Post-pandemic opportunities for Canadian pharmacists: tackling mental health challenges and policy gaps through a social-ecological lens

ABSTRACT

Background

The COVID-19 pandemic was a stressful time for healthcare workers, including pharmacists. The pandemic brought new challenges compounded by pre-existing ones. As Canadian pharmacists assume greater responsibilities with the expansion of their scope of practice, it is essential to examine their mental health needs to ensure their success in the post-pandemic era. Guided by the Social Ecological Model, this qualitative study explored the mental health needs of pharmacists.

Methods

Registered pharmacists across Canada were involved in one-on-one interviews, dyadic interviews, or focus groups. Data were transcribed and then analyzed using reflexive thematic analysis.

Results

A total of 22 pharmacists across Canada were interviewed for this study. At the individual level, the need to prioritise mental health and maintain boundaries has emerged as a prominent theme. At the organisational level, (1) the need for employee retention strategies and quality staff and (2) the need to improve internal and external communication were two emerging themes. The need to perceive pharmacists’ roles beyond dispensing was the central theme at the community level. Finally, the primary theme at the policy level was the need to integrate pharmacies within the broader healthcare system.

Conclusion

With adequate resources, structural support, and targeted investments, pharmacists are well-positioned to alleviate healthcare pressures and expand their roles in meaningful and sustainable ways.

1. Background

Pharmacists experience significant stress in their work (Blue et al., 2022; Boyle et al., 2016; Durham et al., 2018). The demanding workload, combined with administrative responsibilities or supporting inventory-related queries, has posed challenges that impede pharmacists’ capacity to devote time to their clinical responsibilities. Due to these challenges, pharmacists worldwide frequently experience burnout, including emotional exhaustion (McQuade et al., 2020; Tan et al., 2022). Additional factors impacting their mental health include moral distress, staffing shortages, and excessive work hours (McQuade et al., 2020; Tan et al., 2022). In Canada, pharmacists perceive their working environment as poor, reporting they lack sufficient time to perform their jobs adequately due to working in short-staffed environments with limited time for breaks (Lee et al., 2021).

In addition to the pre-existing stressors described above, the COVID-19 pandemic exacerbated concerns while introducing additional stressors (Elbeddini, Wen, et al., 2020; Ishaky et al., 2023; Lee et al., 2021; Zahoor et al., 2023). During the pandemic’s peak, Canadian pharmacists were often regarded as the ‘face’ of healthcare (Zahoor et al., 2023). For instance, a study found that over 70% of pharmacists reported their patients chose to seek care in pharmacies instead of primary care or hospitals due to a perceived risk of infection (Lee et al., 2021). With a reduced number of visits to primary care offices and patients purposefully avoiding hospital settings to limit their exposure to the virus, there was an increased reliance on pharmacists to support patients (Glazier et al., 2021; Lee et al., 2021; Zahoor et al., 2023). These tasks included public health education and following up with primary care practitioners regarding medication inquiries. During this period, pharmacists dealt with unique stressors, including a lack of personal protective equipment, medication shortages, patient dissatisfaction due to the maximum 30-day drug dispensing, and accusations of price gouging (Bookwalter, 2021; Cabral & Xu, 2021; Khan et al., 2024; Lau et al., 2022; Patented Medicines Prices Review Board, 2020).

As the pandemic progressed, pharmacists played a critical role in supporting Canadians, with pharmacies providing testing and COVID-19 vaccinations (Elbeddini, Botross, et al., 2020; Khan et al., 2024). Unsurprisingly, their work demands increased, and thus, they experienced additional stressors. These included their inability to keep up with public health rules (e.g. vaccination types), which impacted patient trust (Zahoor et al., 2023). Additionally, due to public health mandates, some patients aggressively approached pharmacists (Elbeddini, Wen, et al., 2020; Zahoor et al., 2023).

Notwithstanding the challenges presented, the COVID-19 pandemic showcased the competencies and potential of Canadian pharmacists within the broader healthcare landscape (Jordan et al., 2021; Ung, 2020). In various provinces, the pandemic facilitated the acceleration of expanding pharmacists’ scope of practice, now including the treatment of several minor ailments across all 10 Canadian provinces (Nakhla et al., 2024; Canadian Pharmacists Association, 2025). For instance, in Ontario, the scope of practice for pharmacists increased during the pandemic and continued to expand afterward (Ontario College of Pharmacists, n.d.). During the pandemic, they could collect or order COVID-19 lab tests, renew prescriptions for up to a 12-month supply, administer COVID-19 vaccines, and perform certain point-of-care tests. In January 2023, Ontario pharmacists were granted the authority to prescribe for 13 minor ailments, and currently, they can prescribe for a total of 19 ailments (Ontario College of Pharmacists, n.d.).

