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From School to the Workforce, Burnout Plagues Every Level of Pharmacy
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Key Takeaways
- Pharmacy field faces increased burnout and stress, worsened by COVID-19 and educational challenges, leading to workforce shortages and difficult working conditions.
- Rapid increase in pharmacy schools has not resulted in more graduates due to declining applications, enrollment, and pass rates, leading to closures and job market saturation.
Examining challenges in pharmacy school is necessary to solve current problems in the workforce.
Burnout and stress are feelings that many experience throughout periods of their lives, whether it be at work, school, or home. When strain on one’s own routine is increased, these feelings can increase in conjunction. This is particularly prevalent in the pharmacy field, especially since the major impacts of the COVID-19 pandemic.
Now, the effects are being felt. Pharmacists are feeling burnt out of their work more than ever, community pharmacists are facing obstacles when filling positions, and large retail chains are also facing shortages of job candidates. Workforce shortages have led to scheduling conflicts in many pharmacies, with pharmacists facing difficult working conditions and long, arduous hours treating dozens of patients with important needs.1
Pharmacy students face immense burdens while progressing through their education and entering the workforce. | Image Credit: © D Lahoud/peopleimages.com | stock.adobe.com
Of course, many of these effects can be linked to the pandemic. But evidence also points to an underlying problem—the burnout, stress, financial problems, and academic difficulty associated with pharmacy school. Not only do pharmacy students face these problems in school, but many are forgoing pharmacy school at all. As school attendance declines, the workforce declines in number, exacerbating the existing workforce problems in the field.
By examining the issues that many pharmacy students have faced in recent years, it is possible to gain a better grasp of the underlying reasons behind the current shortage of pharmacists while addressing potential solutions.
Obstacles Facing Pharmacy Schools
Since the beginning of the 2000s, the number of pharmacy schools across the country has nearly doubled—from 80 schools in 2000 to more than 140 in 2020. On the surface, this could seem like a positive; more pharmacy schools theoretically mean more opportunities for students to make their mark and receive world-class education.2
However, the increase in pharmacy schools has coincided with a decrease in the number of applicants as well as enrollment rates. With application and enrollment rates falling, the influx of pharmacy school openings becomes redundant; though many students may depend on a new school to propel their academic careers, the lack of applicants will lead to school closures and students facing an already-saturated job market upon their graduation.2
Additionally, new pharmacy schools require experienced faculty, but there are only so many professors to go around. Without adequate teachers, pharmacy students have been feeling the effects on their grades. Ten years ago, the first-time pass rate for the North American Pharmacist Licensure Examination (NAPLEX)—a major assessment for graduates pursuing a pharmacist license from their institution—was around 95% annually.3 Since then, mean pass rates have significantly decreased, to less than 80%. Shockingly, many schools are currently unable to reach a 70% pass rate. The problem is particularly visible in newer pharmacy schools and those that offer accelerated programs. Sixteen pharmacy schools had pass rates below 65% in 2023, with 9 of those having opened since 2009 and 7 being accelerated programs.3
This entire process is quite expensive, as most postgraduate endeavors are. And like many undergraduate students in higher education, pharmacy students are saddled with debt. In a recent study, researchers interviewed 20 pharmacy students regarding their financial situation, finding that their median debt was $77,000, with some debt amounts as high as $200,000.4
High costs, difficulty passing examinations, and a lack of experienced faculty to guide students have left them with little choice but to endure. But their endurance has left them burnt out, stressed, and with a bad taste toward a future profession in pharmacy.
The Kids Aren’t Alright
As pharmacy schools deal with these challenges, students end up facing the brunt of the impact, in addition to difficulties they may have in completing their coursework or adjusting to school. Indeed, pharmacy students are increasingly reporting burnout, financial difficulties that can affect postgraduate life, and low enthusiasm for pursuing a career in pharmacy—specifically community pharmacy—upon the completion of their degree. Taken together, this represents a crisis for pharmacy students and the industry at large.
The debt that pharmacy students take on during their schooling often coincides with feelings of financial stress influencing their career and education decisions, according to a survey conducted by Huffman et al. Students also recognize that, given the saturated pharmacy market and intense competition for positions, being saddled with debt can be risky, though many accept this as necessary for their degree.4
Image Credit: © freshidea | stock.adobe.com
Students reported that their debt would inhibit them starting a life after the completion of their education; the debt relief provided during the COVID-19 pandemic was revealing as to how much of a positive impact it made on their outlook. Overall, students expressed a desire for early financial education as part of their schooling, which can be lacking in pharmacy schools.4
Debt is just one burden students face. A separate survey of pharmacy students aimed to explore factors that impact their well-being through organized focus groups. Students cited common factors that have contributed to burnout at school, including not having enough time to manage their responsibilities, an overwhelming academic workload, competitive culture, and adhering to commitments outside of school.5
Sarah Oprinovich, PharmD, BCACP, clinical associate professor at University of Missouri-Kansas City (UMKC) School of Pharmacy, has seen the struggles many students face firsthand. Oftentimes, Oprinovich encounters students noting the increase in academic demand in pharmacy school compared with any schooling they had to that point. Students are also typically working in understaffed pharmacies on the side, compounding the issues they face both at work and at school.
