The Adequacy of Pharmacist Supply: 2004 to 2030

II.  Pharmacist Supply

An estimated 230,000 to 250,000 pharmacists currently practice in the United States accounting for approximately 86 percent of the estimated 280,000 licensed pharmacists.^[4] With all time highs in pharmacy school enrollment coupled with a relatively young pharmacy workforce, the supply of pharmacists is projected to continue rising both in total number of pharmacists and in terms of the pharmacist-to-population ratio.  Some indicators of a pharmacist shortfall have moderated in recent years, but substantial growth in supply is still needed over the next 2 decades to meet the projected surge in demand for pharmacist services.

A. Current Supply

The current supply of pharmacists can be characterized in terms of their number, demographics, practice setting and practice patterns.  In 2004, the base year for the PhSRM, there were an estimated 226,000 practicing pharmacists (Exhibit 1).^[5] Applying to this supply estimate the gender and age distribution of pharmacists as determined by the 2004 National Pharmacist Workforce Survey (NPWS), approximately 125,000 pharmacists (55 percent) are men, and 49,000 (22 percent) are prepared at the doctoral (Pharm.D) level.  Reflecting the rising proportion of women entering pharmacy and the new minimum education level set at the Pharm.D degree, approximately 61 percent of pharmacists prepared at the Pharm.D level are women, while 40 percent of pharmacists prepared at the baccalaureate (B.Pharm) level are women.

Although a slight majority of active pharmacists are men, male pharmacists tend to be older (median age=51) than female pharmacists (median age=43) (Exhibit 2).  Women constitute the majority of new pharmacy graduates, while men constitute the majority of older pharmacists (with older pharmacists often reducing their workload as they near retirement).  Consequently, within the next few years the majority of full-time-equivalent (FTE) pharmacists will be women.

Exhibit 1.  Estimated Active Pharmacists, by Gender and Education: 2004

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Source: Gender and education distribution based on analysis of the 2004 NPWS.

Exhibit 2.  Pharmacist Age Distribution: 2004

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Source: Analysis of the 2004 NPWS.

Racial minorities (with the exception of Asians) continue to be underrepresented in the pharmacist workforce (Exhibit 3).  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 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.

Exhibit 3.  Pharmacist Race Distribution: 2000

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Source: 2000 U.S. Census

Note: The 2000 Census allows respondents to write in "some other race" in place of selecting the standard OMB single race categories included on the questionnaire.  Of the 5.5 percent of the U.S. population who selected this category, 97 percent are of Hispanic origin.  People in the "some other race" category are distributed across the standard OMB categories based on each standard category's prorated share of the total U.S. population.

Many of the estimated 226,000 active pharmacists in 2004 worked part time.  Defining a FTE pharmacist as one who works, on average, approximately 1890 hours per year (40 hours per week times 47.2 weeks per year), the number of FTE pharmacists in 2004 was approximately 191,200 (Exhibit 4).  Approximately 14,600 of these FTEs are primarily in non-patient care activities (e.g., teaching, research and administration), resulting in an estimated 176,600 FTEs in patient care.  The majority of FTE pharmacists provide patient care work in community retail pharmacies (73,300 in chain pharmacies and 34,300 in independent pharmacies); an estimated 46,700 work in hospitals; 16,800 work in other patient care settings (e.g., nursing homes, clinics); and 5,500 work in mail order.^[6]

Exhibit 4.  Distribution of FTE Pharmacists by Dispensing Setting: 2004

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Source: Analysis of the 2004 NPWS.

B.  Trends in Supply Determinants

The size of the pharmacist workforce continually changes depending on the number of entrants and reentrants to the pharmacist workforce, as well as the number of pharmacists who leave the workforce either temporarily or permanently.  Major trends with implications for the future supply of pharmacists include interest in becoming a pharmacist, the capacity of schools of pharmacy to train new graduates, the changing demographics of the pharmacist workforce (particularly the increasing proportion of pharmacists who are women), pharmacist work hours, and attrition from the pharmacist workforce.

