The Loss No One Measures: The True Cost of Pharmacy Vacancies

As a pharmacy leader, you feel the pinch of vacancies in the day-to-day. You see it in the schedule, the queue, and the strain on your strongest people. You know the cost of labor, but are you measuring the financial impact of roles that go unfilled?

The expenses accumulate over time. They show up as rising overtime, pharmacists covering technician work, growing backlogs, and slower service. The most consequential cost is burnout, which can turn one vacancy into many. The American Hospital Association reported that 65% pharmacy professionals experienced burnout, the highest among healthcare professionals.

Pharmacy Technician vacancies have been reported as high as 40%  or more, according to the American Society of Health-System Pharmacists. Turnover costs can reach $25,000 to $35,000 per technician.

Consider the impact of the vacancy costs that are seldom tracked. Once you make those costs visible, staffing decisions become less about rates and more about restoring operational stability and patient or customer confidence in your organization.

Vacancies Create Daily Operational Losses

Every open requisition reduces capacity and forces daily tradeoffs to keep operations moving. Coverage shifts to overtime and premium pay. Leader time gets pulled into schedule patching and escalation management instead of improvement work. Turnaround times slip, backlogs grow, and clinical capacity gets squeezed as teams focus on keeping the basics moving. As fatigue rises, performance variability and risk exposure rise with it.

Staffing gaps also limit growth. In a survey by the American Society of Health-System Pharmacists (ASHP), 53% of the respondents reported stalling expansion of new pharmacy services and 48% reported reducing pharmacy services.

Mind the (Technician) Gap

When technician roles are open, the work doesn’t disappear. It moves up the chain. Pharmacists take on technician tasks to keep the operation functioning. The result is expensive and inefficient, and it reduces time for verification, patient support, provider collaboration, and other high-value work.

According to ASHP, technician turnover can push organizations into costly workarounds like overtime or expecting pharmacists to fill the gaps. ASHP reported that technician turnover is greater than 20%, with vacancy rates as high as 40% in some settings, which helps explain why pharmacists so often get pulled into gap coverage.

ASHP further estimates that technician turnover can cost $25,000 to $35,000 per technician, before factoring in the downstream impact on pharmacist workload, service delays, and burnout.

Vacancy Cost Compounds Over Time

Vacancy pain accumulates. The longer a role stays open, the more pressure it puts on the system around it. Coverage starts to depend on overtime and internal flexibility. Over time, that extra load creates fatigue, which shows up as more call-outs, lower morale, and burnout. Burnout increases attrition risk, which creates additional vacancies and extends time-to-fill. One vacancy can quickly snowball into a cycle of overload and attrition that becomes difficult to stop.

Workforce data shows how common these dynamics are in hospital pharmacy teams. In an ASHP workforce survey summary, hospitals reported 12.3% pharmacy technician FTE vacancy and a 26.9% inpatient pharmacy technician turnover rate, with technician turnover reported by 74.6% of hospitals. The same summary reported 4.7% pharmacist FTE vacancy and 11% pharmacist turnover.

Cost of Labor is More Than Just Salary

Vacancy cost is often underestimated because staffing math gets anchored to base pay. But salary is only one part of the cost of employment. The fully burdened cost for hospital clinical roles is commonly estimated at roughly 30% to 50% above base salary, depending on benefits, insurance, and compliance overhead.

For specialized clinical roles, it often lands on the higher end because the cost of benefits, professional coverage, licensing, and continuing education support tends to be higher. Benefit load is also moving in the wrong direction. Mercer projects total health benefit cost per employee will rise 6.5% in 2026 and could rise to nearly 9% without cost-control actions.

Consider this example using a hospital pharmacist’s base salary of $140,000 to demonstrate how quickly the fully burdened cost rises. Not every organization matches these percentages, but it shows why comparing rates to salary alone is an incomplete baseline.

Don’t Forget Full Burden

The “burden” includes every cost the hospital absorbs that is not the employee’s take-home pay, such as:

• Statutory taxes like FICA and unemployment taxes
• Benefit load, especially healthcare benefits and retirement contributions
• Coverage costs tied to the clinical environment, such as professional liability coverage
• Onboarding and credentialing items like licensing renewals and certifications
• Continuing education support that may be part of clinical compensation expectations

Even when organizations limit certain benefits, they still carry employer-side payroll costs and administrative overhead. The baseline needs to reflect the real cost of employment, not just salary.

