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Practice Trends
Practice Trends
Pharmacists Challenged by Their Work, Drug Topics Survey Reveals full 87% of pharmacists feel professionally challenged by A their current positions, according to a survey conducted by Drug Topics magazine and presented at the Second General Session of the APhA Annual Meeting in San Francisco. On the other hand, however, a full 97% say that they feel a great deal of stress on the job, and the result of that is a lot of irritability, headaches, fatigue, and other symptoms. The causes behind these two general conclusions are numerous, often complex, and sometimes even contradictory. But the scope and depth of the Drug Topics survey went a long way toward eliciting the exact particulars of what pharmacists think is wrong-and right-with their jobs. Some of those particulars are highlighted here. To get hold of the necessary data, Drug Topics mailed out a four-page questionnaire to 5,000 pharmacists. Of these, 2,224 people sent back usable replies. The resulting nationally representative sample includes 794 independent, 580 chain, and 850 hospital pharmacists. As studies have shown before, independent pharmacists seem to find their positions more challenging than pharmacists in other settings. Specifically, about 39% of the independents' sample said they were professionally challenged most of the time, compared with 35% of the hospital pharmacists and 28% of those working in chains. However, there appears to be some threshold, in terms of job challenge, that relates to the size of the chain: pharmacists in small chains-less than 100 pharmacies-feel as challenged as independents. Challenging Tasks
As might be expected, the opportunity to do patient counseling was a big factor in professional challenge. Among those pharmacists given little chance to counsel, nearly 30% said they seldom, if ever, felt challenged.
1.6
Other professional aspects of worK that independent pharmacists found challenging included: helping people/saving lives; practicing the profession as trained; recognition from the public; and (significantly, this factor came last) earning money. The things that independent pharmacists disliked most about their work, to a great extent, reflected feelings about the external structure of their positions, rather than emotions about pharmacy per se. They were dissatisfied with nighttime and weekend work; lack of time to counsel patients; long hours, monotony/routine; and too much pressure. But one manager, Herb Kett, Senior Vice President of the Genovese Drugstore chain, expects improvement in at least one of these problems-long hours. He told Drug Topics, "We're starting to see a compacture of the time that the prescriptions are being filled during the daytime hours, from early morning to early evening... .It's teaching us now
that maybe the stores don't have to be open as late, especially on Sundays and Saturdays." On the plus side again, the overwhelming majority of pharmacists in all three settings reported that they are treated as professionals or as valuable members of the team by their superiors; only about 6% of the sample felt otherwise. Still, independent pharmacists seem to get the best treatment-approximately 95% of them said they are treated as professionals, compared with 84% in both chain and hospital settings. Intriguingly, there was little evidence of any gender gap. Women, by and large, said they were treated by supervisors in the same way men are. Work Relations
Relations between pharmacists and their supervisors seem to be amazingly tranquil. Only 16% of independent pharmacists (13% of chain pharmacists) said they had even minor conflicts with these supervisors once a month or more;
American Pharmacy, Vol. NS26, No.7, July 1986/489
Practice Trends
major conflicts were even more rare. The most common cause of the few serious conflicts that did occur was schedulinglhours/time off. Relations with fellow employees were equally good. Eighty percent said they were friends with one or more employees; another 13% said these co-workers weren't exactly what they'd call friends, but they got along just fine. Independen t pharmacists reported the most contact with patients. Forty-nine percent said they had a great deal of patient contact, as compared with 350/0 of the chain pharmacists. Nonetheless, both groups would very much like to see their patient contact increased. Sizeable majorities of pharmacists in all settings note that they are encouraged to make suggestions to management about the prescription department. Here, though, a difference by sex pops up: men seem to be getting more encouragement than women. Also, the larger the chain, the less likely it is that the pharmacist is exhorted to speak her mind. And when it comes to the whole operation, pharmacists are given even less encouragement to voice their opinion. In chains, for instance, only 52% say they are urged to do so. Still, pharmacists have shown dogged persistence in offering their new ideas to management. The five top areas where .suggestions were made are: remodeling/layout/merchandise; pricing; purchasing/ordering; hiring and firing personnel; inventory/stock. Commented one Drug Topics analyst, "It looks as though phannacists are a lot more interested in business than some people think." How did management respond to those suggestions? Twenty-two percent of the sample pharmacists said their suggestions were adopted; 56% recall that they were at least seriously considered; 14% said they were ignored. Once more, it appeared that the pharmacist had a better chance of having her idea put into practice or seriously considered if she worked in an independent or small-chain pharmacy.
