Along with shifting healthcare delivery and payment models, the practice of pharmacy shows many signs of transformation.
The face of pharmacy is changing. New pharmacy graduates are entering a profession where women now outnumber men, pharmacists are assuming greater responsibility in patient care, and more pharmacists are stepping outside of traditional practice settings.
With these new responsibilities have come increased stress levels, a growing workload, and for some pharmacists, a drop in overall satisfaction.
These were a few of the findings of the 2014 National Pharmacist Workforce Study, recently released by the American Association of Colleges of Pharmacy (AACP). Based on survey responses from 2,446 U.S. pharmacists, the study examined demographic characteristics, work contributions, and quality-of-life measures for today's pharmacists.
Caroline GaitherThe results show the realization of many anticipated trends within the industry, from the growing role of women in the workforce to the increased numbers of pharmacies now offering additional services such as medication therapy management (MTM) or immunizations.
"There were just some really big things that came out of the project that we had been looking for over time," said Caroline A. Gaither, PhD, a lead investigator of the study.
New pharmacists are entering a profession very different from what it was 20 or 30 years ago, but they report the highest commitment levels to their careers and express enthusiasm about helping the profession continue to transform.
Jon SchommerThe number of U.S. pharmacy-school graduates continues to reach record highs every year. In 1960, according to the AACP, there were fewer than 4,000 new pharmacy graduates; that number has grown from a total of 8,108 pharmacy graduates in 2004 to 13,838 in 2014.
Despite the increasing numbers of new pharmacists entering the industry each year, the report found that there has been a relative balance between supply and demand over the past five years. In 2013 the aggregate demand index was 3.24 on a 5-point scale, with 5 indicating high demand.
Jon C. Schommer, PhD, another lead investigator of the study, said that part of the reason the industry has been able to maintain a balance despite the large number of new pharmacists graduating each year is that many pharmacy veterans who began their career in the 1970s are beginning to retire.
This is creating balance for now, Schommer said, but he cautions that it won't be the case forever.
While there was also a boom of pharmacists in the 1970s, Schommer said, fewer new graduates entered the profession during the 1980s and part of the 1990s, which in turn will mean fewer retirees in the years ahead.
"It's not going to last very long, so five years from now, we're in trouble if we don't expand what we do," he said.
Pharmacists new to the profession say that networking, actively taking advantage of opportunities presented in pharmacy school, and willingness to move beyond a preferred location helped them secure jobs in the field.
Paul Stranges, PharmD, BCPS, BCACP, said that he used the job-placement tool provided by the American Society of Health-System Pharmacists and networking to find his positions as clinical pharmacist at Barnes Jewish Hospital and assistant professor of pharmacy practice at St. Louis College of Pharmacy.
"It's intimidating at first, because it's unknown, but there are a lot of helpful things out there that helped guide me to try to find a job that's within the field that I am looking for," he said.
The study also found that practice settings for pharmacists are becoming more diverse. For the first time in the study's history, the number of pharmacists reporting that they work in a community practice setting dropped below 50%, to 44.1%.
However, since 2009, the percentage of active pharmacists working in a hospital setting, other patient-care practice, and other non-patient-care practice has grown. According to the 2014 findings, 29.4% of actively practicing pharmacists now work in hospital settings, while 16.7% work in other patient-care practices, and 7.5% work in other non-patient-care practices.
"The individuals who used to work in community are shifting to these other practices, and we don't exactly know why that might be. It could be more opportunity in those sectors," Gaither said.
For the first time since the workforce study was launched in 2000, findings reveal that women outnumber men in the workforce. In 2014, 57.1% of actively practicing pharmacists were females.
"We're now a female-dominated profession, in terms of numbers," Schommer said.
Women are also assuming more leadership roles in the industry. According to the study, in 2014 55.2% of women were in pharmacy-management positions, compared to 44.8% of men.
Whitney CowartOne of the only differences found in the study between men and women, Schommer said, is that men still outnumber women in terms of pharmacy ownership. In 2014, 72.5% of pharmacy owners were men.
"We think that's because older pharmacists are just not able to sell or don’t want to sell their pharmacies," he said.
Whitney Cowart, PharmD, is staff pharmacist at an independent pharmacy in Tennessee. Her ultimate goal is to own a pharmacy herself. She said her experience now as a staff pharmacist has been invaluable in helping her prepare for that future. She was very forthright about her ownership plans with her current employer, who has been happy to share his business techniques and allow her to try out new programs in his three stores.
"I took this job for that reason," she said.
One trend seen among both male and female practitioners is the shrinking number of pharmacists with part-time work. The number of men and women who hold part-time positions has dropped since 2009; however, the decrease is more significant for women. According to the report, the percentage of female pharmacists working in part-time roles dropped from 29.8% in 2009 to 18.7% in 2014. The percentage of male pharmacists performing part-time work dropped from 18.4% in 2009 to 16.4% in 2014.
"We don't know whether that's because there is less available for the pharmacists or they are choosing not to do it," said Gaither.
According to the survey, almost 8% of pharmacists in 2014 said they worked a secondary job, which equaled about six additional hours per week.
Most part-time workers were found in the mass merchandiser or supermarket settings.
The study also found that women are usually carrying higher student-loan debt than their male counterparts, regardless of years of experience. In 2014, male pharmacists owed a mean of $31,553 in loan debt upon graduation, compared to a mean of $43,258 for female pharmacists.
The day-to-day workload and responsibilities for pharmacists are more diverse than ever. While in 2009, full-time pharmacists reported spending 55% of their time on patient-care services associated with medication dispensing, that number has now dropped to 49%, and pharmacists report spending more time in other areas.
