Lender readiness to place pharmacies in default, cash flow issues thanks to expensive drugs and pressure from landlords have all put the squeeze on pharmacy businesses
As a result, Small and Family Business Ombudsman has cautioned pharmacy owners to ensure they look after their own mental health.
Ms Carnell was responding to the National Stress and Wellbeing Survey of Pharmacists, Intern Pharmacists and Pharmacy Students, which found that pharmacists face similar high levels of stress as doctors and other health professionals.
While many of the survey participants were employees who commented on the pressures placed on them by owners, some respondents to the survey were pharmacy owners who wrote about their own difficulties managing stress.
“As a pharmacy owner, 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,” wrote one older man who owns a pharmacy in Queensland.
“Owning your own business is great,” says Ms Carnell, who prior to becoming Small and Family Business Ombudsman was the CEO of beyondblue, the national depression initiative. She is also a former ACT politician and pharmacy owner, but is no longer a pharmacist.
“It’s wonderful working for yourself and being able to do your own thing – but then the hours are very long and your house is probably riding on your business and you could lose the family home, so that’s stressful,” she says.
“And of course the regulatory environment has been difficult over the last number of years in pharmacy. The changes to the PBS have made it significantly tougher to make a profit.
“So if you’ve got regulatory uncertainty and economic challenges and long hours – and most pharmacies now really do have to open extended hours to make a living – generally this is a challenging space for pharmacist owners to work in.
“And it really means that looking after your own mental health becomes really important. You can’t run a business if you’re not well.”
The pressures on owners
“We’ve got a number of pharmacy cases at the moment where pharmacists are really struggling financially and having issues with banks and other creditors,” Ms Carnell told the AJP.
“Due to the changes in the PBS and the reduced profitability of pharmacy, some banks have moved pharmacies into default and they’ve ended up with some very real problems, such as bankruptcy.
“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.”
The hepatitis C direct acting antivirals have also caused significant problems for owners, Ms Carnell says.
“We know in business that cash flow is king. Now you’ve got a range of very high-priced medications on which your return is not that high, but you have to pay for them before you get paid for them. It has a real impact on cash flow.
“Then you look at some of the challenges for pharmacies that are in the major shopping centres. This goes beyond the cost issues of rent.
“We’ve got a case at the moment where the shopping centre manager put in a pop-up perfume shop, straight outside the pharmacy, for the week that leads up to Mother’s Day.
“Leases can allow this to happen, so the capacity to stop that is difficult.”
Leases which require refurbishment every few years can also be problematic, she says, particularly against an environment where cash flow problems are growing and lenders are less willing to extend credit.
“It can be a quarter of a million for a refurbishment, and unless you’ve got that much equity in your family home, banks are really reticent to lend on cash flow. They want you to have bricks and mortar.
“So finding capital for things like major refurbishment is becoming more and more difficult, and some owners may be going to much more expensive forms of finance, which again means an effect on cash flow.
“There’s so many issues that make it significantly harder for any pharmacist than it was when I bought my first pharmacy back in 1980.”
Ms Carnell told the AJP that many pharmacy owners also feel a strong responsibility for the welfare of their staff.
“One thing I think people forget about small business, and certainly pharmacy, is that your staff become your family,” she says. “Unfortunately, you’ll see more of your staff than your actual family sometimes!
“So you do care deeply about the welfare of your staff. You know them, you know their family, you often know their kids, and so the challenge of attempting to look after them is very real.”
It’s vital that pharmacy owners recognise the signs and symptoms of stress in themselves, Ms Carnell warns: and that they act on them.
“As pharmacists, we know what the symptoms are,” she says. “It’s part of their job to know that.
“So 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.
“And 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.”
She urged pharmacists suffering from stress to give the same advice to themselves that they would give to customers.
She also encourages owners to keep an eye on their staff and help them manage pressure as well.
“It’s important to have a mental health friendly workplace,” she says. “That means you do have to have a mental health policy, just like you have an OH&S policy.
“It does mean you need to be proactive when somebody is under pressure, or possibly showing symptoms of mental health issues.
“You’ve got to be flexible. Sometimes that’s difficult in small business, it’s hard being able to give people time off or more flexible hours until they’re back on track, but it’s important to do so.”
AJP will be reporting on stress affecting the pharmacy profession over the next couple of weeks. Readers are invited to tell their stories, either by leaving comments below or getting in touch with the AJP team.
Readers who are distressed can contact the Pharmacists’ Support Service on 1300 244 910.
PDL members can contact PDL on 1300 854 838.
Heads Up has tools for creating a mental health friendly workplace.