Learn how three health systems enhanced their recruiting, retention and career advancement efforts to tackle the industry’s ongoing shortage.
It’s no secret that healthcare systems across the nation have struggled with a shortage of pharmacy technicians in recent years. But how is the industry responding to this critical challenge?
Visante interviewed pharmacy leaders from three different health systems to find out what strategies they used to combat the shortage. Their answers shed light on the need for a multi-faceted approach – and offer a path forward for other organizations in search of solutions.
University of Missouri Healthcare Pharmacies
We spoke with Tom Greenlee, PharmD, retail pharmacy manager at University of Missouri Healthcare, and veteran pharmacy technician. Greenlee believes that both pharmacy technicians and pharmacists are pushing their scope of practice, and that more progress can be made if it’s a team effort to advance the profession of both pharmacists and technicians, especially since their work is synergistic by nature.
Building a career lattice instead of a ladder
Developing a pharmacist technician program for career progression requires a more stratified, structured pharmacy technician slate of roles that can cater to technicians’ desire to advance in their career with flexibility. But what’s the difference between a career ladder and a career lattice? Are they synonymous, interchangeable?
Greenlee said the ladder and lattice concepts are similar in that they invoke career progression. However, a career lattice builds upon the idea of a career ladder by giving the employee more role options for advanced roles in different settings. The lattice concept is a sort of seismic shift for technicians to advance in that it allows for vertical, horizontal, and diagonal movement, shifting the focus away from upward mobility and toward best fit.
A career ladder, on the other hand, is a less-stratified, more unidimensional means of career progression typically involving a single pathway allowing for upward advancement in an organization’s pay structure.
“I definitely encourage the lattice structure. Why? Because if you think about career ladders, they’re just so vertical in nature,” Greenlee said.
“From the health system perspective, you’ve got different teams and different silos within your pharmacy department, your acute care side, outpatient, specialty pharmacy, the infusion units, maybe even your business team.”
What if an individual starts on the business team and they find out it’s “really not their jam”? “If they want to do something else, then let’s find a path for them to join a more suitable team, say their infusion or specialty team. And let’s take advantage of and actually celebrate the fact that the health system is so diverse within pharmacy. It’s the idea that the lattice construct provides so much more flexibility for not just upward role mobility, but lateral or diagonal movement.”
Greenlee points out a caveat in training differences, however. For career ladders, some organizations find they can really dig in with the training and development side of things with a more vertical approach. They say, “If you’re going to be in the business unit for the next 15 years, let’s get you started doing this.” They can focus. A career ladder may suit that particular envisioned progression.
But if it’s true with some positions, why is the pharmacy technician role any different? “If I’m sitting in the role of a pharmacy technician, I can appreciate the fact that I may not find my best fit the first time around. If I leave my traditional dispensing role and join, let’s say, the infusion unit, but I find that’s not what I want to do, the fact that I belong to an organization that would support me to make a jump to specialty or retail, I think that’s a unique advantage,” Greenlee said.
Focusing on retention and job satisfaction
The University of Missouri Healthcare pays its pharmacy technicians a wide salary range, from minimum wage to nearly 75% of a pharmacist salary. But looking at compensation alone is thinking along only one dimension. There are many other management considerations that can forge a solid path for technician retention and job satisfaction.
Greenlee points out that their system understands they need to create some incentives to create that path to higher compensation. But in a lattice structure characterized by role flexibility geared to find best fit, compensation increases only occur with level jumps, not lateral role moves.
In their system, there are six tiers of compensation, but there are multiple technician positions on each tier. “This helps to distinguish the pharmacy technician role, including advanced roles, and that is something to be celebrated because there are so many options. They can truly find their best fit and still have a chance for upward mobility.”
Making a great first impression
Furthermore, Greenlee says that it’s true most every employee wants to be successful. Whether you’re the health system, the pharmacy department, a pharmacist, lead tech, or their pharmacy manager, “You have to be invested in their success,” he said. “You never have a second chance to make a first impression [with a new employee]. Their first impression of the organization should be that they understand on day one that we put a lot of thought and investment into their training.”
