The Covid-19 pandemic greatly expanded the role of pharmacy staff, who suddenly had to take on the responsibility of Covid tests and vaccines in addition to their other tasks. However, even before Covid-19, pharmacists and pharmacy technicians struggled to manage their workload.
“The phone was just ringing all day. … The lady on the phone was like, ‘Is anybody going to answer the damn phone?’ I was like, ‘Ma’am, I’m giving flu shots and shingle shots all day.’ She said, ‘Where’s your help?’ Well, the one help I had just had a mental breakdown so I have no clue,” said Maurice Shaw, a former pharmacist at CVS and Walgreens, in a recent interview.
Shaw now works as a clinical pharmacist at the University of Illinois Chicago and is a co-founder of the Pharmacy Guild, a union for pharmacy professionals that launched in November in response to working conditions at large pharmacy chains. The organization was formed after a series of walkouts occurred in the fall among Walgreens and CVS employees. It was created in partnership with IAM Healthcare, a union of diverse healthcare professionals, including nurses, medical administrators and lab technicians.
The Pharmacy Guild aims to be the first national pharmacy union in the U.S. (though there are some regional unions that exist). However, it’s a tall order given that many pharmacists work at large corporations like CVS Health and Walgreens. Shaw is undeterred and believes the effort will be successful.
“Once we get that first set of stores unionized, I think it’s going to be a chain reaction. … I think people really feel like this is the only way,” he declared. “People have reached out to their pharmacy organizations and they feel like [the American Pharmacists Association] has failed them, they feel like their State Board of Pharmacy has failed them and they feel like their state legislators have failed them. So why not try the union?”
What the Pharmacy Guild wants
The Pharmacy Guild has several demands of pharmacy chains. The first is better pay and secure hours for pharmacy technicians, according to Shane Jerominski, a pharmacist and co-founder of the union. Pharmacy technicians help prepare and refill prescriptions, pack medications and process insurance claims, among other responsibilities.
The median hourly wage for pharmacy technicians was a little over $18 in May of 2022, with some making as low as $14.25 an hour, according to the Bureau of Labor Statistics. And oftentimes, their hours will get cut if there is a downturn at the company (such as post-flu season), even if they were hired full-time, Jerominski said. Because of these two factors, it’s very difficult for a pharmacy technician to make a living.
“Even when you have a well-trained, highly-skilled technician that makes pharmacies safer, that makes pharmacists’ jobs easier to navigate, when you have 400-500 prescriptions a day that you’re responsible for checking and getting out safely and accurately, those technicians are always looking for an exit,” Jerominski said. “This is a placeholder job for some of them now because they can’t support their families and they can’t be assured of their hours.”
Then there is the issue of sheer workload. He added that the Pharmacy Guild wants a limit to the volume of work that pharmacists have to deal with. For example, nurses have staffing ratios in which one nurse can only work with a certain number of patients. However, there is no equivalent for pharmacists, which creates the potential for mistakes and dangerous outcomes for patients.
“It’s not like some regulatory body comes in and says a pharmacist can’t legally check 700 prescriptions alone,” Jerominski said.
Difficult working conditions ultimately affect workers’ lives outside of the pharmacy, Shaw said. For example, some people struggle starting a family. He said he’s also seen workers get anxiety and depression prescriptions filled at the pharmacy, likely due to the stress of the job.
“You start to see how much it’s just affecting people’s personal lives,” he stated.
Some efforts have been made to curb staffing problems at pharmacies. This month, the Ohio Board of Pharmacy imposed on a CVS pharmacy a $250,000 fine and three-year probation for understaffing. While Jerominski said he’s glad the agency took action, the infractions at this particular CVS pharmacy can be found elsewhere in the nation.
And understaffing is not only a matter of worker anxiety, burnout and patient safety. There are other dire consequences. USA Today recently reported the story of Ashleigh Anderson, a CVS pharmacist in Indiana who died in 2021 after suffering a cardiac arrest during her shift. As the only pharmacist working that day, Anderson was unable to leave work and go to the emergency room when she felt ill because that would require having to close the pharmacy.
“I really think that unless we unionize, they’re not going to change on their own. If the death of a pharmacist on their watch wasn’t enough, we’re going to have to organize in order to force their hand,” Jerominski said.
Michael DeAngelis, CVS’ executive director of corporate communications, told USA Today that Anderson’s death was a “tragedy that never should have happened.”
However, he added that “it’s impossible for me to comment on why Ashleigh made the decision she made. I think, by and large, pharmacists are highly dedicated health care professionals, and I would not be surprised if there are pharmacists who have the mindset of, ‘I need to keep taking care of my patients,’ versus ‘I’m afraid of being punished by my employer.’”
What’s ahead for the Pharmacy Guild?