Work Environment
In terms of work environment, 70% said they found that their workplace met that most basic of requirements--cleanliness. The present layout and lighting satisfied 60% of community pharmacists, but many hospital pharmacists tended to have negative opinions about their practice settings: a full 30% rated the lighting and layout as "poor."
Community pharmacists rated computers as "good" or "excellent" in terms of: efficiency usefulness
(93%)
ease of use
(89%)
(89%)
Computers seem to have been a real boon to pharmacists. They were rated as "good" or "excellent," in terms of three elements, by these percentages of community pharmacists: efficiency, 89%; usefulness, 93%; ease of use, 89%. With or without computers, the a verage pharmacist, in the survey, fills 93 prescriptions every day (80 by independent pharmacists, 86 by chain pharmacies, and 114 by hospital pharmacists). But with computers, community pharmacists personally filled more prescriptions92 a day, as compared with 70 where there was no computer. Regardless, the prescription workload doesn't seem to bother pharmacists. Fortyfour percent said it was just right, and only 23% thought it was too heavy. Work hours were found to be fairly standard. The average pharmacist in every setting is on the job eight to nine hours a day. But for several reasons, these hours tend to seem long or inconvenient. Communi ty pharmacists therefore suggested that things could be improved if there were better hours; fewer nights/weekendslholidays;
American Pharmacy, Vol. NS26, No.7, July 1986/490
morelbetter help; more time to counsel; a lunch/food break. Right now, the average number of minutes allowed for lunch is 24 minutes in independent pharmacies and 13 minutes in chain settings. Worst of all were large chains, which give an average of only 10 minutes for lunch; 57% allow no time for lunch at all. There's usually some help, however, from non -pharmacist staff. Sixty-one percent of community pharmacists said they got such assistance. Other Tasks
What else do community pharmacists do on the job? A great deal, according to the survey findings. The number one activity, though, is answering phone calls to the pharmacy. Next, nearly seven out of ten counsel patients on nonprescription products; pharmacists are also kept busy supervising employees, waiting on nonprescription customers, and ordering nonprescription merchandise. What they enjoy the most, however, is counseling patients-by a whopping majority, 79%-followed distantly by supervising employees (10%) and waiting on nonprescription customers (5%). Conversely, tasks pharmacist most dislike are cleaning shelves, mopping/sweeping floors, and answering phone calls. Drug Topics analysts tend to think that of all the job factors they surveyed, "the workload tends to be the prime suspect for pharmacist job dissatisfaction." It isn't so much the prescription workload considered alone, but added to the consideration that "It isn't easy doing things you like to do, or weren~t trained to do, especially when you have so little time during the workday for that pause of renewal." Considering the more professional aspects of the work, what do pharmacists want? Surveyed pharmacists listed: more patient counseling and interaction; more clinical involvement; better interaction with other professionals; fewer clerical duties; better physical surroundings; more involvement in decision making; and the chance to practice as they were trained. ®
17
Practice Trends
Pharmacy, Dental Schools Using 'The Dentist and the Pharmacist' Booklet revise~
he intent of the booklet, "The Dentist and the PharmaT cist," put out by the American Dental Association!American Pharmaceutical Association Liaison Committee, was to foster a closer professional relationship between pharmacists and dentists. A recent survey shows that the booklet is doing its job well. Two mailings, of the booklet and a questionnaire, asked for information about the usefulness of the booklet. Of the 72 pharmacy school deans, 58% responded; of the 60 dental schools, 70% replied. Here are the salient findings from the pharmacy school deans: .- In 30 (71%) of the responding schools, either courses or segments of courses deal with interprofessional relations. Typical course titles include: Nonprescription Drugs and Products, Professional Practice, Introduction to Pharmacy Practice, Health Care System, The Pharmacist and Oral Health, and Interpersonal Communication in the Health Professions-Professional Pharmacy Practice. • Thirty-one (74%) of the schools indicated students are encouraged to develop interprofessional consultation with dentists upon graduation. • Thirty-six (86%) respondents indicated that the booklet adequately addresses approriate issues pertinent to the two professions. • Eighteen (42%) indicated that they had used the booklet; 23 (550/0 ) reported they had not. • The most useful items were: Sections on dentist/pharmacist relations and nonprescription products (33.% each); dental fact file and drug side effects chart (28% each); and the section on prescription products (21 %) . Tabulation of the responses from dental school deans showed that: • In 27 of the responding schools, either courses or segments of courses deal with interprofessional relations. However, 13 respondents indi-
