Coming soon – like, real soon – to a chain pharmacy near you: shorter hours…if you’re lucky.

CVS Health Corp. CVS and Walmart Inc. are cutting pharmacy hours in the midst of a pharmacist shortage that has plagued the nation’s biggest drugstore chains throughout the Covid-19 pandemic.

CVS, the largest U.S. drugstore chain by revenue, plans in March to cut or shift hours at about two-thirds of its roughly 9,000 U.S. locations. Walmart plans to reduce pharmacy hours by closing at 7 p.m. instead of 9 p.m. at most of its roughly 4,600 stores by March.

Walgreens Boots Alliance Inc. previously said it was operating thousands of stores on reduced hours because of staffing shortages. Combined, the three chains operate some 24,000 retail pharmacies across the U.S.

Earlier in the pandemic, CVS and Walgreens struggled to meet demand for Covid shots and vaccines. The chains cut hours and, in some cases, closed pharmacies for entire weekends. Walmart, which sells a wider variety of goods, cut overall store hours, in part, to cope with Covid-related labor shortages and make time to restock empty shelves as demand for basics such as toilet paper surged.

CVS, in a recent notice to field leaders, said most of its reduced hours will be during times when there is low patient demand or when a store has only one pharmacist on site, which the company said is a “top pain point,” for its pharmacists.

Here we go with another underreported casualty of the COVID outbreak. And it’s not just pharmacists – it’s pharmacy technicians, too. There’s reportedly a massive shortage of both. It’s been so bad for Walgreens pharmacists, the company has turned to centralized robotic systems to refill prescriptions in an effort to give the pharmacists it does have (and can keep) a break from the unrelenting pressure.

…The nation’s second-largest pharmacy chain is setting up a network of automated, centralized drug-filling centers that could fill a city block. Rows of yellow robotic arms bend and rotate as they sort and bottle multicolored pills, sending them down conveyor belts. The company says the setup cuts pharmacist workloads by at least 25% and will save Walgreens more than $1 billion a year.

The ultimate goal: give pharmacists more time to provide medical services such as vaccinations, patient outreach and prescribing of some medications. Those services are a relatively new and growing revenue stream for drugstores, which are increasingly able to bill insurers for some clinical services.

“This frees up the capacity of our most skilled professionals,” said Rina Shah, a group vice president overseeing pharmacy strategy at Walgreens. “We looked at our system and said, ‘Why are we filling prescriptions the way we did in 1995?’”

I mean, look at everything they’ve got pharmacists doing now!

…Covid-19 increased the demands on pharmacies as they expanded into testing and vaccinations, putting pressure on staff and creating a shortfall of pharmacists that many chains have struggled to fill. Walgreens has reduced pharmacy hours at a third of its nearly 9,000 U.S. stores, and in some markets is offering signing bonuses of up to $75,000 to fill pharmacist job.

That added responsibility coupled with working for corporate overlords takes its toll, too and that is part of the problem here. As with everything, there are two sides to every story.

There's not a shortage of pharmacists. There's a shortage of payroll hours pharmacies are given to actually staff the place the way it needs to be to do things safely, and not burn out the existing staff.

— Lynariela (@Lynariela) January 29, 2023

The trend towards pharmacists leaving the bigger pharmacy chains began before COVID, but accelerated with all the added requirements and stress the pandemic brought along with it. Those demands have not appreciably lessened in scope – in some cases, they’ve gotten worse as chains go after more immunization, etc. business. Fewer pharmacists and technicians are willing and able to put up with the constant additions, bare-bones miserly staffing, and unrelenting pace.

…All three pharmacists we interviewed said working conditions are primarily driving a shortage of retail pharmacists.

Problems include staffing shortages, stressful labor metrics, productivity metrics, and the expansion of practice, leading to additional responsibilities that fall on the same pharmacy team. Pharmacist burnout is so widespread that the American Pharmacists Association released a statement saying it has reached a “breaking point.”

“Few pharmacists want to expose themselves to these working conditions, regardless of pay, and I’m glad few pharmacists take that offer,” said Dr. Barker.

