NailTech plan - Nail Technician Updated: 2023

Hospital and health system pharmacy leaders might be missing out on big-picture goals in "emerging frontiers" as they extinguish long-standing issues, such as rising healthcare costs and a pharmacy technician shortage, according to an Oct. 7 article from McKinsey. 

The consulting agency surveyed 80 health system pharmacy leaders in 2021 and 2023 to conclude which five areas hospital pharmacy leaders should focus on:

1. Inflation

Most hospital pharmacy leaders are planning for a 4% to 6% increase in inflation in the next 12 months. Compared to a 2021 survey, there was an uptick in executives predicting inflation growing more than 7% in a 2023 survey. 

With this financial pressure in mind, survey respondents said they plan to lower costs through a higher utilization of generics and biosimilars, and reducing drug waste. 

Another goal is formulary management, but pharmacy executives are struggling to gain buy-in from service line leaders and physicians. A strong management of formularies, such as instituting one pharmacy committee that manages drug purchases in each service line, can help health system pharmacies save 5% to 10% of total drug spend, McKinsey said.

2. Supply chain

More than 50% of respondents indicated manufacturing and product shortages were a significant threat to their organizations for the next five years, and only 5% said they feel prepared to tackle this concern. 

"Health systems could consider developing internal capabilities — such as a streamlined governance system, a shortage playbook with clear owners and analytical tools that track historical supply fluctuations," the article said. 

McKinsey also recommended hospital pharmacies raise expectations with drug manufacturers when it comes to data sharing and failure-to-supply clauses.

3. Staffing shortages

In hospitals, 81% don't have enough pharmacy technicians, 41% are short on clinical pharmacists, and 34% are short-staffed on pharmacists and ambulatory clinical pharmacists. Less than a fifth were adequately staffed on pharmacy techs, and a slight majority said the same for the other hospital pharmacy roles.

To counteract these shortages, leaders can adjust pay and benefits to match alternative work environments, offer continuous education for license certifications, partner with schools and strengthen career paths. 

4. Stalled projects

Between 2021 and 2023, health systems recorded growth in their networks for retail and mail-order pharmacies, digital and analytics capabilities, and home infusion programs. Two other areas — patient assistance programs and pharmacy benefit management — had stagnant growth. 

All five of these areas were noted as emerging markets among the respondents, who added that specialty pharmacy and ambulatory infusion projects were more mature. Further investment in these projects can propel pharmacy departments by diversifying revenue through new avenues, according to McKinsey. 

5. Partnerships

As private equity deals shrink, health systems are growing interested in partnering with startups, payers and distributors. There's a lack of innovative partnerships, though, such as private equity firms helping create lucrative ambulatory service lines or multiple systems teaming up to address drug shortages.

For the last few weeks, Americans have patiently waited for the new Speaker of the House to explain his overall budget strategy. However, his linguistic evasiveness speaks volumes, especially regarding healthcare expenditures. His focus on avoiding a U.S. government shutdown ensured that healthcare issues would remain unaddressed, at least for the remainder of 2023. Now that a continuing resolutions is set and government funding will continue until at least January 19, that inattention will end. And it is likely that Speaker Johnson will face major healthcare challenges in 2024 that will rival even the pressure of a government shutdown.

1. Perennial targets for controlling government spending are the third rails of Social Security and Medicare. Johnson, while not publicly advocating for cuts, is pushing for the establishment of a bipartisan commission to adjust benefits. If past performance is any indication, beneficiaries have much to be concerned about. Not only are Baby Boomers expecting to receive their hard-earned Social Security and Medicare benefits, but also the entire country is much less healthy in every age group. One illustrative example is the life expectancy for men falling to 73 years (six years less than for women).

For fiscal year 2020, the Republican Study Committee (which Johnson chaired) called for raising the full retirement age to 69 from the current 67 and early retirement to 64 from the current 62. Under this plan, the cost-of-living adjustments would rise more slowly and stop entirely for individuals making $85,000 annually. Under the committee plan, Medicare recipients would face similar age and income adjustments.

While there is understandable concern for individuals should such changes take place, the entire healthcare infrastructure would be at risk as well. Not only individuals but the majority of our healthcare industry, which relies on governmental health sustenance.

