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V. Conclusions
This study looked at the trends in pharmacist
supply and demand determinants to assess
the current and future adequacy of supply.
These trends include changes in technology,
distance and distributive learning models,
growth and aging of the population, expansion
of the Nation’s pharmacy school
capacity, and other developments (e.g.,
creation of the Medicare Part D Program)
that have occurred since HRSA’s
2000 Report to Congress - The Pharmacist
Workforce: A Study of the Supply and Demand
for Pharmacists. This section contains
a summary of key findings and their implications,
as well as the study strengths, limitations,
and areas for future research.
A. Summary
of Key Findings and Implications
Pharmacies across the Nation continue
to experience some difficulty in filling
vacancies, but the severity of the shortfall
appears to have diminished somewhat since
HRSA’s 2000 Report to Congress. Several
factors help explain the improvement in
adequacy of supply.
- The Nation has increased its supply
of pharmacy technicians and has increased
the scope of practice of these technicians.
As the technician-to-pharmacist ratio
increases, however, the Nation cannot
continue to rely on producing more technicians
to reduce the shortfall of pharmacists.
- Rising wages for pharmacists has both
provided an incentive for pharmacists
to remain in the workforce and for pharmacies
to scale back their hiring needs.
- Improved technology continues to make
pharmacists more productive.
In response to high pharmacist vacancy
rates, rising pay, and concerns over a
growing shortfall, the Nation’s
educational capacity has expanded and
an increasing number of people have chosen
pharmacy as a career. The Nation’s
educational capacity has expanded through
the opening of new schools, as well as
increased enrollment at existing schools.
The number of colleges and schools of
pharmacy with accredited professional
degree programs rose from 82 in 2000 to
92 by 2005. AACP predicts that 110 programs
will be open by Fall 2010. The number
of graduates from pharmacy schools has
increased from 7,300 in 2000 to 9,100
in 2005. The use of distance learning
models in pharmacy education has expanded
since the 2000 Report to Congress, and
has contributed to the growth in existing
training programs. Raising the minimum
education level (to a Pharm.D) for new
pharmacists does not appear to have reduced
the desirability of pharmacy as a career.
The Nation’s ability to continue
expanding its educational capacity is
threatened by a potential shortfall of
faculty, with a large proportion of faculty
nearing retirement and wages for faculty
falling behind the wages for pharmacists
in retail settings.
The projections suggest that only when
combining an optimistic supply scenario
with a conservative demand scenario will
future supply be adequate to meet the
needs of a growing and aging population.
However, under most scenarios modeled,
supply will be insufficient to meet the
needs of a population caused by growth
in per capita consumption of pharmaceuticals.
The demand projections assume that the
role of pharmacists will remain largely
unchanged over the projection horizon.
With the Pharm.D now the minimum educational
requirement for entry into the workforce,
new pharmacists have greater ability than
do earlier cohorts to take on increasing
responsibilities in patient management
and counseling. Participants at a 2002
conference discussed the number of pharmacists
that would be needed to deliver high-quality
care under a scenario where pharmacists
play a larger role in patient care management.
These participants concluded that an estimated
417,000 pharmacists would be needed by
2020 (approximately 128,000 more than
calculated under our moderate Rx/capita
growth demand scenario), which when compared
to our baseline supply projections suggests
a shortfall of approximately 157,000 pharmacists
in 2020.[51]
An expanded role for pharmacists
can occur only if a reimbursement mechanism
is instituted to pay pharmacists for such
services. The Medicare Modernization
Act of 2003 has opened the door for pharmacists
to receive reimbursement for medication
therapy management services for a select
number of high-drug-utilization Medicare
beneficiaries.[52]
Women constitute a growing proportion
of active pharmacists. Currently, half
of all active pharmacists are women.
By 2020, approximately 62 percent of active
pharmacists will be women. Female pharmacists
tend to work fewer hours per year than
their male colleagues, so FTE supply will
grow at a slightly lower rate than active
supply.
Racial minorities continue to be underrepresented
in the pharmacist workforce. In the 2000
Census, 25 percent of the U.S. population
indicated they are in a racial minority
group, while only 18 percent of individuals
self-identified as pharmacists indicated
they are in a racial minority group.
The role of pharmacists in the future
is closely linked to the adequacy of supply.
Pharmaceuticals are becoming more complex,
and with a growing elderly population
an increasing number of patients take
multiple medications. Consequently, the
demand for counseling and education by
pharmacists continues to rise. The baseline
demand projections presented in this report
assume that pharmacists will spend an
increasing proportion of their time providing
counseling and educating patients. Such
a shift in work activities will be made
possible by rising pharmacist productivity
made possible through greater use of pharmacy
technicians and improved technology that
reduces the time per prescription spent
dispensing and performing administrative
duties.
