Research in Social and Administrative Pharmacy
Volume 2, Issue 3 , Pages 294-298, September 2006

Much needed attention devoted to pharmacy workforce issues

  • Shane P. Desselle, RPh, PhD, FAPhA

      Affiliations

    • Corresponding Author InformationTel.: +1 412 396 6363; fax: +1 412 396-5130

Editor, Research in Social & Administrative Pharmacy, Duquesne University, Bayer Learning Center, Pittsburgh, PA 15282, USA

Article Outline

 

After years of relative inactivity in the area, researchers and policy-makers have begun to refocus their attention on workforce issues in pharmacy. This has been necessitated in part by well-documented labor shortages in the United States.1 and in other nations.2 These workforce shortages have momentous implications for patient safety, the ability of the profession to meet unmet patient needs in medication therapy,3 and ultimately, its professional image and mandate.

Previous study in the US has attempted to project labor supply in the coming decades and examined pharmacists' workload, time spent in professional activities, and preferences for alternative professional responsibilities. Pharmacists' activities have been divided into 4 principal professional responsibilities: medication dispensing, consultation, business management, and drug use management.4 Not surprisingly, while pharmacists report a majority of time spent in dispensing, they would prefer allocating more energies toward consultation and drug use management; as such, pharmacists experience relatively high role overload and only modest levels of job satisfaction.5 This corroborates the findings of Gaither,6 who showed that the effects of job stress on turnover intentions are mediated through career commitment and met expectations. Kahaleh and Gaither observed subsequently that pharmacists with flexible and visible jobs are psychologically empowered,7 which builds independence and confidence and strengthens their loyalty. Thus, while pharmacists earn healthy wages and have myriad opportunities before them, they struggle with professional identity issues in one of many health professions witnessing its constituents increasingly working for large corporations.

One of the most widely discussed pieces of legislation in the US in decades has been the Medicare Modernization Act of 2003 (MMA, Medicare Part D). Recognizing the need for medication therapy management services (MTMS) for older adults on multiple Medicare Part D medications, the MMA is a potential boon for the pharmacy profession. On the other hand, the law is confusing to many, and places the responsibility of communication and knowledge gaps for patients squarely on pharmacists. Moreover, it is not yet known what sort of impact that the legislation will have on manpower. In this issue of Research in Social and Administrative Pharmacy, Meissner et al8 examine the impact of Medicare Part D on the pharmacy workforce. First, and very importantly, they concede that a more formal system for accurately estimating the demand for pharmacists is absolutely necessary. Even so, they used the best-available estimates to forecast that the increase in demand for prescriptions and consultative services resulting from the MMA will be offset to some degree by the entry of many new pharmacy technicians and pharmacists into the workforce. This might be welcome news, as Herbert et al9 observe that pharmacists currently lack the time and support necessary to provide MTMS. The funding for and provision of MTMS is seen as important for patients' outcomes to drug therapy and a necessary step in pharmacy's continued professionalization. Pharmacists who believe they have more control and who feel as though their peers approve of the provision of MTMS have a stronger inclination to provide these services, themselves.

Discussions of workforce must extend beyond predictions of supply and demand. As such, the current themed issue on the pharmacy workforce explore other aspects of this phenomenon. Zgarrick et al10 are among the first to examine unionization issues among staff pharmacists. Pharmacy has never been a home for strong labor unions; however, consolidation and growth have increasingly removed pharmacists from decisions that affect their practice. While the proportion of unionized pharmacists remains relatively low, there exists a significantly large minority who would vote to unionize their workplace and certain areas that are ripe for union labor growth. Pharmacy managers and researchers should continue to monitor the impact that pharmacist unionization has on their organizations and the profession.

This issue features 2 statewide studies of the pharmacy workforce. Schommer et al11 examined changes in community pharmacy mix (chain versus independently owned) for 87 counties in Minnesota and observed that the ratio of independents to chains decreased from approximately 2:1 to approximately 1:1 in a span of just 10 years. Their results suggest that chain pharmacies follow changes in population density for making market entry and exit decisions. The fact that independent pharmacies also appear to exit the market among declining populations could lead to access problems for persons remaining in those areas. Robinson12 observed that in West Virginia, as well might be the case for other states, staffing shortages impact the services that pharmacists provide to the community. One implication is that well-patient programs in asthma, cholesterol, pain management, and hypertension, among others is offered by fewer than 1 in 4 pharmacies. Respondents to a self-administered survey suggested that inadequate staffing affects their ability to provide basic counseling services to patients.

The face of pharmacy has been changing during the past couple of decades, as a growing number of women comprise the pharmacist labor supply. It is important that women are afforded the same opportunities and pay as their male counterparts. Brown et al13 undertook what is arguably the most comprehensive evaluation of pharmacist salary disparities to date. They observed that any differences in hourly wage taken in aggregate diminish at the state level, particularly when accounting for position. Men continue to hold a higher proportion of manager and owner positions in pharmacy; however it is not yet known whether this can be attributed to individual preferences. Overall, demographic and other immutable characteristics appear to play a small role in explaining variations in hourly wage.

