- CONDITION CENTERS
Dr. Mahrous is an associate professor at the Midwestern University College of Pharmacy-Glendale (MWU-CPG) and Arizona College of Medicine. Dr. Maziarz is a PharmD graduate of MWU-CPG.
Much attention in recent years has been focused on current and projected shortages of community pharmacists in the United States. Fluctuating statistics and predictions highlight the need for a comprehensive picture of what is and will be happening in the changing pharmacy workforce. This is particularly important since pharmacists represent one of the largest health professional groups in the nation, and most are employed in a community setting.1
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.
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.
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.
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.