Slides - Shortage of Pharmacists - Untapped Resource

[whitetulip]

Pharm-D is required for pharmacist license? Where did this come from?
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[phaemcist 26!]

Is There a Shortage?

Three primary sources are used to provide an understanding of the status of the pharmacist workforce. These include the Pharmacy Manpower Project (PMP), the Aggregate Demand Index (ADI), and the National Association of Chain Drug Stores (NACDS).
The PMP is a nonprofit corporation established approximately 15 years ago to gather, analyze, and distribute data on the supply of pharmacists and the demand for pharmacy services in the United States.2 In 2001, the PMP assembled 24 pharmacy experts for a 3-day conference to project the need for pharmacy services over the next 2 decades.3 The conference participants concluded that by the year 2020 the supply of pharmacists is likely to fall short of the need by about 157,000.3 According to the participants, many factors have helped contribute to the pharmacist shortage, including the expanding role of the pharmacist, an increase in the number of prescriptions dispensed, an aging population, higher educational standards for pharmacists, attractive careers in areas other than pharmacy, and a movement toward managed care.3
A second indicator of the pharmacist shortage is the ADI, a tool supported by the PMP that is used to determine the difficulty of filling open pharmacist positions throughout the United States. Simply stated, it is a numerical tracker of current and past demand for pharmacists. The ADI is calculated based on monthly data collected from employers of pharmacists and is reported on a scale of 1 (high surplus) to 5 (high demand). As of July 2006, the ADI for national pharmacist demand is 4.16 (indicating moderate demand), with a value of 3.83 for demand in the community setting.4 Both of these values have increased steadily since July 2005, supporting the claim that the shortage of pharmacists has been worsening.4
Finally, a description of the pharmacist workforce is provided in the NACDS Foundation's July 2005 Chain Pharmacy Employment Survey. Data from this survey indicate that there were approximately 5000 full-time and 1000 part-time chain pharmacist position vacancies nationally.2 Using a scale of 1 (large shortage) to 5 (large oversupply), the survey indicated that the national index was 2.05, demonstrating some shortage of community pharmacists.2
It is clear from these 3 leading indicators that there is a current shortage of community pharmacists and that it will most likely worsen in the next several years.
What Are the Contributing Factors?

One apparent reason for the worsening community pharmacist shortage is the large increase in retail prescriptions dispensed annually. For example, the number of prescriptions dispensed each year has grown by 60% in the last 10 years, a rate that greatly outpaces the increase in pharmacist supply.5 According to the Pharmacist Workforce survey, factors contributing to the rise in prescription volume include growth of the economy, development of new drugs, direct-to-consumer marketing, and an increasing number of refills.1
It is reasonable to assume that the burden of more prescriptions dispensed per pharmacist may contribute to medication errors, longer working hours, and decreased quality of life for pharmacists, while at the same time lessening the number of opportunities for pharmacists to interact with patients and perform managed care activities. This was confirmed by the survey, where pharmacists reported that they are not offering the full services they are qualified to provide because of work burden and time constraints.1
Accompanying this upsurge in prescriptions is an inherent increase in the time pharmacists must commit to thirdparty payment and administrative tasks related to high-volume sales. Oftentimes, these clerical functions can occupy between 10% and 20% of the pharmacist's time, making it difficult to maintain a consistent workflow in the midst of this high prescription volume.6 Some sources maintain that allowing for more technicians and supportive staff members per pharmacist might help alleviate part of the clerical burden for pharmacists. This proposition is difficult to implement, however, due to the number of state and/or employer regulations limiting the ratio of technicians to pharmacists.
Another factor is an evident shortage in the supply of pharmacists available to work in the community setting. Shifts in the demographics between the leaving and entering pharmacist workforce are also of particular importance. One of the most significant differences between past and recent pharmacists in the workforce is the gender shift, or increase in the number of female pharmacists, many of whom opt for part-time positions. According to the NACDS employment survey, 53% of full-time chain drug store pharmacists are men, and 47% are women.2 It is suggested that older men will be lost from the pharmacist workforce due to death or retirement, while younger women entering the profession will tend to choose part-time work.1
The NACDS employment survey supports this premise, estimating that 58% of part-time pharmacists are women, and only 42% are men.2 These findings indicate that once women represent 50% of the workforce, the average number of hours worked per week will drop by 5%, which must be accounted for in judging the workforce shortages.1
The shrinking supply of pharmacists is also partly due to a decreasing number of graduates from schools of pharmacy in the last decade.1 In addition, international pharmacy graduates are currently presented with significant barriers to achieving licensure, thereby hindering one potentially beneficial response to the pharmacist shortage. The opening of 20 new pharmacy schools over the last 5 years should help to increase the number of graduating pharmacists to almost 10,000 in 2007, representing an increase of about 2000 graduates from 2003 and 2004 levels.7 This change will impact long-term shortages in the supply of community pharmacists only modestly, however.
What Are the Implications?

