Dennis Miller, R.Ph. is a retired chain store pharmacist. His book, The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets, can be downloaded in its entirety at Amazon for 99 cents.
Why Is There a Pharmacist Walk-Out?
You may have seen articles recently about CVS pharmacists in Kansas City walking off the job to protest working conditions that endanger the public safety. For example,
USA Today:
Emily Le Coz, “CVS pharmacists stage walkout over working conditions, leaving pharmacy counters closed,” USA Today, September 22, 2023
“Nearly two dozen pharmacists at the nation’s largest retail pharmacy chain staged a walkout in the Kansas City metro area this week over working conditions they say put CVS Health pharmacists and patients at risk. …
“While the group’s specific complaints focus on store staffing and quotas, the walkout reflects a rising outcry from pharmacists at several national pharmacy chains. They say their work requirements leave them unable to safely fill and verify prescriptions, putting patients at risk of serious harm or even death. …
“For years, retail pharmacists working for large chains like CVS and Walgreens have complained about staffing levels combined with rising pressure of corporate performance metrics, which they say push a dwindling number of workers to handle an ever-increasing number of prescriptions, vaccinations and other tasks daily. …
“More than half of pharmacists polled by the Kansas Board of Pharmacy in 2022 said they didn’t feel they could perform their jobs safely; the biggest reasons cited were a lack of appropriate staffing and employer-imposed quotas. …
One pharmacist told the reporter:
…“The workload is so heavy and the amount of staff they allot us is so low that I’m unable to go to the bathroom during my 10-hour shift. I can’t physically walk away from the line of people or the backlog of prescriptions. I’m expected to fill all these prescriptions by myself and counsel all these patients by myself and do all the vaccines by myself so that I’m unable to go to the bathroom and I’m unable to keep my patients safe.” …
National Public Radio:
Bill Chappell, “Have a complaint about CVS? So do pharmacists: Many just walked out,” NPR, September 29, 2023
“Pharmacists working for CVS stores are walking off the job, resorting to a drastic form of protest to highlight what they say are unsafe and stressful work conditions tied to a widespread lack of proper staffing. …
“CVS has cut back on staffing, including less time for technicians to assist pharmacists, even as the demand for prescriptions and vaccines grow, the protesters say. …
One pharmacist told The Kansas City Star:
“It’s like running a McDonald’s with just one person,” adding that they must work alone for the vast majority of the 64 hours a week their store is open. …
“In online discussions, people in the industry say CVS pharmacists in other states will likely hold their own walkouts if their working conditions don’t improve. …
Other Chain Store Pharmacists Support the Walk-Out:
Despite what chain management says, this problem is not isolated to Kansas City. It is a nationwide problem, as any chain store pharmacist will tell you.
California pharmacies are reportedly making almost 5 million medication errors a year
Toby Roca, “California chain pharmacies may soon be required to report every medication error, “ Bay City News, September 19, 2023
“A bill seeking to address understaffing and medication errors in chain pharmacies in California is now headed to Gov. Gavin Newsom’s desk.
“State lawmakers have recently passed Assembly Bill 1286 or the Stop Dangerous Pharmacies Act after months of negotiations with chain pharmacies, labor groups and regulators, bill proponent Assemblymember Matt Haney, D-San Francisco, announced Friday.
“AB 1286 creates first-in-the-nation regulations to crack down on understaffed chain pharmacies making medication errors, Haney’s office said. They added that if the bill is signed into law, California will become “a national leader in pharmacy safety.” …
“California pharmacies are reportedly making almost 5 million medication errors a year, but the state Board of Pharmacy can only estimate that number because currently, pharmacies are not required to report medication errors, Haney’s office said.
“While the direct causes of each medication error are currently unknown, nearly 91 percent of pharmacists in a recent survey conducted by the California Board of Pharmacy report that staffing was not high enough to provide adequate patient care.
“Meanwhile, over 83 percent of pharmacists reported that they did not have sufficient time to provide appropriate consultations to patients to make sure they understand how to safely take their medications. …”
Atlanta CVS mistake–Woman given Adderall instead of oxycodone
Rachel Polansky, “Medication mix-up | Woman given Adderall rather than Oxycodone for pain,” Atlantanewsfirst.com, Published: May 10, 2023 Updated: May. 12, 2023
“Imagine picking up a prescription at a pharmacy but being given the wrong medication.
