Tuesday, February 15, 2011


Nope. Today's not going to be a diatribe on how pharmacies should be staffed. I'm not going to go off on how short-staffing a pharmacy leads to errors. Maybe another day.

Today I'm going to share how oblivious some members of upper management are when it comes to the business of pharmacy.

At one point in my career, I was the pharmacy manager for a Wal-Mart SuperCenter. The pharmacy was open 12 hours Monday thru Friday, 10 on Saturday, and 6 on Sunday. Do the math... 76 hours per week.

We did anywhere from 1900 to 2400 scripts per week. Usually on the lower end but we would get busy from time to time.

We had three full-time pharmacists (only because we had two outstanding applicants at the same time, and this was an extremely hard to staff store... otherwise we would have had 2-1/2) and six technicians (actually five plus a summer-only intern). We were staffed well. On a typical day we had two pharmacists and 4 techs in the store.

For those of you not familiar with Wal-Mart's dispensing system, it is very labor intensive. The first step involves scanning the hard-copy prescription and entering the data into the computer. This takes one or two techs, depending on the volume at the moment. The data then goes to a pharmacist for a 4-point check where the RPh checks the tech's work.

From there the prescription gets transmitted to the third-party. If the claim is rejected, either a pharmacist or technician can resolve the issue. Once the claim adjudicates, it goes to the filling stage. We usually needed two techs to be working on this. Then back to the pharmacists to be visually verified. From there it went down to the will-call bin by the cash register, which was manned by another tech. If a patient needed counseled, we had two privacy windows for the patient to speak with the pharmacist.

At our store, to make the pharmacy run smoothly we needed to have two pharmacists and four techs in the pharmacy at any given time. During lunch breaks it was a little more hectic, but we could manage. A pharmacist would usually help out with some of the tech duties.

Well the powers-that-be from higher up the corporate ladder determined that we were overstaffed. We needed to eliminate two technician positions and split one of our pharmacists with another store. Well the one pharmacist was pregnant and had the baby so we lost her. I let the intern go and released one of the other techs, the one who usually covered the pick-up area. So now we were down to two full-time pharmacist and four technicians to cover the 76 hours that the pharmacy was open.

Wal-Mart had a couple policies that made staffing very difficult. First... no overtime. Period. Second, no hourly associate could work more than five consecutive days, even if the shifts were less than four hours.

You can imagine how much fun it was to try to schedule 4 technicians to adequately staff the pharmacy. 160 tech hours per week to cover the 76 hours that we were open, on a system that requires 4 technicians to function smoothly. We were able to grab a floater pharmacist for 10 hours per week, so we did have some overlap.

I don't know how I did it, but I was able to put together a schedule that somehow covered the pharmacy. I actually broke down the day-by-day volume and determined where we could get by with only three techs. Of course the pharmacists were doing more of the tech duties, but we were a team and it worked. I set the schedule up so that I rotated on a four week rotation. That way the techs could plan on which days and weekends they would have off. Everybody was happy.

Until one day when I went to the office to write the next week's schedule.

You see, Wal-Mart's scheduling software would schedule associates based on when the cash registers were busy. The assumption was that you needed to have more associates on hand when the customers were handing their money over to the cashiers. That works great for the general merchandise aspect of the business, but pharmacy is different.

Over my time at the store, there was never a schedule that was generated that covered the pharmacy anywhere near adequate. That's why I created my four-week rotating schedule. It covered our busy times in the pharmacy and accounted for the lulls that happen during the day and week.

On this day, I walked back to the office to enter the schedule into the computer. As I sat down, the DM for the entire store walked into the office. He saw that I had my hand-written schedule and was starting to enter it into the computer.

He came back and asked me what I was doing. Of course I told him that I was putting in the pharmacy schedule. He questioned me why I wasn't using the computer generated schedule. After all, the computer knows everything.

Except the business of pharmacy. The only factor that the computer used in determining pharmacy staffing was when the prescriptions were actually rang out of a register. We all know that mornings are hectic in the pharmacy, mostly from the overnight refills. Then the evening rush happens as everybody comes in to pick up their medications that either they or their physician called in.

For this particular schedule, the computer said to staff the pharmacy with 5 technicians (remember I only have 4 now) from 6:30 PM until 8:30 PM on Monday. We closed at 8:00. It also said that I only needed one technician on Monday from 11:30 AM until noon. Zero techs for the rest of Monday, at least until 4:00 PM. Aren't Monday mornings usually a little busy? But since the actual sale didn't occur until the prescription was rung thru a register, the computer didn't know how to schedule.

