Ultan Molloy reflects on the causes of pharmacist burnout and takes stock of where the profession might be headed.
Where to start this month. We’ll have likely had the budget by the time of your reading, and I suspect there’ll be little in it for pharmacy and pharmacists. We’re not the worst off in society, but we have had a nearly 20 per cent fee reduction since 2009, and are dispensing nearly 20 per cent more items. There has been an increase of over 18 per cent in pharmacy wage bills along with this. At the politicians briefing by the IPU on 21 September, we will have made this point, discussed a fair fee, a Chief Pharmaceutical Officer, and discussed a vision for pharmacy into the future. It would be most unfortunate if we continue to have net closures of pharmacies throughout the country before someone hits the brakes and decides that investment in the most extensive and accessible primary healthcare resource we have in this country is appropriate. Time will tell.
The free contraception scheme is progressive, by all accounts. We have been trolled by some people on Facebook having advertised the service. I don’t know why I’m surprised at this stage in my life that there will always be a different perspective, in every case, that will see what can only be a good thing, as a bad thing. We have a more respectable fee for managing this service for patients, so perhaps that will be the starting point for discussions around a fee in the new pharmacy contract. Yes, a contract with the pharmacy, rather than the pharmacist(s), although hopefully we’ll see some creativity there when it comes to resourcing employees as part of said contract. One can only hope.
I’ve been working as a pharmacist a lot of late, along with my other jobs as owner, manager, HR person, counsellor, etc, and my role and jobs at home. Decision fatigue, the ongoing concentration and the adaptability required now has left me mentally exhausted at the end of the few weeks just passed. We have our lunch break now, and close for it, and I am lucky to have a fantastic team who carry much of the weight. That being said, checking, thinking, and problem-solving from one end of the working day to the other takes its toll. We can only give so much mentally before the cracks start to show, and mistakes start to creep in. I can better understand now why burnout is a significant issue in our community pharmacist workforce. We are not robots, and the increasing complexity of what’s required of us leaves little spare capacity and energy for doing what’s important and engaging with patients and customers. We have a pharmacy experience in the UK, where ‘call back in a couple of days’ appears to be a commonplace experience for some family friends over there. Do they know the name of the pharmacy staff in their local pharmacy? You must be joking! A relationship with customers is not their priority. Are we headed that way too, with a move to chain pharmacies from independent operators? Where there is skeleton staffing at the counter and in other areas due to increased demands elsewhere?
HealthMail has been hailed as progress, and on ref lection, I’m not so sure how progressive it really is. It’s really just equivalent to us receiving prescriptions by fax. We still have to print everything out that comes through to give us a paper copy, which is costing us a fortune in ink, and it doesn’t integrate with our IT system, so we have to input everything from scratch on receipt of a prescription. We also scan in scripts for quick reference and checking for patients, so another step there.
FMD is of course now another step in the dispensing process. So many steps, stock pulling, labels, printing, scanning, sticking, checking, signing, stamping, etc. One could be forgiven for forgetting that there’s a human being at the end of this process who’s going to ingest the contents of the box that’s going into the bag you’re putting on the shelf. How could having an accurate and competent checking technician not be a good thing? Imagine if the pharmacist could give more time and energy to thinking about the patients and their clinical care, rather than the dispensing process. The relationship, and the patients’ needs, rather than supply chain logistics, followed by a technical check. Interactions and issues could be raised by a dispensing and/or checking technician as needed. Not everything can be a priority.
“Priority: The fact or condition of being regarded or treated as more important than others.”
There seems to be an overall expectation that everything must be treated as a priority when one is working as a community pharmacist. This has driven my stress and anxiety to inordinately high and unhealthy levels over the years. Everyone unfortunately has paid a price for that, from my colleagues at work, to my friends and family at home. Fatigue and a necessary degree of detachment, along with a healthy focus on my family in more recent years, has allowed me a healthier level of detachment in more recent times. “How do you do it? There’s just no joy in it,” a colleague, who has since reduced their hours dramatically, asked me. There’s just “no joy in it”. Now, what would a joyful day-to-day working experience in community pharmacy be like for myself and my colleagues? I’ve been regularly asking myself since.
I’ve tried to carry my responsibility lighter, and temper my enthusiasm for perfection in all things, as well as managing my allocation of limited f@*ks to the most important elements of our job. Focusing on the excellent service we provide, and the work we do for those who avail of our professional services, has been somewhat energising, although I still do not have enough capacity to do everything I’d like to for patients, colleagues, and other people in my life.
The Minister has to review the pharmacy contract and put a new one in place within the next year or so, from what I understand. The most trusted and accessible community healthcare resource in the country. Let’s hope any new contract is supportive and progressive so that we can have an impactful, buoyant and extensive community pharmacy network for the Irish public, and our future generations of pharmacists. Wouldn’t it be great for everyone if there could be more joy in it at the same time!