One of the most troubling questions of the worsening pharmacist shortage is whether or not the increased workload will allow pharmacists to continue to perform adequate quality control checks and provide appropriate patient care. Some pharmacy experts predict that the community pharmacist shortages may result in decreased patient safety and fewer opportunities for patient care as a result of understaffed work shifts and an increase in individual workers' duration and volume of work.
These issues could also promote more medication dispensing errors. Constraining community pharmacists to the role of dispensing high-volume prescriptions represents a step backwards for the pharmacy profession, hindering its advancement as a legitimate and significant contributor of patient care and comprehensive services.
Without overlooking the innate challenges that pharmacists will be faced with in the next few years as a result of the pharmacist shortage, it is important to recognize that there have been several positive outcomes of these difficult circumstances. In an attempt to increase the utility of available pharmacists, significant advancements have been made in information technologies, automation, robotics, electronic prescribing, and an increase in the hiring of support personnel.3 Pharmacist salaries also have been modestly increasing, with pharmacists in the community setting still earning a higher annual income than pharmacists employed in the hospital setting.8 These measures possibly will help yield short-term results, but better methods for improving long-term outcomes are needed.
Conclusion

Current leading indicators show that there is unmistakably a present and worsening shortage of pharmacists in the community setting. Despite attempts to resolve the many factors contributing to these shortages, there is no evident long-term resolution. Inevitably, the many roles of pharmacists and needs of patients will continue to expand. In order to provide the best possible services for their patrons despite personnel shortages, community pharmacists must strive to continue their tradition of providing patients with quality care while meeting the latest challenges in health care.
References

1. Health Resources and Services Administration. The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists. Washington, DC: US Department of Health & Human Services; 2000.
2. NACDS Foundation July 2005 Chain Pharmacy Employment Survey Results. National Association of Chain Drug Stores. Accessed June 2006.
3. Professionally Determined Need for Pharmacy Services in 2020. A report of a conference sponsored by the Pharmacy Manpower Project Inc. AACP. Accessed June 2006.
4. Aggregate Demand Index. Western University of Health Sciences. Aggregate Demand Index - Western University of Health Sciences. Accessed June 2006.
5. Pharmacy Choice Web site. Pharmacy Choice - Career Information for Pharmacists and Technicians - September 4, 2008. Accessed June 2006.
6. Landis NT. Non-patient-care activities dilute pharmacists' time, NACDS study shows. Am J Health Sys Pharm. 2000;57:202.
7. Pharmacist Shortage Worsens Nationwide. ABC News: Health. November 7, 2005. ABC News: ABC News. Accessed August 2006.
8. Pharmacy Week Web site. PharmacyWeek.com: The Pharmacy Professionals' Employment Resource. Accessed August 2006.

[yaya]

Great Job Knok. . This is a very beautiful presentaion

[san77]

its a good work .could you please give me a information about pharm d program

[whitetulip]

I can't understand what shortage you are still talking about. In NC CVS has no hours for the floater pharmacists and started laying off pharmacist. Walgreen and Rite Aid has no opening. I feel like all the work I did to get licensed doesn't worth it.

[bachcha]

I have read it.....very good job.It describes our real suffering..as foreign graduates Health and Wellness - Buy Medicines at Shopeastwest.com

[MJCARR]

no shortage in south jersey can not
find a job

[celestine]

All rubish...There is no job available for even local grads. Where did they get these fake statistics. Please don't distract people..there are no training available, infact walgreens is laying off pharmacists for whom they applied H1 in Florida in Arizona and will be worst in other states. In some states..they don't even prefer to hire foreign grads even with their FPGEC certificate.

Guys..have mercy on yourself and try to stay where ever you are. USA is not the same as it used to be for the pharmacist, and I think soon there will be changes in requirements for foreign grads.

God bless us!!

[celestine]

Before praising someone, please try to research by yourself.

[mocharody]

2015 - When the Shortage
of Pharmacists
Becomes a Surplus!
(Unless Major Changes Occur in the Practice of Pharmacy Very Soon) [To Top]
There has been extensive discussion in recent years regarding the shortage of pharmacists that exists in many parts of the country. Some have suggested that the shortage of pharmacists may continue well into the twenty-first century, and this observation is supported, in part, by the increase in the percentage of the population that are in the elderly age range, as well as the use of a larger number of medications by these individuals and the accompanying greater need for services provided by pharmacists. However, an assumption of some of the projections of a long-term shortage of pharmacists is that pharmacists will be devoting a large amount of their time to the provision of medication therapy management (MTM) and other comprehensive pharmaceutical services that we advocate.

