My second pharmacist job was at a hospital. I was there for eighteen years. I enjoyed working at the hospital. I’ll admit it had its moments. But it was a good place to work.
The hospital was ahead of its time. We performed innovative procedures. The physicians provided their patients with cutting edge therapies quite often found in the literature and not necessarily the package insert. These therapies were performed by these doctors long before they became commonplace.
Some of the services they offered included:
- It had one of the first pediatric ICUs and neonatal ICUs in the state. The chief pediatric physician was known for his research. He was also one of the first to split neonatal TPN bags.
- The Eye Clinic provided outstanding eye care and performed extensive eye surgeries on its patients. The head ophthalmologist was well-known for injecting antibiotic mixtures directly into the patient’s eye.
- A physician established his own pediatric AIDS clinic at the hospital. My pharmacy was one of the first to use IGIV to treat the AIDS patients. A television movie was produced about this physician and his work with the AIDS patients.
- The hospital created a clinic to treat pediatric cancer patients. There were several major newspaper articles which highlighted the clinic’s accomplishments.
- Several prominent physicians practiced cardiac surgeries for neonates and children.
On many occasions, visitors (local politicians, clergy, and community members) stated that the facility was extremely necessary. It was an essential part of the community. My hospital wasn’t the biggest facility or No. 1, but it did serve a purpose. It introduced groundbreaking therapies. It provided an essential need.
The hospital also provided care to an indigent population. It allowed its patients to get the healthcare that they needed. It allowed many physicians to flourish in their field. It also provided jobs for people in the community.
As the years flew by, the lack of money plagued the aforementioned programs. They soon moved on to other facilities which provided them the funding and respect they deserved.
My hospital was very much needed. Which is why it was so upsetting when it closed.
Fortunately for me, I knew when it was about to end.
Now I didn’t have the exact date, of course. And it didn’t happen immediately. But I had a gut reaction that it was over. I saw signs that the end was approaching
Below were some of the signs that I saw.
Not Hiring New People
Whenever I had an open position, either due to a resignation or new task, my goal was to fill the position as quickly as possible. However, when my facility was about to close, the hiring process became more difficult.
I had a very good relationship with my human resource recruiter. She did all my hiring. I often joked that she was my own person recruiter, even though she served other departments.
I was constantly contacting her. I made sure she would place an ad in the Sunday newspaper (that’s how we did it in the 1990s). I asked her to schedule interviews. I asked her to follow up on references. Then, once a candidate was hired, I had her follow up with an employee physical and a starting date.
It was to my advantage to guide her every step of the way. If this meant constantly calling her or walking over to her office every other day, I was willing to do so. Anything to advance the hiring process.
Which is why I found it suddenly strange when she wouldn’t return my phone calls. Or that she was always too busy to see me when I showed up at Human Resources. Suddenly my positions weren’t getting hired. I originally blamed her, but eventually I realized that she was being manipulated by someone in a position above her.
Remember the phrase “the Lord giveth and the Lord taketh away”? In my hospital, upper management was the Lord. Let’s say, my vice-president granted me the opportunity to fill a position. If I did not hire a candidate within a reasonable amount of time, then he might take the opportunity away. After all, why should I be allowed to hire a candidate if the work was getting done without hiring the candidate.
Now it might be argued that even though the tasks were getting completed, we were really short-staffed. Or it might be said that the tasks weren’t really being performed entirely. But my vice-president really wouldn’t care. He would feel that something was better than nothing. And that justified not permitting me to hire a person.
As stated, I needed to hire the person within a reasonable amount of time. Eventually I noticed that this “reasonable amount of time” was getting shorter and shorter. Soon, I wasn’t allowed to hire at all.
Experiencing A Hiring Freeze
Throughout the years, my facility instituted a hiring freeze. They would stop hiring employees at this time. The hiring freeze usually occurred at the end of the calendar year in December. However, sometimes the hiring freeze took place at the end of the fiscal year in June.
The hiring freezes generally lasted one month.
My hospital always said that the reason for the hiring freeze was restructuring. The hospital wanted to evaluate each department’s manpower to determine if it was appropriate to perform its tasks.
I almost believed this too. Except nobody approached my boss (the Director of Pharmacy) or myself (the Assistant Director of Pharmacy) to evaluate our department’s manpower or tasks.
I had a different opinion. I suspected that it was a cost-savings measure. The hospital needed cash at the end of the time period. And what better way to get cash than to put a hold on hiring. This way the hospital saved money by not paying for salaries and benefits.
