The Past, Present, and Future of the Pharmacy Workforce

Boom Times

At the turn of the 21st century, pharmacists were in high demand. It was the peak of the blockbuster-drug era, with antihypertensives, nonsedating antihistamines, acid blockers, statins, gabapentin, inhaled corticosteroids, and a host of other small-molecule advancements. The number of these drugs proliferated, as did step therapy and prior authorizations. Community pharmacies became beehives of activity with an explosion of prescription fills and electronic paperwork. Simultaneously, the addition of 1 to 3 years of schooling in pharmacy doctoral programs temporarily constrained the supply of pharmacists. In response, new colleges and schools of pharmacy were established. New applicants grew substantially due to industry expansion and the appeal of a pharmacist’s salary, which ranked second only to a physician’s.

Technology, Process Change, and Delegating Work

Pharmacies began using automation to fill and process medications to accommodate the dramatic increase in prescription volume. By 2010, what had been considered a “busy” day had grown from filling 200 prescriptions to 400 or more. Pharmacist-to-technician ratio limits were increased or removed. Certified technicians emerged as a paraprofessional workforce, enabling each pharmacist to fill even more prescriptions. The promise of automations and “removing menial tasks and freeing up time for the pharmacist to provide care” was directionally correct, but it largely failed in practice because care delivery was not a billable activity. Community pharmacy practice became a hamster wheel, rushing out as many prescriptions as possible to offset falling drug product reimbursement rates.

Ambulatory Care Practice Arrives

Meanwhile, a spirited and insistent group of pharmacists pressed forward with a long-desired goal of becoming practitioners untethered from dispensing. When the Affordable Care Act was passed in 2010, it included new payment programs that specifically paid pharmacists for their services for the first time, opening new potential revenue pathways based on outcomes and population health activities. Clinical pharmacists began to move into these spaces. Ambulatory care full-time equivalences have grown steadily ever since, tied to neither community pharmacy nor facility-based dispensing.

Shrinking Margins, Rising Student Debt

The decade that followed (2010-2019) became a tumultuous period for community pharmacy practice. As profitable brand-to-generic “patent cliffs” expired, pharmacy benefit managers needed a new way to generate margins and retain health plan and employer customers. The resulting combination of more prescriptions and fewer dollars per prescription increased the pressure to produce more prescriptions per pharmacist full-time equivalent. At the same time, an explosion of student debt, new pharmacy graduates from schools formed during boom times, and significantly higher interest rates during repayment brought a malaise. Evening news spots showed frazzled pharmacists working furiously to fill prescriptions, resembling Lucille Ball on an out-of-control assembly line at the chocolate factory. The portrayal dampened enthusiasm for a career in pharmacy among high school students and their parents. New applicants to schools and colleges of pharmacy fell through the floor. Wages stagnated or fell. Layoffs were common.

COVID-19

Just as the workforce was downsizing, the COVID-19 pandemic shook the world. The health “system” shut down, except for emergency departments, hospital staff, and community pharmacies. Government agencies, public health officials, and patient households turned to community pharmacies for frontline care. Community pharmacy practice got a shot in the arm. Pharmacies built out scheduling systems to safely and effectively deliver more than 350 million interventions to more than 150 million patients over roughly 18 months.¹ Pharmacy’s pandemic-era response to COVID-19 built goodwill and advanced policy related to pharmacists’ scope of practice and billing for services. Community pharmacists and the related workforce are again highly valued and in demand.

After COVID-19, Before Artificial Intelligence

With the exception of certain geographies, we now find ourselves with a relative balance in pharmacist supply but a seemingly unsalvageable business model of thin to no margins, resulting in challenging work conditions that available pharmacists are choosing to forgo. The 2024 National Pharmacist Workforce Study reported some unsurprising but instructive findings. Although pride in the profession remains high (87%), discontent and a sense of foreboding were the prevailing sentiments. A majority of pharmacists across all settings reported an unwillingness to recommend pharmacy as a “good profession/career.” Annual salaries for community pharmacists are stagnant at roughly $123,000, and fewer than 60% said they were satisfied or very satisfied with their work.² The workload rates as “excessively high” as reported by 36% of community pharmacists and as “high” by 40% by a plurality of pharmacists in all practice settings.

Alternatively, ambulatory care pharmacists report high job satisfaction (82%), higher wages ($143,000 per year), and better work hours (93% working days, 6 AM-6 PM), and are much younger as a cohort than in all other settings of care.²

Now What?

Like the COVID-19 pandemic, artificial intelligence (AI) could be a game changer for pharmacists, but likely more impactful and with a permanent trajectory. AI will change not only the profession and its place in a system of care but also much of the fabric of our lives.

Pharmacists and technicians should not be in a wait-and-see mode. We need to gain experience and a working knowledge of available AI tools and agents outside of pharmacy practice and become conversant in their use, utility, and prompts to be prepared when they are introduced into practice. AI is coming more quickly to health care delivery than most health professionals realize. Recently, OpenEvidence launched an AI platform specifically for medical providers; it doubled its valuation in a matter of months, from $6 billion to $12 billion, and claims 40% of physicians use its service.³ OpenAI recently launched ChatGPT Health, and Anthropic has developed Claude for Healthcare. In January 2026, Amazon released Health AI, a virtual health assistant that looks through your records to answer questions, book appointments, and, most vitally for pharmacists, manage medications.⁴

Pharmacies will continue to fill more prescriptions with fewer staff as AI agents enter our workforce. There are literally hundreds of companies working specifically on applying AI models, methods, and agents to streamline pharmacy intake and workflow, with cognitive services coming next.

Imagine an AI agent performing a comprehensive medication review for a patient and the pharmacist stepping in at the final stage to identify AI hallucinations (inaccuracies), review AI-identified problems, and confirm a proposed patient-centered treatment plan. It’s what commercial pilots (computers fly the airplanes) and many radiologists (screen image prior to impressions) already do.

If AI-assisted pharmacies continue to improve at filling prescriptions quickly and cheaply, amid continued reimbursement declines, we will likely see a reduction in pharmacist demand going forward, absent an evolution toward service delivery. We’ve already seen revenue from immunizations-as-a-service become a bulwark against falling dispensing rates, filling the margin gap. If community pharmacies and their workforce transition to a services-based practice and business model, using AI files to capture patients for service delivery and billing, we may see the opposite effect, with the demand for pharmacy workforce remaining steady or even growing as AI pushes overall delivery of health care farther into the community and away from traditional service delivery sites.

REFERENCES

1. Grabenstein JD. Essential services: quantifying the contributions of America’s pharmacists in COVID-19 clinical interventions. J Am Pharm Assoc (2003). 2022;62(6):1929-1945.e1. doi:10.1016/j.japh.2022.08.010

2. Mott DA, Bakken BK, Nadi S, et al. Final Report of the 2024 National Pharmacist Workforce Study. Pharmacy Workforce Center. 2024. Accessed January 23, 2026. https://www.aacp.org/sites/default/files/2025-06/2024-npws-final-report-5.27.25.pdf

3. Schisgall E. Amazon One Medical launches Health AI assistant. Dow Jones. January 21, 2026. Accessed January 23, 2026. https://www.morningstar.com/news/dow-jones/202601216387/amazon-one-medical-launches-health-ai-assistant

4. Hagen J. OpenEvidence scores $250M, doubles valuation to $12B. MobiHealthNews. January 21, 2026. Accessed January 23, 2026. https://www.mobihealthnews.com/news/openevidence-scores-250m-doubles-valuation-12b