The New York Times recently published an article titled How Chaos at Chain Pharmacies is Putting Patients at Risk. This article takes a deep dive into how chain pharmacies are becoming increasingly unreliable as unrealistic corporate expectations are placed on pharmacists and techs.
The NYT article mentions chain pharmacists who are chained to a model that forces them to meet quotas set by corporate metrics and unrealistic workloads. So, why are more and more errors slipping through the cracks at chain pharmacies across the country?
Expectations of the Modern Pharmacist
Over the past decade or so, the job description of the average pharmacist has gotten much larger.
- Filling prescriptions, checking prescriptions and making sure all medications are safe and going to the patient that needs them.
- Checking for drug interactions if a patient is taking multiple medications.
- Consulting with patients and store customers who have questions about over-the-counter medications
- Many pharmacies offer immunization (and other) shots, which is a job that must be handled by a pharmacist. *As of 2020 pharmacy technicians in some states can get licensed to administer shots
- Calling patients, doctors, or both to discuss prescribed medications.
- Placing and double-checking prescription drug orders, sometimes multiple times a day.
- Managing a team of pharmacy technicians.
- Answering phone calls.
- If there are no technicians on staff a pharmacist also checks customers out at a cash register or drive-through.
- In some states, pharmacists can prescribe several medications according to individual state laws. This adds to pharmacist workloads as they must have a sit-down consultation with new patients.
“Pharmacists Don’t Even Take a Lunch Break in Most States”
This is a lot for one person to handle on a daily basis. Pharmacists don’t even take a lunch break in most states! In some cases (shots, consultations) a pharmacist has to take on duties normally relegated to a physician and give a shot or explain potential side effects of a medication to a patient. This can happen in cases where a doctor, a patient, or both forget something during a visit.
Sometimes doctors don’t explain all of the interactions or side effects a new prescription can have on a patient. In cases like this, the responsibility of drug education falls to the patient’s pharmacist.
Imagine a pharmacist doing all these things while having to fill and check 400 prescriptions during an 8-hour shift. How about 600 prescriptions during a 12-hour shift? That is 1.4 prescriptions filled every minute!
The NYT article also mentions a recent trend in chain pharmacists receiving less help from pharmacy technicians, as hours have been getting cut.
Quantity Over Quality at Chain Pharmacies
Chains like Walgreens and CVS have reportedly been cutting jobs (1) and closing stores (2) while filling more prescriptions than ever (3). Getting the right medicine or the best service to more patients with a smaller staff is nearly impossible with the tools pharmacies currently have at their disposal.
Here is a quick example. A chain pharmacy is located in a region that houses 4 total pharmacies from the same chain. Each location fills 500 prescriptions per day. One day corporate decides to close down 2 of the locations in this region. This leaves two pharmacies to fill double the prescriptions they were filling before the store closures (assuming all the patients stick with Pharmacy X). Going from filling 500 to 1000 is a huge increase. Even getting just 20% of the prescriptions from one of our example locations gives the other location 100 more prescriptions to fill each day!
It is crazy to think retail pharmacists and pharmacy employees can give the best care to customers when they have their primary workload doubled. Heavy pharmacist workloads are the primary reasons large chain pharmacies have been having more and more errors over the past few years.
Many pharmacists interviewed in the article mention corporate ‘metrics’ they need to hit to ensure job security. If a pharmacist is more concerned for their own job security than double-checking prescriptions, the quality will drop, as pharmacists must choose quantity (filling as many prescriptions as they can) over quality (safely filling all medications) to keep their jobs.
Chain Pharmacies Forcing Refills on Customers and Doctors
One of the most shocking discoveries in the NYT article was that some chain pharmacies use pharmacists and/or automated computer systems to ‘force’ patients to get refills or 90-day supplies on medications—with or without permission from a doctor. From the NYT Article; “Dr. Charles Denby, a psychiatrist in Rhode Island, became so concerned by the practice [of unneeded refills] that he started stamping prescriptions, “AT MONTHLY INTERVALS ONLY.” Despite those explicit instructions, Dr. Denby said, he received faxes from CVS saying his patients had asked for — and been given — 90-day supplies.
Dr. Denby, who retired in December, said it was a “baldfaced lie” that the patients had asked for the medication, providing statements from patients saying as much.”
Many corporate pharmacists view automated refills as a blessing and a curse. On one hand, they are getting extra prescriptions to hit their corporate metrics. On the other hand, does the patient really need more of a specific medication?
Without automated refills, the NYT article mentions that many pharmacists have to perform borderline ‘cold calls,’ asking customers if they need a refill on a specific prescription. Not only is this irregular practice, having to ‘cold call’ customers takes away from the time a pharmacist could be filling and checking prescriptions—which could again lead to more mistakes during busy times.
What You Can Do to Ensure You’re Getting the Right Prescription
If you are worried that your pharmacy may be in over its head when it comes to customer count, you’ll need to check a few things out when you pick up your next prescription:
- Double-check all your personal information. Make sure your name, address, and any other personal information is correct.
- Look at the name, dosage, and instructions of any medications you are picking up. If something seems off, talk to the pharmacist or call your doctor’s office.
- Make sure the medication in the bag matches the medication on the outside. If the bottle or box in your prescription bag has a different name, be sure to ask your pharmacist about it.
- If you open the bottle of a refilled medication and the pills look different, call your pharmacy. This may be a generic medicine or manufacturer change—your pharmacist can tell you for sure.
Any questions you have about a new medication should be answered by your pharmacist. Pharmacists can make time for you—even when it’s busy—so if you are genuinely worried about anything, be sure to ask to speak to them.
Are Local Pharmacies Better Than Chains?
There is no perfect pharmacy—both chains and local pharmacies have their pros and cons. A better question to ask would be “am I happy with my current pharmacy?” If you always have to wait for a prescription or get bombarded by refill requests from your pharmacy, you may want to think about this question.
Pharmacists are the last line of defense between you and a medication. You want to make sure your pharmacist is someone you trust and someone who has time for you. There are tens of thousands of pharmacies in the US—make sure you choose one that is right for you.
Oswald’s Pharmacy and Our Pharmacy Staff
Over the past few years, we have reinvigorated our pharmacy staff with better training and tools. Last year we hired a new fulltime pharmacist and upgraded our pharmacy system to a platform that lets us better serve our customers.
Our new system is a state-of-the-art pharmacy platform that helps our Pharmacists get our customers the prescriptions and the service they deserve. Even the best pharmacy systems aren’t perfect—every system needs a diligent pharmacist behind it. We pride ourselves on knowing our customers and accommodating all their needs.
If you have any questions about our pharmacy, pharmacists, or anything else, please give us a call or send us an email. If you want to know about transferring prescriptions, read this article and find out how easy transferring prescriptions can be.
