This is what life looks like under a duopsony -- where there are essentially only two buyers for pharmacy labor. Individual pharmacists have enormous sunk costs in terms of 4 years of specialized schooling. There is nowhere for them to go, outside of a smattering of independent pharmacies who are themselves getting crushed because of a lack of bargaining power with PBMs. The outcome of an unregulated free market is misery for employees, bad experiences for customers, and billions in profit for corporations.
There's plenty of in pharmacies besides those two. Most grocery chains have pharmacies. This is just retail being retail for the workers. Without a differentiated service or product, it's a race to the bottom. The bottom is when a pharmacy chain stops accepting a brand of insurance because they feel the bid was too low. https://www.federaltimes.com/fedlife/health/2022/11/14/thous...
"This is what life looks like under a duopsony -- where there are essentially only two buyers for pharmacy labor."
In my area the number of grocery store locations with a pharmacy greatly out numbers the CVS and Walgreens locations. Walmart, Costco and hospitals also employ pharmacists. Walgreens and CVS employ a significant number of pharmacists but I would have to see some proof that they are a duopsony. It doesn't pass my initial sniff test.
My local CVS and Rite-Aid have struck me as exploitative employers going back at least 15 years especially in their treatment of their pharmacists. The employees at my Rite-Aid have this "slightly-dangerous" vibe that suggest that there is a chance that they will turn cruel, vengeful or at least completely cold and uncaring over something insignificant if they think they can do so without getting into trouble whereas the ones at my CVS just seem completely subjugated and broken in spirit.
I always assumed that the cause of this state of affairs is the increasing untenability of independent pharmacies, which increasingly restricts the options available to pharmacists (then the miserableness of the pharmacists trickles down to the other employees in the pharmacy department). I started using large chain pharmacies about 15 years ago after the pharmacist at the local, mom-and-pop pharmacy I was using told me that it would cost him $50 more to fill my prescription (for Bicillin) than he would receive from my insurance company, then I noticed that the large chain pharmacies didn't seem to have this problem of costs exceeding revenue. The local pharmacy went out of business in 2021.
I use Alto.com these years and haven't set foot in a bricks-and-mortar pharmacy in at least 3 years. I have seen no signs that Alto.com's employees are exploited, but then I probably wouldn't see signs even if they were since I never see any employee in person.
Dealing with Alto.com requires from me significantly less patience and persistence than dealing with Walgreens, Rite-Aid and CVS ever did.
I just went through a search for a new pharmacy, so I can tell a bit about the general situation. I've heard that supermarket pharmacies traditionally operated at a loss, just existing to draw in customers. I'm speculating that once some chains downgraded/divested their pharmacy operations, others felt free to follow suit. There has been massive consolidation of pharmacies the past few years. For example, Albertson's and Target sold theirs to CVS, and Kroger has merged with Albertson's.
I had to find a new pharmacy because the one I had used for decades was experiencing declining service after being acquired by Walgreens a couple years ago -- shorter hours, longer lines, mis-filled prescriptions, unanswered phones.
Reading reviews for every place around town, I saw that almost every pharmacy had experienced a drastic decline in service the past 1 to 2 years. Target was good until CVS took over. Kroger was great until about a year ago. Rite Aid is having longer and longer wait times. Even Costco is getting serious complaints now. I even went around to some places and talked to waiting customers about their experiences with those stores.
In the end, the best pharmacy by a significant margin was Walmart. The store was clean, orderly, and well stocked. It looked fully staffed, with three pickup windows open, no lines, and nobody looked harried. They are open 7 days a week and the pharmacist told me they had no problem transferring an order to another store if they couldn't fill it that day and it wasn't a controlled drug. I don't know how long Walmart will stay that way because I read from this summer they were looking to reduce employee hours and pay.
I heard a report on (I believe) an NPR station a couple of days ago about the nursing profession being in a very similar position. That is, excessive stress, people leaving the profession, not enough new hires coming in, etc.
Another day another (preventable) crisis in "the greatest country in the world."
If during a staffing shortage a nurse said "I'm willing to work 30 hours a week, take it or leave it", I'm guessing the company would leave it. So much for negotiating in a free market. Quality of patient care would drop, but patient bills would not, nor would CEO pay.
Our free market is moving away from the proverbial town square full of food carts and merchants peddling their wares and haggling over prices. It's more like a bunch of tired people waiting in line for a single automated computer terminal.
That's not a failure of the market - it's not worth their overhead to deal with someone working 30 hours a week. Quality dropoff and more people quitting takes time to have an effect, and then it takes time to for that effect to be noticed and corrected. Medicine has an additional quirk in that the government strictly limits who can practice and where they can practice.
"not worth their overhead to deal with someone working 30 hours a week"
What a ridiculous thought process. An overworked and stressed-out employee is going to make mistakes and they will always ultimately quit the job. The employer will then have to start a hiring and training process for a replacement. Creating significantly more overhead for the employer.
A happy employee, working a reasonable 30 hours a week is going to be less stressed, less likely to make mistakes, and be overall more pleasant. A happy employee is more likely to stay working for that employer for a long time. Meaning the employer will not have to hire and train new employees, lowering overhead costs.
Yes. To clarify, it's completely reasonable to pay someone working 30 hours a week less, it's even okay to pay them less per hour. Make an offer!
A problem is that almost nobody will offer any salary at all to a nurse willing to work 30 hours per week. It's a testament to the flexibility of our market, or the lack thereof.
If a nurse is willing to perform 30 hours of skilled labor and our economy cannot extract any value from that, what does that say about our economy?
And they get paid way less than a Pharmacist does. Some of the nurses that I have met who helped me take care of my father, and the ones who help take care of my grandmother now are some of the most patient, amazing people I have ever met in my life. I don't know how they do it, dealing with cranky-ass people all the time, working long shifts... and here I sit on a computer all day, in my own house, drinking coffee, listening to music, making way more than them. It's kinda fucked up.