The store's manager and two assistant managers were with the DM. They knew that I had turned in my resignation the previous Monday and that this was the last schedule that I would write. But we sat there and let the DM go on for 45 minutes about how awesome the scheduling program was. When he finished, I told him that the next day was my last day with Wal-Mart.

When I returned to the pharmacy department, everybody questioned me why it took so long to put in the schedule this week. I told them what the DM had done.

We had a good laugh. This DM could be the worst one that I ever had.


Anonymous said...

I subbed in a Walmart four times....It was do-able (barely) until the third time when the store manager decided it would be the perfect time to pull two of three techs for mandatory training leaving me to literally flounder. Did one more shift and left Wally's to their fate. My wife won't go in the local one anymore..claims it smells..at least they don't have a drive up.
Hoooorst Wessell

The Redheaded Pharmacist said...

My time with Walgreens a few years ago was just as frustrating. For a brief period I was PIC while at that company and that might have been the biggest mistake of my career. They had some ridiculous scheduling function that would do the same poor job at schedule creation as you describe here. And upper management tried to make it mandatory to use that function to create the weekly schedule.
I really think this is what is wrong with pharmacy and with America as a whole. We have idiots who are out of touch with reality running the show. My current employer has implemented some recent policies that quite literally a blind monkey could pick apart and tell you why they won't work and yet here we are trying to do these things and still do the jobs they hired us to do. It is both frustrating and disheartening at the same time.

Anonymous said...

I wondered why there was such a shortage of pharmacists working at Wal-mart.

When I worked for agencies, this chain was the one I most frequently worked. I thought the computer system was awesome for a pharmacist to 'come in off the street' and really be able to have an idea of what they were okaying to go out the door. When I worked, it was usually by myself for a good part of the day, occasionally one other pharmacist.

Techs came and went all day long in order to fulfill their mandatory breaks and no overtime (good thing, too, because it was crazy-busy and if they'd not been penalized for not taking breaks they would've never been able to tell customers that they had to take a break).

One crazy time I worked a Wal-mart shop where cashier help was pulled off the floor to help out. The one that came over had a completely rotten attitude and was overly sympathizing with patients about how long scripts were taking to fill, and so there were milling crowds of yammering patients within earshot with the techs slamming things and this rude cashier yelling trashtalk. The floor manager came in the shop and demanded to know who I was and what was taking so long to fill prescriptions. I felt it would not be a pretty sight if I told him that if he did not remove himself from my work area immediately, I was closing the shop, and leaving. By that time I was past exploding, and just resigned to showing him very politely what was going on. He left rather quickly, when he saw the organized operation, phones ringing, and the stack of work piled up and realized he could not do a single thing about it.

Mike said...

Good God... "scanning," "filling stage," computer-generated schedules. Eric, this is a great post and it reminds me why I work for an independent and always will!

Take the prescription from the patient, fill it, bill it, chat with them about it, and get them out the door.

There is no reason for it to be more complicated than that.

Anonymous said...

I work for a large chain. Most mornings it is just me and a tech until 12:30 pm. We have 2 drive thru lanes and fill about 1200 a week. Yesterday morning I had our slowest tech, 2 compounds and a boatload of CII's. I can't take it anymore. I am thinking about law school.

bcmigal said...

I work for a national chain that ate a regional chain. Our tech hours were immediately cut and are now down to 120/week. Today, the pharmacist is alone for nearly 2 hours, 1st tech works 10-5, 2nd tech 1-9, with an "overlap" tech 4 to 8. From 4-6pm both techs work the register leaving the pharmacist to type,fill, check, answer the phone, and resolve insurance.

My dad worked in a factory and was able to "retire" at age 58. Sometimes, I think that was a better way of life.

Anonymous said...

I also worked at WalMart in a previous life. But the store where I worked did about 3-4000 scripts in a week. What a nightmare! At least the store manager stayed away from the Pharmacy. One of my favorite things was the way the techs and/or cashiers became locked out of the Pharmacy system or registers, if they hadn't taken their breaks on time. Came in one morning with 572 in the queue for filling before we even opened. That scheduling program was not enforced by our store manager. Good thing, since we never would have ever got any of the scripts to that point.

Woody said...

I am also concerned about the practice of pharmacy and the degradation of it by high volume, low staffing discount pharmacies. I worked in it for 3 years. The good news is that the experience strengthened my desire to help the elderly with their prescription management. I am trying to figure out how to make a living (not a killing) helping the elderly, e.g. MTM services. Any one else doing this?

Mike said...

This is great insight into the mind of a pharmacy manager. It must be very difficult managing the hours, and also having to follow guidelines such as no overtime PERIOD.