With growing awareness of the mental health needs of pharmacists in Canada, the Canadian Pharmacists Association (CPhA) established a task force to provide its members with various resources, including a wellness toolkit, podcasts, webinars, and workbooks (Canadian Pharmacists Association, n.d.). Some pharmacists may also have access to additional resources, such as psychotherapy through private insurance or employee programmes that can be embedded within their workplace. While these resources can be helpful, they fail to address issues that exist at the organisational level and beyond. Likewise, heavy workloads and long hours can impact achieving a work-life balance, preventing individuals from accessing support (Hsu et al., 2019; Zaman et al., 2022). Moreover, while the CPhA has formed a steering committee to explore staffing issues, which is an organisational challenge impacting mental health, a continued need remains for comprehensive strategies informed by a multi-level perspective. To ensure pharmacists’ success with their expanded scope in Canada, systemic solutions that prioritise workplace mental health are necessary.

This qualitative study examined the mental health needs of Canadian pharmacists, emphasising post-pandemic opportunities for improvement at the individual, organisational, societal, and policy levels.

2. Methods

2.1. Recruitment

This study was approved by the University of Guelph’s Research Ethics Board, which was part of a larger project that explored pandemic stressors and opportunities beyond the pandemic’s state of emergency among various healthcare workers. In this qualitative descriptive study, we conducted a mix of one-on-one interviews, dyadic interviews, and focus groups with registered pharmacists working in any pharmacy setting across Canada to learn about their stressors and opportunities to alleviate stress as pharmacists transition out of emergency pandemic response, with an emphasis on mental health. The interview type was based on pharmacists’ preferences and availability. A multiple-mode recruitment strategy was used, including circulated advertisements from provincial regulatory bodies and associations that informed members about the authorised study materials. The study was also promoted on two social media platforms, LinkedIn and X (formerly Twitter). Additionally, we employed snowball sampling to encourage the participants to share the study with other pharmacists. To mitigate fraudulent activity during online recruitment, participants’ identities were verified through public records and confirmation of their professional roles before interviewing them.

2.2. Participants

Eligible participants were registered pharmacists authorised to practice in a Canadian province in a pharmacy setting. Participants were also required to have practised for at least one year before the pandemic and to have worked part-time or full-time during the pandemic. Informed consent was obtained before the scheduled interviews, during which participants were made aware of their rights and the risks and benefits of participation. Each participant received a $$50 (CAD) Amazon electronic gift card for their participation.

2.3. Data collection

The lead author (BG) interviewed all participants. Data were audio-recorded and transcribed using Microsoft Teams. The transcripts were subsequently de-identified and carefully reviewed by two research assistants from the lead author’s lab. Irrespective of the interview modality (i.e. one-on-one, dyadic, or focus groups), a semi-structured interview approach was utilised, starting with demographic questions such as age, gender, marital status, and work experience to help gain general context regarding the participants’ social environment with possible intersectionalities. Next, the author asked open-ended questions about participants’ experiences working before and during the pandemic, mental health impacts, and lessons learned through a pharmacist’s lens (Supplemental Material Appendix).

The research team, who possess expertise in qualitative research, workplace mental health, pharmacy practices, and public health, developed the interview guide for this study. The data were collected between March 2022 and August 2023. Considering the evolving nature of pandemic recovery, the research team extended the data collection period to encompass perspectives that reflect various stages of the transition to a post-emergency era as defined by the World Health Organisation (World Health Organization, 2023). This approach allowed us to gather more salient and diverse feedback regarding opportunities to improve, ensuring rigorous interpretation that is less sensitive to a specific timeframe. Data collection progressed until we reached data saturation, at which point we observed redundancies in the interview responses.

