Episode 6: Perspectives from Retail and Health System Pharmacies

NHA’s national pharmacy technician advisory board members are industry leaders that represent all facets of the pharmacy workforce. This episode of OnScript with NHA shares insights from within both the retail and health system pharmacy environments related to the expanded scope of practice. Co-hosts Jeremy Sasser and Jessica Langley discuss with these industry leaders key trends impacting the profession, such as professional development and career laddering opportunities. The discussion highlights the importance of elevating the roles of both pharmacists and pharmacy technicians in tandem for the purpose of taking better care of patients.  All members of the team need to have shared goals associated with improving health outcomes, improving practice safety and medication use process in order to help the team work more effectively.

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Jeremy Sasser:
Pharmacy Podcast Nation. This is Jeremy Sasser, host of On Script, the only podcast dedicated to the pharmacy technician workforce. Very excited today because we're wrapping up our pharmacy technician advisory board meeting and we are lucky enough to have some great representation across multiple settings in pharmacy practice.

Jeremy Sasser:
But right now I wanted to get right into a few of our members that are here representing community pharmacy practice from some of the retail chains. I have with me, Adrian Laurie, in Charlotte. If you guys wouldn't mind, just introduce yourself, who you're representing.

Adrian B.:
Sure. My name is Adrian. I am a Clinical Services Manager with Walmart Pharmacy and I practice in Ohio, Pennsylvania and West Virginia.

Lori Wamsley:
And I'm Lori Wamsley with Walgreens. I am the Senior Manager of Pharmacy Affairs based out of Arizona, but I work with hoards of pharmacy all over the United States.

Charlotte W:
I'm Charlotte Whaler. I'm the Health Services Manager for Brookshire Grocery Company. We're a regional grocery chain based out of Texas, Arkansas, and Louisiana.

Jeremy Sasser:
Fantastic. Well, I can't thank you guys enough for being here and for participating in the advisory board meeting for this year. We get great insights from you guys and get great direction. I just wanted to get right into this. So retail pharmacy practice is as challenging as ever, and busier than ever. What's driving the demand?

Adrian B.:
I think part of it is healthcare is just doing a better job of diagnosing chronic diseases, and hopefully getting them earlier. It really drives the demand for retail pharmacy.

Adrian B.:
The other thing is, I think a lot of people are looking to the internet to answer some of their questions and it's not always the greatest place. That's sort of the wild wild west of healthcare.

Jeremy Sasser:
Right. Dr Google.

Adrian B.:
Right, exactly, and so that drives a lot of questions to our pharmacy and that always increases the demand for services.

Jeremy Sasser:
Definitely.

Lori Wamsley:
I think, really, where the drive is coming from is two different items. First off, the population is obviously growing. There are more seniors now than there ever has been before. The baby boomer population is getting older and reaching retirement age. When you look at statistics from now until 2030 there are approximately 10,000 baby boomers each day, that will hit retirement age. All of these patients take more prescriptions than the average patient does today.

Lori Wamsley:
The other area that I think is really causing the evolution in pharmacy is around the scope for retail pharmacists and technicians is continuing to grow across the United States, when you look at it. Pharmacists are gaining more prescriptive authority via statewide protocols, collaborative practice agreements, and autonomous prescribing authority for a variety of drugs and conditions.

Lori Wamsley:
Additionally, as pharmacists and technicians are playing a bigger role in improving patient outcomes through adherence based activities, so really driving additional work into the pharmacies as those scopes that start to continue to expand.

Jeremy Sasser:
So it's kind of shifting into more of the primary health space, a destination that could potentially be primary care health.

Lori Wamsley:
Yes, so more than just dispensing pills in a bottle. There's a lot more activities that are occurring in retail pharmacies today.

Jeremy Sasser:
Absolutely.

Charlotte W:
I agree with Laurie. The population is... As the population ages, we're continuing to see an increase in growth in script volume. But I also think that a younger population is being more concerned about their health...

Jeremy Sasser:
Oh, good point.

Charlotte W:
...then in times past. So I think that that has also seen an increase in business and questions with people being more proactive about their health.

Jeremy Sasser:
Which is really a good sign. And I think the ACA, regardless of your stance on that, I think that's driven a lot more people to go do their annual checkup and they're probably catching a lot more things. Hypertension, high cholesterol, things of those nature that people don't necessarily feel like they're ill and then they find out these things and they get prescriptions for it.

Adrian B.:
Sure.

Jeremy Sasser:
So how is retail shifting? How is the retail setting shifting in... And what that shift, how do you see the role of your technicians changing in the retail space?

