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Aug
23
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The Future of Pharmacy Jobs — Will It Be Feast or Famine? – A Medscape review
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By Darrell Hulisz, PharmD; Daniel L. Brown, PharmD

 

Editor’s Note:
Chances are, if you ask most laypeople about the job outlook for pharmacists, they would say it is outstanding. For many years, pharmacy graduates have enjoyed near-full employment in the geographic areas of their choice. According to the Bureau of Labor Statistics, employment of pharmacists is projected to grow 14% from 2012 to 2022.[1] However, if you ask pharmacy students, recent graduates, and many practicing pharmacists, they are likely to express increasing concern about employment opportunities.

Daniel L. Brown, PharmD, Professor in the Lloyd L. Gregory School of Pharmacy and Director of Faculty Development at Palm Beach Atlantic University, is considered a national thought leader in the field of pharmacy workforce. Dr. Brown published a thought-proving article last year in the American Journal of Pharmaceutical Education[2] and addressed what he called a “looming joblessness crisis for new pharmacy graduates.” Darrell Hulisz, PharmD, Associate Professor, Case Western Reserve University School of Medicine, and member of the Ask the Pharmacists panel for Medscape, spoke with Dr. Brown regarding this important topic, which should be of great interest to all pharmacy professionals.

New Pharmacy Schools: Why So Many Expanded Programs?

Dr. Hulisz: What were the most important factors that led to the rapid increase in the number of newer pharmacy schools?
Dr. Brown: The pharmacist job market in the 1990s and up to about 2007 was characterized by a significant shortfall of pharmacists, fueled largely by a marked increase of community pharmacy positions in chain stores, supermarkets, and mass merchandisers. This made jobs plentiful and caused salaries to rise above 6 figures, understandably making pharmacists a very hot commodity. The lure of a guaranteed job with a high salary attracted many people to pharmacy, and the growing number of applicants created opportunities for new schools of pharmacy to be established and for existing schools to expand.

It is not surprising that many academic institutions found starting a school of pharmacy to be a lucrative enterprise, and many existing schools saw opportunities to build new facilities or secure additional resources by expanding enrollment. Essentially, the financial incentives for academic growth have been considerable.

Dr. Hulisz: Why did the rapid expansion of new pharmacy schools seem to go largely unnoticed for so many years?

Dr. Brown: At first it was a good thing — perhaps up to about 2010 — and allowed the profession to meet legitimate manpower needs. And because pharmacy has a strong accrediting body, which does an excellent job of ensuring that high quality standards are met by all new and existing programs, there was no need for concern about academic expansion weakening the quality of pharmacy education.

However, the rate of growth turned out to be much greater than anyone could have anticipated 10 years ago. A profession that produced a fairly stable graduating cohort of 6000-8000 new pharmacists per year from 1974 to 2003 is suddenly poised to graduate over 14,000 this year. Such growth is totally unprecedented in pharmacy.
To some extent, the magnitude of growth snuck up on people, though the tightening job market has been increasingly apparent to graduates and recruiters of graduates going back to 2007 or 2008. It is ironic that academic growth tends to mask itself by creating many new faculty jobs for pharmacists. Roughly 50 new schools have created a couple thousand jobs for pharmacists as faculty members over the past 13 years. Some in our profession overlooked the growth because they were counting on an expansion of pharmacist patient-care roles to offset the increasing number of graduates, with the hope that they would be assimilated into an ever-expanding workforce as new responsibility for pharmacists generated new pharmacist positions.

I don’t dispute such potential, but I also feel that academic growth has far exceeded the need, and a more reasonable growth rate would have better served the profession.

Dr. Hulisz: In your article, you noted that there were 80 colleges of pharmacy in 2000 and 127 accredited colleges by 2012. What is the current number of pharmacy schools, including those having candidate or precandidate status?

Dr. Brown: The figure of 127 accounted for accredited pharmacy programs within the 50 states. Only 1 new program was established in 2013: the University of North Texas. There could be as many as 3 more in 2014, bringing the total to 131. California Health Sciences University has been granted precandidate status by the Accreditation Council for Pharmacy Education (ACPE). Two other schools in Southern California are hoping to receive precandidate status in time to open in the fall of 2014.

However, the number of programs is not an ideal measure of academic growth. The majority of academic growth in pharmacy since 2000 has been the result of the expansion of existing programs rather than the establishment of new schools.

Just looking at the number of accredited programs does not reflect the full picture. The total number of graduates is a more reliable measure of academic growth.

Dr. Hulisz: In your opinion, should some pharmacy schools consider decreasing student enrollment into the professional division?

Dr. Brown: No, not at this point. It might come to pass eventually through natural supply and demand market forces, but that probably won’t happen until the next decade. For now, I would like to see new growth abate for at least a few years, as a result of individual institutions voluntarily choosing to refrain from either establishing new programs or expanding existing programs. Furthermore, I am not in favor of ACPE or any other agency being given the power to prevent a new program from opening or expanding, apart from a failure to meet accreditation standards.

