Pharmacists Are Excluded in Burnout Conversations

November 30, 2022 - Throughout the COVID-19 pandemic, many experts, industry leaders, and public health officials discussed workplace burnout and its effects on the healthcare industry. The discussion centered on physicians and nurses who saw unprecedented workloads and stress levels. Unfortunately, the conversation failed to include one key player: pharmacists. Physician and nurse burnout is well researched and understood; however, there is a gap in understanding how burnout can impact pharmacists.

As of 2016, the burnout rate of hospital pharmacists was 61.2%. That rate has only risen since the pandemic and has continued to rise. According to an article published in Drug Topics, as of 2019, 71% of pharmacists stated that they had a high or excessive workload.

In a statement by the Board of Trustees of the American Pharmacists Association (APhA) issued in December 2021, the organization acknowledged that workforce issues in the pharmaceutical industry have been building up but reached their peak during the COVID-19 pandemic. Industry leaders and advocacy groups have taken note of the remarkable increase in pharmacists’ burnout, calling for systemic change to address the current issues and prevent future burnout.

What Is Burnout?

According to the Canadian Journal of Hospital Pharmacy, burnout is characterized by emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment. While burnout can occur in any career path, healthcare providers tend to experience it during unforeseen circumstances, such as the COVID-19 pandemic, and when overwhelmed.

Causes of Burnout

Factors contributing to or increasing emotional exhaustion and depersonalization or decreasing feelings of personal accomplishment are pharmacists' main driving forces of burnout.

Workplace Conditions

The APhA states, “workplace conditions have pushed many pharmacists and pharmacy teams to the brink of despair.” Many believe that long hours, harassment, patient demands, insurance barriers, and staffing shortages contribute to pharmacists’ burnout.

According to the US Pharmacist, hospital pharmacists report the primary causes of burnout as having too many non-clinical duties, uncertainty around healthcare reform, and inadequate teaching time. Additionally, community pharmacists report time constraints, performance metrics, and a lack of control as causes of burnout. The data suggests that regardless of whether a pharmacist works in a hospital or community facility, they are understaffed and overworked.

Tonya Shackelford, clinical pharmacist and senior manager for Product and Solutions Management at Cardinal Health, told Drug Topics that “independent pharmacists have a serious job filling prescriptions and ensuring their patients get the right medication with no harmful drug interactions, and that is on top of running a business. As pharmacists get busier during the day, there’s the added pressure of making sure mistakes aren’t made that could potentially hurt someone. This adds to pharmacists’ burnout.”

Payment Models and Reimbursement

Like many other pharmaceutical organizations, the APhA believes that payment issues significantly contribute to pharmacist burnout rates. According to the organization, pharmacists and the pharmacies they work for are only compensated for the products that they dispense. But pharmacists’ role goes far beyond just dispensing the medication; they also counsel patients and provide medical guidance.

The APhA notes, “pharmacists are not able to bill Medicare for their clinical services because they are not recognized as eligible providers under the Social Security Act. Other healthcare professions — including physicians, nurse practitioners, physician assistants, audiologists, and nurse-midwives — are all eligible providers who can bill for their services.” Pharmacists are taking on extra hours to compensate for the lack of reimbursement by the current payment model for the pharmaceutical industry.

The APhA also criticizes pharmacy benefit managers (PBMs) for making a profit off the pharmaceutical system while pharmacies are left struggling with high demand and limited staff.

Assessing Burnout

To assess burnout, clinicians can use the Maslach Burnout Inventory (MBI), a 22-item clinical tool. The tool provides nine statements to assess emotional exhaustion, eight statements for evaluating feelings of personal accomplishment, and five questions to determine depersonalization.

For each statement, the test subject must answer how often they agree using the following responses: never, a few times a year or less, once a month or less, a few times a month, once a week, a few times a week, or every day. Each response corresponds with a score from zero to six, respectively.

Each section is scored independently. For emotional exhaustion, a score lower than 19 indicates low levels of emotional exhaustion, while a score of 27 or greater indicates high levels of emotional exhaustion.

A score of greater than 39 in the personal accomplishment category indicates high levels of personal accomplishment, whereas a score lower than 34 shows low levels of personal achievement. Finally, for depersonalization, scores of 10 or more suggest high levels of depersonalization, while scores between zero and five indicate low levels of depersonalization.

Pharmacists’ burnout may also be assessed using the Perceived Stress Scale. These tools have been reworked to evaluate pharmacists’ burnout even though they were not explicitly created for this field.

Impact of Burnout on the Pharma Industry

Burnout in the healthcare system can have disastrous results, causing medical errors, reduced care quality, and adverse outcomes. US Pharmacist states that medical errors are the third leading cause of death in the US, behind cardiovascular diseases and cancer. Additionally, burnout can delay prescription fulfillment, increase wait times for vaccines and testing, and lead to other issues.

In addition to its impact on patients, pharmacist burnout can lead to anxiety, depression, suicidal thoughts, and many other mental health concerns in pharmacists. Additionally, the stress can manifest physically, causing cardiovascular issues, obesity, and other problems.

Preventing and Addressing Burnout

The impact of pharmacists’ burnout is just as, if not more, dangerous as burnout in other healthcare professions. Many organizations have made recommendations for reducing pharmacist burnout and addressing ongoing issues in the industry, ranging from short-term individualized approaches to long-term systemic approaches.

Individual Care

Pharmacists experiencing burnout may seek mental healthcare or other personal interventions to address and work through their experience.

In a 2021 article published in the Canadian Journal of Hospital Pharmacy, the authors wrote, “Numerous strategies are currently being used to prevent and treat burnout, including mindfulness-based interventions, psychotherapy, and didactic education. Several health professional student groups have demonstrated the success of burnout-prevention strategies at the student level. It is unknown whether pharmacy schools have implemented any courses or programs targeting the prevention of burnout in the workforce and, if not, whether they would be interested in implementing such training.”

Addressing and Reporting Workplace Concerns

The first of many solutions is to address working conditions immediately. Addressing the working conditions begins with addressing staffing issues. Pharmacies, especially larger retail pharmacies, must actively work to staff their locations with pharmacists and pharmacy technicians adequately. Proper staffing will allow pharmacists adequate time to dispense medication, deliver clinical services, and counsel patients.

The APhA has worked on developing ways to monitor, manage, and report causes of burnout in this sector of the medical field. In collaboration with the National Alliance of State Pharmacy Associations, the APhA has developed the Pharmacy Workplace and Well-Being Reporting system. The system allows pharmacists to report work experiences, which can be used to educate and establish effective changes to reduce pharmacist burnout rates.

Reimbursement Issues

The APhA advocates for changes in the payment model. The organization hopes that regulating PBM business practices and allowing pharmacists to bill Medicare, Medicaid, and private insurance for medical counseling services will help properly compensate this sector of the healthcare industry.

“Pharmacists are caregivers, and we must address the fundamental issues causing burnout and frustration. The public, decision-makers, and regulators must be educated about, and recognize, the seriousness of our pharmacy teams’ negative well-being and the need for both additional resources and realistic expectations to safely provide patient care services,” states the APhA.