The Covid-19 pandemic accelerated the rate of change already affecting the U.S. healthcare system by imposing stressors not seen since the turn of the last century. In addition to the immediate stresses of staffing shortages, supply shortages, inadequate monitoring, poor data collection and a host of communication blunders, the hospital industry is going through a period of consolidation. Hospital corporations are acquiring smaller local, regional and independent hospitals along with a significant number of clinical practices. In the name of efficiency, (i.e., greater profit margins), there are fewer hospital beds and hospital staff. The latter must do more with less, including a lack of reserve emergency resources.

2. Staffing shortages will compromise care for all and widen the healthcare accessibility gap for the most vulnerable.

The Covid-19 pandemic created a war zone-like environment for doctors, nurses and other healthcare professionals, leaving countless numbers suffering from a form of PTSD. In response, many changed their areas of specialization and left, or considered leaving, the profession entirely. Even with the current decline in Covid-19 hospitalizations, practitioners trying to adjust to the new efficiency model find it challenging. In the event of another mass outbreak, remaining staff will be even more likely to leave the profession.

In the two years between 2020 and 2022, about 117,000 of the approximately 940,000 physicians in the U.S. left the medical profession and another 13% or 107,000 said they expect to leave by 2023. It is unlikely the reduced physician population will be replenished for some time. Medicare and Medicaid, through patient reimbursement, support post-graduate training (residency and fellowship) programs. Most teaching hospital patients rely, at least in part if not totally, on one form of government reimbursement or another. Any cuts to Medicare and Medicaid programs will hobble existing teaching programs and will stifle program expansion.

The total number of medical residents in the U.S. in 2020 was 140,000. The number includes all fields of study from primary care to neurosurgery. Since residencies take from three to seven years to complete, only about 33% of residents, or 46,000, enter active medical practice each year, which left a deficit of 132,000 physicians over the two years between 2020 and 2022. The deficit will continue to grow because of normal annual departures as well as from the premature departures mentioned above.

The nursing professions also feel the system stressors. According to the National Nursing Study, there were about 5.25 million active nurses in the U.S. in 2019. During the first two years of the pandemic, 134,000 quit. Another 984,000 indicate they are likely to leave nursing by 2027. That is equivalent to roughly 20% of the total licensed RN and LPN/LVN workforce in the U.S. The University of St Augustine for Health Sciences reported that 1.1 million nurses would be needed by 2022 to address the current nursing shortage. The growing absence of doctors and nurses could force hospitals to reduce or eliminate patient services in response.

Even in pharmacies the pressure is palpable. Pharmageddon is the name given to the three-day strike by 4,500 workers at Walgreens, CVS and Rite Aid that began on October 30. Employees in other pharmacies wore green in solidarity with the strikers. Michelle Mele, a pharmacy technician in Massachusetts, wrote on the pharmageddon Facebook page that workers do not feel safe dispensing medications because the pharmacy chains “have chosen to push harmful metrics and cut hours of employee pay. This has created a working environment in pharmacies that produces fatal errors to our patients, not to mention extended wait times, lack of counseling, and many other annoyances.”

3. Covid-19 isn’t back, because it never left. Though in most cases, the frequency and severity of the virus has decreased, it still continues to be active. For the week ending October 21, 2023, 16,186 people were admitted to the hospital in the U.S. and 637 people died. At this rate, 33,124 annual Covid-19 deaths would be substantially lower than 2022, but a more deadly variant could morph into existence at any time. If one did appear, the waning of vaccine immunity and Paxlovid’s diminished effectiveness could put us back to the frequency and mortality rates of 385,000 Covid-19 related deaths in 2020. A surge of that magnitude would overload the current healthcare system and have a devastating effect on the U.S. and world economies.

4. We are facing drug shortages the likes of which we have not seen in a decade. The 10-year trend in active drug shortages has increased to the point at which there were more shortages in Q1 2023 than there were in all of 2019. More than 300 drugs have been in short supply since the beginning of this year. The last time the number of drugs in short supply reached 300 or more was 2015.

The shortages are in every class of pharmaceutical drugs. For more than half, the cause of the shortage is unknown, while 18% were caused by manufacturing problems. Since drug manufacturing is an international enterprise, we can expect that a U.S. government shutdown, increasing world conflicts in Eastern Europe, the Asia Pacific and Mid-East regions, will only cause further problems manufacturing and importing drugs from abroad, further stressing U.S. healthcare.

