Addressing the Wages, Responsibilities, and Education of Pharmacy Technicians

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COMMENTARY

“It’s the economy”: Addressing the wages, responsibilities, and education of pharmacy technicians

Am J Health-Syst Pharm. 2020;77:1532-1536 able to beat the incumbent president, Technicians who are willing to in-

Barbara Hintzen, CPhT, BA, North which is a historically difficult task. We vest in their careers through education Downloaded from https://academic.oup.com/ajhp/article/77/18/1532/5901287 by ASHP Member Access user on 09 September 2020 Memorial Health, Robbinsdale, MN should keep this slogan in mind as we and advanced training want jobs that Devan Carter Doss-DuPree, CPhT, BA, wrestle with creating and implementing will reward them for their efforts. The au- Cleveland Clinic, Cleveland, OH a shared and supported national vision thors have personally witnessed many Tara McNulty, CPhT, RPhT, WellCare technicians leave pharmacy positions Health Plans, Inc, Tampa, FL for pharmacy technicians. The US economy recently marked its after obtaining a degree or certification Scott Knoer, MS, PharmD, FASHP, American Pharmacists Association, longest expansion in American history that qualifies them for a higher-paying Washington, DC (June 2009 through March 2020). This position, and often these opportunities expansion was fueled by job growth and are within our own health systems. Keywords: advancement, advocacy, education, pharmacy, technicians, wages record-low unemployment rates. There We need to offer technicians re- were also wage increases over the last warding and appropriately compensated © American Society of Health-System few years that narrowed the gap between positions within the field of pharmacy Pharmacists 2020. All rights reserved. 2 For permissions, please e-mail: journals. high- and low-paid earners. When the so that they don’t have to leave phar- [email protected]. economy is booming, workers have macy departments to find sustainable DOI 10.1093/ajhp/zxaa203 more opportunities and choices. The careers. Employers that increase edu- average wage of a pharmacy technician cational hiring requirements and adjust is approximately $15 per hour,3 which the rate of pay appropriately will be able may not be high enough to keep workers to retain and engage quality technicians. This would likely offset much of the -in his commentary focuses on challen- from leaving their positions for other creased salary costs through reductions ging and motivating leaders to act opportunities. T in turnover, training costs, and overtime on advancing the role of the pharmacy In the 2015 National Pharmacy paid to fill open shifts left by technician technician through requiring more Technician Workforce Study, respond- vacancies. rigorous and standardized educational ents ranked salary as one of the areas Consensus for change. Nobody requirements and allowing technicians of lowest satisfaction for technicians. questions that pharmacy technicians an increased scope of practice and a cor- State comparisons of health technolo- are essential to providing safe, high- responding higher wage. gist and technician occupations have quality patient care. We also accept During Bill Clinton’s presidential been conducted; the findings place that technician roles have expanded campaign, advisor James Carville pharmacy technicians at the bottom in as technology has increased and as the famously created a variation of the terms of both salary and qualifying re- 4 profession of pharmacy has advanced. phrase “It’s the economy, stupid!” as quirements. While we were recently However, there are still significant obs- a slogan for candidate Clinton in his reminded that no economic expansion tacles that keep us from practicing campaign against incumbent president lasts forever, the one that ended earlier what we have preached and envi- George H.W. Bush in the 1992 election. this year accelerated the need to boost sioned related to pharmacy technician While the slogan was originally intended technician wages in order to attract and advancement. for internal use, the campaign employed retain talent. Over the years there have been it broadly to leverage the recession and The concern addressed in this article summits, statements, documents, and unseat a sitting president. Particularly can be summed up easily: Technicians speeches advocating for and recognizing significant is that President Bush pre- are not paid enough to justify the higher the importance of a highly trained tech- viously had an 89% approval rating, the educational requirements that would nician workforce. For example: highest ever recorded in a Gallup poll, enable the expansion of technician roles, immediately following Operation Desert subsequently allowing pharmacists to Storm in early 1991. practice at the top of their education. If • In his 2006 John W. Webb Lecture The Clinton campaign believed that we want to lower technician turnover, Award address, pharmacist Burnis personal economic issues brought on by attract the best possible employees, and Breland5 stated, “As a profession, we the slow recovery from the 1990-1991 re- advance the role of the pharmacy tech- say we know that technicians provide cession would be the biggest issue facing nician, pharmacy technicians must be value and are a key part of our ability voters.1 They were right, and Clinton was paid a wage that is career enabling. to advance practice.”

