CVS Health Corp.’s plans to transform into a 21st century health care organization is running smack into a twin reality: There are not enough pharmacists in the pipeline, and the ones the company employs are reaching a breaking point.
CVS pharmacists recently staged a three-day walkout along with colleagues at Walgreens and Rite Aid, a sign of intensifying unease about working conditions. Pharmacists across the country have reported widespread staffing shortages, safety problems, and overloaded work schedules.
These issues are intensifying at an especially fraught time for CVS, based in Woonsocket, R.I. The company has spent billions remaking itself from the country’s largest chain of pharmacy stores into a sophisticated health care conglomerate. A key goal is turning its thousands of stores into community clinics where pharmacists, doctors, and nurses work together to improve patient health.
But none of this works if the company can’t hire or retain its pharmacists.
“Pharmacists are burned out,” said William Shrank, who previously served as chief scientific officer and chief medical officer of provider innovation for CVS. “And the system has not really engaged them to really care for patients.”
Experts say the pandemic has pushed already overworked chain pharmacists to the edge. In addition to filling prescriptions for a rapidly aging population, they now administer vaccines, including those for COVID-19, influenza, and shingles.
Ideally, CVS could hire more staff to help pharmacists, using the revenue from selling toys, candy, and other merchandise. But pharmacy chains have reported weaker retail sales as consumers cut back on spending because of inflation. Making matters worse, pharmacies have been earning fewer federal reimbursement dollars for prescriptions.
“There is a critical need for pharmacists” but the business model is breaking down, said Burt Flickinger, CEO of Strategic Resources Inc. consulting firm in New York.
CVS knows it must confront a big problem.
“We face unprecedented demand and a clinical workforce shortage in the health care industry and are making targeted investments in our retail pharmacy business in direct response to feedback from our pharmacy teams,” Amy Thibault, a spokeswoman for CVS Health, said in an e-mail.
CVS plans to work over the coming year to improve training, allow teams to schedule more people per shift, and boost efforts to recruit more pharmacists and technicians as it begins to look beyond an emphasis it has placed on general retail in past years.
Placing pharmacies inside retail stores has traditionally been an awkward but beneficial arrangement for both enterprises. While waiting to consult with pharmacists about medications, consumers could also shop for deodorant, toothpaste, and shampoo.
With the proliferation of dollar stores and large discount chains such as Target and Walmart — many of which have their own pharmacies — CVS and its peers have struggled to keep their retail businesses competitive.
To draw more traffic, CVS and other big pharmacies over the years have expanded their retail options to include toys, clothes, electronics, and even frozen foods.
But the landscape is growing ever more challenging. Online players including Amazon, which already poses stiff retail competition, have launched their own pharmacies. The fierce competition has narrowed already thin profit margins.
In response, CVS, originally known as Consumer Value Stores, has been trying to pivot its business to what it describes as a “value-based” health care model. This strategy emphasizes providing services to wherever consumers need it — at home, urgent care center, or retail store — and to measurably improve patient outcomes.
CVS and health care professionals would get paid based on the quality of service they provide rather the number of services as it is now.
Pharmacists would play a crucial role in this strategy, given their daily interactions with patients.
“When people need to go get a test done, you don’t need to go to the emergency room,” they can go to CVS locations, chief financial officer Shawn Guertin recently told investors. “Those stores might start to look a little bit more like urgent care clinics. They could have more of a retail presence, but it might be very health and wellness focused.”
CVS hopes to use technology, including electronic medical records, to seamlessly coordinate care among doctors, nurses, and hospitals.
“Everyone should be collaborating as a team to optimize the health of the patient,” Shrank, the former CVS executive, said.
However, Shrank, now a partner with the Andreessen Horowitz venture capital firm, said CVS and other providers have not moved fast enough. Progress “has been a little slower that we had hoped,” he said.
One event that seriously complicated matters was the global pandemic. In many ways, the coronavirus outbreak helped convince the public that pharmacists could do more than just write prescriptions. For patients, pharmacists became an important lifeline to the latest news and treatments for the virus.
However, analysts say the companies did not harness the potential of that moment by hiring enough people, especially pharmacy technicians, who help pharmacists fill prescription orders and serve customers.
“They should have been expanding staff instead of cutting,” Flickinger said.
Indeed, pharmacy chains have been closing stores and cutting staff hours. In 2021, CVS said it planned to close 900 stores nationwide over the following three years because of what executives described as changes in consumer shopping behavior, population, and the future of health care needs.
Meanwhile, retailers have been complaining about surging crime, especially organized theft, which has prompted CVS and others to place once ordinary items such as toothpaste and shampoo in locked cases. Some pharmacists have expressed fear for their personal safety.
Surveys by the American Pharmacists Association, a professional organization, indicate that members are highly unhappy.
The organization offers a confidential online reporting tool for pharmacists to report on their experiences. From July to September, the organization said, it saw a surge in reports that detailed “negative experiences,” including workloads, staffing shortfalls, and concerns over personal safety.
CVS’s issues are a sign of an industry-wide problem. Last year, the National Community Pharmacists Association, which represents pharmacists at independent pharmacies, released a survey that showed 76 percent of community pharmacists have experienced staff shortages in the last six months. Almost 90 percent reported difficulty filling positions for pharmacy technicians.
“All pharmacies are under stress,” said Douglas Hoey, CEO of the National Community Pharmacists Association and a pharmacist for over 30 years.
Whether independent or working for retail chains, pharmacists are facing the same challenges: too much work for too few people, Hoey said. Instead of talking with patients, pharmacists must also spend a considerable amount of time dealing with insurance firms, doctors, and pharmacy benefit managers, he said.
Furthermore, Hoey said, he’s worried about developing the next generation of pharmacists.
Over a 10-year period, applicants to pharmacy schools declined 60 percent to 40,552 in the fall of 2021 from 106,815 in the fall of 2011, according to data from the American Association of Colleges of Pharmacy.
At the Massachusetts College of Pharmacy and Health Sciences, 2,218 students enrolled in its pharmacy program last year, a 27 percent drop from 2018.
Pharmacy requires a major financial and academic commitment as students normally need to take about six years of rigorous coursework followed by a residency. So the current struggles of pharmacists might make students think twice about entering the profession, said Carol Spieckerman, president of Spieckerman Retail consulting firm.
“It’s bordering on a crisis,” Spieckerman said. “Word has gotten out that pharmacy is not such a great career anymore.”
Thomas Lee can be reached at firstname.lastname@example.org.