Ozempic and other drugs in the same category are prime examples of the disruptive nature of drug shortages. Novo Nordisk, a leading manufacturer of insulin, also manufactures and markets Ozempic and Wegovy. Both are approved in the U.S. to treat the 14.7% of adults who are diagnosed with Type 2 diabetes. Both are in short supply, as famous personalities have been touting their weight-loss powers. Mounjaro, another diabetes control drug from Eli Lilly, also is in short supply. Though all three are approved for treatment of Type 2 diabetes, Wegovy is the only one approved for weight loss at this time.

All three drugs have been on the FDA shortages list at various dosages. Novo Nordisk, which makes Ozempic and Wegovy, has limited the availability of lower starting doses of Wegovy as it prioritizes a continuous supply of the drug for people who already use it. The company’s CEO recently said that it would take years to catch up to demand.

5. The wild card in this case in healthcare is not intentionally forcing a shutdown, rather it is causing an unintended budget shutdown. Both sides in the house have been playing a delicate and dangerous game of forcing the other side to be the ones to accidentally take the final step that inevitably leads to a government shutdown.

More important than the actual dollar cost of a government shutdown is the resultant perception of governmental instability. Once the U.S. loses the confidence of investors, it also loses all credibility as the world’s most stable economy. If Americans continue to experience an erosion of confidence in their government, their healthcare system and their economic stability, pressure will build. If the pressure is not reduced, a systemic dislocation of unimaginable magnitude will follow. Speaker Johnson has an opportunity to relieve the stress. He also has an opportunity to make it worse.

When creating custom tooling, clarity of purpose is as important as flexibility of planning. The West Ohio Tool Company, a second-generation custom tooling manufacturer based out of Russells Point, Ohio, learned this lesson during a leadership transition in early 2020 and has thrived since. CEO Kaci King even says that the company is on track for its largest year ever in terms of sales in 2023.

Finding Traction

Kaci had performed financial and accounting duties for West Ohio Tool for just over two decades when her father, the company’s founder, had a stroke in late 2019. As he stepped back (reluctantly), she began to take on more of his duties. By early 2020, she was officially CEO, with her husband Rea coming on as president to help fulfill some of Kaci’s father’s duties.

Neither Kaci nor Rea has much experience running machine tools. But familiarity with the company helped them get started, as did Gino Wickman’s Traction: Get a Grip on Your Business, a book Kaci and her father encountered early during the transition. “I had never read a book so full of tools that I felt like I could open the toolbox and be able to start using and implementing them,” Kaci says.

The book detailed the importance of developing core values on the leadership team and building a business around those values. This led to the Kings enumerating six core values for West Ohio Tool:

1. Do the right thing always
2. Exceed expectations
3. Grow or die
4. Embrace and drive change for leading-edge innovation
5. Together, everyone achieves more
6. Focus on the impact/results

But just as Kaci began preparing to put these core values into action, COVID-19 struck. As a tooling company largely serving automotive, the near-overnight shutdown in the industry hit West Ohio Tool hard.

“I read an interview in Inc. Magazine with a woman who basically stated the quickest way to grow your business is to do something at least once a year that absolutely terrifies you,” King says. “And I said to my husband, if we get through this, we are going to grow this thing because we’ve been more scared now than we’ve ever been.”

Careful management carried the company through the pandemic, and the Kings began to carry out their culture shift within West Ohio Tool.

“I feel like the two biggest pieces of the pie are people and processes,” King says. “Because when those things fall into place, the data takes care of itself.”

Success and Succession

Difficulties stemmed from friction between Kaci and the three-person team her father had been building as potential successors. This team had gained a lot of authority over the shop floor over the years, but Kaci and her father had realized the company’s client list was shrinking disastrously under their guidance. Even before the initial leadership transition, the two had discovered that, under the succession team, West Ohio Tool was only targeting repeat business.

The client list had shrunk to one page, and only 0.5% of quotes were captured to become new orders. This attitude also extended to monitoring machines for efficiency, with the team only looking into process issues if job travelers reported efficiency percentages below 50%, as well as customer focus, with King estimating that the shop’s client list was between 95% and 98% automotive at one point.

“Our team became very reactive, not proactive, in a lot of places that needed daily looking at,” King says.