2.4. Analysis

Data were analyzed using the six steps of thematic analysis, specifically reflexive thematic analysis, and incorporating both inductive and deductive approaches (Braun et al., 2022; Braun & Clarke, 2006). A combination of semantic and latent coding was used. Initially, AW inductively coded the data to identify patterns emerging directly from the participants’ responses using the software Quirkos (Quirkos Software, 2021). Subsequently, AW and BG deductively mapped the codes onto the Social Ecological Model (SEM; Bronfenbrenner, 1979) to organise the data into preliminary themes that focused on mental health needs and lessons learned. The SEM, widely employed to understand social and health phenomena, provides a framework to assess individual, organisational, community, and public policy influences (Bronfenbrenner, 1979; Ingram et al., 2021). The research team developed the final themes collaboratively.

3. Results

Data saturation was reached after seven one-on-one interviews, two dyadic interviews (n = 4), and two focus groups (n = 11), with a total of 22 participants (Table 1). More than 45% were from Ontario (n = 10), over a fifth from Nova Scotia (n = 6), three from British Columbia, one from Alberta, one from Manitoba, and one from New Brunswick. Over two-thirds (n = 15) of the pharmacists identified as women, and seven identified as men. The mean age was 40. Most participants worked in a community practice (n = 16) and in an urban setting (n = 16).

Table 1.

Participant characteristics.

Sample	N = 22
Gender	Women = 15; Men = 7
Marital Status	Married/Commonlaw = 14; Single = 8
Age in years	Min = 28; Max = 62; Mean = 40; Median = 38
Work experience in years	Min = 5; Max = 40; Mean = 15; Median 12
Province	Ontario = 10; Nova Scotia = 6; British Columbia = 3; Alberta = 1; Manitoba = 1; New Brunswick = 1
Geographical Characterstics	Urban = 16; Rural = 6
Practice Setting	Community = 16; Hospital = 4; Large Chain = 1; Specialty = 1
Interview Type	Focus Groups = 11; Dyadic Interview = 4; 1-on-1 Interview = 7

Themes were categorised to correspond to each SEM level, focusing on the lessons learned from COVID-19 to improve mental health and well-being (Table 2). At the individual level, the need to prioritise mental health and maintain boundaries has emerged as a prominent theme. At the organisational level, (1) the need for employee retention strategies and quality staff, and (2) the need to improve internal and external communication were two emerging themes. The need to perceive pharmacists’ roles beyond dispensing was the central theme at the community level. Finally, The need to integrate pharmacies within the broader healthcare system was the primary theme at the policy level.

Table 2.

Themes corresponding to the Social Ecological Model.

SEM	Themes
Individual	1. The need to prioritise mental health and maintain boundaries
Organisational	The need for employee retention strategies and quality staff The need to improve internal and external communication
Community	1. The need to perceive pharmacists’ roles beyond dispensing
Policy	1. The need to integrate pharmacies within the broader healthcare system

3.1. Individual level

3.1.1. The need to prioritise mental health and maintain boundaries

While our results suggest that pharmacists experienced stressors primarily at the organisational level and beyond, such stressors have also significantly impacted their personal lives. This highlights the importance of managing mental health, which falls within the individual level. Pharmacists noted that mental health needed to be prioritised, considering the impact of the pandemic. While the availability of mental health support varied among participants, it was noted that it is an essential element, and more resources are required. On a positive note, some participants explained that due to the stressors that accompanied the pandemic, some pharmacy associations introduced mental health workshops for pharmacists. Furthermore, establishing boundaries, particularly during the pandemic, has been viewed as a way to mitigate stress. Specifically, pharmacists described that the workload was substantial and prioritising oneself was necessary.

P64: I think my work stressed me out so much and I got burned out that it actually stressed out my family.

P60: I think the pharmacy associations really realized that they had to be a little more supportive and we’ve done a lot of mental health. There was a whole series of resilience workshops and just coping mechanisms for the stress that came out, which were really good.

P122: Life is short. Create more of a balance between work and life.

P113: You can’t care for everybody. And so learning to set those boundaries on like this is all I can do.

