My first day in retail pharmacy...

[aboveliquidice]

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It really wasn't what I thought it would be...

The counseling is short - the arguments concerning insurance are long - and the prescription/minute ratio is high...

For perspective - My EE site is Walmart - they fill around 650 scripts per day. I am trying to keep an open mind - but it was real culture shock coming from the IV Center at my last hospital. Is it always this way?

~above~

 

[PharmDstudent]

It really wasn't what I thought it would be...

The counseling is short - the arguments concerning insurance are long - and the prescription/minute ratio is high...

For perspective - My EE site is Walmart - they fill around 650 scripts per day. I am trying to keep an open mind - but it was real culture shock coming from the IV Center at my last hospital. Is it always this way?

~above~

What do you mean(the part in bold)? I haven't worked for Walmart, so I'm not familiar with that statistic.

Retail pharmacy is a rat race. It's been that way for awhile, probably since pharmacies started taking insurance. The drive-thru aspect can make it seem even worse.
What have you done in the pharmacy so far? Hopefully you'll do more than just cashiering. I don't mind running the register for a couple of hours, but it gets overwhelming for longer periods of time. There's only so many times I can answer the "how are you doing today?" questions.

 

[Old Timer]

The answer is, maybe. It depends on so many factors. Is your store staffed sufficiently? Is the staff trained well enough? Are the customers nice? I can tell you that it will always be fast paced if you are filling 650 prescriptions per day. If you do not want to work at that volume and if this is your first retail experience you may not. I can tell you if there is sufficient and well trained staff and there are few problems 650 prescriptions can be a breeze. I can also tell you with insufficient or poorly trained staff and a host of problems 150 prescriptions can lead to gross consumption of alcohol.

Here is what you have to balance, width vs depth:

The advantage of a busy store is you get to have a greater variety of experiences. With more prescriptions per day you get more opportunities for things to happen. The more you experience as a student the greater prepared you are as a pharmacist. The disadvantage is you get less personal time with the preceptors. At that volume there is no down time.

The advantage of a slower store is you get a great deal more face time with your preceptor. You get less width of practice but more depth. When a drug interaction comes up you can spend a great deal more time going over how to handle the situation.

I would give it a little more time to get acclimated. If you still find the pace more than you are comfortable with either ask for a transfer or look for a different opportunity. One of the advantages of retail is there are many places to practice, from chain to independent to specialty.

I have worked at every volume from 600 per week to 4000 per week. I can survive at any level of volume. You can also suffer at a slow store if it is not run correctly. The secret to having a successful career is to find a place where you can perform at your best. There are people who need to be busy and they become bored and inattentive at slower stores. There are people who just cannot produce the speed or accuracy at higher volumes. You have to be at a place where you feel the most comfortable. I think you need to experience various levels while you are a student to see if you are comfortable.

 

[aboveliquidice]

Prescription per minute ratio is simply that... How many prescriptions were completed (handed to the patient) per every minute. 0.5 prescriptions per minute means you filled 1 prescription every 2 minutes. It was how my preceptor explained the work load of the pharmacy.

we had a ppm of 1.229 or 590 scripts in 9 hours... We were on point to do a little more than the average. I have also heard some of my classmates talking about auto pill counters - that might make a big difference how the work flow proceeds.

I think I was just in culture shock. Thanks for the replies... maybe next time will be better.

~above~

 

[sdn1977]

Prescription per minute ratio is simply that... How many prescriptions were completed (handed to the patient) per every minute. 0.5 prescriptions per minute means you filled 1 prescription every 2 minutes. It was how my preceptor explained the work load of the pharmacy.

we had a ppm of 1.229 or 590 scripts in 9 hours... We were on point to do a little more than the average. I have also heard some of my classmates talking about auto pill counters - that might make a big difference how the work flow proceeds.

I think I was just in culture shock. Thanks for the replies... maybe next time will be better.

~above~

STOP thinkings like that! There is no prescription per minute volume!!! Goodness - that is a purely corporate number & is meaningless in the professional aspect of our profession.

Yes - if the patient has been on the same regiment of digoxin/hctz/lisinopril for 4 years....then yes....the presciption per minute volume is high, but hopefully, you chatted about his grandchildren, the last vacation he took, the fact that it is so hot (as least here in CA)........don't fall into the corporate "mentality"!

