Their exclusion ripples into demand estimates for pharmacists, leading to a distorted picture of pharmacist demand and, ultimately, impacting the number of individuals choosing to enter the profession.
While media attention has been heavily focused on community pharmacies reducing hours, quitting, and being subtracted from the workforce, the stability of the profession is also being impacted by working pharmacists who have been unaccounted for. In my recently published article “Minding the gap and the value of metrics: Count of working pharmacists in the United States” my coauthors and I found that the Bureau of Labor Statistics (BLS) reported there were 311,200 pharmacists in 2019, which came up short and failed to account for an additional almost 46,000 pharmacists still working. Our study produced this estimate based on the number of individuals receiving their first pharmacy degree from 1965 to 2019, adjusted by the expected survival and work force participation rate by age.
Although not usually cited when BLS data is discussed, the BLS uses a single standard occupational classification (SOC) code (29-1051) that reflects a traditional definition of pharmacist job functions, thus pharmacists working in nontraditional roles outside of this definition are not included in the BLS pharmacist count. Since pharmacist workforce projections are based on the BLS count, this exclusion ripples into the demand estimates for pharmacists, which leads to a distorted picture of demand for pharmacists which likely affects the number of individuals choosing to enter the profession. Thus, an unseen additional shock to the future pharmacist workforce looms, on top of what we are currently undergoing in the US pharmacy community.
Nontraditional roles for pharmacists exist in many different industries such as pharmaceutical companies, managed care companies, and academia. Although the BLS has reported increasing accounts of pharmacists in these industries in recent years, the magnitude of the counts appears low given the industry size, the number of directly related training initiatives, and pharmacy professional associations. Having an inclusive count of pharmacists is critical as projections of below average growth in pharmacist jobs by 2031 are based on counts using this non-inclusive definition of the “traditional pharmacist.”
Although there are likely many reasons for declining applications to US pharmacy schools, the BLS projections of slow, if any, growth in future jobs is an important consideration for students choosing career paths. Pharmacists in non-traditional roles are not visible to the public—or even the profession—if there is no mechanism to count and track them. Combining the BLS projections with lack of visibility of pharmacists in non-traditional roles sets up undue negative perceptions of pharmacy as a viable and varied career path; these perceptions may have long-term ramifications if we are not able to produce enough pharmacists to meet future professional demand.
Pharmacists play key roles in health care teams as it relates to services for patients like medication therapy management, disease state management, and patient education. The public should be concerned that we will not be prepared to meet many of the societal health care needs pharmacists are expected to provide now and in the future. Traditional roles of dispensing, providing information, and advising health care practitioners on safe and effective usage of medications, all of which are expanding due to the accelerating aging of the US population and number of patients using polypharmacy, may not be sustainable.
Additionally, the expanded demand for clinical pharmacy services (testing, vaccinations, prescribing) driven by the pandemic to meet public health needs which have become part of expected pharmacy practice may also not be sustainable. While these are important expansions of pharmacist services, the association between pharmacist burnout and the rising demand for services under current working conditions, which must be improved, is contributing to pharmacist shortages in many areas.
Of course there will be uncertainty in future pharmacist job projections; however, ensuring the base starting count is inclusive and representative of the profession is a critical foundational step. Until the complete and valuable pharmacist workforce is appropriately counted, the pharmacy profession and the patients served will continue to be under duress.
Collective action among stakeholders is needed to first produce an inclusive count of pharmacists giving accurate visibility to the magnitude of pharmacists in non-traditional roles, and second to re-examine projections for pharmacist jobs using an inclusive view for all positions that value pharmacy training and expertise. These are essential steps to allow an accurate perception of pharmacy as a career path and meaningful workforce planning that ensures the profession will be prepared with an adequately trained workforce to meet health care needs of the future.
About the Author
Jan Hirsch, BS, PhD, FNAP, is the founding dean and professor of clinical pharmacy in the School of Pharmacy and Pharmaceutical Sciences at the University of California, Irvine.