This study focused on the national adequacy
of pharmacist supply, although geographic
inequities exist in access to pharmacist
services. Consequently, there continues
to be a role for programs such as the
National Health Service Corps Chiropractor
and Pharmacist Loan Repayment Demonstration
that uses financial aid as a means to
recruit and retain pharmacists in hard-to-employ
settings such as rural areas, low-income
urban areas, and select Federal institutions
such as prisons.
B. Study
Strengths, Limitations, and Areas for
Future Research
The findings of this study reflect an
extensive review of the literature, empirical
analysis, and discussions with area experts.
The major strengths of this study include
the following:
- The pharmacist supply and demand projections
come from a workforce model developed
based on a wide body of literature regarding
the important components of pharmacist
supply and demand, as well as empirical
research that reflects current trends
in supply and demand determinants.
- The supply projections reflect the
recent surge in enrollment and graduations
from schools of pharmacy. This surge
is largely in response to the current
shortfall of pharmacists (with the resulting
rise in wages and job opportunities)
and previous studies that suggested
the shortfall of pharmacists would continue
to grow. Other components of the supply
model have also been updated (e.g.,
retirement and workforce participation
patterns).
- This study quantifies the projected
future demand for pharmacists, whereas
most previous work provides only a qualitative
assessment of future demand.
- The Pharmacist Supply and Requirements
Model was designed so that frequent
updates of supply and demand projections
could be made to quickly analyze the
implications of changes in supply and
demand determinants, as well as analyze
the implications of policy decisions
affecting supply or demand.
The major limitations of this study include
the following:
- The base year demand for pharmacists
is only an estimate, with demand defined
as FTE employment plus FTE vacancies.
If the current system is overstretched
such that pharmacists are working more
hours than is desirable (either from
a quality of services perspective or
a quality of life perspective), then
this definition of current demand might
underestimate true demand for pharmacists.
Underestimates of demand in the base
year are extrapolated into the future.
- There is substantial uncertainty regarding
changes in some demand determinants—especially
regarding technological growth (e.g.,
advances in biotechnology), growth in
the number and role of pharmacy technicians,
and the future role of pharmacists.
- The demand projections are highly
sensitive to growth in per capita consumption
of pharmaceuticals. A range of demand
estimates were projected to reflect
this sensitivity.
Important areas for future research to
improve our understanding of the current
and projected future adequacy of pharmacist
supply include:
- The potential impact of new technology
on pharmacist productivity,
- The potential impact of advances in
biotechnology on individualized drug
therapy and the resulting demand for
pharmacists,
- Whether lifestyle changes are leading
to patterns of fewer hours worked per
pharmacist per year—irrespective
of trends in demographics (age and gender)
of the pharmacist workforce,
- The changing role of pharmacists,
and
- The degree to which pharmacy technicians
offset the demand for pharmacists and
the limits of such substitution before
quality is compromised.
As attributed to Mark Twain, “making
predictions is risky business, especially
when it involves the future.” Over
time, trends in pharmacist supply and
demand determinants can change. In addition
to the uncertainties regarding technological
advances, changes in government policies
and programs and changes in insurer approaches
to managing prescription drug costs can
affect demand for pharmacists.
On the supply side, the number of new
graduates might deviate from projected
levels if a shortage of faculty threatens
the Nation’s ability to train new
pharmacists. Furthermore, work patterns
can change toward the desire to work fewer
hours, and retirement patterns can change.
These uncertainties mean that the accuracy
of the supply and demand projections will
diminish as the projection horizon increases.
This uncertainty highlights the need to
update the projections every few years
to reflect changes in policies and trends.
The overall finding of this study is
that the Nation appears to have responded
to both the current shortfall of pharmacists
and predictions of a growing shortfall.
Market forces (e.g., higher wages) and
political forces (e.g., increased scope
of practice for pharmacy technicians)
have helped reduce the shortfall of pharmacists.
Still, the increase in supply will only
be sufficient to keep pace with rising
demand due to changing demographics. If
a faculty shortfall at schools of pharmacy
prevents the planned expansion in the
capacity of schools to graduate new pharmacists,
or if per capita consumption of pharmaceuticals
continues to increase, then the current
shortfall of pharmacists could worsen.
Likewise, technological improvements
that increase pharmacist productivity
and efforts to control growth in consumption
of pharmaceuticals could slow the growth
in demand for pharmacists to dispense
medications, thus increasing the likelihood
that pharmacists can play a larger role
in counseling patients and providing care
management.
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