1.  New Graduates and Training Capacity

In 2004, 8,158 people graduated from schools of pharmacy with entry-level degrees, of which two thirds (n=5,437) were women.^[7] The year 2004 saw the final graduating class of pharmacists prepared at the baccalaureate level (n=338), with the remainder (n=7,770) prepared at the Pharm.D level.  From 2005 onward all new graduates will be prepared at the Pharm.D level, the new minimum credential for entry into the workforce.  Each year approximately 600 foreign-trained pharmacists begin practice in the United States.^[8]

Since HRSA’s 2000 report, there have been significant increases in the capacity of pharmacy schools due to both growth in existing programs and creation of new programs.  The number of colleges and schools of pharmacy with accredited professional degree programs rose from 82 in 2000 to 92 by 2005.  By Fall 2010 there will likely be 110 programs in operation.^[9]  Projections of new pharmacy degrees conferred in future years (and used in the baseline supply projections presented in this report) are based on the number of students currently enrolled in schools of pharmacy and the assumption that the number of degrees conferred will increase by approximately 100 per year after 2008.  One hundred new graduates per year is equivalent to opening about one new school of pharmacy per year and is consistent with current plans to expand the Nation’s capacity to train new pharmacists by opening new programs and expanding current programs through expansion of traditional programs and the use of distance and distributive learning models.  The projected number of Pharm.D degrees conferred in 2008 is approximately 10,000, and under the above assumptions this number would gradually increase to approximately 12,000 per year by 2030 (Exhibit 5).  Since 1994, approximately 2 out of every 3 new graduates are women, and this trend will likely continue.

Alternate supply projections presented make different assumptions about the future number of new graduates to show how the future adequacy of supply would be affected by a deviation from continued efforts to expand the Nation’s educational capacity.

Each year a small percentage of pharmacists trained at the baccalaureate level return to school to complete a Pharm.D degree.  With the discontinuation of the B.Pharm degree and a diminishing number of pharmacists prepared at the baccalaureate level interested in completing a doctorate degree, the number of pharmacists completing a post-baccalaureate Pharm.D degree is projected to decline rapidly.  In 2000, 1269 post-baccalaureate Pharm.D degrees were awarded.  This number fell to 668 in 2005 and is likely to continue declining (Exhibit 6).  Analysis of the National Pharmacist Workforce Survey (NPWS) finds that workforce participation and retirement patterns for pharmacists prepared at the baccalaureate (B.Pharm) level are similar to patterns for pharmacists prepared at the doctoral (Pharm.D) level, so the education distribution of the workforce does not affect projections of overall supply of pharmacists.

Exhibit 5.  Number of First-time Pharmacy Degrees Conferred

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Source: Historical (1965 to 2005) data from AACP Profile of Pharmacy Students (Fall 2005).

Exhibit 6.  Number of Post-baccalaureate Pharm.D Degrees Conferred

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Sources: Historical data from AACP Profile of Pharmacy Students (Fall 2005).

2.  Distance and Distributive Learning Models

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.  Distance or distributed learning is defined as a separation between the student and the instructor by time or place.  U.S. pharmacy schools first began applying a distance-learning model of education nearly 20 years ago in programs designed to increase the practice competency of working pharmacists. 

The distance-learning model also has been used for many years to offer continuing education classes to practicing pharmacists or classes that confer certification in a particular practice competency.  For example, States such as Wisconsin require continuing education credits for license renewal.  The University of Wisconsin School of Pharmacy offers continuing education teleconference courses each year that reach every county in the State.^[10]

Against a backdrop of growing concern about a significant shortage of pharmacists, the use of distance learning has been expanded in recent years to first-degree Pharm.D programs at a number of institutions around the country.  Currently, at least five programs offer a distinct distance-learning pathway for their first-degree Pharm.D programs (Exhibit 7).  These schools are Creighton University, Nova Southeastern University, the University of Florida, the University of Minnesota, and the University of Oklahoma.  Overall, about 400 students are enrolled each year in a distinct distance-learning pathway under the first-degree Pharm.D programs at these five schools.