Greenlee explains that newstarts should recognize this investment is an extension of the pharmacy department’s culture, that they truly want to help them succeed in finding the best fit for them and says, “It’s the right thing to do.”
In turn, most employees recognize and value that flexibility and investment. It can set the stage for the technician to not only feel connected to the organization, but to then reciprocate with their investment – their hard work and time that translates to serving patients in need.
It’s this recipe of investment, role flexibility, and compensation that can move the needle toward increased retention.
Adapting with training and retention tools
Over the years, as pharmacy technician roles have evolved, University of Missouri pharmacy has learned to adapt with training. Though you have the core human resources training, training of the actual role “will look different for each position,” he said. “We don’t have as standardized an approach to training that’s translatable to all these 17 job codes. We try to tailor it to the respective positions. And for every tech position, it’s going to look different. But we want them to know we are very much investing in them and want them to succeed from day one.”
Pharmacy technicians can become overloaded, especially given staff shortages and almost daily reliance on float pools comprised of cross-trained technicians, many of whom are at an advanced level. But to combat burnout, Greenlee says managers need to be proactive in learning what the issues are. There are typically a variety of tools pharmacy leaders have and should be taking advantage of to improve retention.
“We’re fortunate to be part of a health system that provides free counseling. It’s not just counseling alone either. We want to show as much grace as we can. We encourage struggling employees to apply for Family and Medical Leave Act (FLMA) if they have mental health concerns.” Greenlee says COVID‑19 “definitely changed how we deal with our workforce.”
Many institutions were forced to be more adaptable in creating more remote roles. Over time, many have become more astute and responsive to recruiting efforts to meet pharmacy technician shortages. Float pools for many organizations have expanded with the idea that it is more cost-effective to deploy emergency pharmacy technician assets than temporarily filling a technician job with a pharmacist. Greenlee is a firm believer in a proactive approach to pharmacy workforce management.
“I think one of the most important things is to be opportunistic,” he said. “Some organizations feel a lot of pressure to map out their career lattice incorporating all these technician roles in one fell swoop.” That would be a mistake, he says. Organizational progress takes time. They’ve evolved their current technician lattice with numerous changes and adaptations.
“Invest the capital all in one moment? No. It’s really an incremental process. We’ve been adding and modifying [technician positions] for the last five years. And it’s not just me driving this change, it’s the history of my predecessors and all the progress they made.” They’re now benefiting from what was previously established. He said tech lattices within organizations must continuously evolve and adapt because the practice of health system pharmacy rapidly evolves. Labor markets also fluctuate, which is especially the case with the pharmacy technician job market.
But human resource restructuring takes time. Pharmacy technician needs can sometimes go unaddressed due to other priorities like drug shortages, or financial performance initiatives. That’s why Greenlee says it’s advantageous to formalize a review process at a defined interval as this can help prevent neglect of career development.
At the core of it, the institution has been driven to retain and celebrate technicians. Greenlee says they remain focused on new opportunities, to explore any new pathways for individual and institutional growth. “When new [pharmacy] service opportunities present themselves, we ask the question: Is there an opportunity to employ a pharmacy technician?” Because there just might be a niche to be filled. “The technician can take pride in filling that role and need to be celebrated.”
Dartmouth Health Pharmacies
Visante spoke with Staci Hermann, PharmD, MS, Chief Pharmacy Officer at Dartmouth Health to discuss her organization’s efforts to recruit and retain pharmacy technicians. Dartmouth Health is the most rural academic health system in the country. Because all its hospitals are located in rural areas, they have a much smaller talent pool to recruit technicians from when compared to urban areas.
“The things I think make rural healthcare most challenging are maintaining competitive wages (not only to other healthcare providers, but across all industries in the region) and the fact that most staff live 45 to 60 minutes away, so the cost of travel with minimal to no public transportation available must be
factored in from a recruiting and compensation perspective,” she said.
“The pandemic has made recruiting more challenging. Some health systems in big cities and their surrounding areas have more options to recruit and may have the luxury of a dedicated technician pipeline in the form of pharmacy students,” said Hermann. “Unfortunately, Dartmouth College doesn’t have a pharmacy school, and the closest pharmacy school is over an hour away. This technician workforce challenge can be daunting, especially when Amazon offers forklift drivers upwards of $50 per hour. We’ve had to come up with other recruiting solutions to ensure we have a pipeline.”
