Monday, May 18, 2015


35 Years As a Pharmacist--It's Not What It Used to Be!

I Need a Break From Being a Serious Pharmacist!
From “Proud of My Profession” to “Take This Job and Shove It” in 35 years or Less

     I was a pharmacist for 35 years, and I was good at it. When I graduated from Oregon State University in 1979, I was proud to be a pharmacist, ranked “The Number One Most Trusted Profession” according to an annual poll conducted by Gallup. Beginning in the year 2000 when nurses were added to the poll, pharmacists slipped to second place among the professions listed. The poll expresses the publics’ high opinion of pharmacists’ honesty and ethical standards and for many years I was honored by this public recognition. In 2014, pharmacists dropped to third place for the first time, just a little behind medical doctors. Respect for the profession seemed to be dropping and I could feel that this was the case by the manner that I had been treated by some patients I interacted with in recent years. After 35 Years as a Pharmacist, I could say, “It's Not What It Used to Be!”
     Yes, I had been singing the song, "Take this job and shove it, I ain't workin' here no more!" (in my mind) at the end of most workdays for quite a long time. I was thinking more and more about early retirement. But, what is really so hard about continuing to practice pharmacy for eight more years? When you stand outside of a pharmacy and look in, it doesn’t appear that the pharmacist is working very hard, so what is the problem with this job? I needed to evaluate what has caused my burn out. And what would be my solution to the burn out?

Giving Up that Healthy Paycheck?

I Loved My Prius Plug-In Hybrid!
     Choosing a career as a pharmacist was a financially wise decision. I made good money and was living the American Dream. I was married, owned a home in a nice neighborhood, and had two cars, 2 children, a dog and a cat. I had all the nice things I wanted, including nice furniture, cars, and toys. I belonged to a fitness club, I took nice vacations often, and I had paid vacation time. I enjoyed monthly massage therapy and pedicures if I wanted. I paid a professional to clean my house every two weeks. I had some form of retirement plan throughout my career, from an IRA to a 401(k), and I was paying into Social Security knowing that I would be able to collect a substantial monthly check when I retired at the age of 66, like all pharmacists did, right? Why would I want to give all of that up before the age of 59?
    But, at some point in the past year, I realized I had to answer the questions: “Is the money worth it? Are all those nice things worth the stress of my job or am I ready to give up some of the luxuries I enjoyed and live on much less money. Was I ready to give up my paycheck, my car, my massages, and my other benefits? I had to admit to myself that I was miserable practicing pharmacy. I was to the point that I couldn’t face walking into a pharmacy one more day. So, what is there to dread about this career? 
Downgrade My Primary Mode of Transportation?

Easy Access to Pharmacists Means Many Questions From Patients

     Pharmacists are the most accessible health care professional and their advice is free, so patients frequently go to their “druggist” first when they have medical questions and concerns. In the “good old days” when I began practicing in retail pharmacy, I enjoyed answering patients’ questions and giving advice. While I was filling prescriptions, people frequently interrupted me with requests for help with their health care needs and I was happy to help. Common questions were “What cough syrup should I use?” and “What fever reducer should I give my child?” and “Can you recommend a vitamin supplement?” I actually had time to walk out into the over-the-counter (OTC) department and put the medication the medication I recommended into the customer’s hands and explain how to use it. It was very fulfilling work in those days.
     In the past ten years the number of patients’ questions has increased, the prescription volume has grown, and the profit margin on each prescription has dropped. Pharmacists became too busy to be interrupted so often. Corporations operating pharmacies decided the pharmacists should not be “bothered” while they are filling prescriptions, so they installed glass partitions or moved the pharmacists to a back counter where they would still be visible but could not be interrupted while they worked. Questions then came in the form of numerous phone calls and summons to the counselling windows. Access to physicians became more difficult and expensive, so questions were more challenging. Common inquiries bordered on the need for a diagnosis and pharmacists were faced with more decisions about whether to make a recommendation or a referral to a doctor. A typical day now involved answering questions such as: “My pressure cooker (or car radiator) blew up in face--what can I put on my burn? (likely at least a second-degree burn)” and “Will you look at this bug bite (an angry, infected spider bite) and tell me what to put on it? (I recommend seeing a physician soon)” and “Will you look at this rash (poison oak, scabies, eczema, fungus infection, etc.) on my arm (or breast or foot or …) and tell me what to put on it?” At times the patient’s condition was so serious that the answer was “You need to go to an urgent care clinic or emergency room immediately”.
     Was it any wonder I went home at the end of a ten or twelve hour day mentally and emotionally drained? Other health care professionals experience similar exhaustion from long hours of caring for patients. Years of this can lead to burnout.

Maybe I’m Not Tough Enough to be a Pharmacist Any Longer
I Was a Tough, But Friendly Pharmacist in 1994!