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• The Pharmacy Practice Model technician advancement. He urged position does not pay enough to attract Summit held in November 2010 in the audience to commit to educating, a more highly educated workforce. Dallas, TX, resulted in consensus re- training, and developing pharmacy We don’t need to reinvent commendations strongly supporting technicians with the same intensity the wheel. As we have noted, there technician advancement.6 as for pharmacy students, residents, have been numerous calls for tech- • In Henri Manasse’s7 2007 Harvey A.K. and pharmacists. nician advancement over the years, Whitney Award lecture, he said, “Very • In Max (Mick) Hunt’s11 2017 Harvey and although there has been tangible important for our vision is a need to A.K. Whitney Award lecture, he re- progress in many states related to ac- Downloaded from https://academic.oup.com/ajhp/article/77/18/1532/5901287 by ASHP Member Access user on 09 September 2020 resolve our profession’s ‘dirty little se- commended “[requiring] accredited creditation and registration, we haven’t cret’—the lack of national consensus pharmacy technician training.” moved far enough or fast enough. The and action on the education, training, good news is that maybe we don’t have certification and regulatory oversight Through these events and visionary to start from scratch. Currently many of the pharmacy technician compo- statements the rationale has been pre- existing health technologist and tech- nent of our workforce.” sented, and the consensus is that we nician positions require specific job- • A 2016 American Society of Health- need to elevate the role of the phar- related education and certification System Pharmacists (ASHP) position macy technician, recognize the pos- and/or licensure. Can we tweak a cur- statement noted, “To obtain the ition as that of a key member of the rently existing model that is already in pharmacy technician work force of healthcare team, and standardize the place in our healthcare systems? We the future, pharmacy must attract the education necessary to hold the pos- don’t necessarily have to reinvent the highest-quality candidates. To attract ition. What has not been discussed is wheel. Instead, we just need to mount the best possible candidates, ASHP that with this elevation of education the already existing tire on our own car. advocates that pharmacy technician and responsibility there must also be For example, radiologic technolo- education ultimately require a min- a wage adjustment to align with wage gists and nuclear medicine technicians imum of an associate’s degree from levels in other careers requiring similar have a minimum educational require- an accredited source.” 8 qualifications. ment (an associate’s degree), and guess • In 2016 the Pharmacy Technician The chicken or the egg. To what? Both their pay and turnover rates Certification Board conducted a justify the increase in technician edu- are significantly better than those of survey of 1,000 adults, 62% of whom cational requirements and responsibil- pharmacy technicians (Table 1 and reported visiting a pharmacy at least ities that we have identified as critical Figure 1). once a month to fill prescriptions to overall pharmacy advancement, we Table 1 clearly demonstrates that the or consult a pharmacist. The survey must provide an appropriate, career- pharmacy technician workforce is paid results indicated that patients place enabling wage. Unfortunately, we are considerably less than others in similar a high value on technician certifica- stuck in a Catch-22 situation. Human hospital job classes. We acknowledge tion and that standardized training resources (HR) departments will not that there are different responsibil- and certification would increase their allow higher pay for technicians, be- ities associated with each job, but it still trust in pharmacy technicians’ work.9 cause there is no technician degree re- seems relevant that a primary difference • In his 2017 ASHP Presidential quirement and comparator institutions between pharmacy technicians and Inaugural Address, Paul Bush10 pay the same low rate. But a degree radiologic technicians is the education focused his message on pharmacy requirement is problematic when the requirement.

Table 1. Comparative Wages for Pharmacist Technician and Similar Positions12-14

2018 Median 2018 Annual Job Title Education Requirement Certification and/or Licensure Annual Wage Wage Range

Radiologic and MRI Associate’s degree required; National certification and state $61,240 $40,630-$86,350 technologist bachelor’s degree available license plus CE requirement Nuclear medicine Associate’s degree or 12-month National certification available $76,820 $55,330-$104,730 technologist certificate with alternative healthcare education Pharmacy High school diploma or National certification available $32,700 $22,740-$48,010 technician equivalent plus CE requirement and state registration (not required in all states)

Abbreviations: CE, continuing education; MRI, magnetic resonance imaging.