“It’s a mistake that can have dangerous consequences, but these types of medication mix-ups are not that uncommon, according to an Atlanta News First investigation.
“Gradine Hector-Faison, 51, was prescribed oxycodone for her bad ankle sprain. Not thinking twice, she picked up the medication from her local CVS and began taking it.
Hector-Faison said:
“It didn’t ease the pain up but I was wide awoke. I waited a couple of hours about six hours went by, I took another one, trying to ease the pain again and it never eased up,”
“After taking the medication without any pain relief, Hector-Faison called her daughter-in-law, who discovered the medication wasn’t oxycodone but Adderall.
“Oxycodone is an opioid, often categorized as a downer. Adderall is an amphetamine, often categorized as an upper. Both are schedule 2 drugs. …
Hector-Faison told Atlanta News First:
“I’m frustrated, I’m upset, I’m in pain,” Hector-Faison said. “I just want what belongs to me. I want to ease my pain up. I want CVS to make it right. I want them to apologize for giving me the wrong medicine.”
My Employer Used a Stopwatch to Evaluate Pharmacists’ Speed:
Several years ago, I worked for the Revco chain which was later sold to CVS. Our bosses once subjected pharmacists to what many describe as the most demeaning experience in their lives since they graduated from pharmacy school. It was described to us as a contest to see which stores were most closely following company guidelines. It was, in fact, a productivity test.
I don’t know whether this productivity test was carried out chainwide or just in some regions. Supervisors came around to each store with a clipboard and a list of procedures to see whether we were in adherence.
One of the parameters checked was the time it took pharmacists to fill each prescription. Incredibly, each supervisor had a stopwatch. The supervisor reset the stopwatch with each prescription. When the pharmacist first touched the prescription, the supervisor started the stopwatch. When the pharmacist finally put the medication in the bag, the stopwatch was stopped. Other criteria checked were things like how many times the phone rang before the pharmacist answered and whether or not the pharmacist returned to any calls on hold every 30 seconds to tell the caller the status of his/her call.
What happened in the store where I worked was quite interesting and alarming. The other pharmacist who worked in that store was so distressed by the experience of being timed by a stopwatch that he made a major error. He inadvertently dispensed the antibiotic doxycycline 100 mg to one of our customers instead of the antidepressant doxepin 100 mg.
Let me emphasize that this so-called contest was held on actual prescriptions for actual customers in the middle of an actual business day. It was not held at some special contest site. The chain had the nerve to subject us to this extremely stressful indignity as if it were no more disruptive of our work routine than a wart on our back.
Enough pharmacists eventually complained so vociferously that management was forced to drop the part of the “contest” involving the stopwatch. But the rest of this productivity test remained in subsequent stores.
Chain Store Pharmacists Are Wage Workers:
In my opinion, the fact that the Revco chain had the nerve to conduct this productivity test is an indication of the powerlessness of chain pharmacists, the wage-labor nature of our job, and the fact that pharmacy is now less a profession and more a hamburger assembly line at a fast-food outlet. Like most workers in America today, pharmacists are pieceworkers who are closely monitored by productivity metrics.
As far as I know, this productivity test was not repeated at Revco stores in subsequent years. I have never heard of such a test being held at other chains. But, to me, it clearly indicates the extreme importance that chain drug store corporate management places on speed. That should concern you a lot.
My district supervisor claimed that he could monitor pharmacists’ speed from the parking lot:
One day my district supervisor told me that he sometimes sits in his car in the parking lot adjacent to each of the twenty drug stores in his district. He told me that he monitors how long it takes the pharmacy staff to fill prescriptions.
I didn’t immediately realize it, but clearly my district supervisor was lying to me. There was no way that he had any idea regarding which customers were patronizing the drug store to fill prescriptions and which ones were there simply to buy a cough syrup, decongestant, laxative, hemorrhoidal ointment, acne cream, toothpaste, shampoo, deodorant, suntan lotion, etc.
