Community Pharmacist Shortage: Fact or Fiction?

Dr. Mahrous is an associate professorat the Midwestern University College ofPharmacy-Glendale (MWU-CPG) andArizona College of Medicine. Dr.Maziarz is a PharmD graduate of MWU-CPG.

Much attention in recent yearshas been focused on currentand projected shortages ofcommunity pharmacists in the UnitedStates. Fluctuating statistics and predictionshighlight the need for a comprehensivepicture of what is and will behappening in the changing pharmacyworkforce. This is particularly importantsince pharmacists represent one of thelargest health professional groups in thenation, and most are employed in a communitysetting.¹

Is There a Shortage?

Three primary sources are used to providean understanding of the status ofthe pharmacist workforce. These includethe Pharmacy Manpower Project (PMP),the Aggregate Demand Index (ADI), andthe National Association of Chain DrugStores (NACDS).

The PMP is a nonprofit corporationestablished approximately 15 years agoto gather, analyze, and distribute data onthe supply of pharmacists and thedemand for pharmacy services in theUnited States.² In 2001, the PMP assembled24 pharmacy experts for a 3-dayconference to project the need for pharmacyservices over the next 2 decades.³The conference participants concludedthat by the year 2020 the supply of pharmacistsis likely to fall short of the needby about 157,000.³ According to the participants,many factors have helped contributeto the pharmacist shortage,including the expanding role of the pharmacist,an increase in the number of prescriptionsdispensed, an aging population,higher educational standards forpharmacists, attractive careers in areasother than pharmacy, and a movementtoward managed care.³

A second indicator of the pharmacistshortage is the ADI, a tool supported bythe PMP that is used to determine thedifficulty of filling open pharmacist positionsthroughout the United States.Simply stated, it is a numerical tracker ofcurrent and pastdemand for pharmacists.The ADI iscalculated based onmonthly data collectedfrom employersof pharmacistsand is reported on ascale of 1 (high surplus)to 5 (high demand).As of July2006, the ADI fornational pharmacistdemand is 4.16 (indicatingmoderate demand), with a valueof 3.83 for demand in the communitysetting.⁴ Both of these values haveincreased steadily since July 2005, supportingthe claim that the shortage ofpharmacists has been worsening.⁴

Finally, a description of the pharmacistworkforce is provided in the NACDSFoundation's July 2005 Chain PharmacyEmployment Survey. Data from this surveyindicate that there were approximately5000 full-time and 1000 part-timechain pharmacist position vacanciesnationally.² Using a scale of 1 (large shortage)to 5 (large oversupply), the surveyindicated that the national index was2.05, demonstrating some shortage ofcommunity pharmacists.²

It is clear from these 3 leading indicatorsthat there is a current shortage of communitypharmacists and that it will most likelyworsen in the next several years.

What Are the Contributing Factors?

One apparent reason for the worseningcommunity pharmacist shortage isthe large increase in retail prescriptionsdispensed annually. For example, thenumber of prescriptions dispensed eachyear has grown by 60% in the last 10years, a rate that greatly outpaces theincrease in pharmacist supply.⁵ Accordingto the Pharmacist Workforce survey,factors contributing to the rise in prescriptionvolume include growth of theeconomy, development of new drugs,direct-to-consumer marketing, and anincreasing number of refills.¹

It is reasonable to assume that the burdenof more prescriptions dispensed perpharmacist may contribute to medicationerrors, longer working hours, and decreasedquality of life for pharmacists,while at the same time lessening the numberof opportunities for pharmacists tointeract with patients and perform managedcare activities. This was confirmed bythe survey, where pharmacists reportedthat they are not offering the full servicesthey are qualified to provide because ofwork burden and time constraints.¹

Accompanying this upsurge in prescriptionsis an inherent increase in thetime pharmacists must commit to thirdpartypayment and administrative tasksrelated to high-volume sales. Oftentimes,these clerical functions can occupybetween 10% and 20% of the pharmacist'stime, making it difficult to maintaina consistent workflow in the midst of thishigh prescription volume.⁶ Some sourcesmaintain that allowing for more techniciansand supportive staff members perpharmacist might help alleviate part ofthe clerical burden for pharmacists. Thisproposition is difficult to implement,however, due to the number of stateand/or employer regulations limiting theratio of technicians to pharmacists.

