College of Pharmacists says corporate pressures are compromising safe and effective care

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Published Mar 26, 2024 • Last updated 1 hour ago • 4 minute read

Ontario College of Pharmacists officials said they heard similar stories from the thousands of pharmacists and pharmacy techs who took part in town hall sessions or later commented. Photo: Telegraph-Journal Archive

Pharmacists are angry, frustrated and concerned about their ability to deliver safe and effective patient care as corporate pressures to perform billable services mount, according to the Ontario College of Pharmacists.

In an extraordinary statement Tuesday, Registrar and CEO Shenda Tanchak said the college had gathered compelling and troubling information about the extent and impact of growing “corporate-centric” pressures on pharmacists during a recent series of virtual town halls and written submissions from thousands of pharmacy professionals.

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“We heard that volume-focused corporate pressures results in sub-optimal care and a greater risk of error. And we heard that these pressures affect the wellbeing of pharmacists who fear, or experience, reprisal if they fail to meet corporate objectives and whose health is suffering due to the tension between trying to delivery high-quality care to their patients while coping with corporate pressures to increase the number of services delivered,” Tanchak said in a statement.

The college, she said, has retained counsel and is looking at legal options. “The college will consider every tool available to us to address these concerns.” The college regulates pharmacists in Ontario.

Some of those pressures have been in the news recently, after frustrated pharmacists went to the media saying they faced pressure and quotas to cold-call patients and perform often unnecessary medication checks that are billable under the Ontario Health Insurance Plan (OHIP). Those accusations have been denied.

College officials said they heard similar stories from the thousands of pharmacists and pharmacy techs who took part in town hall sessions or later commented. Among comments the college gathered was this: “The time and quota pressures make you feel like you have to choose between patient safety and keeping your job.”

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And pressure to perform MedsChecks, for which companies can bill up to $75 a call, are not the only area in which corporate pressures are rising, the college says. The MedsCheck program is a one-to-one consultation between a pharmacist and eligible patient that takes 20-30 minutes once a year to make sure they comply with their medications and better understand how those medications might interact with each other and over-the-counter medicine, according to Ontario Health.

The college said the pressure many pharmacists were experiencing to do more MedsChecks was a “symptom of a bigger problem.”

Tanchak said other services that pharmacists said were subject to corporate pressure included placing time limits on conducting minor ailment assessments. The Ontario government has recently expanded the power of pharmacists to prescribe medications for minor ailments. Pharmacists can now prescribe for 19 minor ailments. Pharmacists have also reported that they face pressure to dispense Naloxone kits, among other things.

Tanchak said the pressures being reported to the college were an ineffective use of health system resources as well as contributing to feelings of burnout and stress that could get in the way of pharmacists’ ability to deliver the kind of quality and safe care they wanted to give.

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The pharmacists told the college that the pressure was most often coming from non-pharmacists and those in corporate or regional head offices.

The result is a loss of identity as health-care professionals and loss of autonomy to make decisions in the best interest of patients.

“Pressure and focus on volume leads to mistakes, errors, increased patient safety risks,” the college said in a presentation to its board meeting this week.

The vast majority of pharmacists reporting workplace pressures said they occurred at a Shoppers Drug Mart, with the second-highest number of reports from Loblaw’s pharmacies, followed by Rexall, the college said in its presentation. A significantly smaller number of reports happened at pharmacies in other stores and independent pharmacies.

The college’s board also voted to work with the Ontario Ministry of Health to restrict use of preferred provider networks, which are agreements between drug-plan sponsors and pharmacies. Such a deal between Manulife Financial Group and Shoppers Drug Mart that would have required some patients to buy medication from Shoppers or Loblaws pharmacies was cancelled earlier this year after an outcry. The board, which will draft a statement on the issue, heard that it could result in potential harm to some patients.

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Tanchak, meanwhile, said the college planned to take action over growing corporate pressures.

“The feedback we heard from pharmacy professionals was moving and consistent,” Tanchak said. “The pressures they are experiencing are real and sustained and it was clear from those who responded to us that they are members of a profession under stress and duress.”

She said the college had the authority to investigate individuals and to accredit pharmacies, which is required for them to operate.

“We’re aware that the real solution to the problem won’t lie with us alone and will look to collaborate with other system partners including government to address these concerns effectively,” she said.

Loblaw’s public-relations department said in a statement that it “stand(s) firm that medication reviews are a vital health-care service,” adding that medication reviews had directly benefited patients, “reducing adverse reactions and ultimately keeping these patients out of hospitals and urgent care.”

The statement said the decision to deliver a professional service “has always been and must always be made by the pharmacist.”

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It added that the company “is listening to the concerns raised recently and are working with our teams to ensure we take a collaborative approach to patient care.”

The company did not directly respond to questions about whether pharmacists were pressured to perform medication checks or other services or whether they worked with time targets.

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