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6/30/2003

Pharmacy Personnel Shortage Eases But Remains an Issue, ASHP Finds

Cheryl A. Thompson

The nationwide shortage of pharmacists has lessened for health systems and hospitals overall since a year ago, according to results of the 2003 ASHP Pharmacy Staffing Survey, (http://www.ashp.org/practicemanager/StaffSurvey2003.pdf) but facilities with a low number of inpatients continue to have higher vacancy rates for pharmacists than do the larger hospitals.

"We've seen the vacancy rate declining for the last three survey periods," said Douglas J. Scheckelhoff, M.S., FASHP, director of the ASHP pharmacy practice sections and one of the staff members who conducted the most recent survey. "This general trend downward does seem to be consistent with what we hear in anecdotal reports from ASHP members. And it's also consistent with the scores that are being reported through the Aggregate Demand Index through the Pharmacy Manpower Project."

Started nearly four years ago, the Aggregate Demand Index each month reports a national panel's assessments of states' and practice settings' demand for pharmacists. The Center for Pharmacy Practice Research and Development at Western University of Health Sciences in Pomona, Calif., provides technical support to the project, which is directed by faculty member Katherine K. Knapp, Ph.D.

Based on data reported by the 578 pharmacy directors who responded to the ASHP survey in May 2003, Scheckelhoff found that the average vacancy rates for pharmacists and pharmacy technicians were 5.6 percent and 4.3 percent, respectively.

The vacancy rates in 2002 were 6.9 percent for pharmacists—a decrease from 8.9 percent in 2000—and 4.6 percent for pharmacy technicians. ASHP did not conduct a staffing survey in 2001 and did not obtain data on pharmacy technicians in 2000.

In terms of average daily patient census, hospitals with less than 100 inpatients in 2003 had a vacancy rate of 7.0 percent for pharmacists, a figure that gradually decreased to less than 5 percent as the census increased (see table).

2003 Pharmacy Personnel Vacancy Rates
Average Daily Patient CensusPharmacist Vacancy Rate (%)Pharmacy Technician Vacancy Rate (%)
<997.03.6
 100–199 6.0 3.4
 200–299 5.1 4.2
 300–399 4.7 3.5
 >400 4.9 4.9

"We have known for some time that smaller hospitals have different challenges than larger hospitals that often have more resources," "Scheckelhoff said. But, he added, this is the first time that ASHP has data showing that smaller hospitals have more difficulty recruiting staff members and keeping them.

According to the recent survey, hospitals with an average daily census of less than 100 inpatients averaged an annual turnover rate for pharmacist positions of 11.4 percent, about twice the rate in hospitals serving at least 400 inpatients daily. Turnover rates were calculated by dividing the mean number of resignations in the past 12 months by the mean number of positions budgeted at the time of the survey.

Regardless of hospital size, the average annual turnover rate for pharmacy technician positions was somewhere in the range of 12.9 percent to 14.1 percent for the 2003 survey.

DeeAnn Wedemyer Oleson, Pharm.D., pharmacy director and sole pharmacist at 25-bed Guthrie County Hospital in Iowa, agreed with the study's finding about recruitment. Her hospital is in Guthrie Center, a community of about 1,000 residents in west-central Iowa, 35 miles away from the nearest comparable facility and 45 miles from Des Moines, source of the air ambulances that pick up the hospital's stroke and myocardial infarction patients after initial emergency treatment.

"Trying to recruit someone to come out to communities our size is very, very difficult," Wedemyer Oleson said, summarizing what she has heard from her informal network of pharmacist colleagues in small hospitals. "In terms of turnover in hospitals our size, we find that pharmacists actually stay for quite awhile once they're there. The problem is recruiting when you do need a pharmacist."

According to a task force of the Iowa Hospital Association, hospitals in the state typically needed more than 90 days to fill a vacant pharmacist position. But, compared with urban hospitals, rural facilities had a lower turnover rate for pharmacist positions and not as much difficulty retaining pharmacists.

Wedemyer Oleson came to Guthrie nearly three years ago, fresh from completing a pharmacy residency program at the Veterans Affairs medical center in Boise, Idaho. Originally from a town 25 miles from Guthrie Center, she attended pharmacy school in Iowa and left the state for the one-year residency, but said she grew homesick and wanted to return. She had heard that Guthrie's hospital intended to hire its first on-site pharmacist to improve its application for federal status as a critical access hospital, which would mean cost-based reimbursement for the treatment of Medicare beneficiaries.

Guthrie County, she said, typically has five or six inpatients, nearly always covered by Medicare.

"I was not pleased to be hired at 20 hours a week but have actively pursued an increase in hours over the three years that I have been here," Wedemyer Oleson said. On July 1, she starts working 40 hours a week providing the pharmacy services she originated at Guthrie, including distributing medications in unit dose packages, maintaining the formulary, keeping a current charge master for pharmaceuticals, telling patients about their discharge medications, preparing chemotherapy doses for outpatients, offering inservice education to the nursing and medical staffs, and educating clients about diabetes mellitus.

Up north in Wisconsin, the rural hospitals' health care cooperative, whose members have less than 80 beds apiece, recently contracted with the state's Office of Rural Health to help those facilities solve their problems in recruiting pharmacists and certain other professionals.

Acting Director of Pharmacy Steve Rough, M.S., at University of Wisconsin Hospital and Clinics in Madison, spoke of luck when he described recruitment of a pharmacist for a rural facility 60 miles to the north, in Portage.

"We were lucky that there was a Pharm.D. student from the area graduating at the same time," he said. "We were able to recruit her to work up there."

The university's hospital pharmacy department, Rough said, manages the pharmacy department at Portage's 30-bed inpatient hospital and associated 110-bed skilled-nursing facility through a fairly new 16-hours-per-week consulting contract.

"We convinced administration [in Portage] that they needed to add pharmacists and technicians to staff in order to provide a higher level of service and to be able to do things like make drug therapy interventions, save costs, and provide better clinical services," he said.

That higher level of service, Rough said, makes the pharmacist positions more clinically challenging and rewarding and thus improves recruitment and retention.

"Most rural hospitals don't have attractive clinical service programs, and I think that's part of the vacancy problem in those settings," he said.

For the university's hospital pharmacy department, Rough said he recently hired seven Pharm.D.-degreed pharmacists straight from residency programs. "Supply outmet the demand," he said. "We have services that are progressive, and people want to work here."

ASHP's Scheckelhoff said 57 percent of respondents to the recent survey "reported that pharmacist vacancies have, in fact, delayed expansion of pharmacy services or new programs, which is concerning."

Wisconsin's Rough said delays in his department were related to programs needing a pharmacist who wants to practice on the cutting edge, such as computerized prescriber order entry or emergency room services.

"Sometimes you recruit positions that are so progressive," he said, "it scares people off."