Consolidation among benefit managers gave them more leverage over pharmacies to drive prices lower. (CVS merged with a large benefits manager in 2007.)

Big drugstore chains often responded by trying to rein in labor costs, according to William Doucette, a professor of pharmacy practice at the University of Iowa. Several pharmacists who worked at Walgreens and CVS said the formulas their companies used to allocate labor resulted in low levels of staffing that were extremely difficult to increase.

According to documents provided by a former CVS pharmacist, managers are motivated by bonuses to stay within these aggressive targets. CVS said it made staffing decisions to ensure “the safe and accurate filling of prescriptions.”

The day that Dr. Poole began seriously reconsidering her CVS job in Tuscaloosa came in May 2021 when, nearly eight months pregnant, she fainted at work.

The loss of consciousness was nothing serious in itself — she and the baby were unharmed, and an adjustment to her blood-pressure medication solved the problem. Much more alarming to her was what the episode said about working conditions: Despite the additional responsibilities of the pandemic, like coronavirus vaccines and catering to Covid-19 patients, there was no co-worker around to notice that she had hit the deck.

contract signed in March by a union of Chicago-area Walgreens pharmacists reflected a similar approach. It provided maximum base pay of $64.50 per hour, the same as the previous contract, but lowered the starting wage from $58 per hour to $49.55 per hour by September. (Like many retail pharmacists, the union members also receive bonuses.)

CVS and Walgreens said they had made hiring pharmacists a priority during the pandemic — CVS said it employed nearly 6 percent more pharmacists today than it did in early 2020; Walgreens declined to provide a figure. CVS said its compensation was “very competitive” for pharmacists, and Walgreens cited “ongoing phased wage increases”; both chains have offered signing bonuses to recruit pharmacists. The Chicago union said Walgreens had recently offered to raise pay for about one-quarter of its lowest-paid members.

To explain the wage stagnation of upper-middle-class workers during the pandemic, some economists have suggested that affluent workers are willing to accept lower wage growth for the ability to work from home. Dr. Katz, of Harvard, said the wages of many affluent workers might simply be slower to adjust to inflation than the wages of lower-paid workers.

But Marshall Steinbaum, an economist at the University of Utah, said the fact that upper-middle-class workers were not able to claim a larger share of last year’s exceptionally high corporate profits “speaks to the disempowerment of workers at all levels of status.”

change in state regulations would allow pharmacy technicians to administer shots. “They expected the techs to transition into that role,” Dr. Knolhoff said.

Overall, the industry added more than 20,000 technicians — an increase of about 5 percent — from 2020 to 2021. In that time, prescription volume increased roughly the same percentage, according to data from Barclays.

The effective replacement of higher-paid workers with lower-paid workers has also occurred in other sectors, such as higher education. But at drugstores, where pharmacists must sign off on every prescription, this shift has left little margin for error.

In August 2020, Dr. Wommack, the Walgreens pharmacist in Missouri, got Covid. A colleague covered her first two days out but couldn’t cover the third, at which point the store simply closed because there was no backup plan.

Several pharmacists said they were especially concerned that understaffing had put patients at risk, given the potentially deadly consequences of mix-ups. “It was so mentally taxing,” said Dr. Poole, the Tuscaloosa pharmacist. “Every day, I was like: I hope I don’t kill anyone.”

Asked about safety and staffing, CVS and Walgreens said they had made changes, like automating routine tasks, to help pharmacists focus on the most important aspects of their jobs.

Many pharmacists contacted for this article quit rather than face this persistent dread, often taking lower-paying positions.

Still, none had regrets about the decision to leave. “I was 4,000 pounds lighter the moment I sent my resignation email in,” said Dr. Wommack, who left the company in May 2021 and now works at a small community hospital.

As for the medication she had taken for depression and anxiety while at Walgreens, she said, “Shortly after I stopped working there, I stopped taking those pills.”

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Pharmacies Are Entering the Mental Health Market

CVS, which merged with the insurance provider Aetna three years ago, aims to reduce overall health costs with its mental health pilot program, Dr. Knecht said. Mental health issues that are not addressed become crises, he added, “so our aspiration is to make mental health services accessible and locally available so we can address these issues before they continue to expand and result in substantial morbidity and poor outcomes.”

Removing obstacles to mental health care by making providers more accessible is helpful, said Vaile Wright, senior director of health care innovation at the American Psychological Association, “but they are never the No. 1 barrier to accessing treatment,” she said. “Cost is.”

Psychiatrists are less likely to take insurance than other types of physicians, and many psychologists, social workers and others who offer therapy likewise decline insurance because they say payments by insurers are relatively low and managed care companies sometimes subject them to intrusive audits.

The mental health services provided by the CVS MinuteClinics are covered by many major health insurers and Employee Assistance Program plans, a spokeswoman said.

“Pricing options without insurance range between $129 for an initial assessment to $69 for a 30-minute session, with many options in between,” she added.

At Walmart, the initial therapy session is $60 and the 45-minute follow-up sessions cost $45, according to the company’s website.

If you’re considering using a retail location to receive therapy, be sure to ask the same questions you would of any new therapist, experts advise. Some examples include:

In addition, if you identify as L.G.B.T. or are a member of another minority group — or if you already know that you suffer from a particular condition like anxiety or depression — it’s helpful to know whether the therapist has worked with similar populations in the past and whether they have had cultural competence training, said Alfiee Breland-Noble, a health disparities researcher and founder of the AAKOMA Project, a mental health nonprofit for teenagers and their families.

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