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Burnt out

Discussion in 'Pharmacy' started by MV777, Apr 11, 2018.

  1. MV777

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    Only been in the game for a few years but completely burnt out at big box. Every day is worse than the last. More demands, more metrics, more scripts, less and less hours. I laugh at the image I had of myself when in pharmacy school that I would actually be helping people and counseling them throughly. Now I am lucky I am able to smile at people, not close the pharmacy gates in the middle of my shift, and counseling is literally yelling at them in the drive thru from verification about which strength of their Lexapro are they currently on while I am hanging on the phone with someone else trying to get their controls filled early because “they are going out of town,” just like last month. How are y’all making it day by day? My mental health is being affected, as in I am now a constant ball of anxiety every day. Everyday is the same-people don’t want to wait 15 minutes for their prescription, random consultations about weird rashes and where are the cotton balls, phone calls asking what’s ready and no I don’t need that, I need the other one, I want a 30 day, I want a 90 day, why did my doctor send that, why is it that much, can you call my insurance, it wasn’t that price last month, I don’t have my insurance card, can’t you just look it up?, when is my doctor going to send in my refill?..................... I am to the point that when I am off of work I do not want to be around any human beings. Is this normal? Probably not, but I’m sure I’m not alone.
     
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  3. wagrxm2000

    wagrxm2000 Do not respond to this

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    Join Walgreens, very few metrics.
     
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  4. hye345

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    I realize this depends on your relationship with PIC and DM, but you gotta set proper expectations for patients, and enforce them. Example, if you have 2 waiters, and a third one wants to wait, let them know that it will be a bit longer than usual. If they don't wanna wait, you tell them they can always leave it with you, and return to pick it up. Give them options, let them choose, but don't let them play you. Don't be afraid to say something like "Sorry, I can't do that (over the phone), but if you want to come in side, we will be happy to assist you", or "I can contact your doctor, but it will take some time, you are welcome to wait, but if you want to come back later, I can let you know when we've heard back"
     
  5. grumpyRph

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    amazing post. never time to complete a full thought let alone look up drug information or crucial interactions or enlighten yourself on how a new diabetes medicine works.

    it's just your new norm. i find myself going in waves of being numb to it and getting worked up by it. there will be slow nights and slow weekends where you can clean up and catch up and catch a breath and complete a thought though. the m-f 9-5 chaos is quite something though isn't it?

    but then again there's all these rumor and talk of all pharmacies going 9-5/9-7 and closing on weekends, no overlap rph. blah blah. i guess it's only down from here.
     
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  6. Mambo#5

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    I feel the same way.

    But, imagine if you were in a “mandatory counseling” state (I don’t think you are). In these states you do everything that you described, in addition to having to go to the counseling window every 5 minutes to counsel patients on new scripts.

    In these states the labels with new meds pop up with “Counsel” on them and the tech must say “The pharmacist would like to speak to you about your medication(s)”, not “Do you have any questions for the pharmacist?”, whereupon the tech places the script near the window and you get to run over and counsel (in between verifying, logging in the CII order, answering doctor calls, documenting DURs, checking the pdmp, training new techs, answering random questions at the counseling window, clarifying scripts, answering phones, checking voicemail, and everything else,) and then pull the counseling sticker off and log that script number in the computer as “counseled” or “declined”( if the patient states they don’t want to talk to the pharmacist, whereupon the tech yells “declined!” (and I feel relieved) lol, so that you’re aware).

    In these states patients are overly sensitive to unreal drug interactions, so you get more calls on the phone from patients asking about drug interactions with OTCs.

    Needless to say, while verifying all the benzo scripts with “as needed for anxiety” I often ponder whether I should also be taking some sort of tranquilizer.
     
  7. vtrx2013

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    tips: take a vacation, work hard party hard, when you're off make sure no one bother you about work, strategize work flow, come in a little early.
     
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  8. Mambo#5

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    Its exhausting, to say the least. And, many colleagues agree. On my days or time off I’m recovering and or preparing my mind for the next session.

