A new report has laid bare the anger and frustration that many pharmacists are feeling about their pay and conditions. How can the profession respond?
In March 2021, the union for employee pharmacists released its latest report into pharmacists’ pay: the Community and Hospital Pharmacists Employment and Remuneration Report 2019-20.
The Professional Pharmacists Australia (PPA) report revealed that many Australian pharmacists are unhappy: with their pay, with their conditions, and with their prospects.
The report stated that discount pharmacies—including My Chemist (part of the My Chemist/Chemist Warehouse group) and Discount Drug Store pharmacies, alongside Chemist Warehouse—are paying staff at least $4 an hour less on the basis of median hourly earnings across classifications, when compared with other community pharmacies.
PPA’s Dr Geoff March took particular aim at the discount community pharmacy model.
“The discount pharmacy model is driving pharmacists away from the industry and jeopardising the future of the profession,” he said.
“Discount pharmacies have driven down wages and conditions, and cut staffing levels to the bone.
“The demands of high script numbers, and the relentless pressure to delivery of professional services fast, contribute to unstainable workloads which result a high stress environment which undermines pharmacists health and wellbeing.
“Pharmacists working in discount chains like Chemist Warehouse, Discount Drug Store and My Chemist are receiving a staggering $4 an hour less than pharmacists elsewhere doing the exact same job.
“Over a standard 38-hour week, that’s $152 or over $600 a month less than other pharmacists in the same profession and that is simply unacceptable.”
A sector in crisis
“It’s no secret community pharmacists are concerned about their wages,” said Chris Freeman, national president of the Pharmaceutical Society of Australia.
“Many of the reports we hear relate to pharmacists who want to do more to support their patients, but not having the time or recognition in their practice to be able to do this.
“I recognise we have many members who feel they have been asked to do more yet are paid less in real terms as wages fail to keep pace with inflation. This problem is real: it is unsustainable and cannot continue.”
He said that as outlined in PSA’s Pharmacists in 2023 report, a pathway towards fairer remuneration would include the broader adoption of the advanced practice framework.
“As a sector, we must all work together on this to see this achieved. It is one of the few ways in which we can create career pathways which recognise the experience, expertise and skill which grows as your practice advances.”
But “the money to pay for this has to come from somewhere”, he added.
Dr Freeman said it was important the industry award keeps pace with professional contribution.
“It’s also why remuneration structures need to incentivise quality and impact, as well as volume.
“In nearly all parts of practice, the costs of additional pharmacists are usually a lot lower than the costs of prevented medicine safety problems—such as hospitalisations. We need to recognise that more complex clinical reasoning sometimes requires more time, and it requires remuneration which recognises the complexity and patient value of the care provided.”
The report paints a picture of a sector in crisis, Dr March said.
“For pharmacists, financial stress puts enormous pressure on family relationships, and has led to sleep and mood disorders.
“The injustice of being poorly paid and not properly recognised for the incredible work they do, particularly throughout the intense pressure of the COVID-19 pandemic has been a significant factor that’s undermined the mental health of pharmacists.”
The hospital divide
Significant differences were revealed between the community sector and the hospital sector—and not just with pay.
Pharmacists working in hospitals and covered by enterprise bargaining agreements could expect a median salary of up to $7,500 more each year—or up to $8 an hour higher—than those working in community pharmacies.
The median rate of pay for a community pharmacist was $38 an hour, the report says, compared to $46 for a hospital pharmacist.
“As fundamentally different working environments with different funding models, remuneration of hospital and community pharmacists is subject to different negotiations and agreements,” explained Kristin Michaels, chief executive of the Society of Hospital Pharmacists of Australia.
“In a macroeconomic sense, there are basic market forces at play as there are fewer pharmacists with the clinical experience required to undertake hospital pharmacy practice, compared to the larger pool of pharmacists who are working in, or are ready to work in the community setting.
“This reflects the demands of hospital pharmacy practice, in which medication-related adverse events can have more serious consequences as pharmacists provide care for the most acutely unwell patients with more complex co-morbidities and urgent clinical needs.
