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Executive
Summary
The U.S. Department of Health and Human
Services, Health Resources and Services
Administration's (HRSA's) 2000 report
on the pharmacist workforce documented
the current and growing shortfall of pharmacists.
Health care providers and professional
organizations have continued to report
signs of a moderate current shortage of
pharmacists, as indicated by persistent
vacancy rates, difficulty recruiting and
retaining pharmacists, growing dissatisfaction
by pharmacists with long hours worked,
and rising costs to employ pharmacists.
Since the 2000 report, the U.S. Bureau
of the Census has revised upward its projections
of population growth, the Federal Government
enacted the Medicare Part D program which
expands prescription drug coverage to
more elderly; technology continues to
advance, minimum credentials for entry
into the workforce for new pharmacists
changed from baccalaureate to doctorate
degrees, the Nation’s educational
capacity to train new pharmacists and
pharmacy technicians continues to expand
and enrollment in schools of pharmacy
is at an all time high. The role of pharmacists
in providing care to patients continues
to evolve as well.
Acknowledging the Federal government’s
role and interest in ensuring an adequate
supply of pharmacists, Congress issued
in Senate Report 108-345 a directive to
…encourage the Department
[HHS] to begin a study on comprehensive
pharmacy services in light of changes
in technology, distance and distributive
learning models, the aging of the
population and the Department’s
study on the severe pharmacist shortage
in order to analyze how they may influence
the nature of pharmaceutical education
and interventions in healthcare.
In response to this directive, HRSA's
Bureau of Health Professions developed
the Pharmacist Supply and Requirements
Model (PhSRM) to examine the current and
projected future adequacy of pharmacist
supply in the United States. The PhSRM
was used to generate a best-estimate baseline
forecast of the future balance between
supply and demand, as well as to provide
a range of projections based on possible
alternate scenarios that use different
assumptions about factors affecting pharmacist
education and productivity, and demand
for pharmaceuticals. This work also reflects
findings from a literature review, original
empirical analysis, and discussions with
representatives from pharmaceutical associations
and subject matter experts to develop
supply and demand scenarios.
Key findings from this study
include the following:
- The supply of pharmacists is growing
significantly faster than was previously
projected. The total active pharmacist
supply is projected to grow from 226,000
in 2004 (the base year for the projection
model) to 305,000 by 2020 and 368,000
by 2030. The number of full time equivalent
(FTE) pharmacists is projected to grow
from 191,200 in 2004 to 260,000 by 2020
and 319,000 by 2030. These projections
are higher than those in the HRSA 2000
report and primarily result from updated
retirement patterns, the opening of
new pharmacy programs, and increased
enrollment at existing programs.
- The number of colleges and schools
of pharmacy with accredited professional
degree programs rose from 82 in
2000 to 92 by 2005. The American
Association of Colleges of Pharmacy
predicts that 103 programs will
be open by Fall 2007 and 110 by
Fall 2010.
- The number of entry-level degree
graduates from schools of pharmacy
has increased from 7,300 in 2000
to 9,100 in 2005. This number will
likely continue to increase to about
12,000 graduates per year by 2030.
- The use of distance learning
models in pharmacy education has
expanded since the 2000 report,
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. Applications to pharmacy
programs are at an all time high.
- The demand for pharmacists continues
to grow. Changing population demographics
are expected to increase demand to 256,000
pharmacists by 2020 and 295,000 by 2030
if per capita consumption of pharmaceuticals
were to remain unchanged; supply and
demand would remain roughly in balance.
Per capita consumption will likely
increase, however, as new drugs become
available. Under a scenario with moderate
growth in per capita consumption of
pharmaceuticals, demand would likely
reach 289,000 by 2020 and 357,000 by
2030. The major demand determinants
are:
- Population growth—especially
growth of the elderly population.
- Rising per capita consumption
of pharmaceuticals (controlling
for changing demographics).
- Increased need for pharmacists
to counsel and educate patients
as drugs become more complex and
a growing portion of the population
receives care for chronic conditions.
- Increased use of pharmacy technicians
and technology that can improve
productivity, dampening the growth
in demand for pharmacists.
- There is currently a moderate
shortfall of pharmacists. Vacancy
rates of 8 percent and higher that were
common in the early 2000s have moderated.
In 2004 the overall vacancy rate was
approximately 5 percent, which is equivalent
to a shortfall of approximately 10,400
pharmacists. Factors that contributed
to this reduction in the vacancy rate
include:
- Rising salaries for pharmacists,
which has a positive impact on supply
and a negative impact on demand
for pharmacists (with pharmacies
scaling back on the number of hours
they are open and scaling back on
staff due to rising labor costs);
- Increased use of pharmacy technicians
and technology that have boosted
pharmacist productivity; and
- An expansion in the scope of work
performed by pharmacy technicians
that has reduced the amount of time
pharmacists spend dispensing medications.
Anecdotal evidence suggests that the
vacancy rate has started to rise again
and it is projected that the Nation will
continue to experience a moderate shortfall
of pharmacists.
