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12/20/2000

Pharmacist Shortage Identified by Government

Cheryl A. Thompson

The Health Resources and Services Administration (HRSA) confirmed in December what many in the pharmacy profession already knew: There is definitely a shortage of licensed pharmacists in the United States.

According to HRSA, in a report (PDF) required by the Healthcare Research and Quality Act of 1999 and submitted to Congress, the shortage emerged over the past two years and will not likely abate in the near future without major changes in pharmacy practice and education. This shortage is considered "dynamic" because it seems to stem from a rapid increase in the demand for workers coupled with a limited ability to increase the supply. The report stopped short of offering remedies, because the authorizing legislation did not request the Secretary of Health and Human Services go beyond determining "whether and to what extent there is a shortage of licensed pharmacists."

In The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists, HRSA estimated that in 2000 there were 196,000 actively practicing pharmacists. This number derives from the pharmacist-supply model designed by the Bureau of Health Professions, part of HRSA. By 2010 there will be about 224,500 active pharmacists. The report did not predict the demand for pharmacists in 2010 but expected many of the factors currently influencing demand to persist for at least 5 to 10 years.

Identified as the "most striking evidence" of a pharmacist shortage were greatly increased vacancy rates for positions, employers’ difficulties in hiring, and unprecedented increases in the volume and range of activities demanded of pharmacists. The shortage originated in part from the following factors:

  • Expansions in pharmacy practice and pharmacists’ roles and professional opportunities,
  • Increased use of prescription drugs,
  • Market demand factors such as growth and competition among community pharmacies, and
  • Changes in the pharmacist work force, including more women and their shorter work patterns and transition to the Pharm.D. as the entry-level professional degree.

HRSA pinpointed the growth in demand for pharmacists in hospitals as largely due to the increased complexity of pharmacotherapy and the need for proper drug selection, dosage, monitoring, and management of the entire medication-use process. The demand for pharmacists in long-term care facilities and home health care remains strong, the report said. In the federal sector, substantial disparities between public and private compensation have hampered efforts to recruit and retain pharmacists, resulting in vacancy rates as high as 18% in the armed forces.

For the profession and the public, the report said, the shortage has meant less time for pharmacists to provide patient counseling, increased job stress, inadequate working conditions, reduced professional satisfaction because of longer working hours, service restrictions that particularly affect underserved parts of the population such as the elderly, and recruitment of pharmacy practice faculty away from pharmacy schools. Pharmacist fatigue and inadequate time to counsel patients or check for errors may increase the risks of medication errors, the report noted.

In preparing the report, HRSA relied on articles in peer-reviewed journals; reports of academic, governmental, and private research groups; and analyses and reports commissioned or conducted by professional associations. A call for comments, announced in the Federal Register, elicited 48 responses, 15 of which were from pharmacists or organizations representing pharmacists, including ASHP.

At HRSA’s December 12 "Workforce 2000"conference, held in conjunction with release of the report, ASHP called on policymakers and stakeholders to provide new incentives to help expand the infrastructure of the pharmacy work force. Specifically, federal money should be directed at encouraging pharmacy schools to increase enrollments and at motivating health care organizations and pharmacy schools to expand postgraduate residency training programs. Also, pharmacy leaders should rethink the type of practice model followed at their health systems. And training programs for pharmacy technicians should be standardized and upgraded.

Pharmacy Profession Offers View of Work Force

Four months before release of the HRSA report, the Pharmacy Manpower Project issued its final report on a work force survey conducted in 2000. The survey sought to characterize the work force, not count it.

According to the report, 73.3% of actively practicing pharmacists in 2000 worked more than 30 hours a week, or full-time. Women constituted 44.8% of the pharmacist work force.

More than half of pharmacists practiced in community pharmacies. Nearly 40% of pharmacists practiced in a setting that could be described as part of a health system: 24.8% of pharmacists practiced in hospitals, and 13.6% practiced in "other patient care" settings, namely clinics, HMO pharmacies, long-term care, home health care, mental health facilities, and prisons.

Full-time pharmacists in hospitals worked an average of 43.4 hours a week; in patient care settings other than hospitals and the community, full-time pharmacists worked an average of 44.1 hours a week. Overall, 17.7% of the full-time work force were staff pharmacists in hospitals and 15.8% were pharmacists in patient care settings other than hospitals and the community.

The report, prepared by the Midwest Pharmacy Workforce Research Consortium, is available online. Also funded by the Pharmacy Manpower Project is the "aggregate demand index," which uses a five-point scale to report each month how the demand for pharmacists compares with the supply.