ICare

November 2, 2008 Union Yes? Pharmacists fill prescriptions, educate patients and sometimes carry union cards. How might that play out in Boone County? By John Russell john.russell@indystar.com With their white coats and six-figure salaries, pharmacists might seem like an unlikely group of card-carrying union members. But around the country, 15,000 pharmacists, or about 6 percent of the U.S. total, belong to the Steelworkers, Teamsters and other unions, joining ranks with blue- collar workers who smelt aluminum, build tires and drive beer trucks. Most of the unionized pharmacists work in big industrial markets such as Pittsburgh and Chicago, along with smaller cities, such as Tampa, Fla., and Gary, Ind. No union pharmacists work in Central Indiana, according to the Indiana Pharmacists Alliance, a statewide trade group. But that could change. The United Steelworkers union is keeping a close eye on a massive mail-order pharmacy springing up in Boone County. The $150 million distribution center, being built by Medco Health Systems, will cover an area the size of six football fields when it opens next year. It eventually will employ 1,300 people, including hundreds of pharmacists and pharmacy technicians who may need help negotiating contracts and addressing grievances. "We do represent other Medco pharmacies, and we would seek to address representation issues with Medco at that new facility," said Maria Somma, international organizing coordinator with the Steelworkers' Health Care Workers Council in Pittsburgh. The Steelworkers union represents more than 5,500 Medco workers, including pharmacists in Florida, Texas and Pennsylvania and pharmacy support workers in Nevada, New Jersey and Ohio. The union, better known for organizing workers at steel mills, said it has represented health-care workers for more than 50 years, including hourly workers in hospitals, pharmacies, mental health centers, drug factories and medical offices. But following the loss of tens of thousands of steel jobs as one massive mill after another has closed, the union is pushing aggressively to expand its reach in health care. It's too early to say whether the union will find a receptive ear with pharmacists here, or whether it will face stiff resistance from Medco, the nation's largest mail-order pharmacy. The company said employees are free to join unions if they wish, following the established legal procedure. "Medco values all of its employees, regardless of their union representation status," spokeswoman Ann Smith said. But the union and company have a rocky past. Two years ago, Medco locked out more than 500 pharmacy tech workers at its Las Vegas mail-order center in a bargaining dispute, replacing them with uncertified temporary workers. During that time, the union called for the Nevada Board of Pharmacy to investigate the company's practices and suspend its license. The two sides settled their differences a few weeks later. So why would a pharmacist, who typically holds a doctoral degree and makes more than $100,000 a year, want to join a union in the first place? "When I tell people I'm a pharmacist and I belong to a union, they kind of give me a blank stare, because they cannot put the two together," said Tom Hanson, a staff pharmacist at Walgreens in Chicago. But unions, he said, have helped pharmacists -- who are on their feet all day and under pressure to fill prescriptions quickly -- win a raft of better working conditions, such as getting every other weekend off, avoiding 14-hour shifts, and the right to bid on store locations and vacation schedules. "Because we have a contract in place, we're treated fairly," said Hanson, a pharmacist for 32 years and president of Local 1969 of the United Steelworkers/ National Pharmacists Association. Leo Hans, a pharmacist at a Medco facility in Tampa, Fla., said his union has helped give his colleagues a stronger voice and better hours. Hans, for example, works 6:30 a.m. to 3 p.m., Monday through Friday, hours that are almost unheard of in the industry. "It's great for me," said Hans, president of Local 991 of the Steelworkers union. "When you work in retail, it's usually crazy hours, working on weekends, overnight, stuff like that." In some markets, pharmacists are turning to organized labor to help fight back against drug chains, which monitor how quickly pharmacists fill prescriptions. "If you are filling prescriptions fast enough, a green light appears on the computer screen. If you fall behind, a red light appears," according to a newsletter from Steelworkers Local 1969 in Chicago. "Records are kept and the red-light (pharmacists) are deemed incompetent because they are too slow." That pressure, some say, cuts back on the amount of time pharmacists can talk to patients about drug interactions, side effects and other important health issues. "I probably get four or five calls a month from retail pharmacists who say, 'Help me. I can't be the professional I was trained to be,' " said Somma at the Steelworkers union. Medco, one of the nation's largest pharmacies, dispenses about 550 million prescriptions a year, many of them from a network of highly automated mail-in distribution centers. The company boasts of its speed, efficiency and technology. Its 2007 annual report says its distribution centers help "maximize the efficiency of the dispensing function." Medco's newest center, under construction at the AllPoints industrial project at Anson, west of Zionsville, will be its largest, with the capacity to dispense more than 1 million prescriptions a week. Pharmacists will oversee all dispensing, from scanned-in prescriptions from around the country. The automated centers are springing up, in part, to help alleviate the stress caused by a national shortage of pharmacists, the result of a surge of retirements, a flurry of hospital and drugstore expansions, an aging population and an increased number of prescriptions written. The Pharmacy Manpower Project predicts a national shortage of 157,000 pharmacists by 2020. Some experts, however, point out that pharmacists still are expected to fill prescriptions quickly and accurately. "No question, there's a lot more pressure on pharmacists and their staff to dispense prescriptions quickly," said David Zgarrick, chair of the pharmacy practice department at Drake University in Des Moines, Iowa. But whether that pressure will prompt pharmacists to join a union remains an open question. Some say they have no desire to do so because that could diminish their professional status. "I'm not sure what benefit it brings to me as a professional," said Kelley Viola, a staff pharmacist at Meridian North Pharmacy. "If a pharmacist has too much pressure to crank out pills by the hundreds in any given day, they need to stand up and push back. You can't compromise your license and your ability to serve your patients."