Adrian B.:
There's a huge change now in Ohio. Our technicians, our Certified Technicians, are allowed to do a lot more and as things get pushed down, and as our pharmacists are asking, answering more questions, or asking them to do more, it's a logical step to ask our technicians to do more, and NHA does a great job of advocating for advanced pharmacy technician roles. I'm really excited about that.

Jeremy Sasser:
Awesome. Yes. Thank you.

Lori Wamsley:
So more and more states, to Adrian's point, are contemplating the expansion of technician roles, and especially very much so in the retail space. For example, there are now three states that allow for technicians to administer immunizations. Whereas before, that was only done by pharmacists. They can do that under the supervision of the pharmacist as long as they've been trained. Allowing technicians to help perform items at the top end of their scope is awesome, will help to alleviate some of the pressures that our retail pharmacists feel today.

Jeremy Sasser:
Definitely.

Charlotte W:
Definitely healthcare is, as far as pharmacy, it's changing. It's moving to more outcomes-based for patients.

Jeremy Sasser:
Yes.

Charlotte W:
Pharmacists have to have the time freed up to be able to interact with patients. As that moves forward, there has to be a shift in duties from what the pharmacist typically did in the past, to what technicians can do. We need to further advance technicians to allow them to practice at a higher level, to free pharmacists up, to be able to interact with patients.

Jeremy Sasser:
You're absolutely right and as it shifts, the dispensing volume doesn't decrease, it stays the same or increases, oftentimes. Now we're just asking pharmacists to do more. Somebody has got to be there to do that kind of back log work that pharmacists were traditionally doing. I think advancement of technology oftentimes makes it a lot easier now. Things like final product verification, in states that allow that in the community setting. And just the advent of more and more e-scribing becoming more prevalent, especially now for controlled substances and even C2.

Jeremy Sasser:
So, I remember a day back when I was practicing, where most of the prescriptions that came in were either verbal orders or they were handwritten prescriptions. I think that shifted now to be even more e-script driven than anything else.

Adrian B.:
Yes, there's been a huge shift in that, for sure.

Jeremy Sasser:
One of the things that we've discovered, talking to industry, education, all across the board, one thing that's been a constant struggle is math. Technicians are afraid of math, oftentimes. Instructors, trainers, sometimes don't know how to present it in a way that resonates with those technicians. How do your organizations take a new tech... I use a term that I heard yesterday that I absolutely loved, technician protoplasm. You take a brand new technician, you're kind of training them up. What kind of things do you guys employ to get over that math hurdle that seems to be so prevalent?

Adrian B.:
It's certainly very difficult. We use a combination of computer based learning and on the job training. But it's always a struggle. I think that some of the things that we were talking about here today, that sometimes it's just that mental hurdle that people think they can't do it, and finding the right way to teach that person, because everyone learns differently.

Jeremy Sasser:
Definitely.

Lori Wamsley:
We do it the same. We do a combination of hands on and online learnings. But, to your point, everybody learns math differently. It's very difficult for somebody, if you understand it one way, to teach it in a different way that maybe isn't how you think, and to really find a way that resonates with every single person. That's a challenge because a lot of it is just based on who the instructor is and who that pharmacist is in the store that's teaching the technician, and maybe it's not how they learn.

Jeremy Sasser:
Sure.

Charlotte W:
We do a combination of both as well. In the past, I also taught a live math class. It was typically about eight hours worth of content. But at this point in time, it just doesn't make sense for me to be able to be out of the office to do that, and have technicians come in from three states to do that. Opportunities where there is a different format that they can actually learn and having different ways of presenting that material is amazing.

Jeremy Sasser:
Sure. And quite frankly, all training in pharmacy, there needs to be kind of a bifurcated approach where you have that didactic content, whether that's from an online source or a textbook. But also there needs to be some level of engagement and mentorship from more veteran technicians or a pharmacist, to kind of allow technicians while they're learning that material to see how it's applied in a real world setting, and not always relying solely on a computer to do those calculations for them, or what have you, so...

Adrian B.:
Absolutely, and we certainly lean on our more seasoned techs to try to fill some of those gaps that exist.

Jeremy Sasser:
Fantastic. Anything else you guys would like to just push out there regarding technician workforce in the retail space?

Adrian B.:
Work hard and be nice.

Jeremy Sasser:
That's a good one. That's a good one.

Charlotte W:
Technicians are a valuable part of our profession. Can't stress enough that pharmacy profession wouldn't exist without them, and just they need to know that they're valued.

Jeremy Sasser:
Awesome.

Lori Wamsley:
I would a hundred percent agree with you, Charlotte. The other thing I'd like to point out is expansion of tech roles does not mean the elimination of pharmacist roles. Community pharmacy is evolving so quickly, and it's so important that we elevate both the practice of the pharmacist and the practice of the technician-

Jeremy Sasser:
Definitely.

