A year ago this week, 27 pharmacists walked off their jobs in and around Kansas City to protest understaffing, low technician pay and burdensome workloads at some CVS-owned pharmacies.

Their action forced about a dozen Kansas City-area pharmacies and 10 others in outlying areas to close anywhere from a few hours to two full days. It inspired walkouts at CVS, Walgreens and Rite Aid pharmacies across the country later last fall.

And it sparked a nascent labor movement that is undertaking a national store-by-store campaign.

“We had no idea what we were starting,” said Ed Smith, a former CVS pharmacist who organized the walkouts. “We were just fed up with our situation.”

Experts say the industry was ripe for an uprising.

Economic pressures, transformed buying habits and a worldwide pandemic have forced retail pharmacies to shut down, left pharmacists with overwhelming workloads and put regulators on guard against mistakes in your prescriptions.

Kansas City’s walkout and the wave of news coverage that came with it simply offered a jump start.

‘Go, go, go’ working conditions for pharmacists

The Kansas City pharmacists complained last year that CVS wasn’t hiring enough pharmacists and pharmacy technicians, leaving them handling immunization appointments along with filling prescriptions, answering calls and dealing with customers.

On top of that, Smith said, pharmacists were assigned to help at the chain’s busiest stores but got no relief at their home stores. Smith had to go to a pharmacy in Blue Springs with a backlog of 3,000 prescriptions.

“There were not enough terminals and not enough work space,” he said. “There were drugs all over the floor. You couldn’t even find stuff. I’ve never seen a store in worse shape. Ever.”

In an emailed response to questions, Amy Thibault, a CVS spokeswoman, said that the company has brought in additional staff at that Blue Springs store, at 3201 South 7 Highway. She said the pharmacy has made “significant improvements” since last year and “is focussed on serving its patients in a timely manner.”

In response to last fall’s protests, Thibault said, CVS had hired more than 60 pharmacists in the Kansas City area, added “dozens” of pharmacy technicians and made other changes to ease workloads, like balancing some tasks between stores and directing patients to digital channels.

But chain pharmacies, which increasingly dominate the retail market, continue to face concerns about working conditions in some stores. When the COVID-19 pandemic put these stores on the front lines of testing and vaccinating patients, it only exacerbated the situation.

“Every company, whether it’s Walgreens or CVS or any other corporate chain pharmacy, tries to get as much productivity with as little hours allocated as possible,” said Shane Jerominski, the California pharmacist who co-founded The Pharmacy Guild, the fledgling labor union that is trying to organize pharmacists and pharmacy techs in stores around the country.

A 2022 survey by the Kansas Board of Pharmacy found that more than half of Kansas, Missouri, Oklahoma, Nebraska and Colorado pharmacists were struggling.

Of the roughly 1,000 pharmacists surveyed, half of whom worked for chains, only 37% said their workload-to-staff ratio allowed them to operate “in a safe and effective manner.”

Customers see it when they get stuck with long drive-thru waits or encounter lines inside stores that stretch into the potato chip aisle. And when getting a prescription filled requires waiting hours — or even days.

“Pharmacists used to be busy if they filled 200 prescriptions,” said John Yost, a pharmacist who co-founded Pharmacy of Grace, a charitable pharmacy in Kansas City, Kansas. “Now a lot of the big chains are filling 500 to 1,000 prescriptions a day.”

Workloads only got worse during the pandemic, said Russell B. Melchert, dean of the University of Missouri-Kansas City School of Pharmacy.

“We started to see community pharmacists leave large chain settings,” he said.

And with a shortage of pharmacists willing to take on those jobs — and a significant drop in the number of pharmacy school graduates — chains struggled to fill jobs.

As a result, some pharmacists say they have little time to counsel patients.

“It got to the point where there was no time to have any conversation with people,” said Nick Romo, who left a job at CVS two years ago to start Pharmington Drugs, an independent drug store in Overland Park. “It was just head down to the computer. Go, go, go.”

An evolving industry

CVS and Walgreens spent the 1990s and early 2000s buying up independent pharmacies and building brick-and-mortar stores. They wanted to capitalize on a rapid rise in the number of prescriptions Americans were getting, which came with an equally dramatic jump in prescription drugs on the market.

But the chains have spent recent years trimming costs, by reducing staff and closing stores, and leaning into new revenue streams.

They can make money when a pharmacist gives a vaccine, but they likely won’t make much when they sell a drug.

Industry experts said that’s where the difficulties arose for the pharmacists working at chain stores. To trim costs, they’ve cut staff. To fortify profits, they’ve added responsibilities.

“The chain pharmacies really did take a big hit to morale related to their staffing models,” said Jessica M. Bates, a clinical associate professor of pharmacy at the University of Kansas who has studied work satisfaction among pharmacists. “Lots of pharmacists are exploring other options for a career outside of that setting.”

Jillian Freeman, a pharmacy manager at a CVS in Liberty, said community pharmacists she knows just want to care for their patients. She said that the pharmacists who walked off the job last year were exaggerating problems. No matter which company pharmacists work for, she said in an interview arranged by CVS, they have faced added stress and pressure in recent years.