18
cated that the subject of interprofessional relations was not addressed in any formal course. • Thirty-one (73%) of the schools noted that students are encouraged to develop interprofessional consultation with pharmacists upon graduation. • Thirty-four (88%) of the respondents indicated the booklet adequately addresses appropriate isssues pertinent to the two professions. . - Eighteen (42%) said they had used the booklet; 22 (52%) said they had not.
• Most useful items were: Drug side effect chart (40%); sections on drug interactioris and dentist/pharmacist relations (33%). There were also suggestions for new sections in the booklet: dentists' prescribing authority, a list of ADA accepted/certified/recognized products; common organisms in dental infections; criteria for the selection of fluoride rinses, pharmacist's role in clinical drug consultations; how to write a prescription and a glossary of dental terms. ®
First-Quarter Drug Prices Climb at 5.20/0 ccording to the Bureau of Labor A Statistics Producer Price Index, prescription drug prices at the manufacturer level rose by 5.2% during the first three months of 1986. The increase is substantially higher than is usually seen in first quarters: since 1982, prescription drug prices have edged up at about 4.6-4.7% during the first three months of each year. However, the first-quarter price hikes generally comprise nearly half of the total price increases for the year, and seem to show a correlation with whole-year rises. For instance, prescription drug prices in 1982 and 1983 were up 4.7 and 4.6%, respecti vely, for the first quarter, and then ended the year with 11.5 and 10.7% rises. In contrast, the first quarter of 1984 showed the lowest rate of increase during the year's first quarter-3.7%, and 8.2% for the whole year. Drug categories posting the biggest gains in price for the first quarter of this year included hormones (up 16.9%), dermatological preparations (up 16.6%), and sedatives (up 19.6% since November 1985). Hormone prices appear to be catching up after a recent decline in
price. In the December 1985 compilation of statistics, their prices had dropped by 15.4%. Other drug categories showed more modest gains in price. Muscle relaxants were up by 9.1%; cardiovascular agents, 7.7%;antihypertensives, 9.8%; cardiovascular agents other than hypertensives and vasodilators, 9.6%; and antiarthritics, 7.6%. But there were some price declines as well. Anticoagulant prices fell by 10.80/0 since November; antispasmodiclantisecretory agents, by 4.7%; antipruritics, by 3%; and hospital solutions, by 0.1%. Prices for anticancer agents, which had been showing the quickest price gains since 1981, plateaued a bit during this first quarter-increases were pegged at 3.6%. At the same time, nonprescription price gains for the first three months of 1986 were only 2.2%, while a 3.6% increase was calculated for all drug products, including biologicals, veterinary products, and bulk medicinal products. These figures compare with an overall decline of 3.3% in the producer price index of finished goods (seasonally adjusted). ®
American Pharmacy, Vol. NS26, No.7, July 1986/491
Pharmacists Challenged by Their Work, Drug Topics Survey Reveals full 87% of pharmacists feel professionally challenged by A their current positions, according to a survey conducted by Drug Topics magazine and presented at the Second General Session of the APhA Annual Meeting in San Francisco. On the other hand, however, a full 97% say that they feel a great deal of stress on the job, and the result of that is a lot of irritability, headaches, fatigue, and other symptoms. The causes behind these two general conclusions are numerous, often complex, and sometimes even contradictory. But the scope and depth of the Drug Topics survey went a long way toward eliciting the exact particulars of what pharmacists think is wrong-and right-with their jobs. Some of those particulars are highlighted here. To get hold of the necessary data, Drug Topics mailed out a four-page questionnaire to 5,000 pharmacists. Of these, 2,224 people sent back usable replies. The resulting nationally representative sample includes 794 independent, 580 chain, and 850 hospital pharmacists. As studies have shown before, independent pharmacists seem to find their positions more challenging than pharmacists in other settings. Specifically, about 39% of the independents' sample said they were professionally challenged most of the time, compared with 35% of the hospital pharmacists and 28% of those working in chains. However, there appears to be some threshold, in terms of job challenge, that relates to the size of the chain: pharmacists in small chains-less than 100 pharmacies-feel as challenged as independents. Challenging Tasks