    Retail wasn’t always like this. It’s not healthy, nor is it sustainable for the individual. One just has to develop an exit strategy.
     
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  9. PharmDBro2017

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    Completely normal.

    Interning during school and doing p4 rotations made me hate the general public and change my mind against doing retail.

    I'd recommend you apply to every hospital nearby, and jump at the chance you get a graveyard shift. There's even fewer idiots to worry about during the night. Good luck.
     
  10. Djejdhskhwhxucjenfjsj

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    There's fewer and fewer 24 hour stores left. Mine is going to 6am-midnight
     
  11. RxVampire

    RxVampire PharmDruggist
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    Have you considered seeing a psychiatrist for counseling/behavioral therapy and/or pharmacological aid? There is no shame; I've found it helpful after finishing rotations and coming to that realization what the next 5-10 years of pharmacy would be like

    I like pharmDbro2017's suggestion of doing nights if possible (if you aren't doing so already). You at least get some break mentally of not having to be interrupted/talk constantly with mostly negative attitude persons
     
  12. johnpharm01

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    This is what I call "riding the lightning". Burn out use to take 10 years, now it just takes a few. I would just do my best to fake it when people complain. At my last corporate job I would go home laughing at how many times employees said they were sorry. Collect the paycheck, plan an exit strategy, and try to cope with the stress in a healthy way.
     
  13. Twentytwelve2

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    The trick is to prevent the labeled "issue customer" from having an issue. Half your problems will be gone. Leave notes in their profile or monitor their prescriptions daily for refill auths. If nothing comes in, fax again or call the office.

    Use your time -efficiently- to make your work less stressful. Pull up data review files ahead of time while you are on the phone so you can mow through them quicker. Hell, check small parts of the rx while you are on the phone! Use your hands while you check prescriptions to fold paper at the same time.

    My store does 350-500 on a good day and I work with no overlap pharmacist. I find retail to be very easy because I can put my attention to each task at any second and swap focus prn. Counting fast and accurate helps as well and knowing insurance issues/loopholes.

    If you have the extreme problem customer, hopefully you and your district manager get along well and you inform them of the said customer and ban them from your store. We have a few we banned because they cause way too many unnecessary problems, like complaints that were uncalled for due to patient negligence/stupidity thinking we did something wrong.
     
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  14. dxb8307

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    Exactly how I feel. My anxiety has been thru the roof to the point I feel like I need to be medicated. Cant sleep. Very much considering going part time so I can keep my sanity.
     
  15. oldking

    oldking Senior Member
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    I must have clicked on this by accident but read it with interest, surprise, and for what it's worth empathy.

    I'm a private practice, outpatient radiation oncologist so I probably prescribe less medications than just about any other physician (I "prescribe" radiation treatments mostly) and I'm not on any prescription medications so I don't think I've even spoken to a pharmacist in over a decade (although on the rare occasion I go to Walgreen's and can't find something random like cotton balls I have caught myself almost asking the buys pharmacist where they are before catching myself and spending the extra 12 seconds to find them myself!) since I finished residency. Again for what it's worth I have nothing but respect for the field and fondly recall interacting on rounds or day to day with pharmacists whose expertise and insight I highly valued as a member of the team but I have to say I'm shocked and saddened to read this post and then scan over your forum to see that my understanding of the profession is far removed from reality.

    Are physicians aware of any of this (maybe I am/was just clueless because of my esoteric specialty and practice location)? How about your leadership or professional societies (to be quite honest my field is going downhill in large part due to at least some issues that could be easily addressed but rather than helping our leadership is doubling down and making things worse due to ambivalence or all out greed).

    I'm clearly no expert and have nothing meaningful to add except my sympathy (I can't believe such a historically critical and well respected profession that requires so much intelligence and education can become just another "cog in the corporate wheel" so fast) and agreement with a post (#3) above that it may be helpful to set expectations.
     