The organization is in its early stages and still needs to file for an election with the National Labor Relations Board (NLRB). Elections “certify or decertify a union as the bargaining representative of a unit of employees,” according to the NLRB website. Given that this step hasn’t been taken, the Pharmacy Guild technically doesn’t have any members yet. But Jerominski insisted that there is a lot of interest, noting that 30,000 people went to the Pharmacy Guild website the first day it launched and briefly crashed it.
Jerominski added that the Pharmacy Guild is being “strategic” about where it starts unionizing members. One of the first locations will be “very close to one of the headquarters for one of the major chains,” he said but declined to give more detail. The headquarters for Walgreens is in Deerfield, Illinois, while the headquarters for CVS is in Woonsocket, Rhode Island. Rite Aid’s headquarters are in Philadelphia.
The union is also in “full campaign mode,” with the Pharmacy Guild attending the American Pharmacists Association conference in March to gain supporters.
The response from CVS and Walgreens
So far, Walgreens and CVS have been “kind of downplaying” the creation of the Pharmacy Guild, according to Jerominski. But he doesn’t think “they will be for very much longer,” he predicted.
MedCity News reached out to both of the retail pharmacy chains. Amy Thibault, lead director of external communications at CVS Pharmacy, said the company respects “employees’ right to either unionize or refrain from doing so.”
Thibault added that in response to feedback from its pharmacy teams, CVS has made several investments. The company is making about a $1 billion increase in wages for pharmacists between 2021 and 2024. It’s also giving about $70 million in bonuses to its pharmacists, pharmacy technicians and other frontline colleagues.
“Patient safety is our highest priority,” Thibault said in an email. “Our CVS pharmacists take safety seriously and we work hard to earn the trust of our patients. Safeguards to support patient safety are integrated throughout our prescription workflow, and our pharmacists and pharmacy technicians receive extensive training on all pharmacy systems. We strive to ensure we have appropriate levels of staffing and resources in place at each of our pharmacies through a combination of staffing, labor hours, workflow process, and technology.”
A Walgreens spokesperson who declined to be named also said in an email the company respects the right of its employees to be represented by a union.
However, the spokesperson added that “we continue to believe the best way to accomplish results is through the direct relationship between our team members and their managers, who are striving every day to achieve our shared purpose of serving our communities and reimagining local healthcare.”
The company is making sure “team members’ contributions are acknowledged and rewarded” through “competitive pay and benefits,” the spokesperson said. It has also implemented efforts like micro-fulfillment centers and value-based care models to “free up pharmacists’ capacity to focus on clinical services,” the spokesperson said. In addition, the company has an initiative called the Walgreens Deans Advisory Council, which comprises 17 colleges of pharmacy and aims to encourage more people to go into pharmacy careers.
What will make the Pharmacy Guild successful?
Going up against large chains like Walgreens and CVS won’t be easy, according to Gerald Friedman, a labor union expert and economics professor at the University of Massachusetts Amherst.
“It’s really hard to fight a company like CVS. They’re really big. They can handle a long strike. … They can replace the workers or they can close the store,” he said. “At a minimum, CVS is sitting on billions of dollars of cash flow. They can survive a strike.”
To be successful, the Pharmacy Guild needs to gain national interest, which is going to take a lot of money. It also has to get the message across that “pharmacists are workers, not professionals,” Friedman said. But this is a tough message for people to accept, as most want to consider themselves a professional.
What’s the difference between a worker and a professional? It’s the autonomy of the work and the possibility to walk away from the job, Friedman said. This is an independence that pharmacists have largely lost. Pharmacists used to be able to talk to their customers, get to know them and explain their medications to them. But now, they’re more strapped for time. And if the pharmacist chooses to leave their job at a large retail pharmacy, there are few options for them to go.
“You have to accept that you are working for a paycheck and come to the point where you believe that you need this outside, independent advocate,” Friedman said. “I think it’ll be easier with younger pharmacists. But also, the way CVS treats its people is the biggest asset the Guild has. Issues like giving them a lunch or providing adequate staffing. … They have to point to the specific failures of CVS management.”
When asked what he hopes to achieve with the Pharmacy Guild, Jerominski said “to have changed the face of the profession.
“[I hope] that we have a renewed interest in pharmacists, that kids want to go to pharmacy school again. … That we go back to having pharmacists who want to work in that setting because they have connections with patients and they feel like they’re doing the job of a healthcare professional and they’re changing people’s lives, instead of treading water and worrying every single day that they’re making a mistake,” he said.
To that end, the Guild also wants to work with those in the academic community to encourage more people to go into the pharmacy industry.
“There’s been a massive reduction in the amount of students who want to go into pharmacy because of all this negative media attention,” Jerominski said. “It sounds like a really bad deal, unless you get a clinical position or unless you’re working in a hospital. They’re like, ‘I don’t want to work at Walgreens. I don’t want to work at Rite Aid. It’s going out of business.’”
Photo: Irina Devaeva, Getty Images
