The Pharmacist Shortage
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Transcript of The Pharmacist Shortage
The Pharmacist Shortage The Pharmacist Shortage
Katherine K. Knapp, PhD Western University of the Health Sciences
James M. Cultice, BS National Center for Health Workforce Analysis,
HRSA
Sharon K. Gershon, Pharm.DNational Institutes of Health
Background: How do we study the Background: How do we study the shortage?shortage?
Evidence of a continuing pharmacist shortage Supply
BHPr Pharmacist Supply Model Last census of pharmacists in 1990 Abundance of new pharmacy schools and program expansions National adoption of the PharmD precludes international
pharmacist graduates Women are the majority gender in pharmacy since 2003
Demand Several tracking surveys: ADI, NACDS, ASHP Fluctuations in prescription growth rates Expansion of pharmacist roles
Trends in US pharmacy schools & graduates
50
55
60
65
70
75
80
85
90
95
1980 1985 1991 1995 1996 1998 2000 2001 2002 2003
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
Schools/Colleges Graduates
Significant campus expansions since 2000
University of Minnesota, MN (+1) University of Oklahoma, OK (+1) University of Florida, FL (+3) Nova Southeastern, FL (+3)
More campuses in development
Touro University, Vallejo, CA University of Hawaii, Hilo, HI Hawaii College of Pharmacy, Kapolei, HI Southern Illinois University, Edwardsville, IL Massachusetts College of Pharmacy, Portsmouth, NH University of North Texas, Fort Worth, TX Texas A&M University, Kingsville, TX University of the Incarnate Word, San Antonio, TX Texas A&M, Kingsville, TX University of Appalachia, Grundy, VA University of Charleston, Charleston, WV
Entry-level PharmD degree
National requirement as of 2003 Longer educational program with more
clinical training Phase-in reduced graduate numbers in the late
1990s to present Only offered in the U.S. resulting in an
additional barrier for international pharmacy graduates to enter the workforce
Gender impact on supply
In 2003, pharmacist workforce became >50% female
New graduates are about 1/3 male and 2/3 female; retirees are predominantly male
Gender balance will continue to shift Workforce participation differs by gender
(2000)0.9 FTE (women) 1.1 FTE (men)
Key issues for projecting pharmacist supply
Projecting estimates of the number and size of new schools and program expansions
Projecting new entrants: US graduates and international entrants
Evaluating separation rate patterns by gender (death and retirement)
Limitations: no geographic data
Principal determinants of demand
Retail prescription numbers, closely related to population demographics and overall medication use
New clinical and administrative roles for pharmacists that expand positions
Historical retail prescription growth rates
0.9
2.6
5.44.5 4.3
7.1
9.1
5.85.0
4.3
2.5
0
1
2
3
4
5
6
7
8
9
10
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Source: NACDS Industry Profile
Despite slowing growth rates, surveys suggest the pharmacist shortage is ongoing
1
1.5
2
2.5
3
3.5
4
4.5
5
Jan-
00
Apr-0
0
Jul-0
0
Oct-00
Jan-
01
Apr-0
1
Jul-0
1
Oct-01
Jan-
02
Apr-0
2
Jul-0
2
Oct-02
Jan-
03
Apr-0
3
Jul-0
3
Rat
ing
Rating scheme: 5=difficult to fill open positions, 4=moderately difficult to fill open positions, 3=balance between supply & demand, 2=some excess in supply over demand, 1=supply greater than demand
3=Balance between supply and demand
Source: Aggregate Demand Index, Pharmacy Manpower Project
NACDS Foundation surveys show similar patterns for vacancies
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Feb-9
8
Aug-9
8
Feb-9
9
Aug-9
9
Feb-0
0
Aug-0
0
Feb-0
1
Aug-0
1
Feb-0
2
Aug-0
2
Vac
anci
es
Source: National Association of Chain Drug Stores
Falling prescription growth rates parallel declines in the ADI
0.01.02.03.04.05.06.07.08.09.0
10.0
1993 1995 1997 1999 2001 2003
Per
cen
t
3.853.93.9544.054.14.154.24.254.34.35
Mea
n A
DI
Retail Precription Growth Rate ADI
Continued prescription growth contributes to the sustained shortage
0
500
1,000
1,500
2,000
2,500
3,000
3,500
1992 1994 1996 1998 2000 2002
Pre
scri
pti
on
s (m
illi
on
s)
0246810121416
Per
cen
t
Observed Prescriptions
Expected Prescriptions at Mean Growth Rates 1992-97
Gap as Percent of Expected
Key issues in projecting demand
Future growth rates of prescriptions Growth related to the aging of Baby Boomers Medicare prescription drug benefit 2006
Productivity of pharmacists Pharmacists averaged 22,000 prescriptions/yr at
the beginning of the shortage Technicians and technology
New positions
Study DesignStudy Design
Methods We projected demand for community pharmacists between
2003 and 2010 based on alternative trends in prescription volume including the effects of population growth and aging, and increased third-party prescription coverage through the Medicare drug benefit to start in 2006.