I've seen and felt similar. It's pretty much a thankless job, especially when dealing with the elderly (i.e., most are not going to get healthier, they're mostly trying to mitigate the pain of old age and dying). I couldn't do it, not with the consistency and grace I've witnessed.
While I don't believe money is the cure for everything, a donation here and there to efforts in that field helps to pause the guilt.
Nursing is a different problem altogether. A vast majority of healthcare staff in USA is immigrants. Nurses from Phillipines, India etc. Doctors primarily from India, Pakistan, Iran etc.
Trump's war on immigration definitely hurt these groups massively followed by the green card backlog for Indians. Thousands of Indian doctors and nurses left their jobs and went back to India creating a major stress on the healthcare sector and especially the rural areas. H1B visa is oversubscribed by 8x these days and Doctors and Nurses get pushed out by tech companies. No one wants to hire a doctor with only 1/8 probability of joining due to visa issues.
As more people age and we have young people moving out of smaller towns, this problem is going to become even bigger.
> Nursing is a different problem altogether. A vast majority of healthcare staff in USA is immigrants. Nurses from Phillipines, India etc. Doctors primarily from India, Pakistan, Iran etc.
Citation? I can’t find information on immigration/citizenship status specifically, but the racial demographics of doctors[0] and RNs[1] do not reflect your claims.
Good point. Nonetheless, there's no back filling of the openings. Those who could aren't interested. In addition, Uncle Sam is too busy chasing his tail (e.g., the quarterly or so debt ceiling / budget crisis).
> What policies were implemented that hurt legal immigrant doctors and nurses?
Trump's war on immigrants did not differentiate between legal vs illegal. One common problem I have seen for example is asking (via RFE) a MD as to why his profession is considered "speciality" and asking to prove this job needed a special degree.
What is causing the healthcare staffing issues? Is this all still related to Covid?
Every single healthcare and adjacent person I’ve spoken to in the past year and a half has nigh-universally expressed a sense of impending doom.
My PMC doctor, who I’ve been with since 2017, abruptly quit and left the field entirely. The office is part of a big healthcare conglomerate, but it’s been several months and I’m still being told I won’t have a new official PMC until sometime in the spring of next year!
Feels like something in healthcare is seriously broken with no plans to fix the problem.
Healthcare is hard to automate. So companies need a lot of labor. Some high wage, but a lot low wage. Offering pharmacy technicians $14/hr in 2019 was enough to be fully staffed. $16/hr in 2023 is not enough to keep the pharmacy open all the time. A lot of people retired early, died, or moved up to better jobs after the Covid-19 pandemic began. The same thing is happening to EMT staffing, doctor's office support staff, hospital support staff, etc.
Aging population + locum tenens price fixing. After health systems grifted insurers by buying doctors, somebody figured out you could just grift health systems directly by renting doctors and not have to bother with the running-a-hospital part.
I recently switched to a local pharmacy after getting berated by a CVS pharmacist for standing in the "wrong" line. CVS in general has been absolutely awful in the last few years.
What really turned me against them was "CVS Caremark" insurance.
CVS runs a prescription insurance company that only allows you to buy your meds at CVS or Walgreens. How that's even legal is beyond me. They also have absolutely insane policies, and will NOT pay for anything unless it's prescribed as a 90 day supply. If your doctor is adjusting your dose or you're trying a new medication, fuck you, pay up.
I also once tried CVS's free prepack services where they divide your doses into individual AM and PM plastic pouches on a big reel. Super convenient for someone with severe ADHD, as the pouches are dated, so I always know if I missed a dose.
Caremark wouldn't pay for my proscriptions filled this way. Again, a free service offered by CVS. The Caremark rep I talked to had never even heard of it before.
It's a high wage, indeed. However, it's not a sustainable workload from the stories I've heard, and ultimately people are feeling the effects of the system at its over peak capacity.
To be fair, you don't really need pharmacist for most people. If you're getting a prescription for the first time, then you should see a pharmacist. But if you are picking up a prescription that you've been taking for a while, there are companies that make machines which will fill and label the bottle and dispense it to you. Or just have it mailed to you. Too much emphasis is placed on having to speak or deal directly with a pharmacist, when it might be better to just take them out of the picture.
There is a balance somewhere though. $60/hr is at the level where some big expectations is normal. You can't demand high pay and low stress work for what is basically a rank and file job.
Eventually, people will probably get most of their prescriptions by mail. That might be the solution to this, rather than stressing out and placing so much pressure on people.
This is an odd comment. Do you think CVS and Walgreens pharmacists working in retail locations have anything to do with the pharmacy lobby? I kinda doubt it. I doubt hourly employees at the stores were clamoring at the bit to have more things to do in the same shift.
Well, someone else in this thread claimed that the root of the problem was CVS and Walgreens operating in an "unregulated free market".
Sounds like maybe the market has regulation, but it's shaped to benefit incumbents. I would guess that regulation is the main cause of the duopoly. I don't see anything obvious about the structure of the industry that should push it towards just a few major players, except the presence of regulation.
Rite aid is filing for bankruptcy and closing stores. Target sold off their in store pharmacies to cvs. Most of the mom and pop pharmacy’s near me are closed or a Walgreens or cvs now and Amazon is starting to get into the game.
In a free market and with a public company model like theirs you dont make billions in profit by paying living wages and creating good work environments.
Free markets arent the problem. They can only get away with it if you flood the low skill labor market with immigrants that are willing to accept radically lower standards of living than the natives they are replacing. Then you jack up interest rates and try to cause a recession anytime labor has the upper hand.