The pharmacy department has 350-400 employees, more than half of whom are in various pharmacy technician roles. Hermann says their workforce continues to be impacted by fluctuating market forces, unexpected turnover, and broader workforce shortages. Recruitment efforts are ongoing and competitive rates for technician compensation are routinely reviewed. Recently, Dartmouth Health approved a bump in pharmacy technician pay well above the minimum wage with incentives for those with certification.
“We tried to move the salaries sooner but were challenged by many of the forces impacting healthcare organizations across the country and had to wait. What really helped was the organization moving the minimum wage for other entry-level jobs, which we leveraged to move our technician rates,” she said. ”In addition, COVID and the associated increase in all entry-level jobs in our region also factored in to our push to increase the technician rates” she said. “About a month after our most recent pay raise for technicians, we found out another system raised their rates to match.”
Building a recruitment pipeline
Dartmouth Heath also operates the Workforce Readiness Institute (WRI), a licensed career school that supports recruiting and training for key areas and roles in the health system. Since 2016, over 150 certified pharmacy technicians have been trained through the WRI’s Pharmacy Technician Apprenticeship Program. Through this earn-while-you learn strategy, participants have ability to gain the technical and professional skills needed to enter the profession, all while earning a training wage and working towards their Associate’s in Health Science at Colby-Sawyer College. Base training pay for apprentice technicians was raised to a living wage well above minimum wage and the graduates from the program can be placed at multiple facilities throughout the system. The connection to college credit was very important as it positions technicians for their next career step in healthcare including higher-paying jobs such as a pharmacist. Hermann says the program has a high rate of graduation success.
Dartmouth Health has an established tele-pharmacy group that was asked, in 2021, to take on the medication reconciliation program after pilot programs showed it was feasible. Staci explained, “That was an interesting process, to leverage technology, because everyone suddenly went remote. But when you’re in rural parts of America, it’s all about the technology to make things work.”
Tufts Medical Center Pharmacies
Melissa Ortega, PharmD, MS, is Vice President of Ambulatory Pharmacy Services at Tufts Medicine. We spoke to her about the technician crisis, retention strategies, and the impact of the pandemic on her institution.
“Everyone’s retention story is a little bit different,” she said. “In the technician workforce, what we’re trying to do is create a successful work-from-home model. I think that the pandemic is causing us as employers to rethink what’s possible.”
Training, mentoring and reinforcement
Ortega emphasized their daily long-term strategy is to strive to achieve team identity, a culture of accountability, and empowerment of individual workers to provide quality patient-centered care. And this is their overall practice philosophy whether they are new technician recruits in training or experienced veterans. Much of this is motivated by cooperation with pharmacists themselves.
“Of course, that starts with training,” she said. “Those elements need to be established early on, but they also need to be reinforced. Our pharmacists work with technicians every day at a 1:1 ratio. So pharmacists have an opportunity, especially pharmacy unit managers and all lead technicians, to step up and train, mentor, educate, and reinforce. And they do.
“They can really have an impact on the trajectory of individual technicians. Effective leadership means connecting at the human level to create a sense of team, productivity, and accomplishment. That’s where you see the return on investment in the long run,” she said.
That focus on team includes frequent positive feedback for individual efforts. One of their pharmacy technicians was recently recognized system-wide by the CEO for catching a medication error that could’ve had serious consequences. “It was really nice seeing the CEO praise our technician, who absolutely deserved that recognition.”
Revisiting community partnerships
Tufts Medicine pharmacy has roughly a team of 200, with 100 technicians. “My particular team is comprised of 85 full-time equivalents (FTEs) and half of those are technicians. Recently we did a market analysis, an important initiative we aim to do more frequently.
“Unfortunately, with the technician shortage, it gets really tough when you don’t get technicians to fill positions, you have tasks around distribution that need to get done. The work remaining undone is my greatest concern with the technician shortage. It’s a scary ripple effect.”
