A study has shone a spotlight on stress in the pharmacy profession— and found stress levels comparable to those experienced by other health professionals

Half of Australia’s pharmacists are dissatisfied with their work–life balance, the National Stress and Wellbeing Survey of Pharmacists, Intern Pharmacists and Pharmacy Students has discovered.

And half have been worried by seeing other pharmacists depart from accepted professional standards.

The research, carried out by Monash University’s Emeritus Professor Colin Chapman, together with Master Research Australasia and the Pharmacists’ Support Service, found that pharmacists in general were more stressed than the Australian population.

Those aged under 30, and/or with less than 10 years of experience in the profession, reported the highest levels of stress; those 26–29 years old and 30–39 years old reported a higher level of dissatisfaction with their work-life balance than did other groups.

The report cited an Australian Psychological Society survey which showed that workplace issues made up 32% of stressors amongst the general population, but for pharmacists, this percentage jumped to 60%.

Around 10% of pharmacists said in the new survey that in the last month they either “never” or “almost never” felt confident about their ability to handle their personal problems.

The study also found that:

  • 45% of pharmacists were satisfied with their professional role as a pharmacist;
  • 42% were satisfied with their workplace environment;
  • 30% were satisfied with their workload;
  • 50% of respondents had observed behaviours in other pharmacists that depart from accepted professional standards;
  • 26% reported that they are expected to practice as a pharmacist in a manner which is a departure from accepted professional standards and this causes them to feel stressed; and
  • barriers to seeking help included fears of reprisal, job security fears, worries about experiencing stigma, and of feeling intimidated or embarrassed.

Dr Shane Jackson, national president of the Pharmaceutical Society of Australia, told the AJP that the survey was a “timely reminder that health professionals work in a stressful environment, and pharmacists’ environment is no different to doctors or nurses—no worse, but no better”.

He said that for many pharmacists, stress comes from several angles and can be cumulative.

“I think that often these things add up,” he said. “If you’re not feeling rewarded because your pay level might not be at the level you believe it should be, you have a high workload and you don’t have support structures in the workplace to allow you to discuss issues with other people, this can build up.

“It might create a significant response for some individuals and be difficult to deal with—and that’s not because people are unable to deal with it, it’s because they shouldn’t have to deal with those kinds of things.

“If they’re seeing someone deviating from acceptable professional practice, which puts people at harm, those things shouldn’t be occurring… it’s not that they’re unable to deal with pressure.

“Obviously for a significant number of people they feel those structures aren’t in place.”

Early career pharmacist stress

Pharmacists’ Support Service’s Kay Dunkley told the AJP that when young pharmacists in particular see behaviour that worries them, they may remain silent out of fear for their job.

“Pharmacists are obviously stressed, particularly young pharmacists, by seeing the realities of how some pharmacies practice,” Ms Dunkley said.

“This can happen when people enter the workforce and see things that aren’t in accordance with their university training and how they’ve been led to believe things should be done.

“One of the issues is that young pharmacists don’t feel empowered in their own workplaces to address this, because they’re very dependent on remaining employed and therefore feel that if they start to raise issues around practice, they might not have a job.

“And the job market is very competitive, particularly in the metropolitan areas, and so a lot of graduates and young pharmacists feel that they’re expendable. So they feel quite compromised.

“Workload is also a considerable issue, and from the point of view of PSS, we get a lot of calls around workload: people feel their ability to actually perform their job properly is compromised and that concerns them, because apart from the fact that they don’t want to harm the public, they’re the ones that will bear the responsibility if they miss something or a dispensing error occurs.

“It’s their registration at risk.”

PSA Young Pharmacist of the Year and partner at the Wanniassa Capital Chemist Elise Apolloni told the AJP that it’s very important for pharmacists to take control of their own mental health.

“Perception of control is really important in some of these situations,” she said, explaining how simplified price disclosure was introduced only weeks after she bought in as a partner to the award-winning Wanniassa Capital Chemist.

The partners, concerned that under existing projections they might not be able to remain open, altered the pharmacy’s focus to feature a suite of professional services and longer opening hours.

“Four years in, we’re not complacent, but it’s not so scary any more,” she said.

“We still get nervous every time the next price cuts come around, but the difference is that now we feel we’re in control of what’s happening, in the sense that we have the ability to make it up in other ways.

“Perception of control is really important in some of these situations.”

Feeling the pressure

One concern highlighted by survey respondents was fear of making a dispensing error while working under difficult or high-pressure conditions.

PDL director for NSW Curtis Ruhnau told the AJP that PDL receives contact from members saying, “We feel unsafe, we feel stressed, we feel overworked”.

“And that pressure is something that affects both their work life and home life, because it’s something they feel they can never switch off—they feel the pressure to continue even after their rostered shifts have finished,” he told the AJP.

“That pressure can be unrelenting—it’s not just the workload itself, but the fear,” Mr Ruhnau said.

“PDL experience shows that stress combined with high workload dramatically increases the chance of making an error or making a poor decision.

“It can cause these young pharmacists to think, ‘If I make an error, am I a good person?’”

He says that this fear means the profession could lose some of its best and brightest young pharmacists.

