Bonnie Woody became a pharmacist, sometimes known as the “most accessible” health care professional, largely for the patient interaction. 

She’s worked at the same store now for more than a decade — the Tom Thumb pharmacy at South Hulen Street and Bellaire Drive in Fort Worth. “That’s a lot of life lived with people, both good and bad,” she said. 

When the pandemic began, Woody watched as lines of people wrapped around the grocery story. A self-described “helper,” she did what she could to assuage her patients’ fears. No, she couldn’t help them stockpile medicine. Yes, the pharmacists would still take care of them. When some of her patients contracted COVID-19, Woody personally dropped medications off at their homes. 

But as COVID-19 tests and then vaccines and then boosters became a necessary addition to Woody’s workflow, other tasks, like taking inventory, fell by the wayside. Longstanding pharmacy offerings — like walk-in vaccines — came and went. “​​I have patients that literally I have done every shot for them for a decade that I’m having to tell, like, ‘Pam, I’m sorry, I can’t do this for you. We have to do it by appointment because we’re short-handed, yada yada.’

“For me, personally, I deal with a lot of guilt feeling like I’m not taking care of people because I’m having to, I know it’s dramatic, but I’m having to ration care to some degree,” Woody said. 

Woody worries not only about her patients, but about her profession. Along with pharmacy employees around the country, she’s joined a pharmacy labor movement called #pizzaisnotworking to draw attention to how pharmacy work conditions hamper patient safety and staff wellbeing. The hashtag, which started with a weary Facebook post from a pharmacist in Oklahoma, refers to the inadequacy of pizzas, sent as thank-yous, pharmacies received from their employers during the pandemic. 

But the issue is complicated, as is the fix, according to Emanuel George, a pharmacist and associate professor at The University of North Texas Health Science Center. The movement taps not only into corporate practices, but federal and state legislation — as well as misperceptions from the public about what pharmacists do.

“When we talk about health care burnout, we hear about doctors and we hear about nurses and we hear about all of that from a hospital perspective,” he said. “But sometimes we overlook the ones who are literally keeping communities alive on a day-in, day-out basis, on a month-in, month-out basis. And that’s where the community pharmacists come in.”

‘It’s not just lift, stick, count, pour”

These community pharmacists, or people who work in public-facing pharmacies within drug stores or grocery stores, aren’t simply “human vending machines,” George said — but the public and, in some places, state law, sometimes treats them as such. 

“We don’t go to school just to match pills,” he said. “We know the chemistry of how (a medicine) works in your body, the interactions, the dangerous side effects of the medicines that can affect individuals.”

To become a pharmacist in Texas, a person must graduate from a college of pharmacy — such as the one at The University of North Texas Health Science Center — with a bachelor’s or doctor of pharmacy, which both take at least five years to obtain; complete an internship of 1,500 hours and pass a licensing exam from the Texas State Board of Pharmacy

The exam requires knowledge not only in sciences like pharmacology and chemistry, but also pharmacy law. 

“People are just amazed when they move to Texas and want to start practicing. Most states have a law book that’s about a quarter of an inch thick,” said Carol Reagan, a pharmacy consultant in Fort Worth. “Ours is about an inch and a half.”

The licensure process prepared people like Woody and Reagan, who began practicing as a pharmacist in the early 1990s, for a slate of daily tasks that span from counseling people on their medications to policing the distribution of narcotics. 

“There’s just a vast amount of stuff that we do — it’s not just lift, stick, count, pour,” Reagan said. 

The ability to practice ‘at the top of our license’

“Scope of practice” laws govern what pharmacists can and can’t do. In California, for example, pharmacists can prescribe, rather than simply dispense, birth control. In Texas, they can’t. 

Over the years, those laws have expanded the services pharmacists can provide. For example, when Reagan became a pharmacist in 1994, pharmacists didn’t provide vaccines. By 2009, all 50 states allowed it. 

As an industry, pharmacy needs to better educate patients on “the value of the pharmacist,” George said. But, he said, legislation needs to recognize it, too — and allow pharmacists in every state to practice “at the top of our license.”

That means further expanding the services pharmacists can provide, and allowing them to be reimbursed for those services. For example, a bill that would have allowed pharmacists in Texas to “test and treat” — or test and then provide medicine under a physician protocol — patients with flu or strep, didn’t make it to law in this year’s legislative session. 

Increasing pharmacists’ scope of practice would, rather than giving them more work, allow them to delegate less complicated tasks like dispensing pills to their pharmacy technicians — or, even, literal vending machines, he said. 

“Think about when you go see your physician,” George said. “Your physician’s not the one who does the blood pressure, checks your vitals … They come in, and they’re able to work with you based on their expertise, their knowledge and education. And they get reimbursed for that.”

‘We hope we didn’t miss something’

Increasing the value of the pharmacist in the perception of the public and the Legislature is only part of the battle. 

For Woody, the other issue is time. She’s been short-staffed since June, and the staff of pharmacy technicians she does have is likewise burnt out. “The toll has hit them just as hard,” she said. 

Woody works 12-13 hours shifts with no designated breaks. 

“By the time I take care of each vaccine patient,” she said, “I pretty much only have time to get caught up on helping sick people: dispensing medicine, verifying orders, counseling.”

She’s not surprised when she hears about pharmacy errors in the news.

“On those really extra busy days, my partner and I both discuss, we’re nervous, we’re scared — we hope we didn’t miss something,” she said. “And I would just like an environment where I could know that I fully reviewed everything to my best.”

The changes she’d like to see — enforced breaks, for one — could come at the individual company level, she said. For example, Walmart requires its pharmacists to take a 30-minute lunch break. 

In a statement to the Fort Worth Report, a spokesperson for CVS said that, “while our pharmacists have always had the ability to take breaks, we’ve begun the process of adding a prescheduled daily break time to create a predictable and consistent daily pause while minimizing disruption to our patients.” Walgreens has similarly “increased shift breaks for our team members to provide needed rest,” according to a spokesperson from the company. 

Albertsons Companies, which owns Tom Thumb, could not be reached for an interview.

Ultimately, Woody advocates cementing the requirements in state law.

Workplace protections for pharmacists differ by state. In Texas, state law doesn’t require employers to give breaks to employees. California’s labor law specifically references pharmacists, requiring they get multiple breaks, including lunch, throughout the day. Similar requirements exist in Minnesota.

Woody has seen “person after person leave the profession” from burnout. Her own husband has told her he doesn’t think her work is sustainable. 

“And I think that says something when you have an indoor, computer-based job and you’re being told, ‘This isn’t sustainable,’” she said. “I’m not digging ditches.”

In early December, Woody met with a representative from the Texas State Board of Pharmacy. She’s hoping the board convenes a task force to study workplace conditions — and consequent errors — in Texas pharmacies. The board declined an interview with the Fort Worth Report for this story.

The meeting was promising, she said, but she expects progress to be slow. In the meantime, she’ll be at work. 

“I have no desire to leave pharmacy,” Woody said. “I want to be a lifeline for my patients. But, man, it wears on you.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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