As might be expected, the opportunity to do patient counseling was a big factor in professional challenge. Among those pharmacists given little chance to counsel, nearly 30% said they seldom, if ever, felt challenged.
1.6
Other professional aspects of worK that independent pharmacists found challenging included: helping people/saving lives; practicing the profession as trained; recognition from the public; and (significantly, this factor came last) earning money. The things that independent pharmacists disliked most about their work, to a great extent, reflected feelings about the external structure of their positions, rather than emotions about pharmacy per se. They were dissatisfied with nighttime and weekend work; lack of time to counsel patients; long hours, monotony/routine; and too much pressure. But one manager, Herb Kett, Senior Vice President of the Genovese Drugstore chain, expects improvement in at least one of these problems-long hours. He told Drug Topics, "We're starting to see a compacture of the time that the prescriptions are being filled during the daytime hours, from early morning to early evening... .It's teaching us now
that maybe the stores don't have to be open as late, especially on Sundays and Saturdays." On the plus side again, the overwhelming majority of pharmacists in all three settings reported that they are treated as professionals or as valuable members of the team by their superiors; only about 6% of the sample felt otherwise. Still, independent pharmacists seem to get the best treatment-approximately 95% of them said they are treated as professionals, compared with 84% in both chain and hospital settings. Intriguingly, there was little evidence of any gender gap. Women, by and large, said they were treated by supervisors in the same way men are. Work Relations
Relations between pharmacists and their supervisors seem to be amazingly tranquil. Only 16% of independent pharmacists (13% of chain pharmacists) said they had even minor conflicts with these supervisors once a month or more;
American Pharmacy, Vol. NS26, No.7, July 1986/489
Practice Trends
major conflicts were even more rare. The most common cause of the few serious conflicts that did occur was schedulinglhours/time off. Relations with fellow employees were equally good. Eighty percent said they were friends with one or more employees; another 13% said these co-workers weren't exactly what they'd call friends, but they got along just fine. Independen t pharmacists reported the most contact with patients. Forty-nine percent said they had a great deal of patient contact, as compared with 350/0 of the chain pharmacists. Nonetheless, both groups would very much like to see their patient contact increased. Sizeable majorities of pharmacists in all settings note that they are encouraged to make suggestions to management about the prescription department. Here, though, a difference by sex pops up: men seem to be getting more encouragement than women. Also, the larger the chain, the less likely it is that the pharmacist is exhorted to speak her mind. And when it comes to the whole operation, pharmacists are given even less encouragement to voice their opinion. In chains, for instance, only 52% say they are urged to do so. Still, pharmacists have shown dogged persistence in offering their new ideas to management. The five top areas where .suggestions were made are: remodeling/layout/merchandise; pricing; purchasing/ordering; hiring and firing personnel; inventory/stock. Commented one Drug Topics analyst, "It looks as though phannacists are a lot more interested in business than some people think." How did management respond to those suggestions? Twenty-two percent of the sample pharmacists said their suggestions were adopted; 56% recall that they were at least seriously considered; 14% said they were ignored. Once more, it appeared that the pharmacist had a better chance of having her idea put into practice or seriously considered if she worked in an independent or small-chain pharmacy.