Neither side is greener

Following the release of the study, the AJP asked its online readers to name the biggest stressor in their professional lives: there was a widespread range of issues of concern, but one stood out ahead of the others.

Eighteen per cent (84 voters) of readers told us that “trying to make ends meet on low pay” was the biggest challenge facing them in the pharmacy profession.

PPA’s CEO Chris Walton says that low pay and increasing workload have left some pharmacists feeling like low-paid “script monkeys”.

“Their workload and responsibilities have increased significantly in recent years, but the recognition, rewards and opportunities have not increased.

“With the of cost of living rising including energy bills, rent and other essentials, their pay has flatlined in real terms with many on as little as $27 per hour,” Mr Walton told the AJP.

But life’s not all rosy for owners, either. One participant in the stress study, a Queensland pharmacy owner, wrote in his responses that “my stress is mainly related to what is expected from the profession and the reducing remuneration, and the general uncertainty of having my whole life savings/work invested in a profession and business that everyone seems hell bent on changing the rules and reducing our remuneration”.

Small and Family Business Ombudsman Kate Carnell, a former pharmacy owner and former CEO of beyondblue, said that she had several cases before her where pharmacists are “really struggling financially” and having significant problems with banks and other creditors.

“Generally this is a challenging space for pharmacist owners to work in,” she said.

“The banks have been quite open about the fact that they believe changes to the PBS have changed the outlook for many pharmacies, and so they’re much more willing to move pharmacies into default if they believe there are potential issues for them.”

PBS changes, landlord behaviour, a difficult retail sector and high-priced drugs such as the new direct acting antivirals for hepatitis C are all adding up to put pressure on owners, she says—who are often very much concerned with the welfare of their staff as well as their own financial viability.

“One thing I think people forget about small business, and certainly pharmacy, is that your staff become your family,” she said.

Several stakeholders stressed the need for an all-of-profession approach to tackling pharmacists’ mental health and alleviating some of the pressures on them.

“One of the things that needs to come out of the work of PSS is a profession-wide approach to trying to reduce stress and improve wellbeing in pharmacy,” says Dr Jackson.

“That’s the only way to do it.”

How to get a handle on stress

Talk to your pharmacy owner. “I would hope that if somebody brought [concerns about workload] to an owner, they would take it seriously and might be able to act on it,” said Curtis Ruhnau. “Each case has to be judged by itself, but owners do have a responsibility to be certain that their staff can practice in a safe and ethical manner.”

Explore innovative solutions. Elise Apolloni says after staff raised concerns that one and a half days off a week didn’t give them breathing space from work each week, the Wanniassa

Capital Chemist changed its working hours to allow staff to work four long days and have three days off. “It’s made a phenomenal difference,” she said.

If you’re an owner, try to create a mental health friendly workplace.

Kate Carnell suggested visiting Heads Up (www.headsup.org.au) for some resources.

Recognise symptoms of stress in yourself. “When it’s happening to you—when you’re struggling to sleep or to concentrate, you’re having mood swings, all the things that can go alongside like depression or palpitations with anxiety—you’ve got to recognise them in yourself,” said Kate Carnell.

“You wouldn’t say to a customer, ‘just snap out of it, get over it you silly bugger’, so you can’t say it to yourself.”

Ring the Pharmacists’ Support Service on 1300 244 910. “The study really emphasises the need for PSS to provide support,” said Kay Dunkley.

If you’re a PDL member, talk to PDL. “PDL has professional officers who are experienced pharmacists available to discuss practice issues and provide advice to minimise risk when workloads are high,” said Mr Ruhnau.

There’s no shame in changing profession. “That’s sad, because it’s a long course and we put a lot of heart and soul into pharmacy but like any career, there’s never going to be 100% retention,” said Elise Apolloni.

What respondents said

Kay Dunkley told the AJP that part of the survey’s value was that it invited participants to explain, in their own words, what stressors exist and their impact upon individuals.

Some of these responses were harrowing, with tales of bullying, unprofessional behaviour and huge workloads.

“It’s a toxic draining job,” wrote one pharmacist. “I feel totally disrespected unappreciated and undervalued.”

One pharmacist warned that if his hospital’s pharmacy management didn’t “wake up and look at their little selves,” he would not be surprised if he lost a colleague to suicide.

A pharmacist at a single-pharmacist medical centre pharmacy in a regional area wrote that “I was unable to enlist the help of a locum today and had to work while suffering from gastro with symptoms of nausea, vomiting, diarrhoea, malaise, fever and tiredness.

“It will be a miracle if no dispensing error was made.”

One said that most of her colleagues were great, but their work life was marred by “an angry bully who frequently yells at me and at other pharmacists if her outside life isn’t going well” and there was no support from management.

Others bemoaned rampant illegal activity.

“More than half of the 35 pharmacies I have worked at regularly did illegal things like supplying prescription medicine with no expectation of receiving a prescription, or claiming PBS benefits illegally,” one pharmacist wrote.

“It’s far more prevalent than you realise. Anonymous reporting should be allowed.”

And one young community pharmacist summed up her concerns very succinctly.

“Hell hole, no one in charge, assistants use illicit drugs while at work, danger to the community,” she wrote.