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Figure 1. Three-year trends in turnover rates among Cleveland Clinic technician training program or passed a radiologic, nuclear medicine, and pharmacy technicians. national technician certification exam. We are charged with multiple sim- ultaneous tasks. We must retain and en- Cleveland Clinic Turnover Rates sure appropriate competency for today’s workforce while raising the educational 16.00% requirements to create positions that will entice potential pharmacy technicians Downloaded from https://academic.oup.com/ajhp/article/77/18/1532/5901287 by ASHP Member Access user on 09 September 2020 14.00% to pursue and maintain a career in the 12.00% pharmacy field.

10.00% How do we make this happen? Again, we do not need to recreate the wheel. We 8.00% have established resources, with proven

6.00% results, for getting the current workforce to the level it needs to attain. Requiring 4.00% existing technicians to pass a national 2.00% certification exam would validate and ensure their baseline knowledge. 0.00% 2016 2017 2018 As roles expand, current technicians should be provided with opportunities Radiologic Tech Nuclear Med Tech Pharmacy Tech to meet the educational qualifications necessary for these increased responsibilities. Organizations must support their current technician staff through Turnover case study at leads in supporting and advocating this transition. They must provide cre- Cleveland Clinic. We know that for both pharmacists and pharmacy ative, convenient, subsidized education pharmacy technicians are paid less than technicians. ASHP currently has an ac- and training, such as partnerships with various radiologic technicians. How creditation process for pharmacy tech- community colleges offering online de- does that translate to turnover between nician training programs15 and offers grees for working learners. the groups? The turnover example illus- specialized certification options to gain The vision. While there are many trated in Figure 1 is, of course, not in- and validate knowledge for pharmacy details to be worked out, it is not the intended to represent results of a scientific technicians.16 In 2018, ASHP created tent of the authors to determine or map study. It is an individual hospital case the Pharmacy Technician Forum, a new all the steps necessary to implement study intended to get the pulse of the membership home whose mission is to the final requirements for pharmacy issue so that robust studies can be con- further elevate and advance the phar- technicians. The intent is to advocate ducted to confirm or deny the results. macy technician workforce.17 for action towards a vision that can be Nonetheless, the results, if generaliz- The pharmacy profession and phar- the foundation to build further growth able, are staggering. There is significant macy technician advocates need to and development to advance pharmacy variation in turnover rates between determine where the educational bar technicians. Our vision to create this pharmacy technicians and personnel should be set for pharmacy technicians foundation would start with pharmacy in similar healthcare technology fields and work with state boards of pharmacy technicians being required, at a min- that currently have more robust, stand- to ensure that all states mandate a na- imum, to complete an ASHP-accredited ardized education requirements and a tional requirement for registration and/ pharmacy technician training program higher rate of pay. or licensure of pharmacy technicians. and pass a national certification exam The obvious inference from the data At a minimum we must advocate for in order to work in health systems. shown in Tables 1 and Figure 1 is that if technicians coming into the job market Ultimately, we believe that they should educational requirements for pharmacy to have completed an accredited tech- be required to obtain an associate’s de- technicians were higher, technicians nician training program and explore gree specific to pharmacy technicians. would be paid more and turnover would requiring completion of an associate’s This will allow employers to justify a decrease. degree specific to pharmacy technicians. career-empowering wage so that they Empowering change and In 2018 there were over 420,000 tech- can attract and retain personnel cap- supporting current and future nicians working in pharmacies in the able of practicing in advanced roles, technicians. Although we have made United States, and that number was ex- further empowering pharmacists to progress, we still have a long way to go. We pected to grow.3 Many of these techni- focus on higher-level tasks that require need to build upon our successes. ASHP cians have not completed an accredited professional judgment.