Exhibit 7.  Programs with Distinct Distance Learning Pathways for First Pharm.D

Source:  Individual school Web sites accessed June 2006

According to information published on the individual pharmacy program Web sites, Creighton University enrolls about 110 students each year on their main campus and an additional 55 students in a Web-based pathway.  Nova Southeastern University enrolls 120 students at the main campus in Ft. Lauderdale and another 60 in West Palm Beach and other distant locations.  The University of Florida enrolls about 130 students on the main campus in Gainesville, and an additional 170 students in satellite locations in Jacksonville, Orlando, and St. Petersburg.  The University of Minnesota enrolls about 105 students at the main campus in the Twin Cities, and another 54 students at the Duluth campus of the university.  Finally, the University of Oklahoma enrolls about 78 students on the main campus in Oklahoma City, plus an additional 60 students in Tulsa. 

Creighton’s distance learning program is unique in offering an almost entirely Web-based program, allowing the student to earn their degree largely out of their home location.^[11]  The Creighton program requires attendance at 1- to 2-week lab sessions during the summer on campus.  Eight 5-week clinical rotations are required, and are offered at a variety of locations around the country.  Students applying to Creighton for pharmacy school may apply either to the regular campus-based program or the Web-based program, but not both.

The distance-learning model offered at Nova, Florida, Minnesota, and Oklahoma offers students the opportunity to study out of a satellite location separate from the main campus.  Often some portion of the course material is delivered via distance learning technologies such as interactive television.^[12]  Generally, students apply to the program as a whole, and indicate or rank their choice of location.

In addition to the first-degree pathways offered by these schools, many other Pharm.D programs offer a distance-learning component to their first-degree programs, particularly in the later years of study.  For example, Texas Tech offers third and fourth year Pharm.D students the opportunity to complete their training at a regional site such as Dallas or Lubbock, after spending the first 2 years at the main campus in Amarillo. 

It is likely that the greater use of distance learning models in pharmacist education has contributed to the expansion in pharmacy program enrollments in recent years.  Together, Creighton, Nova, Florida, Minnesota, and Oklahoma have grown their first degree enrollments by 85 percent since 2000, going from 2,013 enrollments in 2000 to 3,714 in 2005 (Exhibit 8).  During this same time period, total enrollments at all schools increased by 35 percent from 34,481 to 46,527. 

Exhibit 8.  First Degree Enrollments at Pharmacy Schools with Distinct Distance Learning Pathways

Source:  AACP Profile of Pharmacy Students (Fall 2005).

Distance learning models address a number of potential constraints to increasing enrollment.  First, these programs allow pharmacy schools to offer students greater flexibility in their study location, making the programs more attractive to applicants.  Second, where space constraints exist on the main campus, these pathways offer a way to expand by adding facilities in other locations, or, in the case of Web-based pathways, requiring only technical infrastructure

A third constraint to increased enrollments has been faculty shortages in pharmacy education.^[13]  Where distance learning may be particularly effective in leveraging scarce faculty is in allowing faculty with specialized knowledge or experience to share that expertise with larger numbers of students.  However, it should be noted that early experiences with these models have shown that they do not require fewer faculty as much as a different deployment of faculty.  Adding a distance-learning component to a campus-based class may actually increase the workload for existing staff, especially when the program is first implemented.  A greater commitment to course planning and course readiness is required, and the expectations of remote students regarding immediate electronic access to faculty need to be managed.  In addition to instructional staff, satellite locations may require liaisons, facilitators, and counselors.  A technical staff is also needed to implement and maintain the distance learning tools and technologies

As distance learning in pharmaceutical education continues to expand, it will be important to continue to monitor and evaluate the quality of such programs and to share lessons learned.  Researchers at the Nova Southeastern University School of Pharmacy published a comprehensive white paper in 2003 on issues relevant to ensuring excellence in distance pharmaceutical education.^[14]  The Accreditation Council for Pharmacy Education (ACPE) released revised accreditation standards guidelines in February 2006 that contain explicit guidelines on the use of distance learning in a pharmacy education program.^[15]

Studies to date have found that outcomes from distance learning programs are comparable to traditional campus-based programs.^[16]  The first graduating classes coming out of these programs are passing licensure exams at rates equal to or better than traditional students.  Because students currently self-select for participation in distance learning pathways, there will be a continued need to monitor and evaluate the impact on performance, especially if students have less choice about participating.  Given the success of distance learning in increasing enrollment while maintaining outcomes, these technologies will likely continue to play a role in pharmaceutical education.