In 2014, pharmacists reported spending 21% of their day on patient-care services that were not associated with medication dispensing, 13% on business and organization management, 7% on education, 4% on research, and 6% on other activities.
Part of the shift in how pharmacists spend their days could be due to the additional services now offered by most pharmacies. It was reported that 60% of practice settings now offer MTM, 53% offer immunization services, and 52% report adjustment of medication therapy. Just under half (48%) of chain pharmacists also reported offering health-screening services, and 57% of supermarket pharmacies reported offering these services as well.
In hospital pharmacies and other patient-care settings, 25% of those surveyed had collaborative practice agreements in place.
Cowart's Tennessee pharmacy offers traditional compounding, immunizations, a medication synchronization program, classes on diabetes management and heart health, and MTM.
"We're lucky enough that we always have two pharmacists at a time," she said.
That seems to be the case for most pharmacists. According to the survey, 76% of pharmacists have at least one other pharmacist working alongside them during the day to help divide their growing work responsibilities. Most hospital pharmacists (69%) also reported working with at least three or more pharmacy technicians, but this was far less common in the community setting. According to the report, fewer than 25% of community pharmacists, other those in mass-merchandiser settings, reported working with three or more technicians.
Andrew ChoWhile the general trend has been for pharmacists to work alongside more colleagues than they did 15 years ago, pharmacists report that since 2009 they have seen an increase in labor reductions as well. The survey found that 35% of full-time pharmacists reported restructuring work schedules to save labor costs, an approach that occurred most frequently in chain and hospital settings. In addition, 17% reported a reduction in hours, 9% reported pharmacist layoffs, and 6% reported early-retirement incentives for pharmacists.
Andrew Cho, PharmD, is a staff pharmacist at an independent pharmacy in Baltimore, Md. He worked for a chain pharmacy as a student and briefly as a licensed pharmacist before accepting his current post. He reported that the chain would often generate a skeleton schedule based on expected prescription and call volumes, and said that pharmacy managers at individual stores were expected to stay within the optimization levels determined by the corporate office.
"The number that's given is just barely enough to get through, " he said, adding that it often didn't account for staff absences.
Pharmacists are doing more than ever, but for some pharmacists, that has also meant an increase in stress and a decrease in job satisfaction.
More than 50% of traditional community pharmacists, hospital pharmacists, and owners or pharmacy partners report a high level of conflict between their home and work lives. The level of work-home conflict appears to be about the same for men and women in the profession; however, it's slightly higher, at 55%, for those pharmacists with five years or fewer on the job.
This latest survey has also shown a drop in job satisfaction, with just 65% of pharmacists reporting satisfaction in 2014, compared to 77% in 2004.
"They are asking the pharmacist to do more with less, so the pharmacists are really doing a lot more, but it may be also taking a toll on them in terms of their satisfaction," Gaither said.
Pharmacists who have seen the most significant drop in satisfaction are those working in the chain-store setting. According to the survey, in 2014 just 46% of chain pharmacists reported having job satisfaction, compared to 70% in 2004.
This finding does not surprise Cho, who said that when he worked as a pharmacy manager at a chain store that filled about 3,300 prescriptions per week, he often worked long, 14-hour shifts, with few breaks. He said there was constant pressure to meet corporate metrics, and he never felt as if the store had enough help.
"I felt like I was changing," he said. "This is not why I went to pharmacy school. I went to pharmacy school to help people, not to look at them as a prescription number."
Now, at an independent setting, Cho is much happier and feels less stressed.
"I feel like I am really helping people, educating people. They really appreciate what we do," he said.
Investigators found that pharmacists who have the highest career commitment are those working in other pharmacy settings (82%), hospital pharmacy (68%), and independent pharmacy (67%). Women also appear to have a stronger career commitment than men. According to the findings, 69% of women reported having a strong career commitment, compared to 61% of men.
When the survey inquired about pharmacists’ sense of control in the workplace, the highest levels were reported by those in the independent pharmacy setting (61%) and other settings (57%), while those with the lowest percentages were employed in the mass merchandiser (18%) and chain (30%) settings. According to the results, 31% of pharmacists in both the supermarket and hospital setting reported feeling control in their work.
When investigators looked at work attitudes based on experience, they found that younger workers had the highest levels of career commitment, with 73% reporting a strong commitment to their jobs.
Younger workers also had good levels of job satisfaction (65%), although fewer reported a feeling of control in their work (35%).
"Those pharmacists who have been out in practice the longest, who should be the most satisfied, the most content, and have the most control - we're not seeing that. So there's a group of pharmacists, the ones who have been out for a while, that are in a different place from where I would have expected them to be," Gaither said. "The younger pharmacists are very excited about being in pharmacy, very satisfied, very committed."
When researchers assessed some of the biggest stressors for those pharmacists just entering the field, they found that the biggest stressor - reported by 47% of those with 0-to-5 years of experience - was having so much work that they felt it all couldn't be done well. Other top stressors for those new to the job included lack of an adequate number of technicians (42%), lack of an adequate number of pharmacists (39%), interactions with difficult patients (32%), and fear of making a mistake while treating a patient (30%).
Stranges, who loves the versatility of his job as both a clinician and teacher, said that one of the biggest things he's learned is to think of his career as a marathon instead of a sprint; this has helped balance his stress levels and his expectations of himself on the job.
"I know that, especially for faculty and new practitioners, because we wear so many hats, there's going to be a lot more opportunity to get involved with various things at the college, within the profession, at the clinic, and teaching. It’s very important to be strategic with what you say yes to and what you say no to, because very quickly you can find your plate is too full, and that will disrupt your work-life balance," he said.
Jill Sederstrom is a freelance writer based in Kansas City.