Wendy Lear lay in bed, bleeding and cramping. Her first pregnancy was ending in a miscarriage.
But the CVS where she worked as a pharmacist in Lexington, Kentucky, could not find anyone to take the night shift. The scheduler asked her to come in anyway, she said.
So Lear went to work, filling prescriptions and answering questions throughout the night. When she could not take the surging pain anymore, she lay down on the pharmacy floor and propped her feet on a stool.
Lear’s story is the result of a systemic problem in Virginia and throughout the country – understaffed pharmacies. Without enough workers, pharmacists and technicians are overworked and burned out, leading to poor mental health and potentially dangerous conditions for patients.
In recent years, pharmacists have been asked to do more, such as administering vaccines and testing for illness. But compensation for drugstores has not kept up, and staffs have shrunk.
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Virginia’s Board of Pharmacy recently passed new regulations intended to protect drugstore workers. But staffers worry drugstore chains will retaliate against whistle-blowers and find ways to skirt the rules.
“We owe our pharmacists and their team a safe and enjoyable workspace,” said Al Roberts, a co-owner of an independent pharmacy near Culpeper, Remington Drug Co.
‘My worst nightmare’
In October, the board opened a comment portal to hear from the state’s pharmacists. The response was startling.
“Being a pharmacist has become my worst nightmare,” one unidentified Northern Virginia employee said. “The stress has become overwhelming.”
“We need more help. We need a lunch break,” said another. “Patient safety is endangered here.”
Virginia is not alone. In September, more than 30 pharmacists employed by CVS in the Kansas City area refused to show up for work, saying they were burned out.
By one measure, the mental health of pharmacists in Virginia is getting worse. Last month, 43% of pharmacy personnel here reported a high level of distress in a survey by the American Pharmacy Association. Virginia ranked seventh-worst in the nation, rising from 18th-worst in 2020.
In the Richmond area, pharmacies are “a little better off than the rest of the country” but still facing significant shortages, Dr. Marlon Levy, interim CEO at Virginia Commonwealth University Health, told the board of visitors this month.
Reduced staff
Years after she experienced a miscarriage, Lear says she kept showing up for work at CVS, even when it was a challenge.
After her baby was born, and Lear continued to breastfeed, there was nowhere to pump and not enough employees for her to step out. The law requires an open pharmacy to have a pharmacist on the premises. So she went to the back of the room, put her back to the security camera and hooked up the pump while sending faxes and filling out paperwork.
One time, she was sick with the flu, and so was her toddler. But she says the pharmacy could not find another employee to open the store and, again, she was asked to come in. Wearing sweatpants and carrying her child, she worked for an hour and a half.
Lear previously discussed her story with USA Today. Michael DeAngelis, executive director of corporate communications for CVS, told the paper that it is not CVS’ policy or practice to require ill staff members to work.
When Lear began her career in 2009, she generally had three full-time technicians working alongside her. As the years went on, the three full-time employees were reduced to one full time and two part time, working fewer hours. The law prohibits a pharmacist from overseeing more than four technicians at a time.
Each time CVS would take on a new expense, it would cut technician hours, Lear said. When the drugstore chain bought insurance giant Aetna for $69 billion, or when it stopped selling cigarettes, the chain cut hours.
“It kept getting worse and worse and worse,” she said.
Drugstores have started closing on weekends and holidays and limiting their hours. But that just condenses the number of customers into a smaller window, staffers say.
CVS also closed hundreds of locations to save money. It reduced the number of stores in Warrenton, where Lear later worked, from two to one. But CVS moved only one employee to the still-open location, while its patient volume doubled.
Later, Lear developed a kidney stone, which she partially attributed to never taking bathroom breaks at work. Pharmacy employees are often measured on how quickly they perform work. Lear had to answer the phone within 20 seconds and fill prescriptions within 15 minutes. Good performance metrics were rewarded with bonuses.
Leadership would tell the employees to provide the same level of customer service as fast-food restaurant Chick-fil-A. The workers laughed at that comment, noting how many more employees work at a Chick-fil-A.
“I’m not selling chicken sandwiches,” Lear said. “If I make a mistake, patients can die.”
To persuade new pharmacists to sign up, CVS has begun offering signing bonuses of $50,000 or more. Recent graduates strapped with student debt often take the jobs to ensure a steady paycheck. If they do not stay at CVS for two years, they have to pay back their bonus.
