At the recent American Society of Health-System Pharmacists (ASHP) Mid Year Clinical Meeting in Anaheim, California, Henri Manasse, chief executive officer of ASHP, and Tom Menighan, chief executive officer of the American Pharmacists Association (APhA), discussed their organizations’ concerns about the accelerating expansion of pharmacy education. Earlier, they had released a discussion paper prepared by both associations which called for reconsideration by the pharmacy profession of the rapid increase in the number of pharmacist graduates. As I was writing this commentary, I received 2 e-mails that suggested that this call for reconsideration was needed and might even be too late. One e-mail was from a reader referring to my previous commentary, “Do We Need More Pharmacy Schools?” He said: “I can speak for my state, the proliferation of pharmacy schools…has been rampant. This to me is damaging to the profession. There are simply not enough positions to sustain the influx of graduates. Not to mention the dilution of talent that accompanies this out of control proliferation of pharmacy schools.”
The second e-mail came from a former student who said: “I am contacting you essentially out of desperation at this point because after many months of searching on my own, I just have not been able to secure a full-time position as a community pharmacist anywhere in the area.” He went on to say: “I have 7 years’ experience in a high volume setting and great esteem and reverence for the practice of community pharmacy.” Unfortunately, this pharmacist is not the only one having trouble finding employment within commuting distance. Is this a temporary problem due to the economy? Once the economy rebounds will the pharmacy jobs follow? My feeling is that the problem is not only caused by the nation’s economy, but related to the serious overproduction of graduates.
The APhA/ASHP discussion paper offers this information about the expansion of pharmacy schools: “Before 1987, the number of pharmacy schools (72) in the United States had remained relatively constant for many years. Since then, there has been a rapid growth of new pharmacy schools and expansion programs (satellite pharmacy programs offered at other campuses of a university and expanding class sizes). As of July 2010, there are 115 U.S. based colleges and schools of pharmacy with accredited (full or candidate status) professional degree programs and five schools with pre-candidate status. As of December 2009, students are enrolled at 120 U.S. colleges and schools of pharmacy. An additional 20 schools have been identified where feasibility and exploration of new programs is underway.”
The discussion paper also pointed out a number of issues caused by the expansion in pharmacy education, including “1) the actual effect on ameliorating the shortage of pharmacists, 2) exacerbation of the already-serious faculty shortage, 3) inability of practice sites to accommodate increased demands for experiential education (both introductory and advanced), and 4) the potential for a negative effect on the quality of education and, ultimately, on the quality of new graduates practicing pharmacy.”
The fact that there is an oversupply of pharmacists seems to be accepted by everyone. What we should do about it may not have as much agreement. Certainly the call by APhA/ASHP for “the pharmacy practice and educational communities to jointly and systematically assess the near-term and long-term workforce needs of pharmacy practice and plan how to best meet those needs” makes sense and should be aggressively pursued. Some suggest this may be too little, too late—and ACPE should simply stop accrediting new pharmacy programs. Or perhaps state boards of pharmacy should do something to keep new schools from opening. Others suggest that both of these options have certain legal, ethical, or practical elements that might make them difficult or even impossible to implement. Others say, just let the marketplace work. If graduates cannot find jobs, enrollment will decline and schools will have to close. The marketplace solution may work, but pharmacist graduates will surely be hurt by being jobless with a high debt load while the profession waits for the market to correct itself.
Could the oversupply be viewed positively in that it will force graduates to pursue careers in nontraditional places? Graduates may be willing to accept a job at a lower starting salary in a related area. As they demonstrate their value, jobs may open up for more graduates in that field.
There is a shortage of primary care providers. Could the oversupply of pharmacists create an impetus to push the appropriate recognition of our graduates as primary care providers, assuming nontraditional roles in rural health or for disadvantaged clientele? Although a revenue stream to support pharmacists doing chronic disease management is not well developed, will the oversupply push a more rapid implementation of this role?
It is always easy to identify a problem after it becomes obvious. Offering solutions is not as easy.
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Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.