3.2. Organisational level

3.2.1. The need for employee retention strategies and quality staff

Staffing shortages were identified as a significant stressor that demands greater effort to maintain a sustainable pharmacy. Initially, pharmacists faced pandemic-related challenges, including exposure to the virus and fear of transmitting it to others, especially vulnerable populations, which resulted in frequent absences from work. However, pharmacists reported that staffing shortages persisted beyond the peak of the pandemic despite the reduced risk of the virus and the availability of preventive measures. They pointed out that a pharmacy with a limited number of pharmacists forces existing pharmacists, typically owners, to work longer shifts. Likewise, the inability to retain assistants amplifies the administrative workload for pharmacists, thereby decreasing the time available for clinical duties. Furthermore, while some pharmacists acknowledged the importance of hiring registered pharmacy technicians, they found it challenging to retain them due to their perceived inability to compete with the salaries and benefits offered in hospital settings.

P121: Like, we just don’t have enough pharmacy staff [laughs] in general; I don’t know how it is in Ontario, but we are really struggling over here. P124:It’s the same in Ontario.

P123: Our pharmacy technicians keep getting scooped by the hospital because they get paid more.

Short staffing and poor employee retention lead to a cycle of existing staff leaving while new staff must be hired and trained. Some pharmacists reported difficulties in training early-career staff, citing staff motivation and engagement challenges. Participants described instances where new hires appeared less prepared to meet workplace demands, hindering the training process and contributing to long-standing staffing shortages. Some pharmacists mentioned that staff were less likely to take initiative, leading to an increase in pharmacist workload. They explained that this issue extended to retaining pharmacy assistants, technicians, and pharmacists. As such, there is an ongoing retention issue, leading to more stress. Nevertheless, the participants noted that age and work experience were not the sole contributors to low commitment levels. They explained that pharmacy assistants and technicians are patient-facing; thus, they often communicate with frustrated patients who speak aggressively. Combined with their low wages due to inflation and the pharmacy’s compensation capabilities, they opt to leave, further contributing to an existing staffing shortage.

P115: I mean the new [staff], they’re younger in age. So they’re not mature enough. And also very hard to train them. They’re in their bubble, and it’s very hard to correct like you know to incorporate with [another setting]that’s been noticed, and it’s been the same complaint with my other colleagues or friends that work at different locations.

P122: Just in general, maintaining a staff load, there has a big shift towards quiet quitting, and you just see people taking on less and less people that you can normally rely on for certain things are kind of transitioning to. I’ve heard this phrase a lot in the pharmacy, and people say, “That’s not my job”. The other day, I went out with a shovel and just shovelled so we could get into the storage shed. And I’m like, I could have been up front helping a patient, but someone is just like,‘That’s not my job’ And I’m like, ‘‘Geez, OK, well, I’ll just go do it. Forget it’’ [laughs] I try to keep staff there and happy long-term.

P48: You can only get yelled at so many times for something that is not in your control. And sadly,it’ss the pharmacy assistants that are the most public-facing

P112: You put a lot of effort into training them [pharmacy assistants and technicians] to a fairly complex system, and then very quickly they’ll get a job literally anywhere else and make more, which is really unfortunate even if you know, of course, they care about the patients, but you can’t expect people to function in society if they’re not getting paid a reasonable wage. Some of them only get minimum wage, which is horrible.

3.2.2. The need to improve internal and external communication

Communication challenges was a topic identified by participants which required improvement. Although, reportedly, communication challenges existed before the pandemic, their impact significantly affected pharmacists’ mental health during the pandemic. Communication can be improved, both internally and externally. Internally, it was noted that communication among the pharmacy staff had led to misunderstandings, causing stress.

P123: The employer not supporting the staff and communication is a big part of that. If you don’t know what’s going on, then you can’t do what you’re supposed to do.

Externally, communication with other prescribers was identified as a significant concern. Similar to internal communication challenges, this issue also existed before COVID-19 and requires improvement. Participants described communication with prescribers, particularly physicians, as stressful, particularly when a patient was in the pharmacy. Delays in receiving timely responses from prescribers were reported to heighten stress levels. The method by which pharmacists communicate with prescribers is also seen as challenging, as described in more detail at the policy level (3.4).

P125: When the eligibilities [related to COVID-19 vaccinations] changed, the government would not give us the heads up, and so we would hear it on the radio or TV or social media.

3.3. Community level

3.3.1. The need to perceive pharmacists’ roles beyond dispensing

This theme describes the need to improve the perception of pharmacists among the public and to be recognised for their work. As healthcare workers, participants described serving as a ‘triage’ for the community, providing prevention-focused recommendations and interventions (e.g. blood pressure, COVID-19 testing, and vaccination), medication consultations, and corresponding with their prescribers. However, the participants described the patients as having unreasonable expectations at times. Furthermore, participants reported some distrust, where patients cite unscientific evidence. Reportedly, this issue was more prominent with vaccine-hesitant individuals but would appear to have created a new wave of distrust unseen pre-pandemic.