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  17. stevephhs016

    stevephhs016 Zug Zug

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    So to address a couple points from your post, I do not believe physicians are aware of any of this as I'm sure us RPhs are not aware of some issues affecting physicians as well. Professional societies really don't do much to help the profession and most board of pharmacies really are there to enforce laws/regulations to protect the public.

    A lot of the reasons pharmacy is the way it is is because of the boom of pharmacy and schools in the recent 10+ years leading to a surplus of pharmacists and students along with the fact that a lot of our employment comes from retail pharmacies. Corporate mindset of meeting/beating budgets, metrics, aggressive cost savings by cutting tech hours/staffing/less overlap, growing script volume, thus leading to worsening job conditions to pharmacists and the general public (almost inhumane: basic acceptable job conditions ie breaks/restroom, no time to really focus on consulting or doing what we graduated school to do i.e.1 rph manning 2 drive thrus/production while 1 tech handles pickup/drop off/phone calls).

    And with continued decreased in opportunities "outside of retail" and greater competition with more and more new graduates with $200k+ in school loans and an increasing # of pharmacy mill schools, unfortunately a lot of us retail RPhs are left in this predicament.
     
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  18. ranger99rx

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    Our DM doesn't want techs to say " The pharmacist would like to speak to your about your medication(s)" since most patients would decline and say " I've taken this before (many years) I don't need to speak to the pharmacist". So now our techs have to yell " Patient care."

    How about people with 5 or 10 different discount cards and want you to try all of them to see if it cheaper than their insurance co-pay? Why does it cost so much? This card says (up to) 80% discount. Many time I want to tell them "did you pay a premium for that card like your insurance premium?" People whine about $10 payment on 1 month prescription, yet their dinner at the restaurant $30 to $50 for 1 meal.
     
  19. Mambo#5

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    Yes, that’s what our DM says too.

    I realize 99% of patients would say no because I started out on the East Coast in a “non-mandatory counsel” state, where the tech only has to say “Do you have any questions for the pharmacist?”(whereupon 99.9% say no)

    “Mandatory counsel” is outdated. It’s all on the label. It’s not that we never counsel in “non-mandatory” states. If we see there is something we need to discuss with the patient, we put that bag and/or contact the patient.

    We also use auxiliary labels 1000 times more than what I see here. Most pharmacy’s don’t counsel on each new script and also don’t use important auxiliary labels like “with food” for ibuprofen or Chantix, etc. Yes, it is on the bottle “with food”, but in fine print, so most patients don’t see this. And they do miss this and take it on an empty stomach(because mandatory counsel is usually not done).

    They should do away with mandatory counsel. It’s the most ridiculous thing. Explain what this is to a pharmacist in a non-mandatory-counsel state..... they are just dumbfounded. They’ll say “No.....your kidding.......”, “Are you serious?!” It’s absurd, the pharmacist is like a human ping pong ball. And, those who want to enforce it don’t work in the pharmacy.
     
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  20. imcallingcorp

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    The way you feel is normal. Been there felt that. The best I was ever able to do was stop caring. Even then hating people was the norm, feeling anxious driving in was daily, and yea it can take its toll on you. Like someone else said try to get a night shift at a hospital . Good luck!
     
  21. ldiot

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    Im in a forced counsel state and the only pharmacists that actually comply work at Walmart.

    When I worked at CVS I never saw a pharmacist actually do this and I worked with many. How is a pharmacist supposed to counsel every patient when they are filling 500 scripts a day with no overlap, 3 techs and a MinuteClinic producing an endless supply of waiters?
     
    #19 ldiot, Apr 17, 2018 at 12:23 AM
    Last edited: Apr 17, 2018 at 12:28 AM
  22. ldiot

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    The best thing you can do is stop giving a **** about customer service and focus on efficiency in the pharmacy. People only care about wait time and price, nothing else matters in their mind.