My viewpoint was further confirmed when my hospital started implementing hiring freezes in both March and September (end of each quarter). This showed they had money management issues throughout the year.
My hospital was in constant need of money. It was not a very good sign.
Resigning En Masse
The end was near for my hospital. Everyone knew it. The morale amongst the employees was terrible.
Upper management tried to have these “rah rah” meetings, where they’d tell everyone that things were going to be just fine. They’d say how even though things might appear gloomy, that the hospital had just turned a corner. And things were going to get better.
I wasn’t buying it. And neither was anyone else. I knew what was happening in my own department. And I heard the same atrocious stories about other departments as well
The final blow came when the same upper management people who hosted these meetings, started leaving.
Then we lost about fifty middle managers in May. By the end of the summer, there were only about twenty remaining. People were resigning and moving to other jobs.
And they weren’t being replaced. Imagine a department running with no one in charge. Or trying to get a CEO to sign an overtime request form.
I fortunately had left with the others. The mass exodus was a sign that things were slowly coming to an end.
Being Put On Credit Hold
I worked in a hospital pharmacy department. My pharmacy took care of their patients by supplying their medications.
I once figured that the average patient received twelve different medications daily. Multiply that by 400 patients— that’s 4800 medications per patient per day. By adding two emergency rooms (adult and pediatric) and a few clinics, the medications can surge to over 10,000 medications per day.
My pharmacy ordered from a major wholesaler in order to obtain the hospital’s medications. An order was placed on Monday through Friday. And a delivery was received five days a week as well. Most items were gotten from our wholesaler, although some medications were gotten directly from the companies.
Our drug budget was approximately $1.5 million per month. When I first started working at the hospital, we were current— my hospital paid its bills. But as time went on, my hospital slowly lagged behind in its payments.
Then one day, my pharmacy got a call from the wholesaler’s sales representative. They were putting us on credit hold until the hospital paid a substantial part of its bill. The hospital’s solution was simple. We just changed wholesalers. And we ran up another bill.
When the other wholesaler put us on credit hold, we tried to change wholesalers again. But this time, it didn’t work. Word had gotten around. My pharmacy had no wholesaler— no source to obtain drugs. Thus, paying the bill became a priority.
As the years went by, our hospital tried playing this game with certain direct medications. These were medicines that could only be obtained from specific companies and not the wholesaler. In these cases, maybe it worked once or twice, but eventually everyone became wise to our shenanigans.
The hospital's credit rating was lousy. This resulted in a few companies insisting on having a check waiting for them when the medication arrived. If there was no check available, then the drugs were put back on the delivery truck and taken away.
Some companies even wanted this check in advance, before the order was released.
The hospital’s money management system was problematic to say the least. I did not see any improvement forthcoming. And I knew it was only a matter of time until the hospital would close.
Using My Own Money
I know teachers use their own money to buy items for their classrooms. It’s not right. Maybe they should be given more money. Or maybe their school should get additional funding. Or maybe we should pay higher taxes to increase the school budget in our town. But the teachers really shouldn’t have to pay out of their own pockets.
I’d never do that. Or so I thought.
As I said previously, our hospital had money issues. We were on credit hold with many of our vendors. We regularly borrowed essential meds from other facilities just to get through the day.
I remember getting a call from the nursing vice-president (we were under nursing at the time). She wanted me to borrow everything we needed from nearby hospitals. We literally had a list of over a hundred things we needed to obtain.
I had no problem calling— I told my vice-president, but was security going to send someone to pick the items up? I didn’t think so.
And it wasn’t only our department that wasn’t getting its supplies. Every department (lab, nursing, dietary, housekeeping, respiratory, etc.) wasn’t getting their items either.
Even when my drug vendors were shipping, I remember that there were non-drug items that I couldn’t get. Things like toner cartridges for my printer (they were considered “gold” in my hospital). Or sterile wipes to clean my IV hoods.
I paid for these items out of my own pocket. Even though I said that I never would.
I wasn’t alone. Many managers and department heads needed things. It was sad. We were doing things to keep the hospital alive, while upper management’s efforts were shutting it down.
Unfortunately, my attempts couldn’t go on for too long. I might be able to buy my own sterile wipes or toner cartridges. I might even be able to borrow a multitude of medications from nearby hospitals.
But there would come a time when the hospital’s downward spiral would exceed my uphill battle. And then the hospital would finally close.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.