For those customers who actually had prescriptions to be filled, he had no way of knowing how many prescriptions they had. He had no way of knowing whether the prescriptions were new or refills. (New prescriptions typically take significantly longer than refills.) He had no way of knowing whether there was a problem with a customer’s insurance. He had no way of knowing how many prescriptions were ahead of that customer. He had no way of knowing if one or more of our technicians were on a break or off sick for the day. He had no way of knowing the speed and competence of the techs on duty at that time.
In short, he had no way of knowing anything by simply sitting in his car in the parking lot and observing the amount of time customers spent in the store. So he clearly was lying to me. I guess I assumed that a district supervisor would not be so blatantly dishonest with me or that he would think that I was too stupid to figure out he was lying.
But my district supervisor did succeed in making me acutely aware of the fact that speed in filling prescriptions is very important to chain drug store corporate management. Store level employees refer to these bosses as “the suits” in an effort to denigrate the fact that they are absolutely obsessed with productivity metrics like the speed with which prescriptions are filled.
Potent prescription drugs are just a blur on a fast-food-style assembly line:
Prescriptions are slung out at chain drug stores across the USA at lightning quick speed on what pharmacists compare to a hamburger assembly line. The public simply has no idea how reckless chain store corporate management is in its pursuit of greater profits. These potent prescription drugs are just a blur as they speed past pharmacists and technicians, very often allowing pharmacists only a few seconds to check that everything is correct. The desire to cut staffing in health care to increase profits is pervasive and, in my opinion, immoral.
Customers are oblivious to the catastrophes that can result from the emphasis on speed. While pharmacists and technicians are working at maximum capacity for their entire shift, customers are honking their horns at the drive thru windows, clanking their keys on the pharmacy counter and repeatedly coughing or clearing their throats to let the pharmacy staff know they’re getting impatient with how long they’ve waited.
Customers often make snide comments like “Why does it take so long to transfer a few pills from a big bottle to a little bottle?” or “Why does it take so long to slap a label on the tube of cream my doctor prescribed?” or “Why does it take so long to place a label on my refill for birth control pills?”
Clearly, the criteria that the public uses most often to evaluate pharmacists is the speed with which we fill prescriptions. Little do these pharmacy customers know that mistakes in the pharmacy can, and do, result in serious injury or death.
Ethics of a National Walk-Out:
Would you support a national walk-out by chain store pharmacists in protest of working conditions that place the public safety at risk? Pharmacists realize that this would place a tremendous burden on the public and could, in fact, result in some customers being harmed because of lack of medication. Pharmacists are considering this drastic step only because the mighty chain drug stores are so arrogant and reckless that there is no alternative.
For decades, pharmacists have been complaining that understaffing places the public at risk of deadly pharmacy mistakes. This seems to have fallen on deaf ears among the public. The public seems to think that there’s no way that corporate management at chain drug stores would run their stores as recklessly as chain store pharmacists claim.
The public seems to think that pharmacists have become fat and lazy. The public seems to think that pharmacists would like to fill a maximum of one prescription per shift (rather than a few hundred) and then go home in their nice car to their nice home that their job has provided.
Articles about pharmacy mistakes have made their way into the mass media for decades. I wrote a book about that subject in 2012 titled Pharmacy Exposed: 1,000 Things That Can Go Deadly Wrong at the Drugstore. (Amazon.com: Pharmacy Exposed: 1,000 Things That Can Go Deadly Wrong At the Drugstore eBook : Miller, Dennis: Kindle Store)
But nothing changes.
The public seems to think that pharmacists want a cushy job in addition to a nice salary. I will admit that pharmacists receive a nice salary, but I (along with most chain store pharmacists) strongly disagree that we’ve got a cushy job.
Corporate management at chain drug stores is banking on you believing that no corporation would run its operations as recklessly as chain store pharmacists claim. In fact, corporate management at chain drug stores have adopted understaffing as their business model and their road to profitability.
It’s more profitable to pay settlements than it is to staff pharmacies safely:
Chain pharmacists feel (rightly, in my opinion) that corporate management at the big chain drug stores would rather understaff their stores, forcing everyone to work at maximum output for their entire shift, and then pay settlements to any customers harmed by pharmacy mistakes, rather than staff their stores adequately so that pharmacy mistakes are a rarity instead of a common occurrence.
