“What can I do for you?” — this question commonly posed by retail pharmacists is now anxiously asked of them by prospective employers.
The pressure to attract, hire and hang on to qualified community pharmacists is mounting for supermarkets all across the United States.
The National Association of Chain Drug Stores, Alexandria, Va., through its pharmacy chain employment survey, has found that the number of full-time vacancies for retail pharmacists hit 4,044 nationwide in July 2006, up from 2,163 in 1998. This is due in part to an increase in the number of pharmacies, sources said.
In addition, IMS Health, Norwalk Conn., reported this month that U.S. prescription drug sales have increased 8.3% to $274.9 billion for fiscal year 2006. The company cited as drivers the Medicare Part D prescription benefit, increased utilization of generics within new therapy classes, and the launch of new drugs for specific diseases that include cancer and diabetes.
Not only are supermarkets in the middle of a pharmacist shortage that continues to increase, but competition from other formats is getting fierce. The ability to provide a working atmosphere that includes the freedom to counsel patients without sacrificing the flow of order fulfillment is necessary, but no easy task, supermarket pharmacy executives told SN.
“I need to free up this expensive limited pool of talent to practice their profession rather than the technical aspects of distribution,” said Verne Mounts, director of pharmacy, Buehler Food Markets, Wooster, Ohio.
“I want to limit the pharmacist's involvement in the count, pour, lick and stick process,” he said.
Earlier this month, Mounts said Buehler's had 3.5 pharmacist positions to fill one of his 11 Ohio stores. Ohio was among the states identified by NACDS as having multiple shortage areas.
THE PRACTICE OF PHARMACY
As retailers, “we are looking at ways to allow pharmacists to practice without getting caught up in the clerical functions that don't fall into the professional spectrum,” said John Fegan, senior vice president of pharmacy, Ahold USA, Quincy, Mass. Duties such as interacting with patients and administering medication therapy management — assisting patients in managing multiple disease states — are better suited to community pharmacists, he said.
The obvious strategies to attract pharmacy employees — high salaries, signing bonuses and memberships in professional associations — are in sill in place, said John Beckner, director of pharmacy and health services, Ukrop's Super Markets, Richmond, Va.
“But the most important thing you can provide a prospective candidate or someone you hope to retain is a professional environment in which to practice,” Beckner said.
His strategy is to expose pharmacists to patient care activities like conducting health education classes, screenings, immunizations, diabetes programs and “to use the skills they were taught in school,” he said.
Other causes of the shortage include an aging pharmacist population that is retiring or going part-time. “Many pharmacists are Baby Boomers who are taking retirement,” Fegan said.
Women, who currently make up 47% of the full-time pharmacist workforce and 64% of the part-time workforce, are consistently choosing part-time hours in order to have a family, as soon as three years after entering the profession, and staying part time through their children's school years, retailers said. “Many women want to work under 40 hours to have a high quality of life and family time while still staying focused on their career,” Beckner said.
It is a quality of life issue. Fegan said. “We must find ways to improve the work environment through the use of technology and patient care programs to alleviate pressure on the pharmacist.”
Supermarket pharmacies do possess strength in numbers of customers. Many patients requiring additional health care shop the supermarket regularly, “giving a greater opportunity than many other community settings to have the interaction necessary to impact the patient's positive health outcomes,” said Bill Felkey, professor of pharmacy care systems at Auburn University, Auburn, Ala.
However, having customers to care for isn't enough. “Pharmacists are being trained to provide therapy through the use of technological support in the appraisal, intervention, monitoring and follow-up process that every one of these patients represents,” Felkey said.
Often that means working at a pharmacy equipped with a computerized record-keeping system that can be integrated with the medication distribution process, he said.
Another example is an interactive voice response system, Felkey said. The system allows a customer calling the pharmacy to select options from a phone menu, such as refilling a prescription or calling in a new prescription from a doctor's office, so that they can be sorted into categories and better assisted by the live staff.
IVR is the technology currently in use at Ukrop's, Beckner said, but he is interested in robotics that can relieve pharmacists of having to count pills. “With the ability to reduce some of the pill-counting crunch, you can free up your existing pharmacists and you may not need as many pharmacists per store,” he said.
One reason more advanced technology is so appealing to pharmacists is that with less physical labor, there is less of a chance for error. “If a pharmacy management system is well designed, it gives the pharmacists peace of mind that even in the busiest of pharmacy operations, they haven't hurt anyone that day,” Felkey said.
“That is a strong attractor to a new person who is honing their clinical skills and wants the technology oversight to make sure they have an efficient practice.”
Buehler Food Markets is implementing the Etreby Pharmacy Management System from Cerner, Kansas City, Mo., and should have the system in place in all of its stores by the end of July, Mounts said. The system integrates and manages every aspect of medication fulfillment from customer ordering and IVR through pill counting so that pharmacists are able to keep track of customers' orders automatically on a computer, Mounts said.
“When I'm interviewing in two different places and one has an antiquated, clunky, non-integrated process, while the other has end-to-end technology support that allows me to do a higher volume with a greater sense of safety, I know which one I'm going to take,” Felkey said.
Depending on the size of each store, however, price can be an obstacle, retailers told SN. “The cost barrier on technology requires justification via a thorough return on investment,” Mounts said. “If you weigh in all of the factors including cost of labor and reallocation of labor to stores that need it, technology can be justified but must be scalable. This means you don't put robotics in every pharmacy.”
Retailers need to figure out whether technology would accommodate the amount of volume that they are experiencing, Felkey said. The solution, he said, is to have a project perspective. “You might not always have the business to support the investment, so you have to do pilots and test your concepts in order to find out if they will really give you the return you were hoping for.”
