The Shortage of Pharmacists in the United States
Jane S. Ricciuti, RPh, MS
In late 2000, numerous articles were published identifying a critical shortage in pharmacy staff for all of the United States. What does this mean to the practicing pharmacist?
Released in December 2000, Health Resources and Services Administration (HRSA) National Center for Health Workforce Information and Analysis, of the U.S. Department of Health and Human Services, published a study that indicated:
the emergence of a shortage of pharmacists, which has resulted in less time for pharmacists to counsel patients, greater potential for fatigue-related pharmacist errors, and fewer pharmacy school faculty; sharp increases in demand for pharmacy services; significant decline in pharmacy school applications; and an unlikelihood that the many factors causing the shortage will abate without fundamental changes in pharmacy practice and education.
Overview of HRSA Study
There are currently 196,000 licensed pharmacists in the United States. Although the demand is increasing, the number of active pharmacists is expected to grow only by 28,500 over this decade -- 800 less than the 29,300 over the last decade. There also is a decline in pharmacy school applications, with the number of 1999 applicants 33% lower than in 1994, the high point of the past decade.
According to the HRSA study, indicators of a shortage include:
Increased job vacancy rates and difficulties in hiring. The number of unfilled full- and part-time drugstore pharmacist positions nationally rose sharply from about 2700 vacancies in February 1998 to nearly 7000 vacancies by February 2000. Such vacancies are expected to continue to grow.
Increases in the volume and range of activities demanded of today's pharmacist. The increased volume is manifested most convincingly by the sharply increased number of prescriptions filled each year in retail settings. The increased range is manifested by the substantially expanded roles and responsibilities of pharmacists in both retail and institutional settings.
Among the factors contributing to the shortage is the increased use of prescription medications. The number of retail prescriptions dispensed per year in the United States increased 44% between 1992 and 1999, from 1.9 billion in 1992 to 2.8 billion prescriptions in 1999. The estimated annual number of prescriptions filled per pharmacist in retail pharmacies grew from 17,400 in 1992 to 22,900 in 1999, an increase of 32%.
Other factors contributing to the shortage are:
market growth and competition among retail pharmacies, resulting in increased pharmacist positions, expanded store hours, and new store openings;
expansions in pharmacy practice and pharmacists' roles and professional opportunities;
increased access to healthcare, and an increase in the number of healthcare providers authorized to prescribe medications;
changes in the pharmacist workforce, including the greater number of women pharmacists and their shorter work patterns; and
the double impact of increased insurance coverage for prescription drugs, resulting in an increase in both prescription volume and the number of third-party payment issues that need to be resolved.
What Are the Consequences of a Shortage?
Practicing pharmacists can anticipate increases in job-related stress that result from longer working hours and inadequate working conditions. An overworked labor force has the potential for increased incidences of medication-related errors, adding more stress to the pharmacist's already busy day.
The Institute of Medicine report published in 1999, "To Err is Human: Building a Safer Health System," noted the important role that pharmacists play in reducing medication error. The report noted the importance of maintaining reasonable working hours, workloads, and staffing ratios, and avoiding distractions, in order to keep errors to a minimum.
As the number of prescriptions increases, pharmacists are faced with the task of implementing pharmaceutical care into their practice and expanding their roles to improve patient outcomes. In the current shortage of pharmacists, ultimately the patient is affected. For example, a patient may not receive adequate counseling or his/her complex medication regimen may not be adequately reviewed; in this setting, there is increased potential for adverse drug events.
There are many additional consequences of the shortage of skilled pharmacists in the United States affecting pharmacists' quality of life and hampering their ability to pursue continuing education to effectively perform their duties. Other healthcare providers and patients will be affected by the decreased quality of care that results from a diminished workforce.
Future of the Practice of Pharmacy
The American College of Clinical Pharmacy (ACCP) published the White Paper: A vision of pharmacy's future roles, responsibilities, and manpower needs in the United States. Corresponding commentaries from leading pharmacy associations were published in the January 2001 issue of Pharmacotherapy. The ACCP White Paper and the commentaries offer a starting point for discussion into what lies ahead for pharmacists. Most significant is the reliance of healthcare on pharmacotherapy to cure disease and improve patient outcomes. The increasing number of prescriptions that are being written today supports this. Also notable is the fact that without automation of the drug dispensing functions of pharmacy practice, the burden on individuals would be too great. Pharmacy will be a technology-driven profession to maintain the status quo of product fulfillment. Pharmacists will need to incorporate technology into their increasing role as patient-centered caregivers. As this model of practice continues to evolve, we will see changes in our education system for pharmacists and, most importantly, changes in reimbursement for pharmaceutical care. Without the drive of reimbursement, pharmaceutical care as a business component will not be able to survive.
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