Customers value speed more than a pharmacist’s drug knowledge:
Many pharmacy customers consider speed in filling prescriptions to be number one in importance. Unfortunately, chain drug store corporate bosses typically think the same way. This places tremendous pressure on pharmacists to fill prescriptions at dangerous speeds, thus jeopardizing the public safety.
Speed is a pharmacist’s biggest asset at chain drug stores, not his/her drug knowledge. Little did we know in pharmacy school that speed would be a much bigger asset during our career than our knowledge of pharmaceuticals’ actions, indications, side effects, warnings, precautions, contraindications, and interactions with other drugs.
Pharmacology is the core subject in pharmacy school, yet you may be surprised to learn that chain drug store corporate executives value a pharmacist’s speed infinitely more than his/her expertise in drugs. A pharmacist who provides excellent and helpful information verbally to customers is valued no more highly than a pharmacist who does a poor job in counseling.
A pharmacist’s slowness in filling prescriptions is infinitely more likely to jeopardize his/her job than his/her drug knowledge (or lack of knowledge). During my career in chain drug stores, I saw many instances of pharmacists being criticized or ridiculed (usually behind their backs) by district supervisors and other pharmacists for being slow.
For chains, speed is far more important than counseling:
I have never seen or heard of a district supervisor criticizing a pharmacist for not providing high quality counseling to customers. To the big drug store chains, speed is clearly more important than informing and educating customers about medications.
Of course, pharmacists can find themselves in hot water for overlooking drug interactions, for overlooking doses that are too high or too low, for misreading prescriptions, and, of course, for dispensing the wrong drug or the wrong dose. But, in my experience, a pharmacist’s speed is far more likely to get a pharmacist in trouble than his/her deficient drug knowledge.
Settlements for pharmacy mistakes are just a cost of doing business:
It is true that chain store corporate bosses don’t want to employ pharmacists who make lots of mistakes. But, in my experience, chain store corporate management seems to view cash settlements for pharmacy mistakes as an inevitable cost of doing business, just like the lease, the electric bill, the water bill, janitorial services, employee wages, liquor licenses, cost of inventory, etc. An inevitable consequence of lightning-fast prescription filling is an increase in pharmacy mistakes and lawsuits.
Pharmacy mistakes can certainly jeopardize a pharmacist’s job, but being slow in filling prescriptions is more likely to prompt action from corporate bosses.
If the district supervisor sees long lines at the drop-off and pick-up windows every time he/she walks into the store, that supervisor’s reaction is NOT that it’s good to see that the pharmacy is busy. The supervisor’s reaction is that the pharmacist and techs are unable to “handle the volume.” To supervisors, long lines don’t mean you’re busy, they mean you’re slow.
Drive-thru windows create an expectation of speed:
Many pharmacists feel that drive-thru windows are the worst thing that ever happened in the world of pharmacy. These drive-thru windows create the expectation that pharmaceuticals are no different from hamburgers and that pharmaceuticals should be dispensed as quickly as hamburgers.
The level of pharmacy staffing is tightly controlled and seldom adequate:
The next time you have prescriptions filled, even though you may be tempted to be angry with how long you have to wait, keep in mind that there are a ton of factors that are in play, most of which you are unaware of. Most pharmacy customers don’t know that the level of pharmacy staffing is extremely tightly controlled based on the number of prescriptions the pharmacy averages filling per week or month.
The number of warm bodies you see in your pharmacy is not some random occurrence. It is, in fact, one of the biggest criteria that pharmacists use to judge whether that drugstore chain is a good place to work or whether it is a dangerous place in which serious mistakes are inevitable.
The amount of technician assistance (often referred to as the “technician budget” or “tech payroll”) is one of the top two criteria that most pharmacists use in evaluating their employer. Pharmacists’ number one concern is probably their own salary.
The job is not worth it regardless of what it pays:
I’ve known pharmacists who say they would gladly take a cut in salary if their employer would provide adequate technician assistance. No matter how nice a pharmacist’s salary is, if the pharmacy doesn’t have adequate technician assistance, the job is not worth having, regardless of how much it pays.
Why Haven’t We Fixed Pharmacy Mistakes?
State boards of pharmacy have largely failed in their responsibility to protect the public safety by failing to mandate safe staffing levels. To increase profits, the chain store business model is based on understaffing. The result is an alarming number of pharmacy mistakes.