My purpose in raising awareness of this issue is simply to encourage institutions that might be considering a start-up or expansion to factor in all the facts before making a decision. In addition to the financial feasibility of their plans, they should give thought to the magnitude of loans that students are likely to accrue while completing a PharmD program and the probability of graduates being able to secure suitable employment in the job market they are likely to encounter upon graduation.

Much attention is paid to the large number of applicants to pharmacy schools and to robust job projections for the future — such as those in the latest Bureau of Labor Statistics report issued in January 2014, which are frequently used to justify new or expanded programs. However, the ever-increasing supply side of the equation seems to be generally ignored.

I would like to hear leaders within pharmacy organizations at least admit to the possibility that academia might have already grown sufficiently to meet the demands of the near future, and that continued growth might not be necessary at this time.

What is wrong with encouraging a full examination of all evidence before making a decision? Why not engage in open discussions about the possibility that the rate of academic growth since 2000 might have overshot the mark, and it needs to be curtailed for a while?

Such feedback might be helpful in dissuading institutions currently contemplating the start-up or expansion of a PharmD program that is not really necessary. I foresee a day when ACPE will require schools to report the employment rate of their graduating cohorts 6 or 12 months out from graduation, just as they report North American Pharmacist Licensure Examination (NAPLEX) pass rates today.

Dr. Hulisz: Do we have surplus of PharmD graduates at the present time?

Dr. Brown: I think we have been hovering around an equilibrium point for a few years. It is a gradual process and it varies from state to state, but as the job market in more states begins to level off, it is becoming more of a national phenomenon.
What concerns me is that the growth or supply side of the manpower equation shows no signs of reaching a plateau. There are currently 17 new schools that have yet to graduate their first class, and there are also newly expanded programs whose larger graduation rates have not yet taken effect. With new programs still on the drawing board and hoping to open within the next 2 or 3 years, a pervasive pharmacist surplus is a very real possibility.

Dr. Hulisz: Has momentum shifted yet? In 2014, has major academic expansion either plateaued or possibly even declined?

Dr. Brown: The answer is a definitive “somewhat.” The last year in which academia did not have at least 1 new school open was 2004. From 2005 through 2012, at least 4 new schools opened every year. To put the magnitude of growth in perspective, the 2001 Pharmacy Manpower Project Conference projected that about 3 new PharmD programs would open every 10 years.[3] Back then, no one could have imagined that a minimum of 4 new schools would open every year for 8 consecutive years. It is a good sign that only 1 school opened last year, but there could be 3 more this year pending ACPE approval, so the growth phase has slowed — but it is by no means over.

The expansion of existing schools has not stopped, either. My hope is that the growth of the academy will finally plateau within 2-3 years and then hold steady for a period of time, as the pharmacist marketplace becomes better defined. It is important to keep in mind that the impact of a new school is not felt in the job market until 3 or 4 years after the program starts, and then it takes a few years thereafter for the market to equilibrate to the expanded number of graduates.

With that in mind, it is reasonable to anticipate that the pharmacist job market will be affected by continuing academic growth for at least another 8 years.
Dr. Hulisz: In your article, you cite the Pharmacy Workforce Center and their statistic of aggregate demand index (ADI) as being at an equilibrium point: close to 3 in 2010. You also cite regional differences in 2012. Where is the ADI today, and in which direction do you see it heading?

(Editor’s Note: The ADI is a data element derived by the Pharmacy Workforce Center [PWC] from monthly impressions of the pharmacist job market provided by a nationwide group of participants. The index consists of a 5-point scale, where 5 = high demand, difficulty filling openings; 4 = moderate demand, some difficulty filling openings; 3 = demand in balance with supply; 2 = demand is less than the supply of pharmacists available; and 1 = demand is much less than the supply of pharmacists available.[4])

Dr. Brown: The latest ADI data from January 2014[4] show that 2 regions of the country, New England and Middle Atlantic, are already below 3. I’m not inclined to venture a prediction on the future of the ADI any more than I would attempt to predict the 2014 NCAA basketball champion. I would point out, however, that the growth rate of pharmacy graduates can be projected into the intermediate future with a high level of certainty. It involves no skill in prognostication. We know for a fact that pharmacy is headed for an annual graduation rate of at least 15,000 graduates within a few years.

In contrast, the number of jobs that will be available for those graduates is an area of great uncertainty. I hope there will be enough new jobs to sustain the equilibrium, but such optimistic job projections are based on assumptions that might not come to pass. Therefore, on the basis of the differing probabilities between the supply side and the demand side of the manpower equation, it seems quite possible that the ADI will trend downward at least into the next decade.

One should also consider that the ADI, as a measure of job market conditions, relies on feedback from employers on the basis of their experiences in hiring pharmacists. The methodology is well suited to a pharmacist shortage environment, such as existed when the ADI was created. However, as the marketplace moves closer to pharmacist surplus conditions, the perspective of job seekers might be more telling than that of the people doing the hiring. I think our profession needs to do a better job of soliciting feedback from the new graduates who are out there trying to find a job

Dr. Hulisz: You note that direct patient care jobs for pharmacists outside of acute care facilities have been slow to develop. Why is this?