P67: I find as a pharmacist, we have to be everything to everybody.

P69: As a community pharmacist, we pride ourselves on being the most accessible healthcare professionals, but that’s also one of the worst parts about the job because we don’t really have much of a way to manage our time. There’s no appointments or any amount of capacity that we reach. Like when you try to get into the doctor or the dentist, and you try to make an appointment, and they say we’re full until Wednesday, then you just can’t get in, but at the pharmacy, people will just come in whenever they feel like it. They want all kinds of services provided on the spot. Then they don’t want to wait twenty minutes to get a prescription filled. So, time management is difficult, especially as the workload increases and there are more services that can be provided that take longer to do. Then we’re standing all day long and we don’t really have any like privacy or space to just like, think or just like process a problem like we just have people staring at us all day. You can’t really buy yourself time very easily.

P111: And another stress issue related to the pandemic is whenever there’s something that’s floating around on social media or Tiktok or Facebook and people coming in asking us about it, and, we can’t do anything about, or we just tell them there’s, like, no, it’s not scientifically proven.

3.4. Policy level

3.4.1. The need to integrate pharmacies within the broader healthcare system

This theme encompasses essential policy changes that could help alleviate pharmacists’ mental health concerns and enhance their quality of care. Integrating pharmacies within the healthcare system involves improving communication platforms among other healthcare providers and re-evaluating the pay structure in pharmacies, given their expanded scope of practice. At the organisational level, participants noted challenges in connecting with prescribers. A recurring challenge related to this issue is the method of communication. Pharmacists report that many physicians fax medications or handwrite prescriptions, which are often difficult to decipher and lead to inefficiencies. The wide variation in how prescriptions and patient information were shared with pharmacists caused confusion. Therefore, there is a need for an easy-to-use provincial or nationwide health platform that includes necessary patient information and adheres to provincial and national privacy laws. Reportedly, some provinces adopted a similar interface with success.

P61: There are still some doctors in the hospital and community that scribble the prescription. It just it just makes everybody like, I don’t know, it’s just a waste of time if you do that.

P62: But you sign up, you get access to all the patients, like lab values and progress notes in the hospitals and stuff like that. So we could sometimes probably be able just kind of to look that and solve our issues rather than having to call the hospital for everything.

The need to review the pharmacy pay structure is also described as an area of need. Participants appeared to welcome the recent scope of practice expansion expedited during the pandemic, which included new billable services. However, they noted that to ensure the sustainability of this practice, the pay structure for pharmacists needs to be reevaluated. Specifically, participants reported that pharmacists are typically paid an hourly wage, and while their responsibilities and workloads continue to expand, this pay does not reflect the additional billable services provided, as any service fees are paid to the pharmacy rather than directly to the pharmacist.

P71: And we have this like a triaging role. Well, we don’t get paid for that. So this is obviously we’re doing community service, but like the whole challenge, I think in pharmacy too is like how does the business model work?

4. Discussion

This qualitative study, guided by SEM, explored the mental health needs of Canadian pharmacists with post-pandemic considerations. The SEM framework helped pinpoint areas where changes were required to improve pharmacists’ mental health. Pharmacists’ stressors arise predominantly at the organisational level and beyond. However, given the complexity and, in some respects, lack of control over these challenges, participants acknowledged the necessity of prioritising their mental health. While they recognised that the pandemic created opportunities to increase resilience and mental health support, healthcare workers, including pharmacists, may have overlooked the importance of self-care. Therefore, the importance of establishing boundaries and fostering a work-life balance was emphasised in light of the pandemic, which was notably seen as one of the characteristics of a successful pharmacist based on previous research (Ward et al., 2019).

Interestingly, the need to establish boundaries and achieve a better work-life balance was reported by nearly all participants, regardless of demographic factors such as gender, marital status, or geography. While previous research indicates that intersectional factors, such as parenting demands, which often fall more heavily on female pharmacists, increase stress (Soleimani et al., 2024), the current demands on pharmacists may be so overwhelming that work-life balance is viewed as a top priority for all pharmacists. It is important to note that our findings should not be interpreted as diminishing the unique challenges that women and other groups may face. Rather, they highlight the high demands placed on pharmacists overall.