Work Environment
In terms of work environment, 70% said they found that their workplace met that most basic of requirements--cleanliness. The present layout and lighting satisfied 60% of community pharmacists, but many hospital pharmacists tended to have negative opinions about their practice settings: a full 30% rated the lighting and layout as "poor."
Community pharmacists rated computers as "good" or "excellent" in terms of: efficiency usefulness
(93%)
ease of use
(89%)
(89%)
Computers seem to have been a real boon to pharmacists. They were rated as "good" or "excellent," in terms of three elements, by these percentages of community pharmacists: efficiency, 89%; usefulness, 93%; ease of use, 89%. With or without computers, the a verage pharmacist, in the survey, fills 93 prescriptions every day (80 by independent pharmacists, 86 by chain pharmacies, and 114 by hospital pharmacists). But with computers, community pharmacists personally filled more prescriptions92 a day, as compared with 70 where there was no computer. Regardless, the prescription workload doesn't seem to bother pharmacists. Fortyfour percent said it was just right, and only 23% thought it was too heavy. Work hours were found to be fairly standard. The average pharmacist in every setting is on the job eight to nine hours a day. But for several reasons, these hours tend to seem long or inconvenient. Communi ty pharmacists therefore suggested that things could be improved if there were better hours; fewer nights/weekendslholidays;
American Pharmacy, Vol. NS26, No.7, July 1986/490
morelbetter help; more time to counsel; a lunch/food break. Right now, the average number of minutes allowed for lunch is 24 minutes in independent pharmacies and 13 minutes in chain settings. Worst of all were large chains, which give an average of only 10 minutes for lunch; 57% allow no time for lunch at all. There's usually some help, however, from non -pharmacist staff. Sixty-one percent of community pharmacists said they got such assistance. Other Tasks
What else do community pharmacists do on the job? A great deal, according to the survey findings. The number one activity, though, is answering phone calls to the pharmacy. Next, nearly seven out of ten counsel patients on nonprescription products; pharmacists are also kept busy supervising employees, waiting on nonprescription customers, and ordering nonprescription merchandise. What they enjoy the most, however, is counseling patients-by a whopping majority, 79%-followed distantly by supervising employees (10%) and waiting on nonprescription customers (5%). Conversely, tasks pharmacist most dislike are cleaning shelves, mopping/sweeping floors, and answering phone calls. Drug Topics analysts tend to think that of all the job factors they surveyed, "the workload tends to be the prime suspect for pharmacist job dissatisfaction." It isn't so much the prescription workload considered alone, but added to the consideration that "It isn't easy doing things you like to do, or weren~t trained to do, especially when you have so little time during the workday for that pause of renewal." Considering the more professional aspects of the work, what do pharmacists want? Surveyed pharmacists listed: more patient counseling and interaction; more clinical involvement; better interaction with other professionals; fewer clerical duties; better physical surroundings; more involvement in decision making; and the chance to practice as they were trained. ®
17
Practice Trends
Pharmacy, Dental Schools Using 'The Dentist and the Pharmacist' Booklet revise~
he intent of the booklet, "The Dentist and the PharmaT cist," put out by the American Dental Association!American Pharmaceutical Association Liaison Committee, was to foster a closer professional relationship between pharmacists and dentists. A recent survey shows that the booklet is doing its job well. Two mailings, of the booklet and a questionnaire, asked for information about the usefulness of the booklet. Of the 72 pharmacy school deans, 58% responded; of the 60 dental schools, 70% replied. Here are the salient findings from the pharmacy school deans: .