The faces of patients served by pharmacists are perhaps changing even more rapidly than the profession. The growingly complex demographic in the US creates challenges for pharmacy. Health services research has documented the hurdles faced by females, ethnic and racial minorities, the disabled, and the economically disadvantaged in gaining access to the health care system and with receiving competent care. There has been little research in pharmacy in this area to date. Quist and Law14 establish a comprehensive research agenda in their proposed ACCULTURE model. They propose developing evidence-based strategies for recruiting and retaining a diverse workforce; studying barriers to adherence and strategies to improve pharmacist-patient communication; exploring variation in pharmacokinetics affecting treatment; and establishing evidence-based strategies to increase the likelihood of better serving diverse and underserved patient populations.

Pharmacy workforce issues are not unique to the US. This is evidenced from a study recently conducted by the International Pharmaceutical Federation (FIP) resulting in their Global Pharmacy Workforce and Migration Report.2 The study collected data on the distribution of pharmacists by country, gender and practice area; pharmacist shortages; continuing professional development and continuing education programs; and migration of pharmacists worldwide. The resultant report evidences momentous disparities in pharmacist density, ability to provide services, professional status, and quality of work life issues among various nations.

This issue of the journal features 2 articles originating from Great Britain. Shann and Hassell15 report on a growing trend among pharmacists to work on a locum, rather than permanent basis. Their in-depth interviews uncovered a desire among respondents for flexibility and a preference for preserving work/life balance. Shann and Hassell15 express concern that isolation, lack of social cohesiveness and amoral attitudes may pose risks for the profession if nonstandard work practices become more widespread. Concurrently, Noyce16 describes the need to modernize regulation of the pharmacy workforce, citing evidence that current arrangements to ensure that health care professionals develop competence applies differentially to various professionals. He contends further that competency-based frameworks for determining fitness to practice should make accreditation qualifications easier internationally and allow pharmacists to be as mobile as medical and nursing practitioners. Noyce also describes a movement to establish a separate registry for pharmacy technicians, who would then become independently licensed health professionals with their own roles and responsibilities. There are a number of implications from this movement for other countries, including the US.

The results of studies and scholarly opinions comprising this issue of the journal will undoubtedly make a significant contribution to the literature on the pharmacy workforce; however, much work still remains on such a critical and dynamic topic. It is hoped that this themed issue will spur much needed research and debate.

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References 

  1. Knapp KK, Livesey JC. The aggregate demand index: measuring the balance between pharmacist supply and demand, 1999-2001. J Am Pharm Assoc. 2002;42:391–398
  2. FIP Global Pharmacy Workforce and Migration Report. International Pharmaceutical Federation, 2006. Available at: http://www.fip.org/www2/subsections/index.php?page=menu_resourcesforhealth#. Accessed 25.07.06.
  3. Law AV, Max DR, Knapp KK, Balesh JK. Unmet needs in the medication use process: perceptions of physicians, pharmacists, and patients. J Am Pharm Assoc. 2003;43:394–402
  4. Schommer JC, Pedersen CA, Doucette WR, Gaither CA, Mott DA. Community pharmacists' work activities in the United States during 2000. J Am Pharm Assoc. 2002;42:399–406
  5. Mott DA, Doucette WR, Gaither CA, Pedersen CA, Schommer JC. Pharmacists' attitudes toward worklife: results from a national survey of pharmacists. J Am Pharm Assoc. 2004;44:326–336
  6. Gaither CA. Career commitment: mediator of the effects of job stress on pharmacists' work-related attitudes. J Am Pharm Assoc. 1999;39:353–361
  7. Kahaleh A, Gaither CA. Effects of empowerment on pharmacists' organizational behaviors. J Am Pharm Assoc. 2005;45:700–708
  8. Meissner B, Harrison D, Carter J, Borrego M. Predicting the impact of Medicare Part D implementation on the pharmacy workforce. Res Soc Adm Pharm. 2006;2:315–328
  9. Herbert KE, Urmie JM, Newland BA, Farris KB. Prediction of pharmacist intention to provide Medicare medication therapy management services using the theory of planned behavior. Res Soc Adm Pharm. 2006;2:299–314
  10. Zgarrick DP, McHugh PP, Droege M. Prevalence and interest in unionization among staff pharmacists. Res Soc Adm Pharm. 2006;2:329–346
  11. Schommer JC, Singh RL, Cline RR, Hadsall RS. Market dynamics of community pharmacies in Minnesota. Res Soc Adm Pharm. 2006;2:347–358
  12. Robinson ET. Assessment of pharmacy manpower and services in West Virginia. Res Soc Adm Pharm. 2006;2:359–369
  13. Brown LM, Schommer JC, Mott D, et al. Examining gender salary disparities: an analysis of the 2003 multi-state salary survey. Res Soc Adm Pharm. 2006;2:370–387
  14. Quist RM, Law AV. Agenda for cultural competency research using literature and evidence (ACCULTURE). Res Soc Adm Pharm. 2006;2:419–437
  15. Shann P, Hassell K. Flexible working: understanding the locum pharmacist in Great Britain. Res Soc Adm Pharm. 2006;2:388–407
  16. Noyce P. Governance and the pharmaceutical workforce in England. Res Soc Adm Pharm. 2006;2:408–418

PII: S1551-7411(06)00074-X

doi:10.1016/j.sapharm.2006.08.003

Research in Social and Administrative Pharmacy
Volume 2, Issue 3 , Pages 294-298, September 2006

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