The next time your pharmacist urges you to get a flu shot two months before the start of flu season, or you get hassled by a persistent robocall from the pharmacy to pick up an automatically filled prescription that shouldn’t be due for months, don’t think that it’s because they are being extra vigilant about your health. It’s because pharmacists are facing increasing pressure to meet unrealistic quotas and targets set by their employers, who are harassing them into pressuring you to buy more services or medications. The concern for profit at major pharmacies in the US, like CVS, Walmart and Walgreen, is jeopardizing the health of the consumer.
The pressure to fulfill quotas ramped up during the Covid pandemic when the medical workforce was already overwhelmed by conditions that worsened by the day.
USA TODAY reports that in a weekly dial-in conference call mandatory for pharmacists, CVS District Leader Khalil Haidar hammered his Texas-and-Louisiana-based team to hit corporate quotas: to sell more store memberships, to push for more prescription pickups, to convince more people to get vaccinated. He threatened taking punitive measures and even firing, those that did not meet the quotas.
Haidar was not alone. At the same time that pharmacists were being harassed in the midst of the biggest medical crisis in a hundred years, corporations like CVS, Rite Aid, Walgreens and Walmart have consistently slashed pharmacy staffing levels while simultaneously also adding to their list of duties.
Stores that a decade ago might have had two pharmacists and six pharmacy technicians filling an average of 500 prescriptions a day now may have half the staff and an even higher prescription volume – plus an endless crush of vaccine appointments, rapid tests and patient consultation calls.
The article notes that, “Every task is timed and measured against corporate goals that reward speed and profits. Staff who do not fill prescriptions fast enough, answer the phones quickly enough or drum up enough vaccination business can face discipline, reassignment or termination.”
In one call of several recorded and shared with USA TODAY, Haidar warns the pharmacists, “If you get your goal, nobody will come after you.” Anticipating an objection, he adds, “And many patients, they are ignorant. They don’t know what the flu is … How are you going to convince them? How can you persuade them? That’s your job as a pharmacist.”
Like doctors, pharmacists take an oath to place the welfare of the patient ahead of any other, but this oath is being jeopardized by an increasing concern with profit.
“The public’s health is in danger,” said Oklahoma City pharmacist Bled Tanoe, who quit her job at Walgreens in August 2021 over what she considered unsafe staffing levels and an emphasis on hitting corporate targets. “The incidents of error are multiplied by infinity.”
USA TODAY interviewed four dozen current and former retail pharmacists from different chains across the nation and spoke with industry leaders, patient advocates and patients harmed by pharmacy errors. They also reviewed more than 100 emails from chain pharmacists sharing their concerns; inspected internal emails, text messages, metric score sheets and coaching notes; and listened to more than five hours of recorded conference calls.
The thorough investigation led them to conclude that the pharmacists who spoke to them, who did so only on condition of anonymity, have unwillingly become part of what amounts to a conspiracy of silence that should alarm the public as the errors pile up.
“I could cry as to what’s happening in my profession,” said Daniel A. Hussar, a professor and dean emeritus at the Philadelphia College of Pharmacy, where he taught for 52 years before retiring in 2018 to focus on his family and his blog, The Pharmacist Activist.
“At corporations like CVS, Walgreens, Walmart, Rite Aid – the huge pharmacies – errors are a cost of doing business,” Hussar said. “I don’t think the boards of pharmacy or the colleges of pharmacy or the professional associations are doing enough to address the issues.”
State regulatory bodies overseeing pharmacies have for years refused to intervene. But now Ohio proposed a series of rules this year aimed at improving pharmacy working conditions. Among them: A ban on quotas and requirements for sufficient staffing.
The response from CVS was, “The Board should stay focused on the regulation of the practice of pharmacy rather than the business of pharmacy,” wrote CVS Director of Regulatory Affairs John Long in opposing an early version of Ohio’s rules last year.
Despite the clear evidence that the safety of consumers may be at in conflict with profit under the conditions placed on pharmacists, CVS continues to assert that, “Patient safety is our highest priority”. “Our more than 30,000 CVS pharmacists approach this responsibility with seriousness and dedication and we work hard to earn the trust of our pharmacy patients.”
With all the evidence that has mounted up, it is difficult to believe our health is their priority.