    If your pharmacy is running more efficiently, it will indirectly result in better customer service and higher moral anyways because your staff is in a better mood and peoples scripts are done on time. Just focus on getting your work done and improving your relationship with your staff. When you are having a good day tell them, and tell them good job. It goes a long way. When things are going terrible you can do your best and joke about it later, but try not to complain and drag yourself down further
     
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  23. pharmacisttotherescue

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    I am literally losing my mind every day. it just gets worse and worse every day less help more work, I walk into work with anxiety, sleep with anxiety and dread having to get up the next day for another day of work. I mean this cant be real and absolutely nothing is done about it, I really dont understand why anyone would go into this profession with the way it is all thaat money and time in school and to have a job that you absolutely hate going to every day
     
  24. flip33

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    Yikes! I once had a job like that. About killed me. Found a small hospital gig with a laid back DOP, and life is pretty good now. Very sympathetic to your situation.
     
  25. Sine Cura

    Sine Cura 10 seconds or less

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    Yeah TBH I never did mandatory consultation in Arizona consistently at CVS. Walmart's mandatory consultation algorithm is really bad though. However I have actually caught a few mistakes doing mandatory consult like duplicate antibiotics, wrong dose that the patient did not want but was within reason, filling an old Rx accidentally, wrong transfer etc.... so yeah it is the last line of defense for a reason. Also you can never be sure those with limited English or no English proficiency will use abx correctly for their kids without a consult.

    Too bad a lot of companies do not allow the pharmacist to exercise professional judgment and inspect the patient profile (things that are required of a pharmacist anyway) to determine what is or isn't truly a mandatory consult. Get a ton of "I've been taking this for 20 years crap" so I just mention please look out for s/sx of X Y and Z and get them out.
     
  26. Apotheker2015

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    Hmmm, you might want to double check if having the tech make the offer meets the requirement for your state. I am licensed in 2 states. One of them is mandatory counseling for everything. That does not fly. You have to go up there for everything. This state requires the pharmacist to counsel which means making an offer is not enough. They want us to just start reciting facts to the patient until the patient realizes you're going to do that for all 15 scripts and they tell you to shut the hell up and take off. At Walmart, even if the patient says no, we have to go up there because bags aren't stapled shut. We have a "bagging station" and that's handled by a tech and in some states a clerk - unskilled laborer/cashier- and god knows what they could put in there by mistake.
    The SOP reads we may staple shut refills but pharmacists refuse to accept that's what the SOP reads. So we have to check each vial, correct name, drug, open it, look at the pill, every time.
     
  27. Apotheker2015

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    That's retail right there. My objective feedback, though, is that you have no control over your environment. I have posted on several threads tips on how to keep your queue clutter-free and maximize your workflow.

    Here's the link to one of the posts. CVS inside Target vs Walgreens I've also pasted two of the posts below. You need to get organized. You're doing way too many tasks that your techs should be doing. They should be screening consults. No more running to the window every time someone walks up there and then 9 times out of 10 - where are the cotton balls?

    And do not accept ever techs doing this "Do you have a question for a pharmacist?" Well you mother @#$%#%%# #%@@#% piece of scum of the earth, what do you think the patient is going to say? They don't care who tells them where the damn cotton balls are. So do not accept that. Make them screen the question. It's not counseling. They must determine if it's a clinical question. Once they do, you acknowledge the request, find a good stopping point and head over to the consultation window.
    Another favorite. don't let techs tell 5 patients in a row with two C-II scripts each that it will be 15 minutes. Smack them if you have to.
    Be in control. Run the pharmacy. Don't let it run you.

    ******************************************************************************************************************************************************************
    "There are several things that you can do in order to keep your queue free of clutter and maximizing the efficiency of your workflow:

    1. PCQ calls and Prescriber calls are time sucks. To keep PCQ calls under control, every patient needs to be on text message notifications, they need to have the app. It's not "would you like to get text notifications?" That sounds like spam and like you're trying to sell them something or like a virus might get into their phone.
    Just say "Let's go ahead and set you up to get a text every time your prescriptions are ready. It's great. It also reminds you when you're due for a refill" DONE. "Let me show you how to download the app. It'll cut your time at the pickup window in half. You'll love it. You know better than they do and that's what we're doing.