3.  Increasing Number of Women in Pharmacy

The proportion of pharmacists who are women has increased from below 13 percent in 1970 to almost half of all pharmacists today.  Because two thirds of new graduates are women and because most pharmacists nearing retirement are men, the proportion of pharmacists who are women will continue rising.  By 2025, two out of three pharmacists are likely to be women (Exhibit 9).  Women are more likely than their male colleagues to work part time, so in percentage terms total hours of pharmacist services supplied will rise more slowly than the number of active pharmacists.

Exhibit 9.  Percent of Pharmacists who are Women

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Sources: HRSA (2000) and projections from the PhSRM.

4.  Pharmacist Hours Worked

In 2004, an estimated 20.6 percent pharmacists worked part time (defined as working 30 or fewer hours per week.  For this study a FTE pharmacist is defined as one providing approximately 1890 hours per year of pharmacist-related services.  This estimate was obtained through an analysis of the 2004 NPWS by estimating the average weeks worked per year for pharmacists working 40 or more hours per week (47.2 weeks), and multiplying this number by 40 hours per week.  Pharmacists age 28 and younger, on average, work more than 1890 hours per year.  Among active pharmacists, average hours worked tends to decrease with age (Exhibit 10). 

Many pharmacists work more than 1890 hours per year, either through long hours on their primary job or by working multiple jobs.  Male pharmacists tend to work more than 1890 hours per year and, on average, are counted as slightly more than one FTE through age 55.^[17] Female pharmacists are more likely to be working part time and, on average, count as approximately 0.8 FTE between the ages of 32 and 60.  For pharmacists age 60 and older, the sample size in the 2004 NPWS is relatively small so FTE rates for men and women are combined for modeling.

Exhibit 10.  Average Hours Worked per Year: 2004

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Source: Analysis of the 2004 NPWS.  Note: Hours for women and men age 60 and older are combined because small sample size makes gender-specific rates unreliable.

In addition to differences in average hours by pharmacist age and gender, anecdotal evidence suggests that average hours worked might be declining over time—in part due to lifestyle choices.  A comparison of NPWS findings shows a drop in FTE rates for both male and female pharmacists between 2000 and 2004, although it is uncertain whether this drop is due to lifestyle choices, market conditions, or other factors.

5.  Attrition from the Pharmacist Workforce

Few sources provide data on pharmacist retirement patterns, and for this analysis data from the 2000 Census were analyzed to estimate the probability that a pharmacist was employed during the previous year.  The Census data on occupation and employment status are self reported, and the assumption is made that a person who self-identifies as a pharmacist and reports that they are working is, in fact, working in a pharmacy-related job.  This information is supplemented with data from the Centers for Disease Control and Prevention on the mortality risk for men and women, which is used as a proxy for mortality rates of pharmacists.

Most pharmacists remain active in their profession for 35 or more years (Exhibit 11).  Over 85 percent of pharmacists who reach age 55 are still active, but this percentage declines to less than 50 percent by age 65.  Between age 65 and age 75, the likelihood that a pharmacist is still active declines precipitously, and for modeling purposes it is assumed that by age 75 all pharmacists have retired.  Labor force activity rates for male and female pharmacists of the same age are relatively similar, although women age 30 to 37 are slightly less likely than men to be active and women age 40 to 65 are slightly more likely than men to be active.

Exhibit 11.  Probability Pharmacist is Active in Pharmacy

Source: Analysis of 2000 U.S. Census and CDC mortality statistics.  Note: All pharmacists assumed retired by age 75.

C.  The Future Pharmacist Supply

Numerous factors influence the decision to become a pharmacist and the decisions by pharmacists regarding how many hours to work, where to work, and when to retire.  The supply model tries to capture the major trends that affect supply.  Following a brief description of how future supply is modeled, projections through 2030 for a baseline and alternate scenarios are presented.

