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.