Lori Wamsley:
...and to improve patient care and also to improve the working conditions for everybody. It's very important that we look at elevating the roles of both individuals, and doing that in tandem. Really for the purposes of taking better care of patients.

Jeremy Sasser:
Absolutely. Improving health outcomes, improving practice safety, medication use process, all of that. We all have the shared goals, so...

Adrian B.:
Career satisfaction, for sure, for everyone.

Jeremy Sasser:
Yes.

Charlotte W:
Absolutely.

Jeremy Sasser:
That is, that's true. I mean, you do a whole episode on burnout. There's been a lot on that for both pharmacists and pharmacy technicians.

Jeremy Sasser:
Guys, I just appreciate you guys so much for being here, for joining me on this podcast, and look forward to talking to you guys more in the future.

Adrian B.:
Thank you.

Charlotte W:
Thanks for having us.

Jeremy Sasser:
So I want to continue now with some additional pharmacy technician advisory board members. We are lucky enough to have at NHA and joining me from a different pharmacy setting, joining me with institutional settings. I have Kristy and Denise. Would you guys go ahead and briefly introduce yourselves and just tell our audience where you're from?

Denise:
I'm Denise. I work at the University of Michigan. I'm the Research Pharmacy Technician Coordinator.

Kristy M:
I'm Kristy Malacos. I am the Pharmacy Administrator and Purchasing Director at Magruder Hospital, which is in Port Clinton, Ohio.

Jeremy Sasser:
Great. So let's just get right into it. How has the job of a pharmacy technician in the hospital kind of evolved over the last 10 years, or however long you guys have been in practice?

Kristy M:
I think from a hospital standpoint, the clinical scope of practice of pharmacists has really expanded, which in turn, you've seen increases then in technician advanced roles, such as some states have Tech-check-tech, they're able to do. Med rec, ER technicians. 340b is a big expansion. I think the role has become a lot more diverse because being a hospital pharmacy technician doesn't mean you do the same thing every day, or you're going to do the same thing in one facility to another.

Denise:
I think that technicians in hospitals have to wear many hats and do a lot of different things. To Kristy's point, there are a lot of opportunities in the hospital for technicians in a variety of different roles, and there's more coming every single day.

Jeremy Sasser:
That's a great point, and one thing that institutional settings have done really well that maybe retail community pharmacy maybe lagging in a little bit, is the development of a career ladder for technicians, right? So they can come in kind of at an entry level, but know that they can work up to something else, work towards an ultimate area of the hospital, or interests that they might have.

Jeremy Sasser:
How do you guys at your institutions, what kind of career ladder exists?

Denise:
We have three or four different levels in our career ladder. The first level is an entry level technician, where they are kind of just learning what the job entails. We have onsite training, as far as getting them acclimated to our systems. Then there's a higher level, which is an intermediate level and that's where you are performing at a little bit higher level, maybe taking on some extra tasks. And then there's a senior level where you might be involved in some specific projects that are... you're giving ideas to your management people about how to improve processes, things like that.

Jeremy Sasser:
So it sounds like for your institution, it's very much based on the desire of the technician to want to climb up that ladder and do more and take on more responsibility. And it's also, allowing them to do that is merit based in the sense that you can see that they have that drive, they have the knowledge and it's not just, Hey, you've worked for 1500 hours, so now you get bumped to the next level. And then when you work another 1500 hours, you get pumped to the next level.

Denise:
That's correct. The managers encourage them to climb the ladder. We would give them projects and ideas on how they could do it based on where we see their strengths and their skills.

Jeremy Sasser:
Great.

Kristy M:
Our ladder is set up similarly. We start as a entry level and then there is a, that's Tech One, and then there's a Tech Two and Three. What I really like about this is that it really is on the technician to own it. If you want to do it, you can. If you don't, you can stay at a Tech One forever and that's just fine.

Kristy M:
But part of it is taking on projects that involve safety, improving a workflow, improving efficiency or a cost goal. Doing these has really helped them invest and care, I think, more about their career and not just, I come in. I make IVs or I fill meds. They're more invested in the operations and safety. That's been really cool. We've had some really awesome projects as a result of that.

Kristy M:
So the next phase then, will be more of a specialization, which as a small hospital, we sort of already have that. So this is an opportunity to both reward them from a pay standpoint, as you increase the ladder, but also has a more defined you've been doing our buying for most of your career here, but we've never designated you as that. So it really gives them, I think, an opportunity to shine in what they enjoy and what they're good at.

Jeremy Sasser:
That's great. Denise, I've always really admired and been intrigued by the specific area that you work in, which is working with investigational drugs. I know that a lot of technicians that may be listening to this out there, have no idea that that is a possibility that that role exists, that that's something that's going on. Can you get into a little bit of what working with investigational drugs is and what it entails?

