Indications of maturation in research on pharmacist workforce issues

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A themed issue devoted to pharmacist workforce issues and featuring 9 original literature contributions from the United States (US) and the United Kingdom (UK) marks a new level of maturation in social and administration sciences research for the profession of pharmacy. The rich collection of papers spans a spectrum of research issues that inform and represent the profession of pharmacy as it takes on a broader societal role in health care delivery—and importantly, identifies gaps that remain in our knowledge. The editor has further enhanced the diverse collection of contributions by including a summary that helps the reader to interrelate the various themes presented. Following are a few specific observations about the compiled papers. For brevity, the first author is cited when a particular paper is referenced.

A Range of Perspectives. A particular value in the collection of papers is the range of the level of analysis presented—from the global/international (Hassell, Noyce) to the (US) country and state level (Schommer and Robinson). Exploration of global issues such as the migration of pharmacists worldwide, global pharmacist shortages, and differences in pharmacist density around the world parallel similar research efforts (mobility, shortages, and gender and geographic distribution) in the US and can inform US researchers in interpreting data related to these topics. Likewise, the evolution of pharmacist roles in England with the legalization of accredited pharmacist prescribing for all medications and attendant regulations and professional requirements presage pharmacist role expansion in the United States, and thoughtful reports from the UK raise awareness of the patient safeguards needed with the expansion of responsibility (Noyce).

At the other end of the spectrum, state-level analyses provide the opportunity to “drill down” on questions of local significance, for example, the perceptions of West Virginia pharmacists about shortages levels in the state (Robinson). The approach to studying wage and gender relationships using single state analyses and comparing results to similar analyses across multiple states with interestingly different outcomes at the different levels of analysis supports the value of multiple levels of analysis. While analysis at the state level is often presented as a “limitation” (to generalizability), the smaller unit of analysis may appropriately disclose relationships not apparent in larger and more diverse datasets (Brown).

Data gaps in the US. A frustrating experience shared by many pharmacist workforce researchers and reflected in a Medicare Part D study in this issue (Meissner) is using potentially strong and appropriate research methods to address significant questions and then meeting with inconclusive results due to the lack of data in a critical area. In this regard, data derived from the Pharmaceutical Register of Great Britain far exceed the best proxies for national datasets in the US; for example, the 5% samples of the US decennial censuses and the sampling efforts of the Bureau of Labor Statistics by occupational type. Unfortunately, the last national census of US pharmacists occurred in 1989-1991; and, in the US, even basic demographic data such as active pharmacist headcounts can only be estimated through modeling and projecting from population samples. The Pharmacy Manpower Project has attempted to address some of these data gaps through projects such as its 2000 and 2004 National Pharmacist Surveys¹, ² and its Aggregate Demand Index³ but these efforts fall far short of regular data gathering for the professions of medicine and nursing. Repetition of surveys and other forms of data collection are necessary for trend analysis—an essential monitoring activity for health professions researchers—particularly in times of change.

A Pharmacist Workforce Research Agenda. Finally, this collection of papers demonstrates something of the broad range of US workforce issues appropriately addressed by research including attitudes toward pharmacist unionization (Zgarrick), training pharmacists to treat culturally diverse patients (Quist), pharmacists' intention to provide medication therapy management services (Urmie) and shifts in the “mix” of pharmacy types and location (Schommer) while introducing international trends toward emerging forms of pharmacist employment, for example, the locum pharmacist and global pharmacist demographics (Hassell). In the US, with our many unanswered questions about basic pharmacist workforce issues including our serious lack of basic demographic data about pharmacists, little has been done to prioritize the research needs for workforce issues and to provide incentives to address critical questions.

In the US, the frequent, national, fully accessible collection and sharing of data that reflect the age, gender, education and postgraduate training, type of practice site, specialization, salary, geographic location and work status of US pharmacists would enable researchers to address many basic demographic questions that have been answered in other countries and other professions. Studies of workforce participation, attitudes toward work including retirement planning and work condition preferences would enable practice environments that produce better patient outcomes. Finally, we in the US can benefit from the social research and policy development commentaries from the UK and elsewhere (Noyce and Hassel) as other nations precede the US in expanding the roles and responsibilities of pharmacists.

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References 

1. Pedersen CA, Doucette WR, Gaither CA, Mott DA, Schommer JC. National Pharmacist Workforce Survey 2000. Pharmacy Manpower Projects, Inc., 2000. Available at: http://www.aacp.org/Resources/Profiles_Reports/manpower.html. Accessed 8/9/06.
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2. Mott DA, Doucette WR, Gaither CA, Kreling DH, Pedersen CA, Schommer JC. National Pharmacist Workforce Survey 2004. Pharmacy Manpower Projects, Inc., 2006. Available at: http://aacp.org/Docs/MainNavigation/Resources/7295_final-fullworkforcereport.pdf. Accessed 8/9/06.
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3. Knapp KK, Quist RM, Walton SM, et al. Update on the pharmacist shortage: national and state data through 2003. Am J Health Syst Pharm. 2005;62(5):492–499
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