When Are Cuts Simply Too Much?

For the longest time pharmacists have talked about numbers. Hospital pharmacists brag about the how many beds their institution is. Retail pharmacists brag about how many scripts they do per day. Some pharmacists also brag about how much profit their pharmacy made and how big their personal bonus was.

When do pharmacists brag about cutting hours?

This is where my usually funny and quirky self turns dead serious.

Let’s face it, in the current economic situation hours and employees seem to be getting laid off or cut everywhere. The once secure job of working in a pharmacy, which was once thought to be an untouchable industry, is not immune either. Pharmacy technicians are especially susceptible to having their hours cut because a pharmacy can run without them but it MUST have a licensed pharmacist.

Over the past year or so I have seen the hours at my own store cut. It was no sooner that we got a new technician hired (based on old corporate staffing guidelines) that we had to cut them 3 weeks later. In addition to this cut of 30+ hours, we had to cut every other technician down from 40 to 36 hours, for a total savings of about 50 hours plus one persons benefits. At the same time, our volume remained unchanged.

Who runs the pharmacy?

These cuts started taking their toll. We had increased wait times for prescriptions to get filled, we had a decrease in our patient satisfaction and increase in complaints, and we had technicians who were getting more and more stressed out as well as an increase burden on the pharmacist. Some people would call this “being more efficient”, which translates to the almighty stock price and analysts as “increased profits”. This is the major downfall of all corporate pharmacies, the stock price.

Notice a few piles going?

I know this isn’t just the company I work for cutting their hours either (example 1, 2, 3, Canada) Almost every one of my friends who is a pharmacist, in both retail and other settings, have seen hours cut. Part time and floater pharmacists are having hours cut or are being phased out, older pharmacists are being forced to retire, and pharmacy technicians are having their jobs cut like the woman in the shower scene of Alfred Hitchcock’s Psycho! To be fair we should have seen this coming. When automation was put into pharmacies it was for 2 reasons, to reduce errors (which I feel it has depending on circumstances) and to REDUCE COSTS.

From others I have talked too this is an issue affecting more than pharmacy. Physicians are having to see more patients or staff longer hours, nurses are taking on more patients as well and not to mention the increase in scripts I see from physician assistants and certified nurse practitioners. For now I will just focus of pharmacy as that is my own profession and what I know best…

So from the outside looking in, it is easy to say, “Well if there were hours to cut, that makes sense. You have to increase profits and productivity as a company. These times are tough.” That argument does make some sense, however with an increase burden put on pharmacists, as with any medical professional, the chance of error goes up, dramatically. According to the Institute for Safe Medication Practices (ISMP), there are 10 key elements that affect medication error rates. Of these 10 key elements, I can see an overworked or stressed out pharmacist being affected by these: Communication of drug information, Drug labeling, packaging and nomenclature, Environmental factors, Staff competency and education, Patient education, and Quality process and risk management. Realistically I can extrapolate scenarios for all of the others but these are probably the biggest areas that would be impacted or would impact the pharmacists’ ability to do their necessary duties to acceptable standards. I do not feel that acceptable should be the goal in healthcare, the goal should be the best possible but cuts have lowered that standard due to an increase in workload.

Now this picture is probably taken out of context but what if there is no one working but one pharmacist? Expect good service or them to be stressed?

Then you have stories like this… “Pharmacist Gives Pregnant Woman Wrong Prescription”

Please watch this video. It does have some media extravagance BUT it should never have happened. I cannot say if pharmacists or technicians here had recent cuts or are overworked but it is an omen to what could happen if cuts continue.

Before people say this is just another pharmacist ranting and venting under an anonymous blog, let me explain something. I am doing this for patient safety, I pray to never make a mistake but realize that is impossible. I would like any possible thing done to avoid mistakes so patients do not get hurt or worse. Yes, I would appreciate less stress at work, but where I work, that is unlikely to happen too much due to the clientele in my area. I am pushing against these cuts because I feel it does not allow pharmacists to use their full ability to help patients. It also does not give patients the best possible healthcare they would like. Therefore, this is as much a patient issue as it is a risk management issue. These are two things that most corporations care greatly about but are blinded by the almighty stock price and perception of their company. I think this quote from the recent movie Wall Street: Money Never Sleeps sums it up very well:

“Is greed still good? Somebody reminded me the other night that I once said ‘greed is good.’ I swear I don't remember it but it sounds like something I would say in the eighties.”

– Gordon Gecko

This leaves the question of, “So what can we do now?” The answer is not very simple and does involve some work but is more than reasonable. LET CORPORATE HEAR IT! In the wake of hour cuts and customer complaints I have taken an active role to ensure my store gets back to having improved staffing. Any time a patient complains or comments of how short of help we are I am always quick to point out exactly where they can go online to let my company know about how they feel and offer them the corporate service hotline. So far it has worked a little in corporate let all of the 36 hour technicians back up to their gull 40 hours. It’s not world changing but it is a start. Since increasing our hours, the district manager has noted that our complaints are down and that our volume has picked up a little bit. Hence the increased staffing has worked to his advantage and to that of my sanity as well as to the benefit of my patients. I wouldn’t call it protesting but the two most powerful things a patient has is their voice and their dollar.

I really hope to see them both used wisely.