“Entering pharmacy school is often a transitional time in life when students are starting to really need to manage adulthood on their own,” Oprinovich said. “I think the stress and anxiety come from that fear of the unknown.”
Academic struggles may also tie to the struggles of the generation that is entering pharmacy school, who have grown up immersed in technology and finished higher education during a pandemic.
“We seem to have an increasing number of students that are less internally motivated and require more external reward to participate in academic activities,” Oprinovich said.
Strains on Pharmacies
The problems many students face in pharmacy school often do not end following their graduation. In fact, if they pursue and achieve a career in community pharmacy, their problems may be exacerbated by high workloads, difficult schedules, and staffing shortages.
"There is a difference between being busy and overwhelmed."
After years of arduous schooling, students are entering the workforce with negative perceptions of a career in community pharmacy. A cross-sectional questionnaire administered in 2023 received responses from more than 100 student pharmacists, with a mean age of 24 years. Most of the respondents were not interested in pursuing community pharmacy following their graduation (52.7%), nor as a long-term career (59.6%). Deterrents to pursuing a career in the field included work hours and schedule, business management responsibilities, navigating insurance-related tasks, and the pace of the work environment.6
“There are not enough voices within schools of pharmacy that speak highly of what community pharmacy practice can be with the right leadership and support,” Troy Trygstad, PharmD, PhD, MBA, editor in chief of Pharmacy Times, said in an interview.
These identified factors are real, and lead to burnout among pharmacists. One systematic review analyzing data from over 11,000 pharmacists found that over half were experiencing burnout. Risk factors included long working hours, high patient and prescription volumes, and poor work-life balance, with the COVID-19 pandemic having significantly worsened these feelings.7
Another review, analyzing feelings of burnout among community pharmacists specifically, came to similar conclusions. Prior to the pandemic, pharmacists faced low quality of life and extreme fatigue, and these feelings have only worsened. The type of community pharmacy a pharmacist works in, their education or training levels, and stress were factors that were found to contribute to these high burnout rates.8
“Pharmacists are, and remain, quite busy, but there is a difference between being busy and overwhelmed,” Trygstad said. He particularly focused on the outsized role pharmacy technicians have played due to staffing shortages in pharmacies across the country. Any absence of a technician can put “stress on the entire pharmacy” as available staff work to fill in the gaps.
Pharmacies also have “lean” staffing models, according to Oprinovich. A 2022 survey conducted by the National Community Pharmacists Association found that three-quarters of community pharmacists reported struggling to fill open positions. At the same time, chain pharmacies are also struggling to fill staff openings, and many are closing. The CEO of Walgreens recently announced that 1200 stores would close over the next 3 years, while CVS has laid off thousands.1,9
“We ask more and more of community pharmacists every year, but haven’t increased the staff in a proportionate manner,” explained Oprinovich. “Community pharmacists have the knowledge and training to do so much, but there is only so much one person can do safely.”
Trygstad elaborated, saying pharmacists have “too many non-clinical, non-patient care related tasks, often with conflicting alignment to the patient.”
Student pharmacists are burnt-out, and practicing pharmacists are, too. How can one problem be fixed to help ease the other?
Pharmacists—And Pharmacy Students—Are People Too
"There is only so much one person can do safely."
Above all, pharmacy students need academic support. Whether from their fellow peers, professors, or colleagues outside of their education, students in pharmacy school require a thorough support system to help them persevere through a challenging and difficult time. Some strategies that could help improve student well-being, according to students themselves, include changes to their curriculum and culture, as well as providing resources to improve their well-being.5
Financial resources should be included in this outreach. Students—already dealing with their coursework—are often compelled to work in understaffed and busy pharmacies nearby to help make ends meet. If more financial support is provided to pharmacy students by their school, they may not be forced to juggle both their education and a job and can focus more on completing their studies.
“Their rotation experience in a community pharmacy is often an accurate predictor of their desire and trajectory of practicing in a community pharmacy later in life,” Trygstad said. “The best advice I can give a student is to find a rotation in a pharmacy that is well-managed, orderly, and engaged in a lot of clinical services.”
At UMKC, Oprinovich and her team have taken steps to help prevent burnout among students. Prior to school beginning, they identify risk factors for academic difficulties, so at-risk students can be set up with a learning specialist to create a plan for academic success, with follow-ups throughout the year. Students are also encouraged to limit the hours they work outside of class, and every student receives professional advising from a faculty member.
“I think a lot of these things have really been helpful for transitioning students from undergraduate coursework to the more rigorous professional doctorate level,” Oprinovich said.
Practicing pharmacists need support, too. Large chain pharmacies must provide more financial support to their stores to alleviate staffing shortages, especially in rural communities without another pharmacy nearby. Trygstad also spoke to the need for pharmacists to be granted provider status, as well as the ability to bill current procedural terminology (CPT) codes, as 2 strategies for improving the experience of pharmacists.
“With that, you can build a sustainable practice model, and our bright young pharmacists can utilize all of those wonderful clinical skills they worked so hard to develop,” Trygstad said.”