1.  Modeling Future Supply

Future supply is projected using an inventory model that tracks the number of active and FTE pharmacists by age, gender, education level, and year.  An inventory model starts with the number of active pharmacists in a particular age, gender and education level (Exhibit 12).  Each year new entrants are added to the pharmacist workforce using an age and gender distribution that reflects current and projected trends.  Also, each year some pharmacists separate from the workforce due to retirement and mortality, with the probability of separating increasing with age.  The number of pharmacists at the beginning of the year plus the net change in number of pharmacists during the year determines the supply of pharmacists at the end of the year (which becomes the starting point for the next projection year).

Exhibit 12.  Inventory Model of Supply

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2.  Baseline Supply Projections

The baseline scenario is our best estimate of future supply under the assumptions presented above regarding the number of new pharmacist graduates, average hours worked, and separation rates.  This scenario assumes that the number of entry-level degree graduates from schools of pharmacy will experience moderate growth, that pharmacists of a given age and gender will continue to work the same number of hours as their counterparts today, and that retirement patterns will remain unchanged over time.

Under this scenario, the number of active pharmacists will grow at a slightly faster rate than the overall resident population.  The number of pharmacists per 100,000 population grew from approximately 56 in 1975 to a current estimate of approximately 78.  This number is projected to increase to approximately 101 by 2030 (Exhibit 13).  These projections through 2030 are slightly higher than suggested by a linear projection of the pharmacist-to-population ratio based on data from 1975 to present.

Exhibit 13.  Active Pharmacists per 100,000 Resident Population in the US

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Source: Historical data combines U.S. Bureau of Labor Statistics data on pharmacists with U.S. Census Bureau population estimates.  Projections from the PhSRM.

The baseline supply projections suggest that the number of active pharmacists will increase from approximately 230,000 in 2005 to 305,000 by 2020 and 368,000 by 2030 (Exhibit 14).  The FTE supply estimates remain approximately 85 percent of active supply over this projection horizon, increasing from 194,000 in 2005 to 260,000 by 2020 and 319,000 by 2030.

All entry-level degree graduates of pharmacy schools now graduate with a Pharm.D degree.  In addition, each year hundreds of pharmacists originally prepared at the baccalaureate level earn their Pharm.D degree through distance learning and other programs.  The percentage of pharmacists trained at the Pharm.D level is projected to continue rising from its current level of 30 percent to an estimated 90 percent by 2030 (Exhibit 15).

Exhibit 14.  Total Active and FTE Pharmacists: Baseline Supply Projections

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Source: Projections from the PhSRM.

Exhibit 15.  Total FTE Pharmacists: Baseline Supply Projections

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Source: Projections from the PhSRM.

The recent increase in number of new entry-level degree pharmacy graduates is projected to result in a pharmacist workforce that in 2015 has a larger proportion of young (under age 35) pharmacists than existed in 2005 (Exhibit 16).  While young pharmacists tend to work more hours per week than their older colleagues, a growing proportion of these new pharmacists are women who tend to work fewer hours per week than their male colleagues.

Exhibit 16.  Age Distribution of FTE Pharmacists

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Source: Projections from the PhSRM.

3.  Alternate Supply Projections

Most people who train in a specialized field such as pharmacy remain in that profession throughout their career, so national supply projections tend to be relatively stable.  Actual future supply might diverge from the baseline projections if trends in supply determinants deviate from current or expected levels.  To test the sensitivity of the supply projections to key supply determinants the following alternate scenarios are modeled:

1. What is the impact on FTE supply of increasing (by 2010) the number of new graduates from pharmacy schools by 10 percent and by 20 percent above the baseline assumptions, and what is the impact if educational capacity stops growing past 2008 (Exhibit 17)?
2. What is the impact on FTE supply if pharmacist retirement patterns were to change such that pharmacists decided, on average, to retire 2 years earlier or to delay retirement for
   2 years compared to current patterns (Exhibit 18)?
3. What is the impact on FTE supply if pharmacists increase/decrease their hours worked annually by 10 percent (Exhibit 19)?

Supply projections for the baseline scenario and alternate scenarios are summarized in Exhibits 20 and 21.

