Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, FCCP
There has been much discussion over the past decade regarding the growing number of pharmacy schools. Institutions of learning announce they are opening a pharmacy school, citing the need for more pharmacists and the great career opportunities the graduating students will have. On the other hand, the pharmacy community’s complaint following these announcements is that the pharmacy profession does not need more pharmacists.
The suggestion has been made that the workforce data on which the decision to open pharmacy schools is based is outdated. The supply appears to be already outstripping the demand—there do not seem to be enough jobs for the current pharmacists. And if we add even more graduates, it will only exacerbate the current situation. The first question to ask: Can someone regulate the addition of new schools?
The only regulator that pharmacy really has is the marketplace. A recent article in The New England Journal of Medicine
, “Are We in a Medical Education Bubble Market?”, made some convincing arguments from the perspective that a correction for pharmacy could soon be on the horizon.1
While the article focused primarily on medical education, it had some interesting statements about pharmacy education. The authors utilized a metric called the “ratio of debt to income.” This measures the accumulated amount of student debt compared with the income one will receive upon entering the marketplace. The assumption is that a student will be able to take on more debt if there is greater potential to pay it off.
Over the past 15 years, the ratio of debt to income for pharmacy has continued to increase. Since there has not been a drastic change in the starting salary of a pharmacist, the assumption one would draw is that the average tuition of pharmacy schools must be increasing at a rate greater than any increase in salary.
Furthermore, the current relative percentage is more than 100%. If you estimate that the average starting salary of a pharmacist is $100,000, this means that the average student debt load upon entering the profession is greater than $100,000. This is a staggering amount.
More alarming was that the authors compared this ratio against other professions and found that pharmacy trailed only veterinary medicine and optometry in the ratio of debt to income. Professions that had lower ratios included all medical specialties, law, dentistry, and business.
If we are in a medical education bubble market, when will it pop for pharmacy? Will this be before other health care professions, and what will happen if it does? Future pharmacists will recognize that there are better careers financially than pharmacy when considering the ability to pay off debt once entering the workplace. This will lead to fewer qualified individuals entering pharmacy schools compared with some other professions, and the slowdown will have nothing to do with concerns of oversupply. It will all be based on the economics of debt and the ability to pay off student loans. A pharmacy education costs too much.
Since many pharmacy schools are on a tuition-based revenue model, having all seats full at the current tuition rate is essential for survival. However, if people do not see the economic value in becoming a pharmacist and if the current tuition rates remain the same, many will choose not to apply. One might argue that pharmacist salary increases would resolve the concern, but increases are market driven and will probably not happen any time soon.
What are we to do then? Schools that are able to reduce the cost of pharmacy education will be able to not only survive but thrive. Potential ways to accomplish this could include taking advantage of online education, changing accreditation requirements to reduce the time needed to get a pharmacy degree, and limiting the number of paid faculty that are involved in pharmacy education. While none of these are easy to do, they become essential if one needs to reduce the cost of tuition to increase the value of a pharmacy education.
While the oversupply of pharmacists is concerning, just as worrisome is the cost of pharmacy education as measured by debt to income ratio. Let us take leadership on these issues before it is too late and no one wants to have a future career in the profession that has meant so much to us.
Do you have insights on how we can improve the value of a pharmacy education?
Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, FCCP, is associate director of pharmacy, University of North Carolina Hospitals, and clinical associate professor and director of graduate studies at the University of North Carolina Eshelman School of Pharmacy.
Asch DA, Nicholson S, Vujicic M. Are we in a medical education bubble market? N Engl J Med. 2013;369:1973-1975. www.nejm.org/doi/full/10.1056/NEJMp1310778.