Fegan said Ahold, which has an IVR system, is looking into improving its pharmacy system with workflow automation, software that organizes all of the steps involved in the distribution of medication into one computer system.
The company is also looking into opening a central fill facility, which would allow Ahold to gather prescriptions from multiple locations and direct them to a centrally located prescription fulfillment center, Fegan said. There, prescriptions could be assembled, verified, packaged and delivered to the originating pharmacy or possibly mailed directly to the patient's house, also called mail-order.
“This could allow us to participate in mail-order, but we don't have any set plans yet,” Fegan said. “We are probably looking at three to six months until we begin to implement any of these things, but it is a goal we have.”
HEALTH CARING BENEFIT
One way to attract pharmacists, even when lacking the latest technology, is with the opportunity to be reimbursed for medication therapy management, Fegan said. Under Medicare Part D, insurance plans can choose to reimburse pharmacists for helping beneficiaries stay on their medication schedules. Although not every plan is participating, retailers, insurers and plan benefit managers are developing MTM strategies, industry observers said.
“Allowing the pharmacists to do MTM for reimbursement is a relatively new area, but there are certain insurers in Washington, D.C., and Maryland that are reimbursing us. That is something today's pharmacy students are being trained for and that today's pharmacists want to be involved in,” Fegan said.
MTM is an incentive, Beckner said. “As more companies let pharmacists provide that service, it will become an integral part of the pharmacy operation.”
Mounts, along with Buehler's pharmacists, the Ohio Pharmacists Association and several pharmacy schools, is developing educational programs that train pharmacists to pursue MTM, “not only for Medicare patients but as a cost-saving health care benefit,” he said.
Pharmacy schools make valuable allies, because they are training as many pharmacists as they can, said Beckner.
“More colleges are developing and offering pharmacy programs,” Mounts said.
One such school, the University of Maryland, Baltimore, will expand its pharmacy program to a satellite campus in Montgomery County this fall. “We have had a long-standing pharmacist shortage in Maryland, said David A. Knapp, dean of the pharmacy school.
Knapp hopes that retailers will support the school's efforts by agreeing to take on student residencies as “experiential learning” sites, he said.
Integrating Voice Response Technology
Interactive Voice Response, or IVR, is a common technology at supermarket pharmacy. “We have IVR and most people have it,” said John Beckner, director of pharmacy and health services, Ukrop's Super Markets, Richmond, Va.
IVR is a computerized system linked to the phone system that separates callers into categories based on the reason they are calling. It generally gives the caller a menu of options chosen by pressing a certain key.
An upgrade from basic IVR is integrated IVR, said Bill Felkey, professor of pharmacy care systems at Auburn University, Auburn, Ala.
“The difference is that with a message left on a normal IVR, an opportunity for error exists in taking the prescription number or the information recorded by the IVR, and then manually keying it into the pharmacy system,” Felkey said.
The same IVR, interfaced into the pharmacy management system, would allow the recorded information to be automatically keyed in with one verification keystroke, he said. “This is not only more efficient, but more effective because it removes the opportunity for error in the process.”
“The cutting edge of IVR is to have it directly connected to the computer system,” said John Fegan, senior vice president of pharmacy, Ahold USA, Quincy, Mass. Ahold has a traditional IVR system at this time, but the company is looking into technology upgrades, he said.
“It streamlines the workflow and allows the pharmacists to use their judgment without having to do the manual keying that is necessary,” Felkey said.
Seeking the Best
While supermarket retailers are constantly trying to recruit and retain new pharmacists, they still want the best in the field.
“I am looking for pharmacists who want to practice their profession at the highest level in community retail pharmacy,” said Verne Mounts, director of pharmacy, Buehler Food Markets, Wooster, Ohio.
However, today's talented young pharmacists are looking for the best in the workplace as well.
“Most chain pharmacies are so busy that we're not able to utilize the knowledge we obtained from school,” said Anissa Park, a sixth-year pharmacy student at Rutgers Ernest Mario School of Pharmacy, New Brunswick, N.J.
Park has plans to work at a large discount store after graduating in May.
“For some chains, it's more about the numbers than making an impact on patient care,” she said.
For Park, the working environment makes all the difference. “Working for retail is a team effort,” she said. “Pharmacists must be able to communicate well with the rest of their staff and must be able, above all, to trust the pharmacy technicians they are working with.”
Kim Nguyen, who holds a full-time position in medical information at a pharmaceutical company and works as a part-time pharmacist in a chain drug store, agrees. “Working environment is the most important thing when choosing which pharmacy to work for.”
She maintains a job at retail to stay knowledgeable on the latest in the industry, like new medications and Medicare Part D, she said.
“If your store does 300 scripts a day and the company is only willing to give you one technician, it's going to be the worst day of your life,” she said.
“This also goes for technology,” she added. For example, one chain Nguyen worked for had a “tight tech budget and was eons behind in technology.” She would process 150 to 200 prescriptions per day and go home wanting to quit, she said.
At her current store, however, “everything is computerized. Prescriptions are scanned into the system and organized based on image. Every prescription is essentially accounted for in the computer system so no matter what the volume, you can keep up. It makes a world of difference.”
Technology and staff support can be even more important than money, she noted. Since a pharmacist's salary is based on market value, it isn't a bargaining chip, Nguyen said.
“An extra $2 an hour means nothing when you have to work 12 hours with no lunch, an outdated system and one technician.”
Supermarkets should keep in mind that they are not only competing with other channels, she said. “They are competing with industry jobs, clinical jobs in hospitals and long-term care pharmacies.”