Home Pharmacy practice The great migration of pharmacists in hematology-oncology is caused by problems other than burnout that could be quickly solved

The great migration of pharmacists in hematology-oncology is caused by problems other than burnout that could be quickly solved


Pharmacy hours interviewed Zahra Mahmoudjafari, PharmD, BCOP, DPLA; Alison Gulbis, PharmD, BCOP; and Kamakshi Rao, PharmD, BCOP, FASHP, in a 2022 ATOPP Summit session they will co-present to address the research they conducted to assess the underlying causes of the great migration of pharmacists in hematology- oncology.

Question: What is the great migration of pharmacists in hematology-oncology, and when did it start?

Zahra Mahmoudjafari: That’s an excellent question. I honestly couldn’t put my finger on exactly when it started. I think we all started to understand and recognize this about a year ago when we met for a brief conference in June 2021 and recognized that many of our colleagues and team members who have worked with us and alongside us in direct patient care roles, since moving into different roles, were doing different things.

It allowed us to start asking ourselves why this was happening and led us to ask these questions directly to our colleagues, and we came together at the end of this conference, and at the time we framed it as “ the great migration. There are other publications that are available for the entire workforce, especially on what is called the “big quit”. But we chose to call it the “great migration” because our pharmacists are still working in pharmacy in some respects, but not necessarily in the direct patient care role. So we were motivated to understand why some of these reasons were happening to motivate our team members to move into non-direct roles with patients.

Kamakshi Rao: I think I would just add to that to say that I think pharmacists have been migrating between clinical and other roles for a long time. It is therefore nothing new for pharmacists to move or change roles. I think what we talked about was, I think it was 2 things.

The first was the rate of change, like how quickly it seemed like every few days, every week, we heard from someone we knew pretty well, and I think the three of us are connected pretty well to know the oncology pharmacists across the country, and so it kind of surprised us to see the pace of change.

Then I think there were probably for each of us a few people that we knew in our heads that you never thought would happen. He was someone who, when you met them, you’re like, he’s a person who’s going to be taken care of for the duration, that’s completely his zone. Then to see these people make the decision to leave patient care, I think those 2 factors kind of stung our ears, because something different is going on here, something has changed.

Question: How has the pandemic contributed to this migration?

Zahra Mahmoudjafari: Yes, I think the pandemic may have accelerated what was already happening and potentially made it even more painfully obvious, thinking this was a time when pharmacists really needed to sit down and assess what matters to them . So sometimes what mattered to them was increased flexibility and the ability to work from home. What mattered in terms of mental health or career advancement, they took time to really assess that specifically, and I think that just made it worse and really highlighted it and really cleared the rug from under us.

So I think that really made me see things in a more positive light and allowed us to really look at some of the things that are causing the problem and allows us to have much more honest conversations. So as a result, our patient-facing pharmacists can really have the time to spend with our patients and care for our patients, and we now have more honest conversations than we ever had before. So I like to think it’s positive. But it was definitely a tough two years, and I think for all of us in many ways, just when you thought you had overcome one thing, the next problem came along.

The other facet of this situation is certainly the direct scarcity which has never gone away, and the situation is only getting worse, it seems, in the end. Again, I think the pandemic helped highlight it, but also helps us understand some of those fundamental factors and the main reasons why it was already happening, maybe it just accelerated it.

Alison Gulbis: I think adding to what Zahra said about all the work from home and flexibility that people have come to realize there is – many institutions have taken on these clinical pharmacy specialists who had direct roles with the patients and made them work from home. So it’s really started to realize that flexibility is helpful for some, but, on the other hand, I think working from home has also blurred the boundaries of when you stop working. Also, I think it got people thinking about their personal time and what they needed, so I think that helped as well.

Question: What are the causes of the great migration, and is it above all burnout?

Zahra Mahmoudjafari: Burnout is a big facet, but it’s not the only reason. In fact, our research revealed many emerging trends, some of which were more obvious than others. Some of these are surprising things that we would call low-hanging fruit that institutions can implement quite quickly in an attempt to retain their staff.

One thing that came out pretty clearly is that team members want more support and potentially better patient ratios. They feel a lack of recognition, they don’t necessarily feel valued.

One thing that stood out loud and clear was the number of administrative responsibilities our pharmacists took on both in military spending and as QA lead. Another facet was the flexibility of wanting to work from home potentially, and then there are other facets, including career advancement – ​​I think our pharmacists are extremely high achievers and they want to keep working towards something. Some of them have different strengths that don’t necessarily mean they want to be in direct patient care, offering them ways to explore those opportunities are all facets of some of the trends we’ve identified in our research. .

Again, there are other fruits at hand, as I said, which include things like support for board certification, the ability to attend conferences and network with other co-workers, which we see as something that could easily be done, if given the right resources, but it’s not just about burnout.

Kamakshi Rao: I should draw attention to, I think, burnout and well-being are very important. And you consider that so many things overlap and contribute to a person’s risk of burnout and well-being. These things can include more than just workload. We’ve heard of a lot of people who felt their desires for advancement didn’t fit the strict narrative of the job descriptions they had, feeling like their time was nickel and dime and reduced to things that really didn’t use their skills. , so when a pharmacist spends an inordinate amount of their days on insurance authorizations trying to navigate the system rather than being able to provide patient care.

We also heard from oncology pharmacists who are also involved in so many different things – teaching, research, committee work, representation and service to local, regional and national organizations, and most of them do so during their free time.

Also, going back to the pandemic discussion, our own time has become more important than ever. So when things started to seep in, and the idea was that whatever you wanted had to happen in your free time. It really changed people’s level of satisfaction that their career advancement was not tied to the proper metrics. So I think we’ve heard a very strong call for more appropriate measures that drive clinical pharmacy practice and career ladders and advancement opportunities that are more than just administering pharmacy as 3 people who have made these transitions to administrative roles. I think 3 of us had really healthy discussions about how this was the only option for advancement, and we pursued those options. But if we could go back and look at advancement using different avenues, whether it’s securing protected time for education research fellowships, it would have changed the course for many pharmacists who have chosen the administration as a pathway that may have changed the choices they made.