Another factor is an evident shortagein the supply of pharmacists available towork in the community setting. Shifts inthe demographics between the leavingand entering pharmacist workforce arealso of particular importance. One of themost significant differences betweenpast and recent pharmacists in the workforceis the gender shift, or increase inthe number of female pharmacists, manyof whom opt for part-time positions.According to the NACDS employmentsurvey, 53% of full-time chain drug storepharmacists are men, and 47% arewomen.² It is suggested that older menwill be lost from the pharmacist workforcedue to death or retirement, whileyounger women entering the professionwill tend to choose part-time work.¹

The NACDS employment survey supportsthis premise, estimating that 58%of part-time pharmacists are women,and only 42% are men.² These findingsindicate that once women represent50% of the workforce, the average numberof hours worked per week will dropby 5%, which must be accounted for injudging the workforce shortages.¹

The shrinking supply of pharmacists isalso partly due to a decreasing number ofgraduates from schools of pharmacy inthe last decade.¹ In addition, internationalpharmacy graduates are currently presentedwith significant barriers to achievinglicensure, thereby hindering onepotentially beneficial response to thepharmacist shortage. The opening of 20new pharmacy schools over the last 5years should help to increase the numberof graduating pharmacists to almost10,000 in 2007, representing an increaseof about 2000 graduates from 2003 and2004 levels.⁷ This change will impact long-termshortages in the supply of communitypharmacists only modestly, however.

What Are the Implications?

One of the most troubling questions ofthe worsening pharmacist shortage iswhether or not the increased workloadwill allow pharmacists to continue to performadequate quality control checks andprovide appropriate patient care. Somepharmacy experts predict that the communitypharmacist shortages may resultin decreased patient safety and feweropportunities for patient care as a resultof understaffed work shifts and anincrease in individual workers' durationand volume of work.

These issues could also promote moremedication dispensing errors. Constrainingcommunity pharmacists to therole of dispensing high-volume prescriptionsrepresents a step backwards for thepharmacy profession, hindering its advancementas a legitimate and significantcontributor of patient care and comprehensiveservices.

Without overlooking the innate challengesthat pharmacists will be faced within the next few years as a result of thepharmacist shortage, it is important torecognize that there have been severalpositive outcomes of these difficult circumstances.In an attempt to increase theutility of available pharmacists, significantadvancements have been made ininformation technologies, automation, robotics,electronic prescribing, and anincrease in the hiring of support personnel.³ Pharmacist salaries also have beenmodestly increasing, with pharmacists inthe community setting still earning a higherannual income than pharmacists employedin the hospital setting.⁸ These measurespossibly will help yield short-termresults, but better methods for improvinglong-term outcomes are needed.

Conclusion

Current leading indicators show thatthere is unmistakably a present andworsening shortage of pharmacists inthe community setting. Despite attemptsto resolve the many factors contributingto these shortages, there is no evidentlong-term resolution. Inevitably, the manyroles of pharmacists and needs of patientswill continue to expand. In order toprovide the best possible services fortheir patrons despite personnel shortages,community pharmacists must striveto continue their tradition of providingpatients with quality care while meetingthe latest challenges in health care.

References

• Health Resources and Services Administration. The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists. Washington, DC: US Department of Health & Human Services; 2000.
• NACDS Foundation July 2005 Chain Pharmacy Employment Survey Results. www.nacds.org. Accessed June 2006.
• Professionally Determined Need for Pharmacy Services in 2020. A report of a conference sponsored by the Pharmacy Manpower Project Inc. www.aacp.org. Accessed June 2006.
• Aggregate Demand Index. Western University of Health Sciences. www.pharmacymanpower.com. Accessed June 2006.
• Pharmacy Choice Web site. www.pharmacychoice.com/careers. Accessed June 2006.
• Landis NT. Non-patient-care activities dilute pharmacists' time, NACDS study shows. Am J Health Sys Pharm. 2000;57:202.
• Pharmacist Shortage Worsens Nationwide. ABC News: Health. November 7, 2005. abcnews.go.com/Health/wireStory?id=1290319. Accessed August 2006.
• Pharmacy Week Web site. www.pharmacyweek.com. Accessed August 2006.