Vacancies Have Two Price Tags

Once you understand the burden rate, it becomes clear that vacancies create two overlapping cost problems. First, you lose capacity. Work piles up. Priorities get triaged. Clinical support work gets delayed.

Second, you pay more for coverage. That coverage can be overtime, incentive shifts, or redistributing work to higher-cost roles. The longer a vacancy persists, the more your operation shifts into expensive workarounds.

Stabilizing Faster Can Be a Conservative Choice

Once you recognize vacancy loss as compounding, focusing on cheaper per-hour cost becomes a risky metric.

Stabilizing faster can reduce:

• Overtime and premium pay
• Backlog and throughput loss
• License mismatch, pharmacists covering technician work
• Burnout-driven turnover

In other words, paying more for coverage can cost less overall if it stops the vacancy drain.

This is where pharmacy leaders can pivot the conversation from price to cost avoidance. The question becomes: what does it cost to run short for another 30, 60, or 90 days, and what does it cost to stabilize now?  And how much can stabilizing now actually save the organization?

Operational Metrics That Reveal Vacancy Cost

You don’t need a perfect model to improve decisions. You need consistent signals that translate operations into economic impact.

A practical starting set of metrics:

1. Vacancy duration by role and site

• Days open for pharmacist and technician positions
• Trend line over the last 2 to 4 quarters

2. Overtime and premium pay tied to coverage gaps

• Overtime hours per week during vacancy periods
• Incentives or premium shifts used to cover holes

3. License mismatch hours

• Estimated pharmacist hours spent on technician-level tasks during shortages
• High-value work deferred as a result

4. Throughput indicators that move with staffing

• Queue length, verification turnaround, delayed discharges, or local measures you already report
• Correlate staffing gaps with performance shifts

5. Retention warning signals

• Absence spikes, schedule refusals, internal transfer requests, resignation velocity
• Track leading indicators, not just exits

These measures won’t capture everything, but they reliably make lost value visible to operations and finance.

A Finance-Ready Frame for Staffing Decisions

For cross-functional alignment, keep the framing simple:

1. Fully burdened internal labor cost, not salary alone
2. Weekly vacancy loss, overtime plus throughput loss, plus license mismatch, plus retention risk
3. Cost to stabilize capacity, the investment required to restore staffing, and protect performance

This shifts the conversation from rate comparison to cost avoidance and risk reduction, terms finance teams can evaluate.

Why External Coverage Makes Economic Sense

Once you quantify fully burdened cost and weekly vacancy loss, external coverage can shift from “premium expense” to a practical hedge against disruption. The goal is to stabilize capacity fast enough to prevent overtime, backlog, and burnout from compounding into turnover.

External coverage often makes financial sense in situations like these:

• Overtime is already structural. If you are routinely paying premium rates to cover gaps, the cost comparison changes quickly, and fatigue risk rises.
• Technician shortages are pulling pharmacists off high-value work. Paying pharmacist wages for technician tasks is a predictable cost multiplier.
• You need flexibility without long-term headcount risk. Temporary coverage can stabilize operations while permanent recruitment continues.
• You want to shift liability and administrative load. Many external arrangements place workers’ compensation and certain insurance burdens on the staffing partner rather than the hospital.
• Time-to-stability affects retention. Reducing the duration of overload can reduce the probability of burnout-driven turnover, which often creates additional vacancies.

When leaders evaluate options using total cost, not just visible cost, “expensive” often becomes “avoidable.”

The Reality: The Cheapest Option is Rarely the Least Expensive

Vacancies don’t just cost money. They cost stability and capacity, and those losses accumulate quietly until they show up as overtime, performance breakdowns, resignations, and lost revenue.

The best staffing decisions start by measuring what’s usually ignored: the value lost while roles remain open. Once that’s visible, leaders can evaluate solutions based on total impact, not just the most visible line item.

ASHP’s burnout cost calculator uses pharmacist benchmark inputs, including a 10.9% turnover rate and a 64% occupational burnout rate, underscoring how quickly burnout-related churn can become a measurable cost driver.

How Rx Relief Can Help

Rx Relief helps pharmacy leaders restore stability quickly without lowering standards. With pharmacy-specific screening, credential readiness, and clear accountability from request through placement, Rx Relief reduces vacancy time and helps prevent overtime, backlog, and burnout from compounding.