To counter these issues, the Kings embarked on a two-pronged approach: implementing the six core values they had developed, and following a plan Traction called RPRS (or, “Right Person, Right Seat”). While the core values shaped a general philosophy for the shop, RPRS called for the adjustment of roles to ensure people were in the job best suited for their talents. “When the right person is in the wrong seat, people argue,” King says. For the few employees who needed to be shifted between departments, their productivity and job satisfaction noticeably improved.

Unfortunately, the former succession team did not take to this new leadership style, with two people leaving in 2020 and the third being let go in early 2022. These departures led to a gap in machining experience on the shop floor, until the Kings found that an experienced service technician they worked with was looking to get back into production. They hired him in March 2021 and swiftly began shoring up their production staff with additional local hires.

But where West Ohio Tool previously hired for experience, it now hired for culture fit. In an even larger change, it advertised less for open positions, and instead headhunted people locally. The new production manager then taught these new hires machining skills.

“I feel like the two biggest pieces of the pie are people and processes,” King says. “Because when those things fall into place, the data takes care of itself.”

New Business

Thus far, the data seems to agree with King. The client list now fills 3.5 pages. West Ohio Tool is also capturing quotes with much greater frequency — around 40%, rather than 0.5%. Even softer metrics are seeing benefits: the production manager took a vacation around the time of my visit in August 2023, with King saying it was the manager’s first absence since he was hired that the shop didn’t need to call him mid-vacation for his assistance. Even hiring looks good, with no open positions — almost unheard of in the manufacturing world.

As for West Ohio Tool’s client mix, it has seen mild diversification. Automotive is still the company’s top industry, but it only makes up about 70% of its clientele. The rest come from a wide range of industries, including aerospace, defense, semiconductors, healthcare and spaceflight.

To further gain work, West Ohio Tool is implementing AS9100 — a feat which King says has kept the shop on the ball with maintaining its culture. While waiting for the final certification, it has also taken steps to meet the defense industry’s upcoming CMMC requirements. This has involved overhauls of the company’s security and computer systems, and with the installation of security doors, it should be compliant with CMMC level 2.

According to King, this could make the shop one of the first outside parties in Ohio approved for CMMC level 2 certification. As the shop is seeking additional defense (and defense-related automotive) work, this will set West Ohio Tool ahead of its competitors for many defense-related quotes.

Gaining an Edge

“If you say you’re an innovator, you need to have the technology to be able to do it,” King says, and the shop actively tries to use advanced technology to streamline production of increasingly durable tooling. In the first six months of 2023 alone, the shop invested 50% of sales back into equipment. As for what gets bought from year-to-year, the shop can only plan so far ahead. “With custom cutting tools, depending on carbide or PCD or CBN — the breakdown of orders can look so different in January than in June,” she says.

This was the case in 2023, when the shop bought a second Walter Power Helitronic Diamond tool grinding and eroding machine. West Ohio Tool had bought the first in 2017, using the erosion capabilities to produce certain complex geometries and helical features its wire machines could not reach. It also performs better on PCD tooling — an aspect which went from boon to necessity after one automotive transmission manufacturer declared it wanted to move from carbide to PCD, whether or not West Ohio Tool could supply it.

After several experiments, West Ohio Tool developed what it calls the EdgeX4, a carbide tool with an entirely PCD edge. The new tool is more expensive, but boosts tool life from around 25,000 estimated holes and 10 regrinds to well over 1,000,000 holes. In truth, the company still doesn’t know the full tool life of its new tooling — none of its clients using EdgeX4 have reached it.

Early in 2023, a new customer came onboard with West Ohio Tool and mentioned that tooling from this machine was the only tooling it had found that could cut multiple parts and multiple holes in its ceramics. King says the company quickly exploded in importance, with six figures of sales within six months. Plans for other machines had to go on hold however, as resting this entire contract (as well as West Ohio Tool’s entire EdgeX4 line of tools) on a single machine could spell disaster if it was to go down.

As such, the shop pivoted and bought another Walter Helitronic Power Diamond, and plans to replace a handful of manual machines still on the shop floor were pushed back.

West Ohio Tool has also been able to take advantage of Walter’s rebuilding program for some of its old machines. As part of this process, Walter replaces everything but the metal housing. All the electrical connections and axes are new, just housed in the old machine. King says that this process is roughly half the cost of buying an entirely new machine, but can Improve job cycle times by 30% to 50%.