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Along with boards of pharmacy and improved quality of patient services and 9. Continue to develop pharmacy techni- employers we also need pharmacy pro- reduced turnover. cian sections within state and national fessional organizations at both the na- What can pharmacy leaders do now societies. tional and state levels to dedicate focus on an individual and collaborative basis 10. Establish voting representation by on pharmacy practices and patient to solve this problem? How can they technicians on professional society care as they relate to pharmacy tech- push the envelope and achieve a state boards of directors to create a culture nicians. Integrating the importance of of full employment and low turnover for of respect and acceptance. the pharmacy technician at the profes- highly qualified pharmacy technicians? Downloaded from https://academic.oup.com/ajhp/article/77/18/1532/5901287 by ASHP Member Access user on 09 September 2020 sional organizational level is necessary These technicians are the base of the Closing notes. In summary, it’s not in reaching a true culture of acceptance pharmacy operations pyramid. Building difficult to see why we have struggled to and professionalism for technicians. this foundation will allow advancement achieve a sustainable, well-trained phar- It’s time to act. So, what’s holding of both pharmacy technicians’ careers macy technician workforce. We have been us back? It seems to be us—pharmacists and pharmacy practice. unsuccessful in defining and standardizing and pharmacy technicians—as well as Recommended action steps. a foundation for nationally required phar- the pharmacy profession. For pharma- The following are what we see as the macy technician education. Technician cists, hesitancy in addressing this issue top 10 initiatives for chief pharmacy wages are not at a career-empowering may be due to their analytical training officers and professional societies to level in an era when pay levels at all ends of and the self-selection of overthinkers undertake in order to elevate the role the educational spectrum have outpaced within the profession, both of which and wage of the technician while redu- pharmacy technician pay. However, we might fuel a tendency to want to follow cing turnover: have the passion and resources to move guidelines and established best prac- change and advance pharmacy techni- tices rather than charge ahead and in- 1. Make pharmacy technician education cians. This may mean being bold and novate. For the pharmacy profession and advancement a top priority for the taking risks. Implementing a requirement and technicians, it may be more the pharmacy profession. of accredited education and certification worry about how to transition and what 2. Create a robust national study to com- will place financial burdens on technicians to do with the existing workforce. pare turnover rates of radiologic and newly entering the job market, but this will We don’t need to study this anymore. nuclear medicine technicians vs phar- strengthen our fight to increase pharmacy We already know that standardizing macy technicians. technician wages. This will also allow us to training and increasing educational re- 3. Require new hires to have completed attract, develop, and maintain a workforce quirements for pharmacy technicians is an ASHP-accredited pharmacy tech- that empowers pharmacists to advance a best practice. Although we believe this nician training program and to have their practice by delegating tasks not re- to be true, we have not widely adopted achieved national pharmacy techni- quiring professional judgment to highly these standards. cian certification.19,20 trained technicians. How do we facilitate a more rapid as- 4. Work with local community colleges similation of these practices? Earlier we to create and/or disseminate online Disclosures mentioned some good news: The model associate’s degree programs for phar- Ms. Hintzen is a past chair of ASHP’s PTFEC, already exists. Pharmacy leaders will need macy technicians and, ultimately, require a past chair of the ASHP Advancement and to take risks to make this a reality. We must this academic credential for employment. Advocacy Section Advisory Group, and a cur- step up rather than wait to follow. 5. Convince HR departments to pay tech- rent member of ASHP’s Council for Pharmacy The action-oriented thought leaders nicians with relative formal education Practice. Mr. Doss-DuPree is a member of the PTFEC Professional and Career Ladder in pharmacy will take these issues on as (from an accredited pharmacy tech- Development Section Advisory Group and sits a challenge and an opportunity to create nician training program or college) on the advisory board for Cleveland Clinic’s a strategic advantage in the technician wages commensurate those of other School of Pharmacy Technology .Ms. McNulty employment arena. Following Rogers’ healthcare professionals who must meet is a past chair of ASHP’s PTFEC. Diffusion of Innovation model,18 the in- similar educational requirements. novators or pioneers in the field will start 6. Lobby for mandatory, standardized Previous affiliations in the venues within their control, their pharmacy technician training, degree At the time of writing Dr. Knoer was affiliated own hospitals. Next, the early adopters requirements, and certification at the with Cleveland Clinic, Cleveland, OH. will join in, and eventually the other state and national levels. successive groups will catch up, likely 7. Provide financial assistance for current after regulatory requirements are im- technicians to achieve an educational References plemented. Once significant action has standard. 1. Hart J. It’s still the economy, stupid. Forbes website. https://www.forbes.com/ 8. Provide funding to technicians for started, this movement should quickly sites/johnhart/2017/12/27/its-still-the- spread across the country as we pub- travel to professional meetings for con- economy-stupid/#39d488f32c9a. Published lish our experiences, demonstrating tinuous professional development. December 27, 2017. 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