There has not been a previous time when the need for the expertise and services that pharmacists are able to provide has been as great as it is now, and this need will continue to grow for the foreseeable future. We are encouraged by a number of progressive practice initiatives (e.g., MTM) of individual pharmacists and groups of pharmacists that are valued and respected, and for which compensation is provided. However, the pace at which these initiatives are being developed and implemented is far too slow, and the number of pharmacists whose employment situation positions them to pursue expanded practice responsibilities is far too low. With all due respect and appreciation to those pharmacists whose accomplishments have provided excellent practice models, we have been largely ineffective as a profession in providing and documenting the value and need for comprehensive pharmaceutical services to the point that others are willing to pay for them.

During this same period of time we have observed changes such as 1) the increased utilization of technology that has made prescription dispensing systems more efficient, 2) an increase in the number, education, and credentials of pharmacy technicians, and 3) the development of many new schools of pharmacy and an accompanying large increase in the number of pharmacy graduates. These factors will have an important influence on the need for and supply of pharmacists.

Although acute shortages of pharmacists continue to exist in some areas, several indicators suggest that the overall shortage is easing. The number and type of factors that most influence the supply of and demand for pharmacists make it very difficult to make predictions with any degree of certainty, and most are wise enough not to make such predictions. However, a surplus of pharmacists may occur sooner than many would have anticipated. In the absence of studies, data, or statistical projections, my expectation is that there will be a significant surplus of pharmacists in 2015, UNLESS major changes occur in the practice of pharmacy very soon. My "crystal ball" is no better than anyone else's and I actually hope that my prediction is wrong. But let's consider some of the consequences of a surplus and actions that pharmacy needs to take to best meet the needs of patients and advance our profession.

Consequences of a Surplus

I wish to be clear that my comments are not provided for the purpose of maintaining a shortage of pharmacists or avoiding a surplus. Rather, they are offered to demonstrate the important ways these issues are intertwined in influencing the provision of pharmaceutical services to patients and the future roles of pharmacists. The consequences of a surplus of pharmacists by 2015 include, but are not limited to, the following:

1. Failure to attain recognition of the expertise and services of pharmacists. The provision of comprehensive pharmaceutical services to the tens of millions of patients who need them will require the participation of many more pharmacists than we will be able to supply for at least several decades. If a surplus of pharmacists occurs as early as 2015, it will mean that our profession is failing in its efforts to convince those paying for health care, as well as other health professionals, that the expertise and services we are capable of providing are valuable, needed, and worth paying for. Many pharmacists will continue to be employed in traditional practice responsibilities, and these positions, in which a shortage currently exists, will soon be occupied by the significantly larger number of pharmacists who are graduating from colleges of pharmacy.
2. Unemployment and lower salaries. The clear implications of a surplus for individual pharmacists are greater difficulty in obtaining a position, unemployment, and lower salaries. There are important questions as to which pharmacists are most likely to be hired for practice responsibilities if a surplus of pharmacists exists. Would it be those pharmacists who are the most highly motivated in providing services to patients and extending the professional role of pharmacists, or would it be those pharmacists who are content with the status quo and would not "make waves" when working for an employer that is content with having its pharmacists carry out just the traditional dispensing responsibilities?
3. Closing of some colleges of pharmacy. In the last 20 years, approximately 40 new colleges of pharmacy have opened or are well along in the planning process. Prior to the late 1980s, the number of colleges of pharmacy in the United States had remained constant at 72 over a period of many years. The number is now 112 and is continuing to increase. The vast majority, if not all, of the new schools (and additional campuses for some older schools) have identified the shortage of pharmacists as the/a primary reason for which the new school is needed/justified.
   
   If a significant surplus of pharmacists occurs, not as many young people will consider pharmacy as a career opportunity, the number of applications will fall, enrollment shortfalls will be experienced, admission standards will be lowered, and some schools of pharmacy will close. These challenges that are associated with a surplus of pharmacists will be experienced not just by the new schools (some of which have innovative and dynamic programs that make them very competitive), but also by the older schools (some of which have not implemented progressive changes).

Actions Needed

The highest priority must be given to having a much larger number of pharmacists providing comprehensive services to patients and being paid for it. Past experiences and frustrations have taught us how difficult it is to do this. However, we must persist and we must be far more effective in attaining this goal than we have been in the past. Pharmacists are strategically positioned and have the expertise to optimize drug therapy outcomes and reduce the occurrence of drug-related problems. The frequency with which the media reports the occurrence of medication errors and other drug-related problems (many of which result in litigation) reflects an increasing outrage on the part of the public with respect to these situations. If the profession of pharmacy is unwilling and/or unable to effectively address these problems, someone else (e.g., physician assistants, nurse practitioners) will have to. We must not default on this opportunity.

Daniel A. Hussar