These are your patients - they are they're someone's mom, dad, child, spouse - someone who is very, very important. When you put in that perspective - the rx take what it takes, what it takes. If its the same d*mn dose of digoxin that he/she has always taken for the last 10 years - no problem. The point is - your continued conversation will bring out other problems - getting up a lot a night to urinate, perhaps falling a bit, perhaps some confusion......

See the difference? You can be pushed by corporate needs - or you can decide to experience what this experience is - take it for what its worth & evaluate it worth based on what you see & experience. Then....you can decide to pursue what you choose professionally.

Personally, I will NEVER work at a place which will measure my rxs per minute - what a ridiculous & nonsensical measure. If you have a high volume store which also provides the personal & professional measure of interaction...then - its good. But, those are usually lost when the volume increases because your tech/RPh level increases & the techs don't bring you into the conversation.

Thus...you become the faceless/nameless, but fast pharmacist.

Personally, in the last week, I've received 3 gifts (of which I've needed to return because of corporate policy which does not allow me to take gifts) due to my personal & detailed interaction with patients. Often, when I consult them on difficult or detailed regiments - travel medications, which I've prescribed....or things like Lovenox, Procrit, etc....I'll do it at my lunch break which allows me to be uninterrupted. They appreciate that & recoginize my contribution.

Don't follow those riduculous corporate rates/hr/minute - whatever! If you are an intern - you have no choice. But, if you are not - you have lots of choices. Choose wisely!

 

[fenixtnlfan]

Just out of curiosity (in regards to SDNs post), say you are working retail. You try to counsel patients and get to know them better. Would you get in trouble for not filling prescriptions as fast? Say you don't receive bonuses, promotions, and maybe get a bad review.

I think counseling and working with patients is an amazing part of pharm. I was just wondering if corporations try to keep this down with the above mentioned negatives.

 

[Hels2007]

I can tell you if there is sufficient and well trained staff and there are few problems 650 prescriptions can be a breeze. I can also tell you with insufficient or poorly trained staff and a host of problems 150 prescriptions can lead to gross consumption of alcohol.

Don't you say... I just got off my shift. First of all, I could never understand why people go to a pharmacy on a Saturday night. I am paid rather handsomely to do so - otherwise I would never set my foot there! It seems like half the state of New Jersey had insurance change on 8/31 - and it was a zoo. I was with a (rather inexperienced) tech, and even though I only filled maybe 150 scripts and sold maybe 200 (it's always a bad sign when you sell more than you fill) in 8 hours, it was a zoo. I spent insane amount of time explaining people who barely spoke English what the problem is, tried to call doctors on missing dosages/wrong directions (offices of course were closed), insurance (many of which were also closed, inluding Medicaid, which is what most of my patients have)...

 

[All4MyDaughter]

I would give it a little more time to get acclimated. If you still find the pace more than you are comfortable with either ask for a transfer or look for a different opportunity. One of the advantages of retail is there are many places to practice, from chain to independent to specialty.

Don't follow those riduculous corporate rates/hr/minute - whatever! If you are an intern - you have no choice. But, if you are not - you have lots of choices. Choose wisely!

The OP is a first year pharmacy student on rotation at Wal-Mart. He has no choice at this point, I'd guess.

Although, some students from my class were removed from a rotation site at Kroger because the store was so fast paced and none of the pharmacists wanted to spend time teaching the students. So it can happen.

 

[sdn1977]

Just out of curiosity (in regards to SDNs post), say you are working retail. You try to counsel patients and get to know them better. Would you get in trouble for not filling prescriptions as fast? Say you don't receive bonuses, promotions, and maybe get a bad review.

I think counseling and working with patients is an amazing part of pharm. I was just wondering if corporations try to keep this down with the above mentioned negatives.

Sure - anything CAN happen. But, ask yourself, what would you do if you received a bad review?

For me....I'd honestly say, hmmmm - okaaaay. Then, when the time was right, I'd move on. I wouldn't argue, fight, explain or anything else. I'd just realize I'd gotten myself in a bad situation & get myself out as soon as I could in the most professional manner possible.