In 2021, Lear quit CVS after 12 years and joined Remington Drug Co., which does not measure the efficiency of its workers and fully staffs its pharmacy. Her worst day there is better than her best day at CVS, she said.
“It is so refreshing,” Lear added. She now wonders why she so often sacrificed her health for her job.
“Ultimately, it hurts the patient in the long run,” said Roberts, the co-owner of Remington. The more a pharmacist works, the more likely he or she commits an error. He called the current environment a “ticking time bomb.”
A CVS in Virginia Beach mistakenly gave a patient 100 extra doses of a strong opioid, Percocet. Another patient went to the emergency room after developing an allergic reaction to a drug, even though the patient had a known medical history of allergic reactions.
The problem, the employees said, was understaffing. The CVS was fined $427,000 by the Virginia Department of Health Professions.
A pregnant patient in Las Vegas was undergoing in vitro fertilization, an expensive procedure to help her conceive, and was supposed to receive pregnancy medication. Instead, she was given Misoprostol, which is used to conduct an abortion. The patient lost her pregnancy.
Midlothian CVS is fined
More often, understaffing can lead to bad customer service. Patients can wait days to receive their medicines.
A CVS in Chesterfield County had closed its drive-thru and stopped answering the phone, said Mykl Egan, a discipline case manager for the Board of Pharmacy, during a hearing last month. A patient could not get his Metformin, a medicine used to treat diabetes. Despite calling, emailing and visiting in person, he could not get the prescription transferred to a better location.
The store, at 8121 Midlothian Turnpike, was routinely understaffed, employees told an investigator. Ten technicians had resigned or been terminated, and only five new employees were hired. Unable to properly fill customer needs, the staff had received numerous complaints. The investigator discovered the patient’s Metformin sitting in the pharmacy for no apparent reason.
Last month, the state Department of Health Professions proposed a $2,500 fine, which CVS has about a month to appeal.
A representative for CVS said the company is looking into the matter and works to make sure its locations are properly staffed. A spokesperson for CVS could not facilitate an interview to discuss the allegations, and CVS declined to send an employee to the hearing.
Large drugstore chains have responded to complaints that they are not adequately staffing locations. Walgreens said it spent $265 million last year to retain and recruit pharmacy staff.
CVS has experimented with different ways to ease the burden on employees, including directing them to not answer the phone immediately and call back patients when time allows.
At the heart of the problem is that pharmacies are being asked to do more with fewer resources, K.C. Ogbonna, dean of the Virginia Commonwealth University School of Pharmacy, said last month. Pharmacists are now issuing millions of vaccines and tests for COVID, flu, strep throat and UTIs.
But the reimbursements pharmacies receive from insurers can be so low that it risks pharmacies’ ability to turn a profit. Pharmacies buy drugs through middlemen called pharmacy benefit managers, which negotiate prices on behalf of the manufacturers that build drugs. Sometimes, the reimbursement they receive is less than what the pharmacy paid to get the medicine.
‘We are listening’
Earlier this year, the state’s Board of Pharmacy extended what it hopes is a lifeline to tired workers. The board approved emergency regulations for workplace conditions and OK’d them earlier this month for permanent status. The regulations await the signature of Gov. Glenn Youngkin.
The new rules require drugstores to staff enough employees to prevent fatigue. They also require that pharmacies avoid productivity quotas that interfere with a pharmacist’s ability to serve patients. The rules guarantee uninterrupted breaks and provide safeguards for a pharmacist who reports his or her employer for a violation.
“I want people to know we are listening,” said Wendy Nash, a pharmacist and board member from Brunswick County.
But pharmacists worry drugstore chains will retaliate against them or find ways around the rules. The board stopped short of capping the number of prescriptions a pharmacist can fill in a day, which some have called for. The board said it will continue working on this issue.
“This may be a start, but we have a lot to do,” said Shannon Dowdy, a pharmacist and board member from Henrico County.
The state needs tougher punishments, Roberts said. It needs stronger fines and the authority to shut down a pharmacy that does not follow the law.
“They need to feel the pain when these infractions are seen, documented and have gone through the official process,” Roberts added.
Case in point: The CVS that was penalized $427,000 has not paid one dollar of that fine, a spokesperson for the Department of Health Professions confirmed last week. CVS continues to appeal the case.