We used the Bureau of Health Professions' Pharmacist Supply Model for comparable supply projections with pharmacist supply projected both as headcounts and full-time equivalents.
Data sources: American Association of Colleges of Pharmacy, Pharmacy ManpowerProject, National Association of Chain Drug Stores and U.S. Census Bureau.
Key assumptions
We assumed these annual prescription growth rates: 2% (2003-04), 3% (2005), 4% (2006-10) Gender-related full-time equivalent (FTE) work patterns: 1.1 FTE (men pharmacists), 0.9 FTE (women pharmacists) Annual productivity level of 23,000 prescriptions per pharmacist
based on averaging per-pharmacist productivity 1998-2003 and current vacancy levels in retail pharmacies.
No change in the use of pharmacist technicians, automation, or hours worked.
Medicare prescription benefit to add approximately 84 million retails prescriptions annually after 2005 if 100% of those eligible enroll.
120,000
125,000
130,000
135,000
140,000
145,000
150,000
2003 2004 2005 2006 2007 2008 2009 2010
Ret
ail P
harm
acis
ts
Head Count FTE
Pharmacist Supply Model baseline data from the 1989-1991 pharmacist census FTE contributions: women pharmacists (0.9 FTE); men pharmacists (1.1 FTE) Community/retail pharmacists assumed to account for 65 % of all pharmacists
Pharmacist Supply Model projections
Estimates of future prescriptions Estimates of future prescriptions
02468
10
Per
cent
01,0002,0003,0004,0005,000
Pre
scri
ptio
ns in
m
illio
ns
Growth rate Count
Source: IMS Health and NACDS Industry Profile Assumption: growth at 2% (2003-5), 3% (2006), 4% (2007-10) Growth rates do not reflect the impact of the Medicare drug benefit 2006-2010 ( )
Projected growth in retail prescriptions could widen the shortage fromProjected growth in retail prescriptions could widen the shortage from7-8% today to over 25% by 2010 with the onset of the Medicare drug 7-8% today to over 25% by 2010 with the onset of the Medicare drug benefit in 2006.benefit in 2006.
-------Impact of Medicare drug benefit---------Projected
Assumes all Assumes 1/2 of Without Medicareheadcount
eligibles enroll eligibles enroll drug benefitsupply of
PercentNumericPercentNumericPercentNumericcommunity
shortage shortage shortage shortage shortage shortagepharmacistsYear
6.5%8,513131,2692003
7.6%10,154133,1232004
9.2%12,426135,1502005
14.3%19,71213.0%17,88611.7%16,059137,4192006
17.0%23,69915.6%21,84114.3%19,982139,6352007
19.7%28,00318.4%26,10417.1%24,204141,7982008
22.7%32,60321.3%30,66520.0%28,727143,9162009
25.7%37,52224.4%35,54723.0%33,571145,9772010
The Medicare Part D drug benefit starting in 2006 could require another 2,000-4,000 pharmacists by 2010.
130,000
140,000
150,000
160,000
170,000
180,000
190,000
Nu
mb
er o
f p
ha
rm
acis
ts
2003 2004 2005 2006 2007 2008 2009 2010
Supply Without Part DHalf enrolled All enrolled
ConclusionsConclusions
The shortage today, estimated at 10,000 retail pharmacists, points to a stressed system given the continued significant vacancy rate and difficulty in filling vacant positions.
Prescription volume is expected to accelerate again through 2010 due to the expanding elderly population and improved insurance coverage through Medicare causing the shortage gap to grow. An increasing percentage of women pharmacists, who tend to work fewer hours than men, may further widen the shortage.
Implications for Policy, Delivery or Practice
The shortage is foreseen to worsen as demand for prescriptions and related services outpaces growth in numbers of pharmacists.
Introduction of a Medicare drug benefit could aggravate the shortage, particularly if pharmacists must spend more time in counseling and administrative activities.
The number of new pharmacy schools that have opened, and prospective schools, will expand the supply and help relieve the shortage, as may greater use of pharmacy technicians and automation.