Dr. Brown: I wish I could answer that question definitively, but I can only provide my best guess. First, I should mention that the impact of the medication therapy management provisions of Medicare Part D has not been as dramatic as originally anticipated. It has been slow-going. Billing for such services and integrating medication therapy management practices into the workflow of community pharmacies have proven to be daunting logistical challenges. Aside from Medicare Part D, it is the development or lack thereof of direct ambulatory care roles that is more central to the issue.
I was the Director of Ambulatory Care at the University of Illinois Medical Center in 1990. At that time, I thought direct pharmacist involvement in primary care and ambulatory care was about to take off, but it didn’t.

In 2001, the conference hosted by the Pharmacy Manpower Project that I spoke of earlier predicted a major expansion of primary care jobs over the next 20 years.[3] Their projections were reasonable at the time, but the growth of such ambulatory care jobs hasn’t materialized to any great extent.

Over the past couple of decades, the prevalence of pharmacists working in an ambulatory care environment has been somewhat localized to 3 specific areas: first, the Veterans Administration and Public Health Service; second, sites that have accepted a faculty practitioner funded by academia; and third, closed health maintenance organization systems, such as Kaiser Permanente.

The fact of the matter is that new patient care positions for pharmacists in outpatient care have failed to expand in a manner comparable to the consistent expansion of inpatient clinical positions during the 1980s and 1990s. I suspect that this disparity has a lot to do with differences in reimbursement for services.

It was relatively easy to justify the cost of pharmacist activities on the inpatient side, whether on the basis of a cost or a revenue model. As a result, clinical pharmacy services in hospitals were easily assimilated into inpatient pharmacy operations.
Reimbursement for outpatient clinical pharmacy services is an entirely different matter. Even as pharmacists gain provider status and prescribing authority, the rate-limiting step to job growth is going to be reimbursement for services rendered and the ability to readily assimilate new patient care functions into existing pharmacy operations.

In other words, the system needs to undergo fundamental change for pharmacy to develop clinically on the outpatient side as it did on the inpatient side. It appears that such change might be forthcoming, but the scope and rate of change remain uncertain.

Dr. Hulisz: Do you see the Affordable Care Act as serving to increase or decrease demand for pharmacists, and why?

Dr. Brown: At this point in time, the Affordable Care Act is fraught with unknown variables. I hesitate to conjecture on the impact it might have on the profession of pharmacy. Some expect great opportunities for pharmacists to find new niches in the patient-centered medical home model. I just don’t know.

However, the one aspect of the legislation that seems most likely to affect pharmacy practice is Medicaid expansion. I would expect that community pharmacies will see more Medicaid prescriptions in coming years and, perhaps, greater opportunities to engage in preventative services, such as health screenings and immunizations.

We also might see a greater emphasis on establishing routine medication therapy management services. Other than that, we will have to wait and see how the law unfolds, which provisions remain untouched, which are fully funded, and which are modified or eliminated

Dr. Hulisz: US News & World Report[5] ranked the career of pharmacist as #5 of 100 careers overall and #3 among the best healthcare jobs. Among the reasons cited was solid employment growth. Do you agree?

Dr. Brown: I am a pharmacist, so I am biased — but yes, I agree. Pharmacy is and always has been a rewarding profession that provides valuable healthcare services and unmatched access to care. The role of pharmacists will continue to develop and expand, as it should.
A tightening job market due to the growth of pharmacy schools changes neither the importance of pharmacy nor the public’s need for pharmacy services. It might become more challenging to find the right job amid increasing competition from a growing applicant pool, but those who prepare themselves well and are willing to be flexible should have no trouble securing employment. When they do, I expect that they will find pharmacy to be a richly rewarding vocation.

I consider myself blessed to have spent 3-plus decades in this field. On the other hand, those who are attracted to pharmacy primarily because they anticipate an easy-to-find, high-paying job might want to reconsider.

Dr. Hulisz: What advice would you give to a current pharmacy student?

Dr. Brown: Be optimistic, and have faith that you have chosen the right profession. It is a profession that will serve you well if you take care of business. By that I mean, fully dedicate yourself to making the most of your pharmacy education, and prepare yourself for the future in ways that maximize your marketability.

Study diligently for the sake of learning, not just to pass exams. When engaged in a real-life training experience, treat it as a 24/7 interview. Impress everyone at the training site with your work ethic, your commitment to excellence, your service-oriented mentality, your compassion for all people, your emotional maturity, and your ability to work well with others. In short, put your best foot forward at all times. People tend to notice a positive attitude, a willingness to work hard, and a trustworthy character. If they witness such attributes in you, they will want you to be a member of their team.
Also, get involved in supporting, promoting, and developing your profession. Be an advocate for pharmacy issues, and prepare yourself to be a pioneer of progressive new roles and services. Become the kind of pharmacist who feels compelled to blaze a trail where one does not already exist.

If you follow this advice, grounded in a sense of humble gratitude for the talents and opportunities that have been afforded to you, employers will eagerly seek to hire you. Issues pertaining to employment will become inconsequential.

There is a well-worn biblical expression which suggests that we tend to reap what we sow. That principle supersedes the dynamics of the job market. Pharmacy students who sow a great education are destined to reap the rewards of a great career.

Courtesy – Medscape



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