As for bonuses - forget those. You don't work for a bonus!!!! You do the work you're paid to do! That means being the very best pharmacist possible.

If you're in it for the bonus & you're watching the clock tick ....or worse yet, watching the clock tick for someone else - you're in the wrong business!

Now, think, what if your physician treated your office visit the same way? Sure - some do, but, do you want to join those ranks voluntarily?

Now - think again.....toward promotions....what is the worst possible thing that could happen? You don't get promoted to a DM because you don't join the "party" line on how many rxs/min you do? Who cares? If you do...then, you're not in this business for the patients - you're in it for the corporations. Because, even in the small independent pharmacies who must absolutely make money on each & every patient - they are the ones who go back after hours, deliver on days there is no deliver & go the extra mile - not the run of the mill, counting rxs/min large volume corporate pharmacies.

From my personal experience (and I have very few years in retail - only 8 part-time years) - I have never, EVER been penalized for taking the extra time counseling a patient. In fact, I took 25 minutes going over a travel immunization recommendation for a patient last week with the end result being - go home, read the material & get back to me next week. I may or may not dispense anything - but I gave this patient 25 minutes of my time because he asked for it.

 

[sdn1977]

The OP is a first year pharmacy student on rotation at Wal-Mart. He has no choice at this point, I'd guess.

Although, some students from my class were removed from a rotation site at Kroger because the store was so fast paced and none of the pharmacists wanted to spend time teaching the students. So it can happen.

So - what's your point? Lots of students take lots of classes they see very little point to - it could be pharmaceutical chemistry, microbiology - whatever. This is a rotation the student is on & he/she does not appear to like it. Those of us who are in practice settings or who advocate classes which students don't particularly care for & are either instructors of or preceptors for don't really care that the student likes or dislike it. They just have to show up (sadly............!!!!!). Altho - student evaluations eventually do come to have an impact on what continues & what does not in a curriculum - but, long after that student is gone.

Of course, as a student he/she has no choice - but, he/she does not have to adopt that mentality! The student could have just as easily been on a pediatric rotation & hate dealing with kids!

Of course it can happen & pharmacists choose this practice setting all the time - hence the environment he/she finds himself in! But, he/she does not have to like it & I've encouraged him/her to follow his professional instincts - which have seemed wise to me so far......

As a student, you must endure what you're given as a rotation site. But, don't believe each & every retail outpt setting is like the Walmart experience or that each & every pediatric inpt setting is like a county hospital. There are huge variations & you can indeed choose the practice setting which fits your professional strengths & personal inclinations. Just don't piss people off right now as a student.

 

[dgroulx]

I currently have a FAMU student on rotation. He is inexperienced, so we try to show him a little bit of everything. My store only does around 150 to 200 per day. We have lots of people wanting help with OTC products and we do a lot of counseling. In the morning, I only have one tech because everyone is in school. I try to verify all the entered prescriptions and refills, which will clear the queue. The computer then prints the patient leaflets out by promised time. Walgreens removed all the KPIs (key performance indicators) quite a while ago, so prescriptions per minute, etc. are not tracked.

I do process prescriptions quickly if someone is waiting. If someone comes to pick up a medication and it's not ready, we grab it out of the queue and get it done right then. A good chunk of prescriptions are filled at least an hour after their promised time because I'm doing other things like helping patients. It doesn't matter because they aren't there to pick it up, yet.

I've been at stores that do 650 per day, but there are always 3 pharmacists on during the day to make sure there is time for patients.

 

[All4MyDaughter]

So - what's your point?

My point was that as a student on rotation, ALI is not in a position, as you suggested to not "follow those ridiculous corporate polices" or "choose wisely" about his practice site.

Don't follow those riduculous corporate rates/hr/minute - whatever! If you are an intern - you have no choice. But, if you are not - you have lots of choices. Choose wisely!

See the above quote for why I thought you might have misunderstood his situation.

My follow up point is that what the OP is experiencing is a realistic view of what it is like to work in some of the current corporate environments. If he doesn't enjoy it, he'll know that particular environment is not for him. But if he is seriously not learning ANYTHING (working the cash register all day, as some of my classmates were) then he might want to speak to the rotation coordinator. At my school we are encouraged and expected to report if we aren't have a good educational experience.

