The GAO takes a look at the pharmacist shortage
Hiring and retention still a multifaceted problem
Although automation is becoming more commonplace, vacant pharmacy positions are not filling any faster, according to an October report issued by the U.S. General Accounting Office (GAO) in Washington, DC.
The report, "Supply of Selected Health Workers" (GAO-02-137R), looks at the current and projected supply and demand for pharmacists and laboratory and radiology workers and trends in their employment and earnings. The report gave the following statistics on pharmacy vacancy rates:
• A 2001 American Hospital Association survey of hospitals reported an average pharmacist vacancy rate of 21% in 2001, and half of all hospitals reported more difficulty in hiring pharmacists than in the previous year.
• An American Society of Health-System Pharmacists survey of its pharmacy-director members reported that the average pharmacist vacancy rate was 11% in 2000.
• The Department of Veterans Affairs recently reported that many of its facilities have filled fewer than half of their authorized pharmacist positions.
Unfilled pharmacy positions on the rise
When discussing the pharmacist shortage problem, the GAO often quoted a comprehensive report issued in December 2000 by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).
The study, "The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists," was mandated by Congress and concluded that the number of unfilled full- and part-time drug store pharmacist positions nationally rose sharply from about 2,700 vacancies in February 1998 to nearly 7,000 vacancies by February 2000. The report is available on the web at www.bhpr.hrsa.gov/healthworkforce/pharmacist.html.
Although the demand for pharmacists is increasing, the study says, the active pharmacy workforce is expected to increase only by 28,500 pharmacists over this decade — 800 fewer than last decade. There also is a decline in pharmacy school applications, with the number of 1999 applicants 33% lower than 1994, the high point of the past decade.
There are multiple reasons for the current shortage of pharmacists, says David Witmer, PharmD, director of the professional practice and scientific affairs division and director of the section of clinical specialists, American Society of Health-System Pharmacists (ASHP) in Bethesda, MD. HRSA’s study identified a number of causes for the growing demand for pharmacists, including:
• increased use of a wide range of prescription medications;
• increased access to health care and more health care providers authorized to prescribe medications;
• expanded health insurance coverage resulting in increased prescriptions and time-consuming third-party payment tasks, which take an estimated 10-20% of a pharmacist’s time;
• the growing emphasis in pharmacy education on a Doctor of Pharmacy degree, which lengthens the education program and increases the amount of training in clinical practice;
• strong competition for pharmacists trained at the residency or fellowship level, with schools of pharmacy, managed care organizations, pharmaceutical corporations, and hospitals all competing for these highly trained pharmacists — resulting in sector shortages, especially for schools and hospitals less able to compete economically.
But is there a shortage of pharmacists or a hyper-demand, asks Susan C. Winckler, RPh, Esq, group director of policy and advocacy for the American Pharmaceutical Association in Washington, DC. "You have opportunities for pharmacists that didn’t exist when my parents finished pharmacy school in the mid-1950s. There was not the breadth of activity available today. It’s another side effect of the growth of prescription drug use."
Pharmacists’ skills have been more widely recognized across the entire realm of health care, Witmer says. "As a result, there has been a much greater demand for pharmacists in a variety of practice settings and in different job functions. That is likely to continue to grow, particularly as we have a workforce that is more highly educated with PharmD degrees and with more people graduating from residencies."
He predicts that the profession is going to continue to see people moving into key positions in the pharmaceutical industry, both in medical science liaison positions as well as research positions. "You are going to see managed health care and other business entities recognizing the skills of pharmacists, in terms of pharmaceutical economics and managing populations of care."
According to the study, the shortage results in less time for pharmacists to counsel patients; job stress and poor working conditions with reduced professional satisfaction; longer working hours and less scheduling flexibility with greater potential for fatigue-related errors; and fewer pharmacy school faculty because of their recruitment into the workforce.
Has anything changed?
More than a year since the report, ASHP continues to see difficulties in hiring pharmacists and keeping those positions filled. "[Our surveys] have shown that there are increasing difficulties in recruiting pharmacists in all facets of our membership, whether that be home care, acute care, or chronic care settings," Witmer says.
He suggests addressing the shortage by:
• Increasing the efficiency of the drug distribution process through automation and the increased use of technicians so that pharmacists can spend more of their time on the important patient care aspects.
• Increasing the number of pharmacists by providing more funding for pharmaceutical education and larger class sizes.
Winckler expects to see some streamlining of pharmacists’ activities through the improved use of automation and better use of certified pharmacy technicians. She also hopes to see improvement in the administrative requirements. "That situation is really untenable and adds costs to the health care system that haven’t really been tracked accurately. That simply has to change.
"I’m not sure we will have a surplus of pharmacists anytime soon," she adds, "but we can manage the shortage by improving the environment so that more pharmacists will want to stay or perhaps even return to practice."
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