Each piece of this puzzle — from machine investment choices to culture shifts — has helped build West Ohio Tool’s ability to service its customers. For now, King’s aims to reach a $10 million sales goal. With 2023 shaping up to be the company’s largest year yet, this goal might not be too far off.

Landscape Photo Credit: West Ohio Tool Co.

Open this photo in gallery:

Name, age: Caitlyn, 33

Annual income: $35,000, plus $4,200 from extra shifts and $10,800 in rental income

Debt: $9,000 on a line of credit, around $200,000 to her parents

Savings: $0

What she does: Veterinary technician

Where she lives: In a small Ontario city

Top financial concern: Feeling “like I’m going to have to work until I’m 99 years old…there’s no contingency plan.”

Caitlyn thought things would be different by now. She’s 33 with more than 15 years of work experience, but she’s dependent on financial help from her parents.

“It feels like I’ve been working harder and harder and sliding backwards down the scale,” she says.

She earns a $35,000 salary as a registered veterinary technician, which works out to about $2,500 a month after taxes. She tops up her income with an average of $350 a month from extra shifts at another clinic. She has no savings, no investments and does not go on holidays. She relies on a personal line of credit for unexpected expenses, whether it’s a broken appliance, car repairs or veterinary care for her cats. Sometimes she uses it for regular purchases too, when her bank account is running low.

In 2013, her parents bought her a 1,200-square-foot semi-detached two-bedroom house in a small Ontario city, a university town. They paid $230,000 for it - in cash. They gifted her the majority of the $20,000 down payment although Caitlyn contributed $3,000.

She pays them back for the outstanding $210,000 through monthly mortgage payment of $1,162.70 – at an interest rate of 3 per cent. Internet, hydro and utilities amount to roughly $533 per month and for the last three years, she has collected $900 a month from her roommate.

Caitlyn admits she’s missed some payments over the years, like when she took six months off work because of a health issue. Her parents covered her housing expenses during that period, as well as travel and accommodations for out-of-town appointments.

They have also previously paid off her credit card debt, bought her a used Honda CRV, covered a kitchen renovation and helped with other expenses. They added each of these debts onto her mortgage. As a result, Caitlyn still owes them around $200,000, despite having made almost $37,000 in mortgage payments over the last 10 years.

There is a less tangible cost to her parents’ help. “It’s a lot of guilt. That’s the over-arching feeling. Obviously appreciation too, but those two things kind of tie in together.”

At her job, Caitlyn handles everything from drawing blood, performing X-rays and giving injections to answering phones, doing paperwork and cleaning the office space. She always knew her salary wouldn’t be high but didn’t aspire to be rich. What she didn’t realize was that she would struggle to afford basic things like shelter and food.

“I think the old-school principle is if you go to school and you get good grades and then you go to post-secondary education … the thought process was then you live comfortably,” she said.

Instead, she’s been readjusting her lifestyle to keep up with the climbing cost of living. She rarely eats out, makes her coffee at home and has cut back on ordering in and drinking alcohol.

Even still, she finds herself questioning whether she can see her boyfriend, who lives an hour away, based on whether she can pay for gas. She can no longer afford her cats comfortably either.

When she was broke in her early 20s, it felt like regular student life. When she was struggling right after graduating, it still felt normal – growing pains that come with just getting started.

Now, she says, depending this much on her parents feels scary.

“I used to make this joke that if it weren’t for them I would live in a cardboard box, but it’s not funny any more.”

Investments: $0

Savings: $0

Pensions: $0

Taxes: $415 in monthly tax deductions

Household: $2,175

Mortgage: $1,162.70

Utilities: $233

Hydro: $165

Internet: $135

Property tax: $216

Property insurance: $184

Phone bill: $80

Transportation: $384

Car repairs: $50

Car insurance: $184

Gas: $150

Food and drink (total): $520

Groceries: $400

Eating out: $60

Coffee/tea: $20

Alcohol: $40

Miscellaneous (dental, clothing, other shopping, nails, hair, spa etc) - $680

Her cats: $350 (food, meds and litter)

Haircuts/cosmetics: $150

Prescriptions: $100

Dental: $0 this year

Clothing: $50

Apps: $30

Vacations: $0

Hobbies/recreation: $0

Some details may be changed to protect the privacy of the person profiled. We want to thank her for sharing her story. Are you a millennial or Gen Z who would like to participate in a Paycheque Project? Send us an e-mail.