“We’re also seeing growing recognition of the importance of medication safety that has touchpoints with all areas of hospital care, not just pharmacy departments, and recognition of pharmacists’ importance to contribute to system-wide governance on safety and quality.
“As part of this, stewardship roles —that is, subject matter expertise on antimicrobials, opioids, anticoagulants, etc—are also increasing in prevalence.”
Should I stay or should I go
Up to 30% of pharmacists at some groups are intending to leave their employment, the PPA report found.
It noted that years of downward pressure on wages, “hazy career progression” and a lack of recognition have had a negative effect on morale—and only 28% were willing to recommend the profession as a career.
This varied across banner groups, from 15.1% from those employed by the discounters (DDS 11.8%, Chemist Warehouse 14.5%) to a high of 31% at TerryWhite Chemmart and 30.6% at Amcal/Amcal Max.
Hospital pharmacists were happier, with 44% saying they would recommend the profession—varying from 50% directly employed by public hospitals, to 40% of Slade, 33.3% of Epic, 23.5% of HPS pharmacists and 16.7% of “other” hospital pharmacy employers.
The report looked at pharmacists’ plans for their careers: and found that 30% of those employed by discounters said they intended to leave the profession within the next five years.
A still significant 13.7% of pharmacists employed by other banner groups said they intended to quit, as did 8.9% of hospital pharmacists.
“Poor pay, stress and a lack of support, particularly amongst the discount chains continues to ferment a crisis in the sector that will see talented individuals abandon pharmacy for greener pastures,” the report warned.
A stark response
An AJP reader poll showed even starker results. At the time of writing on 7 April, a vast majority of readers had said they wanted to leave pharmacy.
We asked community pharmacists whether they worked at discounters, or non-discounters, and whether they planned to stay in the profession for five years.
Our poll showed that 26% of respondents worked for discounters, and 74% for non-discounters.
Of the total respondents, 21% (173 readers) said they worked in discounters, and planned to quit the profession within five years, while another 5% were discount workers who planned to stay.
Just over half (51%, or 414 readers) worked for non-discount chains and plan to leave. The remaining 23% were non-discount employees who planned to stay.
As for recommending pharmacy as a career, only 13% (2% discounters, 11% non-discounters) said they would do so.
Meanwhile a quarter of respondents—214 people who worked for discount pharmacies—said they would not, as did a whopping 61% of respondents (530 people) who worked at non-discount stores.
“The results confirm that the pharmacy sector is in crisis,” said PPA’s Geoff March.
“Consistent surveys over several years have shown pharmacists are deeply unhappy with their pay and working conditions and these grievances are not just confined to the discount pharmacy sector.”
He said that pharmacy employers need to “take their heads out of the sand” and address the problem.
“The pharmacy sector must improve wages and working conditions, generate proper career pathways for pharmacists and create safe workplaces,” he said.
Even pharmacy groups with better pay and conditions can find it difficult to recruit pharmacists.
UFS CEO Lynne McLennan said that it was understandable but disappointing that a bad experience early in a pharmacist’s career can put them at risk of leaving.
“I’ve been the CEO here for 20 years, and I have been concerned about the increasing difficulties in recruiting pharmacists, and the number leaving the profession,” she said.
“Particularly when young grads come into a profession like pharmacy and they’re full of hope and promise, it’s really sad if their first job is not a great experience that can sour them on the profession,” she said.
She said that even offering some of the highest salaries and best conditions in the community pharmacy sector, “it’s still a struggle to recruit”.
“We have a modest turnover of staff, but we are growing and recruiting—and people are occasionally allowed to retire! We had a pharmacist retire late last year who started as a message kid. His father had been a pharmacist. He worked for us for over 50 years. So we do have people come here, and they like it.
“It’s just getting people through the door. Part of that is the regional factor [most UFS pharmacies are in regional areas]. We struggle to find interns as well, though there are more pharmacy schools in Australia than you can poke a stick at.”
Concern over conditions
The PPA report also covered the conditions pharmacists work under: do they have access to penalty loadings, lunch breaks, paid parental leave?