“Our community college apprenticeship program is unfortunately not active anymore. But it’s a good past learning point we haven’t forgotten—that we should partner when we’re able,” she said.
Historically, they’ve gained “pockets of success” by bringing in community apprentice technicians who would rotate through pharmacy units and fill work shifts. “In fact, we’re currently discussing this type of partnership to once again complement our source for technicians. Our Melrose Wakefield Hospital was an important point of partnership.”
Incentivizing internal referrals
Staying competitive in the marketplace has required a shift in mindset in attracting pharmacy technicians since they’re in such short supply. Tufts Medicine pharmacy leadership has worked with their health system’s human resources to incentivize an internal referral program, and has also approved a signon bonus, which appears directly on their job listings.
“Yes, we had to go that high,” said Ortega. “Boston has multiple hospitals. We’re competing with them for technicians. We’ve made sure our rates are competitive. We receive referral sources and perform traditional marketing.”
Evolving the career advancement ladder
Ortega is particularly proud of the evolution of their technician advancement ladder, which provides upward mobility for technicians to advance to greater responsibility and can help retain those who believe they’re being invested in by the health system. Levels 1 through 5 technicians are briefly described below, with level 5 being the most advanced functioning technicians.
- Level 1. In Massachusetts, they distinguish technicians by certified vs. non-certified. Both perform core medication distribution and fulfillment and are registered with the state.
- Level 2. All are certified technicians, and while they may also perform foundational medication distribution, they can take on additional responsibilities, such as outpatient pharmacy services, helping with compounding, delivery, automated dispensing, and fulfillment.
- Level 3. This level requires additional experience and expertise, and performs patient reconciliation, prior authorization, medication access, affordability, patient assistance programs, and compounding for hazardous medications.
- Level 4. Unique expertise is required for special roles. “They’re overseeing a program or operational process,” said Ortega. “They’re lead technicians, supervisors, or serve as an expert or trainer.”
- Level 5. This level typically consists of even more unique roles, like medication access coordinator, who may directly help patients arrange for their pharmacy needs, manage Medicare Part B, provide support for the entire pharmacy revenue cycle, and may support the 340B program. For instance, this may include the role of business analyst, who helps with financial auditing, analytics, trending, and accreditation efforts.
Using technology to make technicians’ jobs easier
Beyond career ladders, Tufts Medicine is looking at what work can be offloaded from technicians.
“Technology and automation solutions—that’s the big challenge. Where can we continue to deploy automation and technology to support technicians to work at the top of their license? On the acute care side, we’ve deployed automation at every phase of the medication use process. On the ambulatory side, we’ve deployed robotics to help fulfillment processes. Right now, we’re exploring automation for our adherence management program, which is very manual. Prior authorization technicians have now
partnered with a third-party company with expertise in helping health systems manage patient assistance programs and reimbursement with a central portal.”
“We’re also looking at the types of functions that our advanced techs complete in specialties that align with tasks such as benefit investigations, completing their outreach and coordination calls [typically level 4 technicians], completing assessments and coordinating home deliveries,” she said. “There’s a lot our pharmacy technicians can do, and they do make a big difference.”
Ortega leans toward a practical vision for their workforce considering the state of the economy, which has temporarily tempered growth prospects.
“No health system right now is looking at their financial statements and smiling,” she said. “Very few health system organizations are doing well. Whenever you are pausing growing services—and I know other leaders have said this—you can’t grow services by cutting people. The challenge is to ensure your current workforce can operate well and actually leverage technology.”
Ortega views this technician crisis as an ongoing uphill battle with seemingly unending demand. But armed with greater tools to recruit and retain, she also sees the slope improving as long as larger health system investment is there.
“We have to use a system-level approach to improve our workforce,” she said. “We’ve seen that reaching this level of success is certainly a challenge to self-identify as a single cohesive team. But we can certainly drive solutions across our three hospitals. This is a priority. We know we’re going to invest more resources in supporting technicians.”
Want to learn more?
Pharmacy technician shortages can decrease productivity and employee engagement, compromising pharmacies’ ability to distribute drugs safely to patients. Learn more about the shortage, and what your organization can do to address it, in Visante’s latest whitepaper.