An Open Letter on Pharmacy Workforce and Well-Being
July 29, 2019
Your Voices Are Not Silent
Over the past few months, I have fielded multiple calls, texts, and emails from pharmacists who have either lost their jobs, been forced to cut staff hours, sold or closed their pharmacies, or are gravely concerned about the changes happening within our beloved pharmacy profession. Without a doubt, this is the most difficult part of my job. I am eternally grateful that these folks recognize the importance of TPA as their professional voice to support them in both the good times and the hard times, and I appreciate you all for the important role you play in improving the lives of the patients you serve. The fear, pain, and uncertainty I hear expressed in their voices weighs on me in ways that I cannot express. That burden is what keeps me up at night and stays with me every day. From discussions with pharmacists across many different practices, I know that each is experiencing similar pressures and challenges.
The difficulty in finding stability and sustainability in health care is universal. While the most recent news affects many of our pharmacists in corporate chain community pharmacies, the same struggles exist for our pharmacists in hospitals, independently owned community pharmacies, and many other pharmacy practices. Even TPA is not immune to these challenging times; we are all encountering the tremendous hurdle of doing more with even less. Our association has experienced marketplace changes and budgetary constraints which have forced me to make some of the same difficult decisions that you are experiencing, including reductions in staff and operating expenses, as well as finding a more financially sustainable location for TPA operations. All of these changes, while painful, are necessary for us to sustain operations, and I sympathize with each one of you. Much like you and your pharmacy team, our staff is overworked, underpaid, and peddling as hard as we can to maintain the same level of service that we have always provided. Much like you, we continue to press on.
I know that each of you continues to provide care to patients in the face of ever-mounting adversity. Your resilience and strength are unassailable. Now is not the time to let fear of the unknown consume us. Now is the time for us to come together as one unified profession and build a better future for pharmacy and for our patients.
How Did We Get Here?
The primary issue facing pharmacy right now is that our current model for payment is based on margins for prescription drugs. This model has afforded many different middlemen and competing interests the opportunity to chip away at pharmacy profits, and we have now reached our breaking point. As pharmacists, it is essential that we continue to demand recognition as medical providers and be compensated appropriately for our knowledge and the positive impact we have on patients. Product-based compensation alone cannot support or sustain the current pharmacy practice model. We must remain patient-centric and seek opportunities to integrate in meaningful ways that provide payment for the knowledge, expertise, and value we offer to our patients. Until now, our profession has been able to survive on margins for prescription drugs which have been used to provide patient care services, but this approach is being challenged. And so, we must now fight harder than ever: for our patients, for our profession, for our livelihood, for our future, and for our rightful place at the table.
What Should We All Be Doing Right Now?
I’ve been asked by members about prescription per hour limits, unions for pharmacists, reducing college of pharmacy enrollment, mandatory breaks, and many other very important issues for our pharmacists. These issues are difficult and complex, and each policy consideration must be weighed very carefully. If pharmacists had all the power, we would wave our magic wand and instantly bring about a myriad of changes to the pharmacy marketplace. We would establish in law and rule that pharmacists are the medication experts on the patient’s health care team. We would ensure that pharmacists are appropriately compensated for their value and role as medical providers. We would require that every individual, entity, and corporation respect the autonomy and professional judgment of pharmacists as essential health care providers. We would establish that pharmacy technicians are paid a meaningful wage to ensure their long-term sustainability. We would mandate that all pharmacy practice sites be staffed for optimal patient care and protection instead of quarterly profit statements. We would ensure that all pharmacists (new graduates through veterans) are ensured full-time positions consistent with marketplace demand.
Until pharmacists rule the world, here are some practical tips for navigating these challenging times:
Show Kindness Toward Your Fellow Pharmacist Colleagues: Right now, it is very important for us all to surround our fellow pharmacist colleagues with love, support, and empathy. Many pharmacists in a variety of different practice settings are experiencing fear and concern for the uncertainty in the future. We must constantly remind ourselves that we are all pharmacists, and many of these issues that seem to make us different are not as important as the challenges that we are all facing right now. Call your pharmacist friends to check in on them, and genuinely listen to their concerns, even if you don’t understand fully what they’re going through. Most importantly, be there for them.
Take Advantage of Existing Pharmacy Practice Laws: It’s also not the time to hunker down and ignore the larger changes happening in pharmacy. We must come together to work toward a brighter future: it is out there. One of the most important things you can do right now is use recently enacted state laws driven by TPA to create innovative new practice models and integrate as members of the patient’s collaborative care team. Pharmacists in Tennessee have unique opportunities to create leading-edge practice models, thanks to some of the most expansive pharmacy practice laws in the country. I am proud of the fact that pharmacists are increasingly being viewed as essential medical providers in Tennessee, both in law and in practice.
- Tennessee is one of only a few states that have enacted legislation requiring insurance companies to credential and contract with pharmacists as medical providers. While there are unique challenges that come with becoming a medical provider, there are pharmacists here in Tennessee who have successfully navigated this process and are recognized and paid as medical providers.
- TennCare’s Medication Therapy Management Pilot Program is another great example of a novel service that recognizes and pays pharmacists as medical providers for the services they provide to patients.
- The formation of collaborative pharmacy practice agreements between pharmacists and prescribers can expand pharmacists’ opportunities to integrate as members of the patient’s medical team and actively manage patients.
The role of the pharmacist is becoming ever more vital, given the growing shortage of primary care providers and the increasing gaps in patient access to essential health care services. There are many pharmacists across the state who are using the new laws to establish innovative pharmacy practice models.