    Prescriber calls - teach your techs to not just send refill requests on everything. they should be thinking through this checklist:
    - Double check if it's an ER doctor,
    - is it for an ABX,
    - is it for a prednisone taper?
    - a short course of flexeril for neck pain?
    - was the prescription even written with additional refills to begin with?
    - is it for a starting dose of a stating or whatever? Of course, it won't have refills. The doctor for sure told them they would need to be seen in 3 months, but no, in one ear, straight through that empty Medicaid brain and out the other ear.
    - does the prescription state "NO MORE REFILLS UNTIL SEEN IN CLINIC. NEEDS APPOINTMENT".
    In all cases but the latter, do not send the fax. They have to see their provider. If it clearly states that the patient needs an appointment, sure, send the fax, but delete that thing off your queue or send it manually. You know you won't get a response anyway. So why let it clutter your queue? Tell the patient you're sending it as a courtesy but not expecting a response and will not follow up on it. They need to see their provider. Tell your techs to add that to the label. If adding that to the label is an issue with CVS or state law then, print an auxiliary label with "NO MORE REFILLS UNTIL SEEN IN CLINIC. NEEDS APPOINTMENT" and stick it on their bottle.

    If you do these consistently, your life will be a lot easier.

    Prior authorizations - take 15 minutes to educate your techs on the basics of prior authorization and to reason through rejections. Just because it says "requires PA" does not mean that is the best course of action.
    They need to understand:
    - Step therapy: if the rejection states tier 3, that means the patient has to try and fail a preferred tier 1, then tier 2 and then and only then will the insurance cover. Sometimes the prescriber is just writing for whatever brand name the drug rep just told them about over the free lunch they brought to the clinic. So there's no need to tie up resources and delay therapy by starting a PA process that will to the PA being denied and the prescriber realizing the patient needs to start with a preferred generic.
    Medications like Qsymia (phentermine/topiramate) - that PA is never going to be approved. I worked for a PBM a while back and the criteria is impossible. Unless the patient has a free trial card, teach your techs to fax the prescriber back "prescribe phentermine & topiramate separately"

    Another favorite is Epiduo Forte - I just want to smack sense into them every time I see this one cluttering the queue. Fax back for separate prescriptions foi adapalene and benzoyl peroxide.

    You get the idea.

    When patients pick up their meds, don't ask them if they're ok with getting reminder calls, push text messages or get them to decline getting the phone calls. You're in control of it all. Techs have to follow suit. They're inside the pharmacy because of YOUR license. Don't let them forget that.

    Everyone gets switched to 90 days supply. Agnes does not need to stop by the pharmacy every other week, twice each week. Nonsense. Everytime you see a new script for 30 day supply and 11 refills, either change it to a 90 day supply if your state law allows you, too (and your company, of course) OR have your tech fax the prescriber right back asking for the ok on 90 day supply. Add a huge note that states:
    TO ALL PRESCRIBERS AT YOUR FACILITY. WE GREATLY APPRECIATE YOUR CHOOSING OUR PHARMACY. IN ORDER TO BETTER SERVE THE NEEDS OF YOUR/OUR PATIENTS, WE KINDLY ASK THAT WHENEVER CLINICALLY APPROPRIATE, PLEASE PRESCRIBE FOR 90 DAYS SUPPLY INSTEAD OF 30 DAYS SUPPLY. THANK YOU.

    Fax that note to every clinic every day if you have to. Once you get everyone on text notifications, app express pay, and 90 day supply, and you keep your queue clutter free because your techs are actually reasoning through QT and not just pushing "send refill request" every time a patient doesn't feel like seeing their prescriber, your life at CVS will be a lot easier.

    It will take some work and you might face some resistance, but they should jump on board once they realize their lives will be easier.

    When someone gets a new script 45 days after filling their usual meds, try to get that person on scriptsync, and don't use that Spiel CVS tells you to sell it, just do the 45 day supply, explain the first copay will be X and then, the following prescriptions will be 90 day supply and the copay may change. Otherwise, try to sync it manually.
    ******************************************************************************************************************************************************************
     
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