“You can go to any competitor and it’s the same situation,” Freeman said. “We’re facing going through COVID. We’re facing vaccines and supporting the community. … And there continues to be an uptick in medications.”

Fear of mistakes

Some pharmacists worry that the added responsibilities and pressures will lead to medical errors. So do regulators.

That led the Missouri Board of Pharmacy to adopt new rules in 2022 banning policies or procedures that could threaten patient safety.

The board’s April 2021 guidance statement had cautioned against  “any dispensing or vaccination metrics/requirements that place unreasonable expectations on pharmacy staff (e.g., # of prescriptions or vaccines per hour).”

And a December 2021 update to the statement, pointed to “an alarming number” of complaints still coming in about working conditions. They included pharmacies having “excessive” prescription backlogs and pharmacy staff not being given sufficient lunch or rest breaks and having to work extended stretches without days off.

Meanwhile, those workers now also handle vaccines and COVID testing, answer phones and manage a queue of drive-thru customers.

The Kansas Board of Pharmacy also has responded to a growing number of complaints about working conditions with rule changes. In July, the board passed rules that will require pharmacies to review a log of incidents — anything from medication dosage errors to patient information handling mistakes — more frequently. The review, meant to trigger changes so mistakes aren’t repeated, now must happen every two months instead of every three months.

“When concerns voiced by pharmacists began indicating a potential impact on patient safety,” said Alexandra Blasi, executive secretary of the Kansas board, “that is when the board became engaged and involved.”

There’s no clear data indicating that pharmacy errors are increasing. In most states, pharmacies have no obligation to report them to state regulators.

But last year, California’s Board of Pharmacy estimated that pharmacists in the state were making 5 million errors a year.

The Missouri Board of Pharmacy opened 507 complaints in fiscal year 2023 and took disciplinary action in 67 cases. One pharmacist license was revoked, two were voluntarily surrendered and 24 technicians were disqualified.

The Kansas Board of Pharmacy received 115 complaints in 2022. As a result of one of those complaints, the board ordered CVS to pay a $1,000 fine after an investigation found that its pharmacy at 12691 Antioch Road in Overland Park had supplied a patient with the wrong needles for her insulin. Instead of getting the prescribed eight units, the patient injected 10 times more because the needles were the wrong size.

The board noted in its order that the legally required internal report “was weak in preventative measures to ensure the prevention of the same type of incident from recurring.”

Labor takes a stand

After Kansas City’s walkout, Jerominski got serious about starting a union. Once The Pharmacy Guild got backing from IAM Healthcare, an arm of the International Association of Machinists and Aerospace Workers, Jerominski and other organizers launched a national campaign.

When their website first went up late last year, 30,000 people logged in all at once to fill out a labor union interest form, crashing the site.

Since, The Pharmacy Guild has led successful union elections at CVS Omnicare in Las Vegas and at CVS stores in Woonsocket and Wakefield in Rhode Island and a Walgreens in Vancouver, Wash.

Jerominski said more Pharmacy Guild union votes are on the horizon. That includes Kansas City stores, he said, although he declined to provide details. Labor unions are becoming more common across health care professions.

But the reality, said Gerald Friedman, a professor of economics at the University of Massachusetts at Amherst, is that organizing chain pharmacy stores will be an uphill battle.

“You’re going up against really large corporations,” he said. “You organize a few locations, and they ship those customers to mail order. You organize a few more locations, and they just close them down.”

Both CVS and Walgreens said in written statements that they respect their employees’ right to unionize.

The United Food and Commercial Workers Union already has a pharmacy branch that represents 20,000 CVS, Walgreens and Rite Aid retail and pharmacy workers. But The Pharmacy Guild is focusing solely on pharmacists, technicians, interns and residents.

Kansas City’s pharmacists were successful last fall partly because their walkout drew national news coverage. And in response, CVS sent Chief Pharmacy Officer Prem Shah to Kansas City to meet with the disgruntled employees.

Smith said those meetings gave him hope that something might change.

“I genuinely thought they would come in, fix the problems and we’d move on,” he said.

Smith still has the two-page memo he wrote just after an Oct. 13 meeting, detailing eight steps the company had agreed to take in response to pharmacists’ concerns. It included promises to limit the number of vaccines that stores had to give and increase the number of hours techs could work.

Smith ended his memo with clear optimism.

“CVS has taken the team here in KC very seriously and saw that we had legitimate ‘pain points’ that had to be addressed,” Smith wrote. “As I read through this list, more has been accomplished to improve our stores in the last 3 weeks than in the last 25 years.”

But his hope was short-lived.

Smith said the company canceled vaccine appointments at some Kansas City stores for a time. And it sent workers in from other markets to help stores get caught up on prescriptions. But Smith said everything at his store went right back to where it had been before the walkouts  — something CVS disputes.

Smith left CVS in January.

“They put a Band-Aid on a hemorrhage,” he said.

Now he’s a pharmacist at a Walmart in Atchison, Kansas. And he’s still working to organize pharmacy workers.

“Maybe something stronger (like a union) can help change the industry,” Smith said, “because we obviously did not.”

Correction: This story originally misstated when Shane Jerominski, a founder of The Pharmacy Guild, stopped working at CVS.

This article first appeared on Beacon: Missouri and is republished here under a Creative Commons license.