Diversify Your Talents and Learn New Skills: There is no better time to invest in yourself and your professional future than right now. As pharmacists, we all sacrificed an incredible amount of effort in obtaining our degrees and licenses, but lifelong learning is what provides long-term stability and marketability, as well as provides you with the ability to create your own unique pathway to achieving professional fulfillment. Investing in yourself and your career is a great way to make yourself more marketable and desirable to potential employers, provider groups, health systems, and other practices where pharmacists are increasingly being incorporated as members of the patient’s care team. While completing a pharmacy residency may not be practical or ideal, there are many different options to help you grow your professional skillset. Certificate training programs for immunization delivery, medication therapy management, diabetes management, and other clinical services, as well as board certification, are great ways to obtain advanced training. If you want to connect with pharmacists in different practice settings but don’t know where to start, please reach out to TPA. We’re happy to connect you and support you along the way!
Strengthen Your Professional Relationships: Pharmacy is a small world, and making key connections will open new doors and help you build relationships with decision-makers and potential employers. One of the most compelling reasons our members consistently report as a reason for their ongoing membership and support for TPA is the opportunity to connect with others within the profession. TPA meetings and events, such as the Winter Meeting, Summer Meeting, and Emerging Leaders Program, provide pharmacists with the opportunity to get to know other pharmacists, make meaningful connections, and build a professional and personal support system. As your state pharmacists association, TPA represents all of our pharmacists and pharmacy professionals working hard every day to overcome the maze of corporate metrics, decreased technician hours, and blogs full of skepticism and bleak predictions regarding the future of the pharmacy profession. Now is a great time to get involved and connect with your fellow pharmacists.
Get Your Personal Finances in Order: One topic that most Americans feel ill-prepared to tackle in life is managing personal finances in the face of challenging times. Despite the plethora of resources, books, and financial planning professionals out there, most folks are not prepared for an unexpected major expense or loss of income. It is impossible to predict what the future holds, but we can all do our part to make meaningful change. Financial health and freedom are equally as important as physical, mental, and emotional health, and it’s a good practice to routinely assess your disaster preparedness plan. If you’re prepared, great! If you’re not, begin by assessing where you are financially and start with some practical goals.
Regularly Assess Your Well-Being: Your well-being as a member of the health care team is vital to a patient’s outcome. TPA, in collaboration with the American Pharmacists Association (APhA), invites you to participate in the Well-Being Index. This validated screening tool, invented by the Mayo Clinic, is an opportunity to help you better understand your overall well-being and areas of risk compared to other healthcare workers across the nation, as well as provide access to general and pharmacist-specific resources. It’s important to note, this tool is 100% anonymous – your information and results are private, and your individual score will not be shared with TPA, APhA, or anyone for that matter.
What Is Our Path Forward?
Thanks to each of you and your ongoing support, TPA has been able to achieve some monumental legislative changes in recent years, which will support pharmacists and pharmacy practice here in Tennessee. Our active and dedicated association members all worked together as one to make pharmacy’s voice heard on several very important issues: advancing pharmacists’ scope of practice through collaborative pharmacy practice; increasing opportunities for pharmacists to provide compensated patient care as medical providers; reining in the abusive practices of pharmacy benefits managers through licensure and added pharmacy protections; making pro-patient and pro-pharmacy changes to existing opioid laws; and removing pharmacists from being required to pay the professional privilege tax. I am confident that, with your continued support, we can all work together to pursue meaningful changes which enhance pharmacy workplace conditions and promote optimal patient safety. Here are a few steps TPA is already taking to address pharmacists’ concerns:
- In response to feedback and concerns expressed by TPA members, the TPA House of Delegates adopted a Resolution Advocating for Pharmacy Working Environments that Promote Optimal Patient Care during the House session at the 2019 TPA Winter Meeting. This resolution will help to guide TPA’s advocacy efforts and policy considerations related to the pharmacy working environment.
- TPA is working with the Tennessee Board of Pharmacy to address concerns expressed by pharmacists and work to bring about regulatory changes which ensure an optimal work environment for pharmacists and the patients they serve.
- The TPA Legislative and Regulatory Policy Committee will be convening in advance of the 2020 Tennessee General Assembly session to explore legislative remedies to promote optimal pharmacy practice environments and ensure the safety of our patients.
- Dr. Mary Jo Collins, Speaker of the TPA House of Delegates, was recently appointed as the association’s representative to serve on the Steering Committee for the National Consensus Conference on Enhancing Well-Being and Resilience Among the Pharmacist Workforce. The conference brought together 75 individuals from across the nation earlier this month in Chicago, IL, to develop policy recommendations to support provider well-being and resilience.
- TPA continues to work to contemporize the community pharmacy practice environment and free up time for pharmacists to provide care, through our Community Pharmacy Transformation pilot program in partnership with the Tennessee Board of Pharmacy.
The Bottom Line…
Change is achievable, but it will take us all working together and being persistent in pursuing our shared end goal (just look at TPA’s collective success in repealing the professional privilege tax for pharmacists). However, in order to move forward, we must do so with one unified voice. As a second-generation pharmacist who grew up surrounded by incredible mentors and pharmacy greatness, I know that pharmacy is a close-knit professional family. Like most families, we may sometimes disagree internally, but if anyone messes with one of us, they mess with ALL of us. Our strength and unity will get us through this challenging time, and I remain optimistic about the promise of tomorrow. On behalf of the Board and staff at TPA, thank you for your ongoing support for TPA and the profession of pharmacy that we all care about so passionately. TPA will continue to work with you, for you, and because of you, to provide you with support and assistance as we work together toward a brighter future.
Micah Cost, PharmD, MS
Tennessee Pharmacists Association