Take a Restroom Break? Pharmacists Tough It Out! 
     Years ago we, as pharmacists, joked that if the company could force us to wear a catheter attached to a urine bag attached to our leg, they would, just to keep us working without a bathroom break. It was considered a tough work standard for pharmacists to see how long you could go without urinating. Many of the old-timers still work that way and brag about not needing a break, purposely keeping themselves dehydrated to avoid having to run to the restroom.. I finally realized how wrong that was and started taking two 15 minute breaks each day, even when the pharmacist I was working with would say he or she didn’t take breaks. Some co-workers would scowl at me when I would tell them I was going on a break, as if to say, “How dare you leave me to fill all of these prescriptions while you go sit down?”
     One of my worst fears was being the only pharmacist on duty for the day and needing to leave the pharmacy to use the restroom when there was a customer standing at the counter waiting for their prescription. I still recall the glares I have received from people as I walked past them and across the store to use the only public restroom. I imagined them thinking, “You have a lot of nerve leaving the pharmacy when you haven’t finished filling my prescription! I don’t think I’m tough enough to endure that any longer.

A Lunch Break? Pharmacists Don’t Need Them! 
     For many years, pharmacists have been expected to work long days without lunch breaks. That was just normal practice and still is in many retail drug stores that I have worked in. When I got tired of working ten and twelve hour days without breaks or lunch periods, I took a Staff Pharmacist position at Wal-Mart simply because they actually gave the pharmacists a 30 minute lunch break. That was the first time in my career as a retail pharmacist that I had a lunch period when I was allowed time to sit down and eat without interruption, go to the rest room, and come back to work mentally and physically refreshed. I could drink water and coffee during the day at work knowing that I would get a chance to go to the restroom, a real treat during the day as a pharmacist. But many pharmacies I have worked in during the past few years still have no planned lunch break for the pharmacists and it is not uncommon for some to skip eating or to grab bites of a stale sandwich or a granola bar between prescriptions. I could no longer work that way. When my hypoglycemia threatened to interfere with my ability to safely fill prescriptions, I found a place to hide in the back of the pharmacy for a short lunch break while I considered early retirement.

Sit Down On a Stool While Working at the Computer? Are You Lazy?
   Pharmacists traditionally have stood while working, which means for 10 or 12 hour shifts, often without a break to sit and rest. In the days when the pharmacist did everything from typing labels with the typewriter, to counting pills, to talking to patients, we were in constant motion in and out of the pharmacy so that was logical. That takes endurance! Since the introduction of computers and pharmacy technicians, pharmacists stand in one place in front of a computer monitor most of the day. But it is still traditional to stand for the entire shift and highly frowned upon to pull up a stool and sit in front of the computer, even for a few minutes. How many more years can my legs hold me for these 10 or 12 hour shifts?

Who Can Crank Out the Most Prescriptions on the Assembly Line?
         Pharmacists are a competitive bunch, enjoying the “game” of who can fill the most prescriptions. Some call other stores in their own company during the day to ask, “How many have you done so far today?” and then brag about their own accomplishments. Other pharmacists enjoy calling competitors and taunting them in a playful way with their own high prescription “numbers”. This seems to be a way they cope with the stresses of the job.
             The average number of prescriptions filled by one pharmacist has risen steadily over the years as the aids of computers and pharmacy technicians have been introduced. Boards of Pharmacy try to keep the average around 150 per pharmacist per day. Drugstore chain executives push the expectations higher, with up to 300 prescriptions per pharmacist in one day becoming not uncommon. The “queues” in the pharmacy computer systems constantly track and remind the pharmacist how many prescriptions he or she has filled thus far for the day and how many are backed up to be verified and completed before day's end. Green, yellow, and red color-coding contribute to keeping the pressure on. A constant flow of prescription orders keeps coming in the form of telephone orders, eScripts (electronic transmissions), faxes, and hand-carried paper prescriptions. Pharmacists and technicians just keep their heads down at the assembly line counter and keep cranking out the product as fast as possible. Meeting the requirements of the insurance companies that are billed for the prescriptions, the patients who are waiting, the administrators who want more profit, and the State Board of Pharmacy who expects each step to be completed legally and safely, and do it in a fast, friendly, accurate manner--that’s a lot of pressure. I thrived on the challenge when I was young, but not after 35 years of this steadily increasing intensity.

Call in Sick? Don’t Even Think About it!
     Pharmacists work when they are scheduled, regardless of whether they are healthy or sick. It is an unwritten expectation wherever I have worked, whether hospital or retail pharmacy. In most cases when they are ill or injured, they take a medication to treat or mask their symptoms, go to work, and power through the day. I found that the best defense against illness, and therefore disapproval from the boss, was to take plenty of vitamins, eat right, exercise regularly and stay healthy.
What 35 Years as a Pharmacist has Done to Me!