What Is the Responsibility of State Boards of Pharmacy?
It is the responsibility of state boards of pharmacy to protect the public safety in matters relating to pharmacy, pharmacists, and drug stores. For example, state boards of pharmacy license and discipline pharmacists.
A pharmacist once wrote a letter to People’s Pharmacy asking readers to contact their own state board of pharmacy if they have personal experience or knowledge of a pharmacy mistake. This pharmacist was hopeful that state boards of pharmacy would react by requiring adequate staffing levels in pharmacies.
In my opinion, many pharmacists have a naive view of the ability of state boards of pharmacy to stand up to the mighty drug store chains and force them to improve pharmacists’ working conditions and correct dangerously low staffing levels.
Pharmacists Fear Their State Board of Pharmacy:
Many pharmacists are afraid of state boards of pharmacy because these boards have the power to fine us for infractions or mistakes or, in a worst-case scenario, they can revoke our license to practice pharmacy. This can happen for things like selling narcotics or benzodiazepines illegally, but it can also happen for serious pharmacy mistakes that result in death or great harm to patients.
In my opinion, the mighty drug store chains are much less fearful of state boards of pharmacy in comparison to the fear that individual pharmacists feel toward these boards. That’s because the chains can easily afford aggressive legal representation to fight with state boards of pharmacy.
State boards of pharmacy seem to be much less threatening in their interactions with the drug store chains in comparison to their interactions with individual pharmacists. Individual pharmacists don’t have the legal and political clout that the big drug store chains have.
State Boards of Pharmacy Fear Being Labeled as Anti-business:
It is important to understand that state boards of pharmacy fear being labeled “anti-business,” especially by pro-business (as opposed to pro-consumer) politicians and legislators. Even though the various state boards of pharmacy have demonstrated varying levels of fortitude in standing up to the chains, my impression is that state legislatures have very substantial power over state boards of pharmacy, just as they have very substantial power over all state agencies and regulatory boards.
In my experience, when a brave state board of pharmacy attempts to pass rules addressing working conditions and understaffing, legislators often claim that the board has exceeded its authority. The big chains claim that these are employer-employee issues that are outside the purview of the state boards of pharmacy. Pharmacists are enraged by these assertions by chain executives.
Instead, the pharmacists would (or should) say,
“NO! These are public safety issues! The state boards of pharmacy have a duty to protect the public safety by mandating safe staffing levels to decrease the very common occurrence of pharmacy mistakes.”
Early in my career, a pharmacist I worked with told me that he would like to report the chain we worked for to one of our United States senators at that time: Jesse Helms. My immediate reaction was that Helms, being a well-known Republican, would typically be strongly pro-business. Therefore I thought this pharmacist was naïve and wasting his time, even though I did not tell him that.
My Conversation with the Head of a State Board of Pharmacy:
I once called the head of the state board of pharmacy in the state where I worked. I asked him if I could speak with him anonymously. He consented. Of course, I realize that it was possible (or even likely) that he could see my name if he had caller ID on his phone. I decided to tell him about my concerns anyway. I told him that the big chain I worked for was a threat to the public safety because, to increase profits, the chain engaged in the dangerous practice of understaffing, thus causing a very worrisome number of pharmacy mistakes. The head of this state board of pharmacy responded in precisely the way I had hoped he would not.
He said to me,
“If you have a specific store in mind, we’ll send an inspector there to investigate.”
I can’t remember precisely how I responded but my reaction was that the problem is not with an individual store or stores; it is a chain-wide problem.
The head of this state board of pharmacy was sympathetic to my concerns, but his offer to send an inspector to investigate a specific store was entirely inadequate and disappointing. He did, however, admit that his worst days were those in which he interacted with lawyers representing the huge drug store chains.
The Public Is Unaware of Understaffing Problems:
The business model of understaffing is profitable for the big drug store chains because it forces all employees to work at maximum output for their entire shifts. Pharmacists and techs are so busy as a result of understaffing that we seldom catch up on our work and often need to stay beyond the end of our shift to do so.