 

[rxlynn]

It really wasn't what I thought it would be...

The counseling is short - the arguments concerning insurance are long - and the prescription/minute ratio is high...

For perspective - My EE site is Walmart - they fill around 650 scripts per day. I am trying to keep an open mind - but it was real culture shock coming from the IV Center at my last hospital. Is it always this way?

~above~

I worked on a project this summer which involved interviewing quite a few community pharmacists in their practice site. Every time I walked into a Wal-Mart, I saw/heard a very close variation on what you report. My anecdotal evidence is that the $4 prescription is driving Wal-Mart's volume to a point that they really aren't being able to handle it very well in a lot of stores.

ALI, a 650 script store is a VERY busy retail pharmacy. Keep in mind that not all retail sites are like this. My home store does around 1800 per week, and we have much more time to counsel, talk to customers, etc. I do work some at a much busier store, and I always try to take that opportunity to do more OTC counseling or learn about new drugs that I haven't seen before. As Old Timer points out, you really will see a lot more things at a highvolume store. So, just try to take this temporary experience as the best learning experience you can, and in the back of your mind keep reminding yourself that not all retail is this type of atmosphere.

 

[Old Timer]

I have never seen any corporate environment where an outsider is permitted to handle cash. At CVS an extern student is limited to duties in the pharmacy and is NOT permitted to handle money at the register. Only CVS employees ring the register.

A student on rotation who is ringing the register is being abused, period. There is NO educational value in performing this duty. When any pharmacy or pharmacist accepts the responsibility of taking externs they should understand their role is strictly educational and any benefit they get as far as free labor should be considered a bonus.

The student should speak to his/her school and be transfered to a site where she is the recipient of the service not the donor of free labor.

 

[All4MyDaughter]

I have never seen any corporate environment where an outsider is permitted to handle cash. At CVS an extern student is limited to duties in the pharmacy and is NOT permitted to handle money at the register. Only CVS employees ring the register.

A student on rotation who is ringing the register is being abused, period. There is NO educational value in performing this duty. When any pharmacy or pharmacist accepts the responsibility of taking externs they should understand their role is strictly educational and any benefit they get as far as free labor should be considered a bonus.

The student should speak to his/her school and be transfered to a site where she is the recipient of the service not the donor of free labor.

That is what happened, as I understand it. The student/s got moved to a different rotation site.

 

[aboveliquidice]

A new workbook has been introduced - that has assignments to be completed in the pharmacy each and every week. It has some stuff that you share with your preceptor - but mostly it dictates what my day to day tasks are. This is awesome, because it allows me to sit down and develop my schedule with my preceptor...

Pretty awesome - we shall see how it goes.

~above~

 

[Farmercyst]

It'll be interesting to see what happens when I go to Sav-on for my first pharmacy experience. I should have my immunization cert by then, so I may be able to do a few flu shots. I think it'll be worthwhile. About the fast pace, seems kind of tough. Though hopefully not as bad since you've had some experience before. This'll be my first time getting my feet wet.

 

[sdn1977]

It'll be interesting to see what happens when I go to Sav-on for my first pharmacy experience. I should have my immunization cert by then, so I may be able to do a few flu shots. I think it'll be worthwhile. About the fast pace, seems kind of tough. Though hopefully not as bad since you've had some experience before. This'll be my first time getting my feet wet.

You're not supposed to get your feet wet😉

In fact, you're supposed to wear gloves so you don't even get your fingers wet😛.

If you have influenza vaccine on your feet, you're wasting the solution😀.

j/king!!!!

 

[Farmercyst]

You're not supposed to get your feet wet😉

In fact, you're supposed to wear gloves so you don't even get your fingers wet😛.

If you have influenza vaccine on your feet, you're wasting the solution😀.

j/king!!!!

Yeah, well, when we were giving our practice NS shots, my partner pulled my SQ out at an angle so that it flicked saline down my arm. Of course I'm not looking, so I don't know what liquid just ran down my arm. Fortunately (or not??) it just flicked saline off the needle when it straightened out after being removed from my stretching skin. (GoldenPharmD doesn't read these, so she tells me 🙂)