LAS VEGAS–With the Pharmacy Manpower Project estimating that there will be a shortage of approximately 160,000 pharmacists by the year 2020, many hospitals are looking for innovative ways to recruit talented new pharmacists and retain the experienced staff they already have. One growing solution involves flex-time and job-sharing programs.
In the 2006 Pharmacy Staffing Survey conducted by the American Society of Health-System Pharmacists (ASHP), approximately 45% of pharmacy directors polled reported having job-sharing arrangements available and another 25% were considering them. Compressed work weeks—in which employees work 10- to 12-hour shifts in order to work fewer days—were reported by 54% of pharmacy directors.
“You see more and more arrangements like this,” said Jill Robke, PharmD, BCPS, a clinical pharmacy specialist at St. Luke’s Hospital in Kansas City, Mo., and a member of the ASHP’s Task Force on Changing Demographics. “It’s fairly new in clinical pharmacy, but we have to find solutions that both get our patients taken care of and keep employees happy by helping them find balance.”
At the ASHP Midyear Clinical Meeting, pharmacists from the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tenn., presented their successful experiences with a flex-time job-sharing approach. Since January 2006, two clinical pharmacists in the pediatric critical care unit (PCCU) have shared 1.6 full-time equivalent (FTE) positions, with each working approximately 32 hours per week (0.8 FTE).
Devising a Plan
The new approach at Vanderbilt had its inception when both clinical pharmacists involved, each of whom had been with the hospital at least three years, became mothers at the same time. Julie Sinclair-Pingel, PharmD, and Alison Grisso, PharmD, were both pregnant with their first children and delivered within a few months of each other in 2005. Dr. Sinclair-Pingel had planned to return to work full time, but while on maternity leave, realized that she wanted more balance between family life and work. Dr. Grisso, who had already planned on returning to work only part time, suggested that they approach their management team with a job-sharing proposal.
Together, Drs. Sinclair-Pingel and Grisso crafted an approach they thought would benefit everyone—patients, other pharmacists and pharmacy management as well as themselves. They would each work three days per week and share responsibility for management of the patients in the PCCU. With the 1.6 FTE positions that they now share, one full position represents a clinical pharmacist and 0.6 FTE represents a staff pharmacist.
In this arrangement, Dr. Sinclair-Pingel works 6 a.m. to 4 p.m. on Tuesdays, Thursdays and Fridays, working in the main pharmacy handling responsibilities as staff pharmacist from 11 a.m. to 4 p.m. on Thursdays and serving as a clinical pharmacist the remainder of the time. Dr. Grisso works Mondays, Wednesdays and Thursdays, performing duties as staff pharmacist from 10 a.m. to 1 p.m. on Wednesdays and 6 a.m. to 8 a.m. on Thursdays, with the rest of her hours spent as clinical pharmacist. Both women also work every sixth weekend as staff pharmacists, from 7 a.m. to 1:30 p.m. on Saturday and Sunday. By working at least 30 hours per week, the two pharmacists retain their full employee benefits.
Both pharmacists were surprised at how little resistance they encountered when proposing their plan. “It was really well received,” said Dr. Grisso. “Nobody has ever said, ‘You should be here every day.’ They had to make tweaks to schedules, but no one had a problem with it, I think because we presented a plan that benefited everyone.”
The pharmacy and hospital benefited by not losing two long-time, highly experienced clinical pharmacists—which both agree would likely have happened without the job-sharing arrangement. “We did so much training to become pediatric clinical pharmacists, but at the same time, you’re a parent before you’re a pharmacist,” said Dr. Sinclair-Pingel. “I had to feel I was with my child more than I wasn’t, and without that I would not be here.”
Dr. Grisso agreed. “I wanted to make this work and was willing to see what the hospital would let us do, but if it came down to 40 hours a week, five days a week, or no other option, then personally I would have done something else.”
The new arrangement also benefited the existing staff pharmacists, who were able to go from working every third weekend in the pharmacy to every fourth weekend. Clinical pharmacists had to go from every eighth weekend to every sixth weekend, but the change only affected Drs. Sinclair-Pingel and Grisso: Other clinical pharmacists in the unit have been hired since the change, so it’s the only system they’ve worked under.
Old-Fashioned Patient Tracking
Tracking patients may appear to be a challenge when two pharmacists are involved, but Drs. Sinclair-Pingel and Grisso address the issue in writing—by hand. Although they use a computerized patient order entry system, they rely much more on paper notebooks.
“We print out the patient’s profile, meds, labs and anything else we need daily to create a communication sheet, which we take on rounds with us in a patient notebook,” Dr. Sinclair-Pingel said. “If any changes are made, we make notes for each other in that notebook, and the next day the other person can see what happened the day before and add their own notes. That’s pretty much how we communicate, by entering notes in the patient profile notebook.”
Interventions are also recorded in a pharmacy drug intervention database, but that is not part of the patient record.
Clinicians within the PCCU praise the new arrangement. It’s been “seamless,” said attending physician Tyler Berutti, MD. “I think unless it’s pointed out to them, many people don’t even realize that they’re job-sharing,” he said. “There have never been any problems with transitions, or any instances where they were unsure of what the child was on before or where we were in the level of care for weaning off or coming on drugs. They do such a great job, and I’d rather have the job-sharing than lose either of them.”
Dr. Berutti has seen scheduling prompt turnover in other parts of the hospital. “I know there are other areas of Vanderbilt that don’t allow job-sharing, and I think they’ve lost a lot of talented individuals who are trying to choose between family and work.”
To avoid that prospect, more institutions will need to jump on the flexible-hours and job-sharing bandwagon, said Dr. Robke, who was part of a group that developed the first part-time system for clinical pharmacists at St. Luke’s in 2001. An original group of four pharmacists did what Dr. Robke called “professional partnering”—not actually sharing the same job, but sharing FTE positions, transforming four FTE positions into three with each of the four serving as 0.75 of an FTE.
The group created its own scheduling committee, which now develops schedules six months in advance. “Now, we’ve evolved to the point where we have several part-time pharmacists who work any number of fractional components of a full FTE, and we all make it work through the scheduling committee,” Dr. Robke said. Clinical pharmacists also have some degree of flex-time: They are permitted to come in any time between 7 a.m. and 8 a.m. and leave any time between 3:30 p.m. and 4:30 p.m.
Dr. Robke added that lifestyle has no bearing on who can participate in flexible scheduling: Parents aren’t given preferential treatment over a single clinical pharmacist who wants to make time to train for a marathon. “The reason you want a particular schedule doesn’t matter,” she said. “As long as we can make it work and take care of patients, we’ll do it.”
Are You Ready for Flex-Time?
If you’re interested in persuading your institution to follow the lead of Vanderbilt and St. Luke’s, Dr. Robke has a few tips for the successful pursuit of flexible scheduling:
Be proactive. Don’t wait for your operations manager or director of pharmacy to come up with a solution to your problem. You have to propose it to them.
Develop a written proposal and prepare for questions.
Don’t complain; identify solutions instead.
Focus your pitch, as Drs. Sinclair-Pingel and Grisso did, to explain how your plan will benefit the pharmacy as a whole and, in particular, lead to better patient care.
“Your administration may worry that if they do this for you, they have to do it for everybody. But that’s not necessarily a bad thing,” said Dr. Robke. We’ve found that we’re able to accommodate everyone as long as there’s give and take on both sides. When you’re looking at a manpower shortage of 160,000, you have no choice but to entertain these types of proposals.”