The DM we interviewed also felt like this was part of a long trend. “Community pharmacy [work] over the past many years has increased in stress and expectations, with the addition of immunizations, adherence programs companies have set up, and now being able to prescribe Paxlovid.”

These are important milestones for the advancement of pharmacy and for allowing pharmacists to play a larger role in public health. But without adequate staffing, the piling on of responsibility adds stress to an already overwhelmed pharmacy team.

Dr. O’Shea spoke of pharmacists working the entire day alone. Even at a low-volume store, that can be stressful. For example, if the phone rings, someone comes to the register, and someone pulls up to the drive through at the same time, the pharmacist can get overwhelmed in a matter of minutes.

COVID has exacerbated the stress pharmacists are under. “The pandemic brought many people to the conclusion that the stress and work they were putting in was not worth it. And they took jobs in other areas of healthcare. Quality of life became more important, and retail pharmacy did not take steps to reduce stress and add staff so they could entice people back into the profession.”

Pharmacists and, by extension, technicians, are also responsible for billing authorizations and having to deal with the snafus that follow, including when insurance companies won’t pay or delay in okaying a prescription. Who does the customer at the counter unload on? Well, it’s not Aetna or Blue Cross. It’s the person who probably has not gotten a lunch break and/or already had 3 other pissed-off people losing their cookies at them beforehand.

…Pharmacists on the front lines also must handle the challenges with billing and reimbursement. Two main ways billing adds pressure are prior authorizations that cause delays in care and angry patients verbally abusing staff due to things beyond their control, says Dr. O’Shea.

So there is this disconnect between staffing shortages and available licensed pharmacists and trained technicians. But there also are signs that interest in pharmacy as an occupational field may be waning in general. Anecdotally, pharmacy schools like South Dakota State University’s College of Pharmacy and Allied Health Professions missed their enrollment quota for the first time ever, and by a whopping 34%.

…The pharmacist shortage has already hit pharmacies across the country, and it’s looming over South Dakota.

“I think we’re headed into the mess nursing is in now,” Darger said.

South Dakota’s only pharmacy school at South Dakota State University missed its target enrollment goal for the first time ever this year, said Dan Hansen, dean of the College of Pharmacy and Allied Health Professions.

The target enrollment for the fall of 2022 was 65. Only 43 students are enrolled.

COVID-19 is the likely culprit for the drop in enrollment, Hansen said, since this class would have been high school seniors during the first wave of the pandemic.

The pandemic is a factor in the number of early retirements among pharmacists or pharmacists choosing new careers. They’re burned out from the stress, said Amanda Bacon, executive director of the state pharmacists association.

“Pharmacists were the frontline of the pandemic too,” Bacon said. “In a lot of cases, clinics were closed and hospitals had limited access. But your neighborhood pharmacist was still there and made sure you got your medications in a safe manner.”

Those pharmacists are warning students not to enter the profession, Hansen said.

One of his first-year pharmacy students was told by seven pharmacists over summer job shadows to stay away.

With those pharmacists leaving, employers are looking to hire people who aren’t applying.

The problem is, it seems America runs on pharmaceuticals, doesn’t it? Drug shortages enrage customers, masks/no masks enrage customers…

I just thanked the pharmacist at @riteaid for wearing a mask, albeit a cloth one.
"Yeah, we'll I am feeling under the weather."
Me: "You need to put on an N95 mask!"@riteaid — why is your PHARMACIST at work SICK, with a crappy CLOTH MASK???
And I DO expect a response.

— AnnieRN (@ann_mcnitt) January 29, 2023

…insurance glitches and fights enrage customers and I’m sure enraged customers however many times a day take their toll on a person, especially when literally none of it is your fault.

Pile on the responsibility inherent in the job itself, plus that dang phone jangling all day, and I can see where one could be a stress monster in no time at all.

With the equity they’re demanding in math, I’m not sure where the next generation of pharmacists comes from in any event.

Dropping out probably sounds pretty good.