on a new group, that will function more to represent the interests and safety of the profession as a whole. I’m mainly looking at APhA here, which is supposed to represent us all. APhA hasn’t done much, in my opinion, to help fight the disempowerment felt by most retail pharmacists.

We are also starting to see more action and awareness brought to issues regarding PBMs at the state level.

What’s missing? More ground level pharmacist advocacy.

So please, get involved. I’m not going to tell you to stop complaining because it can be therapeutic.

But do something about it too.


Who am I and what am I doing?

Well, aside from these quite wordy blog posts, I started a group to get people talking in ways I didn’t see happening elsewhere. If you’re a pharmacist or intern and interested, you can check out The Pharmacist’s Slack and related spaces. Request membership via www.PharmacistsConnect.com.

Because I’m interested in advocacy and interested in servant leadership, I’m running that site for free to members. No ads. I do all the vetting of members myself. No small feat considering our membership list is up to about 300 and I’ve started this endeavor literally the week before my son was diagnosed with cancer.

If you want to know more about why I started the site, check out my related blog post “Why Pharmacists Connect.”

And I’m here. Pursuing my own personal interests and personal outlets as well as trying to prepare pharmacists (along with everyone else) for lifestyles that can be accommodated by less pay, while still living their best lives.

3 comments

  1. I think the writing is on the wall as automation and mail order will eventually make local pharmacies much less useful to the average consumer. The only way to impact the supply and demand equation for pharmacists is to restrict the supply. Med schools have done a good job of that for MD’s by ratcheting up entrance requirements so high that only a tiny portion of applicants are accepted. But those accepted to pharmacy school average only a 25 ACT. While that beats the average for the college football team it is hardly elite enough to keep enrollments low. The real long term solution is to raise entrance requirements high enough to cut the number of graduates in half, maybe more. However this would severely impact the budget of the teaching institutions which makes it politically difficult. I don’t think the forces that control demand are within control of your profession, but drastically cutting the supply at the same time a huge wave of boomer pharmacists is retiring just might fix the problem.

    1. I think that is a solution that should be explored. Unfortunately from what I’ve been seeing lately, they are getting even less strict in admissions, probably due to declining class sizes. Some schools have eliminated the PCAT requirement. Sad to say, but even state schools are still a business with employees of the schools who have an interest in keeping class sizes up. Keeping residencies low is an option, but, but a fair one. Students are sold a different reality than what they find when the graduate. Both job prospects and job realities day to day. I don’t agree with taking on the student load and then not having enough residencies for them to get jobs if we make resident a hard requirement.

      Thanks for weighing in with some honest suggestions!

  2. Pharmacy is over, and there is nothing that can be done at this point. The ridiculous high school drama, the constant fighting among staff for hours, the back stabbing, all of this allowed a complete lack of respect and compassion to embolden corporate to divide and conquer. If you are a retail pharmacist, you will lose your job soon. You will have your pay slashed, probably by half, down to whatever the thousands of unemployed new hires are willing to take to start paying off their loans. I worked in retail for 12 years, and you are some of the most self serving, disingenuous back stabbing people I ever had the bad luck to work with. It destroyed your profession, and you didn’t even see it happening. And you know what? You deserve it.

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