The mighty chain drug stores are able to get away with “murder” (figuratively and, in cases of serious pharmacy mistakes, almost literally) in part because the public has no idea how serious and widespread the problems of pharmacy mistakes and understaffing are. The drug store chains know that pharmacy mistakes are inevitable with understaffing, so it is not surprising that they often pay multi-million-dollar settlements for pharmacy mistakes that cause serious harm or death.
The public wrongly assumes that aggressive plaintiffs’ lawyers keep the big chains from recklessly understaffing their stores, endangering the public safety, and facing huge payouts for settlements resulting from pharmacy mistakes.
Understaffing Is a Cold Economic Calculation Placing Profits above Public Safety:
In my experience, the mighty drug store chains operate based on a model of dangerously inadequate staffing levels regardless of the risk to the public safety and will do so until the cost of settlements for pharmacy mistakes exceeds the cost of adequate staffing.
Chain Store Corporate Spokespeople Respond to Reporters with Minimization:
When a serious pharmacy mistake occurs in a community, reporters for the local newspaper and TV stations often contact corporate headquarters for a comment or statement from that drug store chain. The chain spokespeople always seem to engage in the same tiresome minimization routine and claim that pharmacy mistakes are “rare” and that “even one mistake is one too many.”
Pharmacists are livid at those lies and deceptions from corporate spokespeople. Pharmacy mistakes are by no means rare at chain drug stores. Claiming that “one mistake is too many” implies that chain management has wrestled the problem of pharmacy mistakes down to a manageable level, and that the chain is actually approaching eliminating the problem. In fact, nothing could be further from the truth.
It is like an official at the National Rifle Association stating that even one death from a handgun is too many. It is like a corporate representative for distillers stating that even one death from drunk driving is too many. The fact is that the problems of pharmacy mistakes, handgun violence, and drunk driving are nowhere near manageable levels. They are all out of control.
Are Americans Too Trusting of Large Corporations?
Many Americans assume that there is no way that mighty corporations such as chain drug stores would run their operations as recklessly as pharmacists and pharmacy techs witness every day. Thus the big drug store chains are banking on the ignorance of the public about the recklessness and arrogance of huge corporations.
In my opinion, corporate executives for the big drug store chains are just as ruthless as corporate executives at pharmaceutical companies, oil companies, insurance companies, Wall Street, etc.
The problem of pharmacy mistakes is so entrenched in our society because the public is not aware of how serious this problem is. The public is not aware that the state boards of pharmacy are intimidated by the massive legal and political clout of the huge drug store chains. Clearly a large segment of the public is not aware of the recklessness of huge corporations in general.
I am not optimistic that the massive problem of pharmacy mistakes will be fixed any time soon. In my opinion, resolving the problem of understaffing in drug stores is as unachievable and naive as hoping that gun violence will end, that deaths from drunk driving will end, that massive chemical companies will stop polluting our air and water, etc.
In my opinion, contacting your state board of pharmacy about a pharmacy mistake you’ve experienced is a good place to start. But I am not naive enough to hope or believe that state boards of pharmacy have the strength, fortitude, guts, independence, or cojones to stand up to the mighty chain drug stores.
In Conclusion:
Please be patient at your pharmacy and don’t blame the pharmacy staff for taking so long to fill your prescriptions. Please be aware that staffing levels at chain drug stores are tightly controlled by corporate management. Understaffing is possibly the thing that most angers pharmacists but please realize that pharmacists are powerless to do anything about it.
State boards of pharmacy exist to protect the public. Pharmacists complain to state boards of pharmacy quite regularly about the risk to the public safety posed by understaffing.
You might be inclined to complain to your state board of pharmacy, but the reality is that most state boards of pharmacy are intimidated by the immense legal and political clout of the chain drug stores with their corporate lawyers. Thus the state boards of pharmacy have largely done a very poor job protecting the public from understaffing, which definitely causes pharmacy mistakes.
The big drug store chains typically claim that staffing levels are an employer / employee issue when in fact understaffing is a serious public safety issue. Lobbyists for the big chains tell members of the state legislatures that the board of pharmacy is being anti-business and is interfering with the internal affairs of these businesses. The state legislatures then pressure the board of pharmacy to ease up on the mighty pharmacy chains. This is not a good way to protect the public’s health.
Dennis Miller, R.Ph. is a retired chain store pharmacist. His book, The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets, can be downloaded in its entirety at Amazon for 99 cents.
