1. 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.D National Institutes of Health

2. Background: How do we study the 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

3. Trends in US pharmacy schools & graduates

4. Significant campus expansions since 2000  University of Minnesota, MN (+1)  University of Oklahoma, OK (+1)  University of Florida, FL (+3)  Nova Southeastern, FL (+3)

5. 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

6. 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

7. 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)

8. 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

9. 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

10. Historical retail prescription growth rates Source: NACDS Industry Profile

11. Despite slowing growth rates, surveys suggest the pharmacist shortage is ongoing 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

12. NACDS Foundation surveys show similar patterns for vacancies

13. Falling prescription growth rates parallel declines in the ADI

14. Continued prescription growth contributes to the sustained shortage

15. 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

16. Study 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 Manpower Project, National Association of Chain Drug Stores and U.S. Census Bureau.

17. 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.

18.  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

19. Estimates of future prescriptions  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 ( )

20. Projected growth in retail prescriptions could widen the shortage from 7-8% today to over 25% by 2010 with the onset of the Medicare drug benefit in 2006.

21. The Medicare Part D drug benefit starting in 2006 could require another 2,000-4,000 pharmacists by 2010.

22. Conclusions  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.

23. 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.