Ironically, maintaining boundaries, to a certain extent, was also perceived as an obstacle within the workplace. Participants indicated that staffing shortages represent a significant concern at the organisational level, with generational factors potentially contributing to the issue. Irrespective of their job role in the pharmacy setting, less experienced staff members have been described as exhibiting lower levels of engagement and teamwork, and may be reluctant to extend their working hours when necessary. This observation aligns with recent research suggesting that individuals from the Gen Z demographic prioritise work-life balance, engagement, and job satisfaction relative to other cohorts and may be unwilling to compromise their lifestyle for monetary compensation (Tan & Chin, 2023). Additional studies focusing on preparedness for practice in the healthcare sector, including pharmacy environments, have highlighted communication skills and conflict management as challenges confronted by new trainees (Chanakit et al., 2015; Hussein et al., 2025; Kairuz et al., 2010; Mak et al., 2014). Such insights indicate a change in workplace culture that demands organisational adaptation and possibly a re-evaluation of expectations if pharmacies aspire to fulfill the requirements of a diverse and dynamic workforce.

Communication challenges within pharmacies represent an additional issue that requires changes to improve pharmacists’ mental health. This theme was consistent with two other pharmacy-related studies focusing on the pandemic in Canada, one focusing on registered pharmacists in Ontario (Zahoor et al., 2023) and the other on pharmacy technicians across Canada (Khan et al., 2024). While the factors contributing to ineffective communication varied in previous studies, effective communication with prescribers was identified as a recurrent challenge. These issues are often exacerbated by demands observed at the community level, where patients fail to fully comprehend the complexities and competing priorities that pharmacists navigate during their shifts. Furthermore, there has been a steady increase in instances of abuse directed toward healthcare workers, including pharmacists (Bhagavathula et al., 2023; Elbeddini, Wen, et al., 2020; Khalid et al., 2020; Liu et al., 2019). Previous research highlighted that vaccine-hesitant individuals, commonly referred to as anti-vaxxers, were more likely to mistrust medical professionals and thus expressed their dissatisfaction with public health guidelines and the restrictions imposed (Silver et al., 2022). Indeed, evidence suggests that the abuse experienced by healthcare workers persisted throughout and beyond the pandemic (Bhagavathula et al., 2023; Elbeddini, Wen, et al., 2020; Gregory et al., 2023).

Based on the study’s findings, policy-level needs could improve pharmacists’ mental health, potentially creating a trickle-down effect to other levels as per the SEM. Participants appear to welcome the expansion in their scope of practice, allowing them to exercise their skills. As more provinces opt for further expansions, a unique opportunity arises for Canadians to seek immediate medical support (Valliant et al., 2022). Pharmacists’ services could help reduce the strain on hospitals and, to some degree, alleviate some of the pressures due to Canada’s rapid population growth combined with a notable physician shortage (Dalton & Byrne, 2017; Isenor et al., 2023). Geographically, it could also offer support to residents living in rural regions with limited access to care (Timony et al., 2022; Tsuyuki et al., 2018). However, it is essential to note that pharmacists faced challenges preceding the scope expansion. Issues, including but not limited to poor communication among healthcare providers, high workloads, and limited resources, existed before the expansion and have not been adequately resolved. With the ongoing shortages in healthcare, including pharmacists, it is important to envision sustainability through a prevention-focused model to help pharmacies thrive and support patients.

4.1. Recommendation

Pharmacy owners and leaders should be encouraged to focus on employee retention strategies. At both the individual and organisational levels, leaders should adopt a transformational leadership model within their practices, which can have promising implications for all pharmacy employees. Transformational leadership focuses on the pharmacy’s shared mission and values (Nguyen et al., 2019). It helps improve intrinsic motivation and a positive work culture in pharmacy settings. A recent review study revealed that transformational leadership, compared to other leadership styles, is the most effective for Gen Z employees (Kwartawaty et al., 2024). Effective communication strategies embedded within leadership training could help practice owners model adequate communication within the broader team and with patients, including conflict management (Jankelová & Joniaková, 2021). Transformational leadership and effective communication were found to improve job satisfaction and retention.

