New York Times Essential Article for Pharmacists
Among the pharmacy community, it has become known as the New York Times article. From outside the profession, this may seem to be an odd, non-specific reference. In speaking with those in the community, however, pharmacists immediately recognize that I am referring to the January 31st New York Times article written by Ellen Gabler entitled, “How Chaos at Chain Pharmacies is Putting Patients at Risk”. If you have not read the article, this one is an absolute ‘must read’ for all pharmacy professionals, if only to understand the broader context of the patient care conversation the article has initiated within the health system. As the title suggests, Gabler highlights a number of affidavits filed from pharmacists across the country, citing problematic workplace conditions that potentially foster an error-prone environment.
To many in the profession, the allegations sound much too familiar. The article summarizes pharmacist challenges of “struggling to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients, and call doctors and insurance companies… all while racing to meet corporate performance metrics that many health care professionals characterized as unreasonable and unsafe.” Indeed, participants in our own classrooms at freeCE echo so many of these sentiments after airings of medication safety programs. And the unanswered question after each session is, “What can I do about so many of these corporate decisions that are out of my control?”
For some, the answer has been to turn to the state boards of pharmacy. The boards, after all, are tasked with promoting, preserving, and protecting public health within health care. And, some states have formally addressed such concerns. The state of South Carolina, as one example, created a task force to look specifically at workplace conditions in 2019. As the New York Times article points out, the South Carolina board published a statement “discouraging quotas and encouraging employers to value patient safety over operational efficiency and financial targets.”
The article brings into question the ability, or even willingness, of the state board of pharmacy structure to regulate the industry in a meaningful way. As the article points out, company representatives from major chains occupy seats on many state boards. The state of Florida is highlighted as an example where, of a nine-member board, one seat is occupied by a lawyer for CVS while another seat is occupied by a director of pharmacy affairs at Walgreens. This is by no means a contemporary argument. In 1984, author Stanley Gross published the book, “Of Foxes and Henhouses” in which he examined the ‘self-regulated’ structure of many health care professionals, including pharmacy. In this book, Gross argued that this level of ‘self-governance’ led to a focus on the protection of the PROFESSION versus the intended protection of the PUBLIC.
In the case of the claims made in the New York Times article, one could argue that it is difficult to ascertain whether or not the profession OR the public is being protected. Many of the pharmacist’s concerns in the article centered around the workload and increasing potential for critical mistakes. Not all voices that the boards of pharmacy hear, however, echo this sentiment. For example, the article points out a conversation with the trade group, National Association of Chain Drug Stores, in which the statement was made that it was “wrong to assume cause-effect relationships between errors and pharmacists’ workload.” The group goes on to argue that state boards themselves sometimes block meaningful change, citing recent pushes to increase the pharmacist to technician ratio, a move that proponents say will free up time for pharmacists. Opponents say that more pharmacists and technicians are needed for patient safety, not less.
As you can imagine, the boards of pharmacy hear conflicting arguments constantly… all being made in the name of protecting public health. And, the conflicting arguments sometimes result in inaction or indifference. Prescribers are often brought into the equation, with an entirely different set of interests surrounding drug safety and appropriate medication use.
Of course, the pharmacy board’s control of a private corporation has legal limitations… and, to the credit of countless public servants who have roles on these boards, they are often unjustly blamed for failure to act when they do not have the backing to do so. The chilling accounts from pharmacists in the New York Times article point to multiple critical problems. The word is out. We are, in part, a self-governed profession. If viable solutions can not come from within, outside mandates are inevitable. The commitment to patient safety must, without resolve, be evident throughout the profession, throughout our boards of pharmacy, and throughout every level of our health care and corporate structures.
[Author’s note: The article being referenced appeared in the New York Times on January 31, 2020. There are many points to unpack in ‘the’ article. Future postings will evaluate other aspects of this article. The original article, in its entirety, may be viewed here.]