It found that access to penalty loadings for unsociable hours was more common for hospital pharmacists than community pharmacists, despite the fact that community pharmacy is more likely to see pharmacists working those hours.
In hospital pharmacy, 86.2% of respondents said they received penalty loadings during unsociable hours, compared to 59.9% of community pharmacists.
But the prevalence of these hours was 36% across all hospital pharmacists—compared to 52.1% of respondents who worked in community pharmacy.
The most likely to work unsociable hours were those employed by Chemist Warehouse (76%), TerryWhite Chemmart (63.8%) and Discount Drug Store (61.1%), while the least likely worked for Amcal/Amcal Max (37.8%), Guardian (33.3%) and UFS (29.4%).
“Penalty rates/employment agreements vary depending on the state or territory, and their effect in isolation would likely be minor, but they contribute to the overall appeal of working in hospitals, behind the high impact on patient care, supported career breaks, diverse career pathways and baseline remuneration,” said SHPA’s Kristin Michaels.
As for employment agreements, 93.3% of all hospital pharmacists worked under one, as did 80% of community pharmacists—but this prevalence dropped sharply for some banner groups, with only 59% of pharmacists employed by independent pharmacies, 50% of Blooms pharmacists and 44.4% of Discount Drug Store pharmacies subject to them.
Across all hospital pharmacists, 95.1% had written job descriptions, as did 72.9% of community pharmacists—but this dropped to 44.4% for Discount Drug Stores and 40% for Guardian.
Out to lunch
Across the community sector, around half of employee pharmacists worked through lunch breaks: 52.8% altogether, with those most likely to work through lunch being employed by Guardian (73.3% or TerryWhite Chemmart (72.4%).
The least likely was UFS, at 29.4%, followed by Chemist Warehouse at 34.7%.
Employer support for professional costs was 60.5% among hospital pharmacists, and 27.2% across community pharmacy.
Some pharmacists were more likely than others to be subject to prescription-based key performance indicators: from 34.7% at Chemist Warehouse and 32.5% at Priceline, down to 13.3% at Guardian and 11.8% at UFS.
In hospital, these were much less common, with only 12.2% subject to KPIs based on the number of scripts filled: from 40% at Slade to 5.6% at HPS.
Ultimately, it’s conditions and prospects as well as pay that can make or break a pharmacy career, stakeholders said.
“Our members tell us it is rewarding to see their patients improve during their hospital stay and satisfying seeing them empowered in their healthcare upon discharge,” said Kristin Michaels.
“The hospital team environment is also both personally and professionally supportive, with value placed on lifelong learning and multiple career progression pathways.
“With most hospital pharmacy departments being in the public sector, there are standard provisions for parental leave, as well as widespread measures to support study leave and planned career breaks.
“Hospital pharmacists are not subject to script-based KPIs. This is a quantitative measure that has no demonstrable value to the quality of patient care.
“Hospital pharmacist KPIs are qualitative, based on clinical activities that are demonstrated to improve the safety and quality of care, such as percentage of medication reconciliation completed within certain number of hours of admission, percentage of patients receiving a medication chart on discharge or percentage of patients receiving counselling upon discharge.
Where to from here?
Several stakeholders offered advice to pharmacists who are unhappy with their experience practising the profession.
Kristin Michaels encouraged pharmacists who are interested in moving to the hospital sector to join SHPA and take advantage of educational opportunities.
“In a practical sense, hospital pharmacy dispensary jobs are a common transfer point, as are some hospital pharmacy roles in the private sector,” she suggested.
Lynne McLennan suggested that disillusioned pharmacists “not throw the baby out with the bathwater: look around the find a good employer that values your skills”.
And Chris Freeman suggested pharmacists “Demonstrate your value”.
“Describe the contribution you make in the care you provide to your patients and in turn the contribution you make to your employer.
“And follow your passion. You are more productive and more successful in roles which excite and fulfil you. This may involve taking a risk, it may require you to research a new role, and it may involve stepping-stones to get there. But they are career challenges usually worth taking.”
Several entities approached by the AJP for this article declined to comment, including the Pharmacy Guild of Australia and Chemist Warehouse.