- In 30 (71%) of the responding schools, either courses or segments of courses deal with interprofessional relations. Typical course titles include: Nonprescription Drugs and Products, Professional Practice, Introduction to Pharmacy Practice, Health Care System, The Pharmacist and Oral Health, and Interpersonal Communication in the Health Professions-Professional Pharmacy Practice. • Thirty-one (74%) of the schools indicated students are encouraged to develop interprofessional consultation with dentists upon graduation. • Thirty-six (86%) respondents indicated that the booklet adequately addresses approriate issues pertinent to the two professions. • Eighteen (42%) indicated that they had used the booklet; 23 (550/0 ) reported they had not. • The most useful items were: Sections on dentist/pharmacist relations and nonprescription products (33.% each); dental fact file and drug side effects chart (28% each); and the section on prescription products (21 %) . Tabulation of the responses from dental school deans showed that: • In 27 of the responding schools, either courses or segments of courses deal with interprofessional relations. However, 13 respondents indi-
18
cated that the subject of interprofessional relations was not addressed in any formal course. • Thirty-one (73%) of the schools noted that students are encouraged to develop interprofessional consultation with pharmacists upon graduation. • Thirty-four (88%) of the respondents indicated the booklet adequately addresses appropriate isssues pertinent to the two professions. . - Eighteen (42%) said they had used the booklet; 22 (52%) said they had not.
• Most useful items were: Drug side effect chart (40%); sections on drug interactioris and dentist/pharmacist relations (33%). There were also suggestions for new sections in the booklet: dentists' prescribing authority, a list of ADA accepted/certified/recognized products; common organisms in dental infections; criteria for the selection of fluoride rinses, pharmacist's role in clinical drug consultations; how to write a prescription and a glossary of dental terms. ®
First-Quarter Drug Prices Climb at 5.20/0 ccording to the Bureau of Labor A Statistics Producer Price Index, prescription drug prices at the manufacturer level rose by 5.2% during the first three months of 1986. The increase is substantially higher than is usually seen in first quarters: since 1982, prescription drug prices have edged up at about 4.6-4.7% during the first three months of each year. However, the first-quarter price hikes generally comprise nearly half of the total price increases for the year, and seem to show a correlation with whole-year rises. For instance, prescription drug prices in 1982 and 1983 were up 4.7 and 4.6%, respecti vely, for the first quarter, and then ended the year with 11.5 and 10.7% rises. In contrast, the first quarter of 1984 showed the lowest rate of increase during the year's first quarter-3.7%, and 8.2% for the whole year. Drug categories posting the biggest gains in price for the first quarter of this year included hormones (up 16.9%), dermatological preparations (up 16.6%), and sedatives (up 19.6% since November 1985). Hormone prices appear to be catching up after a recent decline in
price. In the December 1985 compilation of statistics, their prices had dropped by 15.4%. Other drug categories showed more modest gains in price. Muscle relaxants were up by 9.1%; cardiovascular agents, 7.7%;antihypertensives, 9.8%; cardiovascular agents other than hypertensives and vasodilators, 9.6%; and antiarthritics, 7.6%. But there were some price declines as well. Anticoagulant prices fell by 10.80/0 since November; antispasmodiclantisecretory agents, by 4.7%; antipruritics, by 3%; and hospital solutions, by 0.1%. Prices for anticancer agents, which had been showing the quickest price gains since 1981, plateaued a bit during this first quarter-increases were pegged at 3.6%. At the same time, nonprescription price gains for the first three months of 1986 were only 2.2%, while a 3.6% increase was calculated for all drug products, including biologicals, veterinary products, and bulk medicinal products. These figures compare with an overall decline of 3.3% in the producer price index of finished goods (seasonally adjusted). ®
American Pharmacy, Vol. NS26, No.7, July 1986/491