With the increase in pharmacies across Canada, staffing shortages is a growing concern (Bishop & Zwicker, 2024; Canadian Pharmacists Association, n.d.). While effective communication and a stronger leadership presence can, in part, improve retention, fair compensation remains a significant contributor (Canadian Pharmacists Association, 2023; Khan et al., 2024; McDermott et al., 2025). Thus, we recommend that policymakers reenvision the roles of pharmacies within the broader healthcare system. As Canada’s population grows, pharmacists may play a significant role in maintaining the country’s healthcare system, and therefore, proper compensation should be reflected. In this study, participants reported that although pharmacies receive direct payments for expanded services, this revenue does not necessarily translate into higher individual pay. Instead, they report that pharmacists’ wages often remain hourly and disconnected from service-based billing, creating a structural gap where their expertise is undervalued. Unsurprisingly, compensation is among the top factors affecting pharmacy professionals’ mental health, with more than 25% likely to leave the sector and over 20% considering early retirement (Canadian Pharmacists Association, 2023). With various payment structures existing among provinces for patient care (Houle et al., 2014), policymakers should examine how different structures affect frontline pay and consider ways to ensure that billing for services fairly benefits pharmacists themselves.

Community pharmacists report challenges in retaining registered technicians, as they often cannot offer competitive salaries. Yet registered pharmacy technicians in the community can improve pharmacies’ efficiency and expand health services (Banks et al., 2020; Fuschetto et al., 2022). Given their potential to strengthen services, retaining technicians should be viewed as an opportunity for growth. Therefore, we recommend that policymakers consider implementing subsidies for technicians in community pharmacies, which may also enable pharmacists to reinvest savings in hiring or retaining pharmacy assistants to further support their operations, thereby reducing administrative workloads and, inherently, work stress. This is particularly important since the scope of practice for registered technicians has expanded in some provinces (Khan et al., 2024). With both professions able to provide additional services to Canadians, provincial and national governments must consider how best to support pharmacies to ensure their success.

Finally, governments should consider providing the public with more information on various healthcare workers’ roles within the community, including pharmacists. While pharmacists play a critical role in fostering trust with patients (Gregory & Austin, 2021), their communication ability can often be hampered by heavy workloads and time constraints. In addition to organisational efforts highlighted above to improve retention and work demands, there is a need for public awareness campaigns to highlight pharmacists’ diverse responsibilities and contributions, fostering greater appreciation and understanding. Such initiatives may reduce patient frustrations, promote more respectful interactions, and ultimately create a more supportive healthcare environment for patients and providers.

4.2. Limitations

Despite our efforts, we could not recruit all provinces and territories across Canada. There could be differences across the provinces. However, it is important to note that despite the possible differences in needs, the presented needs were consistent across the six provinces included in the study. This study explored various pharmacy settings, and while the majority of participants worked in community-based, challenges were consistent across settings. However, future studies should focus on specific work and geographical settings for more in-depth results and follow with quantitative data across all sites to identify risk and protective factors related to pharmacy mental health. Finally, our findings are specific to Canada, where pharmacists’ roles and scope of practice may differ from those in other countries. However, the successful integration of pharmacists into diverse healthcare services internationally highlights their expertise and potential for expanded roles both in Canada and globally (Hattingh et al., 2020; Taylor et al., 2019).

5. Conclusion

The COVID-19 pandemic has increased the stressors experienced by Canadian pharmacists. However, this crisis facilitated new opportunities to showcase pharmacists’ capabilities to serve Canadians. To continue supporting Canadians, necessary changes are required to reduce stress. Guided by SEM, we identified individual, organisational, community, and policy mental health needs. It is suspected that necessary changes at the policy level are the most important and likely the most challenging to attain. Nevertheless, Canada is at a crossroads with high patient demands and the physician shortage. With adequate resources, structural support, and targeted investments, pharmacists are well-positioned to alleviate healthcare pressures and expand their roles in meaningful and sustainable ways.

Funding Statement

This work was supported by Canadian Institutes of Health Research [grant number: CIHR; EG7- 179466].

Ethical statement

This study was approved by the University of Guelph’s Research Ethics Board (REB# 22-03-001) for studies involving human participants.

Informed consent

Informed written consent was obtained from all participants involved in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

Data is only available upon request due to concerns about confidentiality regarding the qualitative information.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20523211.2025.2587468.