Prescription for Trouble
Shortage of Pharmacists Raises Risk of Errors, Poor Customer Service
By Bill Brubaker
Washington Post Staff Writer
Friday, June 21, 2002; Page E01
While many new college graduates are facing a tough job market, Mariel
Sinkov, fresh out of the University of Maryland pharmacy school, has had
a mailbox full of opportunities. Long before she picked up her diploma
last month, Sinkov said, she was offered $75,000 or more to work for
CVS, Safeway, Walgreens, Kmart, Rite Aid and Giant Food.
Hospital recruiters were also on her trail. And CVS offered a $15,000
signing bonus if she would work for the chain in Washington.
"I feel blessed," said Sinkov, 25, who joined Rite Aid for a salary she
declined to disclose, citing a confidentiality agreement the company
required her to sign.
Cities and towns across the United States face a pharmacist shortage --
severe in some locations, such as the Washington area -- as baby boomers
take more medications and retail chains open more drugstores.
While this is good news for new pharmacy school grads -- offers of
leased BMWs and $100,000-plus salaries have been reported in some
hard-to-staff regions -- it has meant poorer customer service and an
increased risk of errors by overworked pharmacists, some experts warn.
The 56,000 retail and mail-order pharmacies in the United States filled
3 billion prescriptions last year, up from 1.9 billion in 1992. The
number will soar to 4 billion by 2005, according to industry estimates.
At last count, there were 6,500 openings for pharmacists at the 20,500
chain drugstores, and independents and hospital pharmacies are also
recruiting.
"The ticking time bomb" is how the shortage is described by the dean of
the University of Maryland's pharmacy school, David A. Knapp. He warns
of "stressed out" pharmacy staffers -- many working 12-hour shifts --
miscounting pills and "grabbing the wrong bottle off the shelf."
He added: "With the elderly population increasing . . . the extent of
those problems is going to increase as well."
A spring 2001 survey of 500 pharmacists found that nine out of 10 were
aware of a "medication error" in their own pharmacies in the previous 12
months. The most common error was dispensing the wrong dosage or the
wrong drug.
Pharmacists attributed the errors most often to "work overload" and
"inadequate staffing," according to the survey by two industry
publications, Drug Topics and Hospital Pharmacist Report.
The National Association of Chain Drug Stores (NACDS) recently asked its
members to rate the severity of the pharmacist shortage in the 50 states
and the District from one to five, with five being the most severe.
The District had the 45th-highest grade, indicating the shortage is
worse only in Arkansas (which ranked last), California, Maine,
Minnesota, Wisconsin and Massachusetts. Virginia ranked 39th and
Maryland 36th.
Safeway's eastern regional pharmacy director, Murhl Flowers, said the
shortage has had a "detrimental effect" on customer service at some of
the chain's 104 pharmacies in the Washington-Baltimore area.
"In some instances it's simply because of the increased volume," he
said. "In other instances it's because of a diminished quality of
pharmacists. . . . When you need a pharmacist -- or any employee -- you
take the best of whatever is available. That doesn't mean they are the
highest quality." Sometimes, for example, a store will hire someone who
has problems communicating with customers, he said.
CVS disclosed in its 2001 annual report, published in April, that it was
forced to cut pharmacy hours last year at stores in the District and
other cities. "In D.C., there were situations where pharmacies would
close early -- unexpectedly -- because someone had called in sick and
there wasn't a replacement," said Todd Andrews, a CVS spokesman.
Andrews said CVS hired 2,000 pharmacists last year and has about 100
openings at its more than 4,000 stores. Rite Aid would not say how many
pharmacists it needs. "It's an industry-wide shortage," Rite Aid
recruiter Michele Belsey said.
Safeway executives said they have five openings at the chain's 10 stores
in the District alone. One position -- at Hechinger Mall in Northeast --
has been vacant since last summer. Jerry Rhoades, a Safeway recruiter,
said many pharmacists do not want to work in inner-city neighborhoods.
Concerns about traffic and security, especially since Sept. 11, have
made it harder to attract pharmacists to the District, some executives
say.
"When we interview new pharmacists they say, 'Gee, why do I want to go
down there, fighting the traffic and the hassle and security and all
that stuff when I can stay closer to my home and get a job making the
same amount of money?' " Flowers said.
The shortage was created, in part, by tougher academic standards that
are being phased in at the 83 U.S. pharmacy schools, some chain
executives say. Students generally must complete at least two years of
undergraduate work before they can enter pharmacy school. In the early
1990s, many pharmacy schools began lengthening their programs from three
years to four so that students would graduate with doctor of pharmacy
degrees.
Several store chains have begun offering financial assistance to
encourage students to attend pharmacy school. Recent Howard University
pharmacy school graduate Kathleen Hershey, from a Baltimore family of 12
children, said she accepted $16,000 in aid from Giant Food with no
strings attached.
CVS requires its "scholarship of excellence" recipients to work a full
year as a CVS pharmacist for every $5,000 in aid they accept.
Some retail pharmacists complain they cannot use the skills they
acquired in school. Rather than counseling patients on drug side effects
or on how medications interact with each other, they are increasingly
sorting out customer complaints -- about HMOs, for example.
"The worst thing is a patient -- especially a senior citizen -- who's
just found out that they have cancer," said Barbara Kirby, the longtime
pharmacy manager of the Safeway in upper Georgetown. "They come in to
you with a lot of prescriptions. They want to talk to someone. They want
to talk about the medicine and how they feel. Sometimes they cry."
But with other customers waiting, Kirby often must counsel these
patients over the phone. "Ten years ago, I was busy but at least I had
more time to sit down and talk to patients," she said. "Now it's really
difficult."
While salaries have grown in recent years, so has on-the-job stress,
pharmacists and industry executives agree.
"I've worked in pharmacies where you didn't have time for a restroom
break, let alone a lunch break," said Douglas Hoey, a vice president of
the National Community Pharmacists Association, a trade group.
"I've lost probably 15 pounds working here," said Bill Ranker, 24,
pharmacy manager of the Safeway in Chester, Md.
Ranker joined Safeway as an $81,000-a-year "floater" pharmacist last
summer, straight out of the University of Maryland's pharmacy school.
Within months, he was promoted to pharmacy manager -- a job that pays
about $86,000, he said.
While starting salaries are high, they don't grow much. "Unfortunately .
. . a new hire is going to make the same salary . . . no matter whether
they've worked 30 years or are a new grad," Safeway's Rhoades said.
"That's just the way pharmacy traditionally has been."
Retail pharmacies generally pay more than hospitals, which also are
facing a shortage. Six out of 10 new graduates elect to work in retail
settings, according to NACDS data.
"One problem I have with retail is, quite often they are looking at the
bottom line," said recent Howard graduate Nakita Cropper, who is
entering an advanced-studies program at an Atlanta hospital. "I can't
say they're not patient-focused. But the financial aspect is the most
important to them."
Inova Health Systems, which operates five hospitals in northern
Virginia, pays new pharmacists $65,000 to $70,000 a year, spokeswoman
Kathleen Thomas said. Senior pharmacists earn $80,000 and up.
"I prefer a hospital setting where I can interact more with patients,"
said Michelle Le, a pharmacist at Inova Alexandria Hospital. "It's more
satisfying."
To most new graduates, though, retail is the way to go.
"It's just kind of handy being there for grabbing hot food and for your
shopping," said Cheryl Walker, a recent Maryland graduate who plans to
work for a supermarket chain. "I don't like hospitals because the
atmosphere is maybe just too heavy."
--Walter Watts Tulsa Network Solutions, Inc.
"No one gets to see the Wizard! Not nobody! Not no how!"
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