Denise:
Well, basically our pharmacy, we always call it a pharmacy within a pharmacy. We do everything that a large pharmacy does. We do purchasing. We do inventory control. We do exploration, recalls, all that kind of stuff. But we also, we make IVs, we dispense oral medications, we do all that. But we do it all with drugs that are very specifically regulated by the FDA. We have to not only incorporate the regs of the hospital, the regs of the FDA, and the regs of what the sponsor wants, so we're always kind of balancing all those three things.

Denise:
The technicians in our area do everything. They make IVs, they dispense oral medications, they do inventory, they receive packages, they do recalls, they do everything. We have a lot of, a lot more, I guess, paperwork than most because everything is very attention to detail and very detail oriented. We are quite large as far as that goes. One of the largest in the country as far as as research goes.

Jeremy Sasser:
Now, Kristy, I know that you do have a Baccalaureate and Post Baccalaureate degree, but you're a pharmacy technician by training. You've done a lot of writing for various publishers. Can you kind of just explain how your career path kind of took the road it did to the point where you're director of a hospital, as a CPHD.

Kristy M:
Yes, I feel pretty lucky every day. My boss is pretty innovative in thinking. He's a pharmacist and now the COO of the hospital. His idea for this role was to have a person that had maybe some pharmaceutical science background, and perhaps was a technician also, and then to really manage the operations. So becoming a pharmacy manager as a technician is definitely doable. It's interesting dynamic with managing pharmacists, but it's really fun to have the opportunity to grow with the pharmacy practice as a technician, but to really, what I feel like expand what technicians can do in my role.

Kristy M:
That's then morphed into managing 340b, opening a retail pharmacy, running a anticoagulation clinic. So now, I'm also the supply chain director of the hospital. Having that working together to integrate with pharmacy has been a really beneficial relationship. So I've been really lucky in what the opportunities... Denise talked about what a large facility... We're a pretty small facility, so you kind of have to wear a lot of hats. But that diversity just makes your job a lot of fun.

Jeremy Sasser:
That's great. And I, too, was lucky enough to have some really wonderful mentors that empowered me and had that not been the case, I don't think perhaps the career path that I took would have panned out. So it's definitely important to have that pharmacist that you can learn from. That they can be a mentor for you, but also empower you to really be innovative and think outside the box.

Jeremy Sasser:
So as we wrap up this episode, I just wanted to get two questions in for both of you. One is what is the best part about working in a hospital setting for you and what would be one thing you could recommend to a technician out there that's listening, who would want to land a role in a hospital and kind of start their career and move up?

Kristy M:
The best part for me, I mentioned earlier, is the diversity. I think there is something new every single day. I think a lot of us in the pharmacy practice love to learn, so I'm constantly getting to learn new things. Obviously regulation standards, all of those things change. So it's never the same. But it's something fun. It's fun, it's new, and it's interesting.

Kristy M:
I have pharmacy technicians that apply to our hospital that have never worked in hospital, and I'm always willing to interview them, and you have to start somewhere. But I think one thing for me especially that I always recommend is if you can learn 340b, you may not have any hospital experience, but if you can learn 340b, there's a lot of hospitals that that would impact, and that makes you a very valuable asset.

Jeremy Sasser:
Yes, definitely.

Denise:
I like the variety. Never a dull moment. Never... Nothing's ever the same. Every day is a new experience. And like Kristy said, you're always learning because everything changes all the time.

Kristy M:
Never bored.

Denise:
Never bored. So I think that if you were a new technician coming into the hospital space, I would say that you need to be very adaptable to change. I would encourage them to think of this as a career path, not as just a job. Think about ways that they can step up and maybe improve processes. Look at things because sometimes when you're coming in from somewhere else, it's a little bit nice to have fresh eyes.

Jeremy Sasser:
That's great. Yes, really embracing that growth mindset and be willing to take on change and adapt. I like how you put that. That's great.

Jeremy Sasser:
Well, I can't thank you guys enough for being members of our advisory board. We get fantastic insights from you guys and allows us to know what direction we should be heading and maybe what direction we shouldn't be heading. So we certainly appreciate your participation. I appreciate you joining us for this podcast.

Kristy M:
Thank you.

Denise:
Thank you.

Jeremy Sasser:
For those of you who are out there listening, don't forget that you can contact us by email at OnScript@nhanow.com, and you can subscribe to these podcasts via the Pharmacy Podcast Network by going to pharmacypodcast.com or going to our blog at www.nhanow.com/learning-leading.

Jeremy Sasser:
You'll find our blog, great content, maybe even some content from people you've heard be interviewed on this podcast, as well as the podcast itself. So until we are back on here, thank you for listening. Take care.