- The future supply of pharmacists
is projected to grow at a rate similar
to the projected growth in demand from
changing demographics. If per capita
consumption of pharmaceuticals (adjusting
for changing demographics) remains unchanged,
then projected future supply will be
adequate to meet the demands of a growing
and aging population.
- If per capita consumption continues
to grow at rates seen in the past
few years, then the current shortfall
will continue to grow.
- The baseline supply scenario
assumes that expansion of the Nation’s
educational capacity will occur
as planned, with output from the
Nation ’s pharmacy programs
increasing by approximately 100
new graduates per year (equivalent
to approximately one new school
of pharmacy per year).
The “best estimate” demand
scenario assumes that the role of pharmacists
will remain largely unchanged, and that
increased time spent counseling and educating
patients will be offset by increased productivity
through greater use of pharmacy technicians
and technology to improve dispensing efficiency.
Over the next 2 decades, the projected
average annual increase in demand for
pharmacists will grow by approximately
1.4 percent per year due to population
growth and aging. Increasing per capita
consumption of pharmaceuticals could add
another 2 percent to the annual growth.
With moderate (approximately 1 percent)
annual growth in pharmaceutical consumption
per capita, demand could reach 289,000
in 2020. Supply is projected to be 260,000
pharmacists, resulting in a shortfall
of 29,000 pharmacists (10 percent). By
2030 demand is projected to be 357,000;
supply is expected to be 319,000 resulting
in a shortage of 38,000 pharmacists (11
percent).
- Supply and demand are projected
with a level of uncertainty. Only under
an optimistic supply projection combined
with a conservative demand projection
is future supply adequate to meet demand.
- If the planned expansion in the
number and size of pharmacy programs
fails to materialize (e.g., because
of a faculty shortage), then supply
might be lower than projected.
- The demand projections are sensitive
to assumptions of annual growth
in per capita consumption of pharmaceuticals.
- If the role of pharmacists changes
where pharmacists spend substantially
more time providing patient care
management services, then demand
will be higher than projected.
- · Additional findings
include the following:
- Women constitute a growing proportion
of active pharmacists. Currently,
half of all active pharmacists are
women. By 2020, approximately 62
percent of active pharmacists are
expected to be women. Female pharmacists
tend to work fewer hours per year
than their male colleagues, so the
full-time equivalent 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 population indicated
they are in a racial minority group,
while only 18 percent of self-identified
pharmacists indicated they are in
a racial minority group. The percent
of pharmacists who were Hispanic
or Latino was 3.2 percent, compared
to 12.5 percent of the U.S. population
that was Hispanic or Latino in 2000.
- Technologies that automate prescription
dispensing and order processing
are used by a majority of pharmacies.
Most community pharmacies have automated
pill-counting devices and can accept
prescriptions through fax, interactive
voice response systems, or over
the Internet (e-prescribing), resulting
in moderate increases in productivity,
safety, and convenience. Hospitals,
mail order pharmacies, and larger
volume pharmacies are increasing
investing in sophisticated robotics
systems, which can significantly
increase pharmacist productivity
but at a cost that is prohibitive
for lower volume operations.
- The future role of pharmacists
is linked to the adequacy of supply
and to reimbursement rates. With
competing demands on pharmacists’
time, the work that must get done
(dispensing) generally takes priority
over work that pharmacists report
wanting to do more of, such as patient
education and monitoring. A greater
role for pharmacists in patient
care management is feasible only
with a reimbursement system that
compensates pharmacists for such
services.
Although this study focused on the national
adequacy of pharmacist supply, geographic
disparities 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 use financial aid as a means to recruit
and retain pharmacists in hard-to-employ
locations such as rural areas, low-income
urban areas, and select Federal institutions
such as prisons.
Projections of future supply and demand
are made with some level of uncertainty
about what the future holds. For example,
advances in biotechnology and the impact
on individualized drug therapy; the development
of new pharmaceuticals; and development
of improved methods for ordering and dispensing
medications all have the potential to
affect demand for pharmacists. Changes
in government policies and programs, and
changes in insurer approaches to manage
prescription drug costs can affect demand
for prescription drugs. On the supply
side, the number of new gradates might
deviate from projected levels, work patterns
can change towards desiring to work fewer
hours, and retirement patterns can change.
The implications of uncertainty regarding
these future trends is that supply and
demand projections become less certain
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 conclusion of this study
is that the Nation has responded to earlier
predictions of a growing shortfall of
pharmacists, and to market forces that
have raised pharmacist earnings, by expanding
supply and increasing the use of technology
and technicians. Still, the increase
in supply will only be sufficient to keep
pace with a rising demand due to changing
demographics. Supply would need to increase
further than currently projected to meet
the demand caused by growth in per capita
consumption of pharmaceuticals. Improvements
in productivity through further employment
of pharmacy aides and technicians and
the application of evolving technologies
should continue to help the supply meet
these increases in demand.
Publication Date: December
2008 |