Now You Want Me to Give Vaccinations, Too?
    A few years ago chain drugstore companies discovered that if pharmacists were trained to administer influenza and other vaccinations in addition to filling prescriptions, the profit potential was great. When I went to college, nurses gave vaccinations, not pharmacists. I chose a pharmacy degree partly because I am queasy about needles and blood. It must be time for me to retire!

Risk of Errors and Possible Lawsuits under these Working Conditions?
      Errors when filling prescriptions are unacceptable to me. It is the pharmacist’s job to provide the final check on each bottle of medication dispensed to ensure everything about it is correct, but there are many steps in the process that can contribute to a misfilled order. I have always been extremely cautious in my work, diligently checking each prescription. But with the increased responsibilities placed on pharmacists plus the many interruptions in the workflow process, I find that each year I am more concerned about being involved in a serious prescription error that reaches the patient, the possibility that the patient could be harmed by the wrong medication or dose, and then the potential lawsuit that could follow. 

 Fear of Being Robbed at Gunpoint for Narcotics
      The incidence of pharmacy robberies at gunpoint is about as common as bank robberies, some reports say. The robbers are looking for narcotic pain pills such as Oxycontin®, Vicodin®, and Percocet®, either due to an addiction or to sell on the street. I fear that the incidence of pharmacy robberies at gunpoint may increase now that Vicodin® has been reclassified as a CII narcotic, a highly restricted drug and the price has gone up. Pharmacists are trained in how to handle a robbery in the event that we are faced with one. I have worked with a few pharmacists who have been traumatized by this experience. It is something I dread, and each time I rehearse the proper procedure in my mind, my fear increases.
Prescription Pain Medication is Often Abused

Ashamed to be Called a “Drug Dealer”

     When my children were young, twenty-plus years ago, they would joke about their mom being a “drug dealer” and everyone laughed at their joke, including me. People knew me as an honest, "by-the-book" Pharmacist Terry and that I was the farthest thing from a “drug dealer”. At that time the narcotic abuse had not yet reached alarming levels. It is no longer a joking matter.
     In recent years the dilemma for me was that the number of narcotic pain medication prescriptions we dispense has become huge and I had come to feel that pharmacists are now legal drug dealers. Prescription narcotic drug abuse has become so outrageous that the Center for Disease Control (CDC) has recently declared it an epidemic in the United States. In Canada, the per capita use of narcotic pain pills is even higher than in the U.S. Every time I filled a prescription for Vicodin®, Percocet® Oxycontin®, or another narcotic pain medication for a patient that I was sure was either addicted to it or selling it, I felt helpless to combat the abuse.
    A recent article in Pharmacist Letter about prescription drug abuse stated, “Just about every pharmacist has a story to tell about being duped into dispensing an opioid to an abuser. It is human nature to resent being conned, and most pharmacists try hard to avoid dispensing opioids to con artists and abusers. In fact, the problem of diversion and abuse is so prevalent that pharmacists often look askance at any patient with an opioid prescription.” I know that I had become one of those suspicious pharmacists, annoyed at filling the same prescriptions for the same narcotic pain medication for the same patients, month after month, year after year, with no indication that these patients were ever going to discontinue use or abuse of narcotics.
     I had become weary of being the “narcotic police” (I thought I was a pharmacist), trying to prevent phony narcotic prescriptions from being filled on my watch. Monitoring for forged prescriptions was a daily challenge. Pharmacists watch for prescriptions altered by patients to increase quantities, fake prescriptions (for real or fictitious patients) written on stolen or fabricated prescription pads, and telephoned prescriptions without authorization from the prescriber. When a forgery is discovered, the next step is calling the police to report the forgery, helping trap the druggie so the police could arrest him, and then testifying in court if called. When, in the majority of cases, the druggies get "a slap on the wrist" and are sent home to continue their games, pharmacists give up on wasting their time pursuing the legal steps to punish these drug abusers. We just use every precaution to avoid filling forged prescriptions.
    I had reached the point when I knew I could not in good conscience continue filling prescriptions for people who are dependent on narcotic pain medications and making no effort to withdraw from use, and others who are obtaining the drugs to sell to friends and acquaintances. Pharmacists provide an important service helping many patients with their legitimate health care needs, but unfortunately are sucked into aiding the drug addicts and drug dealers as part of the job. I was done contributing to the drug abuse cycle in the health care field. That's when it became clear that it was time to change careers or retire altogether. 
Full-time RV Living in Mazatlan, Mexico

     We decided to become full-time RVers, living and traveling year-around in our motorhome. We live six months in Mexico and six months traveling in the United States. I now enjoy having the time to write my books and blogs. I may have given up that paycheck, but I feel happier and healthier. Follow our adventures .

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