Applications to first professional degree pharmacy programs more than tripled since the late 1990s, rising from 23,500 applications for the 1998-1999 school year to over 79,000 for the 2004-2005 school year.  During this time, enrollment in first professional degree programs increased by about a third, from 34,500 in 2000 to 46,500 in 2005.  The large increase in number of applicants suggests that interest in becoming a pharmacist is high, although the more moderate increase in enrollment suggests the presence of training capacity constraints.  If capacity increased such that from 2010 onward the number of new U.S. graduates remained 10 percent to 20 percent above the baseline graduate assumptions, by 2030 the number of FTE pharmacists would be approximately 23,000 to 46,000 higher than the baseline projections (Exhibit 17). 

A possible constraint to future increases in pharmacy graduates is a shortage of pharmacy faculty.  According to the annual AACP Survey of Vacant Budgeted and Lost Faculty Positions, total reported vacant or lost faculty positions have increased from 354 in 2002-03 to 406 in 2004-05.^[18]  If faculty shortages or other factors prevent further expansion of colleges and schools of pharmacy past the 2008 graduating year, then the number of FTE pharmacists would be 24,000 fewer than the baseline projection for 2030.

Exhibit 17.  Sensitivity of FTE Supply to Number of Graduates from US Schools of Pharmacy

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Source: Projections from the PhSRM.

Another factor that could influence supply is when pharmacists decide to retire.  Factors that could delay retirement include increases in the age for Social Security and Medicare eligibility, and continued high demand for pharmacist services that raises the opportunity cost of retirement.  Factors that could contribute to retiring earlier than historical patterns include the increasing number of people caring for elderly parents, lifestyle changes, and economic prosperity.  Under a scenario where pharmacists retire, on average, 2 years earlier or 2 years later than historical patterns, by 2030 the number of FTE pharmacists would fluctuate by only 5,000 to 8,000 from the baseline projections (Exhibit 18).

The baseline projections take into consideration the changing gender and age distribution of the pharmacist workforce and the implications for hours worked.  Factors that might contribute to a change in average hours worked include lifestyle decisions and the adequacy of pharmacist supply (e.g., a shortfall might increase hourly earnings, providing a financial incentive to work more hours).  If pharmacists change their hours worked by +/- 10 percent relative to the baseline assumptions, the number of FTE pharmacists will shift up/down by 10 percent reflecting some ability of supply to expand or contract (in the short term) to meet demand (Exhibit 19).

Exhibit 18.  Sensitivity of FTE Supply to Retirement Patterns

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Source: Projections from the PhSRM.

Exhibit 19.  Sensitivity of FTE Supply to Shifts in Average Hours Worked

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Source: Projections from the PhSRM.

Exhibit 20.  Active Supply Projections (Baseline Scenario)

* Columns might not sum to total because of rounding.

Exhibit 21.  FTE Supply Projections

4.  Comparison to Previous Supply Projections

The baseline supply projections suggest that pharmacist supply will grow faster than previously predicted, with these latest projections for 2020 suggesting pharmacist supply will be 50,000 higher than projected for the HRSA (2000) report (Exhibit 22).  This finding is not unexpected given the attention pharmacy has received since release of the 2000 report.  The new projections reflect the growing interest in pharmacy as a career choice, the rise in pharmacist average annual earnings, and the Nation’s renewed interest in expanding pharmacy training capacity in response to the current shortfall and earlier projections of a growing shortfall, and updated pharmacist retirement patterns.^[19]

In the late 1990s, the Nation was graduating approximately 8,000 new pharmacists per year and the HRSA (2000) projections assumed that the annual number of new graduates would continue increasing to approximately 8,500 by 2020.  In reaction to the predicted growing pharmacist shortage, enrollment in pharmacy programs rose such that the Nation will soon be graduating close to 10,000 new pharmacists per year, with plans for expansion of pharmacy schools expected to gradually increase the number of entry-level degree graduates to about 12,000 per year.

Exhibit 22.  Comparison of Active Pharmacist Supply Projections

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Sources: Projections from the PhSRM and HRSA (2000).