More opportunities to practice than there are pharmacists

Many more practice opportunities are available to pharmacists than were available 10 years ago. Today’s pharmacy graduate has more to choose from than the traditional hospital and community pharmacy roles. Emerging practice opportunities include a continued expansion of community pharmacy, pharmacy benefit management, drug utilization review, physician office practice, managed care, and home health, to name a few. But what has become a great scenario for the new or transitioning pharmacist has created a problem for the nation.

"There are more opportunities to practice than there are pharmacists," says Ed Webb, vice president of professional affairs and health policy at the American Association of Colleges of Pharmacy (AACP) in Alexandria, VA.

As the limited number of pharmacists spreads over a wider selection of practice settings, the number of pharmacists practicing in the traditional settings of hospital and community pharmacy has diminished. One chain plans to hire 4,000 new pharmacists by the year 2002.

"That represents half of the graduating class of 2002," Webb reports. "Output of pharmacists is not keeping up with consumption. Even if we were able to double today’s enrollment in our colleges of pharmacy, the number of graduates we would have in four years still would not take care of the shortage problem predicted for the year 2002."

In his report to Congress last fall, Rep. James McGovern (D-MA) reported that Massachusetts anticipates a 39% growth in the number of prescriptions from 1998 to 2005, with only a 13% growth in the number of pharmacists over the same time period. That reflects a similar situation facing the nation.

"This year, the nation’s pharmacy schools will graduate more than 8,550 new pharmacists. For 2001, the number will be around 7,400 graduates," says Webb, because many of the schools are still in transition to programs with the PharmD degree as the first degree. In addition, there are 3,000 pharmacists currently enrolled nationwide in nontraditional PharmD programs supported by more than 45 schools of pharmacy.

"This nationwide shortage of pharmacists is a real phenomenon requiring multiple solutions," says Webb. Several national pharmacy organizations, including AACP, the National Association of Chain Drug Stores, the American Pharmaceu tical Association, and the National Community Pharmacists Association have been working together to evaluate the problem. Those associations also are talking with nursing and dentistry, two other health care professions experiencing similar shortages.

Part of the solution is to increase the output in the pipeline of graduates. However this is a resource and time-intensive process. "We have 81 schools of pharmacy now, and enrollment will begin this fall for the 82nd," Webb reports. Others have expressed interest in creating new pharmacy schools, but it takes two to three years for start up, then another four years before graduates are produced.

"From an efficacy point of view, it’s better to increase output from the graduate pipeline by expanding the caps on existing schools with infrastructures already in place than by increasing the number of schools," he says.

Time for decisions

Technicians and robots can fill more prescriptions, allowing pharmacists to make decisions about and to educate patients on issues of drug therapy. "Right now, pharmacists spend about two-thirds of their time in nonpatient care activities," says Webb. Those pharmacists who do serve in the traditional hospital and community settings often carry a very heavy workload and/or wind up working long hours that grow only longer as Americans grow older and take more prescription medications. While paychecks may increase as a result, quality of life decreases.

As a result of McGovern’s amendment to Congress last fall, the secretary of the Department of Health and Human Services has been instructed to conduct a study to determine the depth and breadth of the problem of a nationwide shortage of licensed pharmacists. The secretary then will submit a report to Congress describing the findings with a summary of comments.

In the meantime, pharmacists will work toward resolving the problem.

Distribution alone is not enough

Distribution of drugs, by itself, is not enough, Webb says. Pharmacists must ensure safe distribution. Safe distribution must include successfully filling orders that are, if not prepared, then at least checked and verified by a pharmacist who is a) alert and b) not so rushed that an error is overlooked. Safe distribution also includes a review of concomitant medications, existing disease states, and preparation for surgery or procedures that might require discontinuation of a medication by a particular hour.

Also, effective passing of drug information to the nursing staff, patient, or caregiver who will administer the drug is necessary for safe distrib ution of drugs, Web says. All those activities require time and clear cognition. Pharmacies must be adequately staffed in order to protect pharmacist quality of life and help protect patients, he says.

C. Edwin Webb, Vice President, Professional Affairs and Health Policy, American Association of Colleges of Pharmacy, Alexandria, VA. Telephone: (703) 739-2330, ext.1030. E-mail: Web site: