Major OCP report reveals what corporate pressures pharmacists say they’re facing really look like

“I feel like my clinical judgement is second to corporate directives.” “The pressure to push services on patients is relentless.” “Quality control is difficult to maintain when your primary metric is speed.” “We are routinely asked to compromise our professional standards for the sake of profitability.” Those were some of the comments pharmacists and other pharmacy professionals made in a March survey and accompanying town halls on corporate pressures, hosted by the Ontario College of Pharmacists. The organization released a report on the responses, Under Stress and Duress, earlier this week. The OCP set out to investigate the issue after long-simmering problems boiled over with well-publicized concerns about MedsChecks. While MedsChecks ended up being the most commonly reported workplace pressure in the survey, the OCP found stress realting to them was symptomatic of broader pressure to perform services and meet volume and revenue targets. The survey also found that these issues are pervasive. Indeed, 70% of the 4,289 pharmacy professionals who fully responded to the survey said they were currently under “workplace practices that include direction or pressure to complete an activity in a limited timeframe or to a certain target number or dollar amount.” Even more (85%) said they were currently experiencing or had previously experienced those workplace practices. “Registrants told us that not only are corporate pressures real, but they were also prevalent throughout the province, they were impacting the quality of care they want to provide to their patients, they were antithetical to the essence of healthcare professionals, and they were having an impact on their wellbeing and mental health,” Shenda Tanchak, registrar and CEO, wrote in the report. Most (90%) respondents were pharmacists, but pharmacy technicians and others, like assistants or students also took part. Read: Ontario College of Pharmacists Corporate Pressures Hotline goes liveQuotas and time constraintsThe most common workplace direction and pressure reported was to meet a quota around MedsChecks, followed by pressure or direction to either “cold call” patients for MedsChecks or do them even though they were unnecessary.That was followed by meeting quotas, either in numbers or dollar amounts, for professional services, naloxone kits and minor ailments. Respondents also said they were pressured to do things quickly. They reported they were under direction or pressure to verify prescriptions, do therapeutic checks or do other services in a limited amount of time and to do minor ailment assessments in a limited time. Just over a third said their organizations had told them to complete minor ailment assessments in less than five minutes, and another 50% said their companies expected them to do minor ailment assessments in five to 10 minutes. They also reported that organizations had directed or pressured respondents to prioritize patients with easier medication profiles over those with more complex profiles. Read: 'I'm surprised it hasn't done it': OCP could be doing these three things right now to address corporate pressures in pharmacy: lawyerLoblaw/Drugstore Pharmacies tops list of high-pressure workplacesThe pressures were worst in corporate-owned pharmacies, with 93% of respondents who worked at Loblaw/Drugstore Pharmacies saying they are experiencing workplace pressures, followed by 89% of those at Rexall, 85% of those at Walmart and 82% of those at Shoppers Drug Mart.Those working at Costco and Sobeys/FreshCo were less likely to say they had workplace pressures, at 69% and 63%, respectively. In contrast, only 18% of those who worked in independently owned pharmacies and 26% of those who worked in hospitals and healthcare facilities said they did. Some pharmacy chains are missing from the analysis, as the OCP did not include responses from people who worked in multiple places or workplaces with fewer than 40 respondents. Read: 'Counsel has been retained': Ontario college takes zero-tolerance stance against corporate pressure on pharmacistsOverworked and overwhelmed The college also examined qualitative responses. It found that corporate pressures are widespread and affect professional autonomy. That makes pharmacists feel less like healthcare professionals and more like customer service staff—as one pharmacist put it, “I didn’t study pharmacy to be pressured into sales.” Pharmacy professionals said that led to them feeling overworked and having their mental health suffer. “I’ve never felt more stressed and less supported in my career,” one told the OCP. Several reported depression, anxiety, exhaustion and extreme stress as a result and said that burnout is common. Others said they feared making mistakes and were worried that these pressures lead to suboptimal care. “I never thought I’d have to choose between keeping my job and staying true to my ethical principles,” one wrote. “I worry about the ethical implications of pushing unnecessary products on vulnerable patients,” said another. Others pointed out that they might end up having a complaint made to the College against them as a result of not having enough support and time to do their jobs. Some also reported the pressure to make decisions that aren’t based on patients' best interests was wearing on the patient-provider relationship. Pharmacy staff described some patients’ trust in them diminishing and interactions becoming “more transactional.” They also shared workload and staffing challenges, such as routinely understaffed shifts and a lack of proper equipment, training and support. Read: Getting ahead of burnoutChanging jobs and asking to change the system The pharmacy professionals said that they were scared of retribution if they spoke out against these issues to their employers. Many pharmacy professionals who managed to shift from experiencing these workplace pressures to not having them anymore did it by changing from a corporate-owned pharmacy to an independent one or, less commonly, to a hospital pharmacy. Only a small percentage managed to get rid of these workplace pressures by switching to a different corporate pharmacy. Pharmacy professionals had a clear desire for systemic change around these issues. They wanted regulatory bodies to step in and push back against corporate pressures to protect pharmacists from them. “There’s a disconnect between the ideals promoted by our regulators and the reality in corporate pharmacies,” one pharmacy staffer said. They asked for regulatory oversight over the big pharmacy chains and policies that would support pharmacists. More regulatory levers are needed, they said, that would prevent these sorts of pressures from being put upon pharmacy staff. Read: Lunch breaks, quota bans and more: Ohio’s new rules fight burnout and understaffing

Major OCP report reveals what corporate pressures pharmacists say they’re facing really look like

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