Remuneration, Workload Remain Barriers to Pharmacy Expansion

Community pharmacy professional services have evidence-based clinical value, but remuneration gaps and workload demands are consistently hindering sustainable implementation, according to the International Journal of Pharmacy Practice.¹

“Professional pharmacy services have come to encompass a range of clinical and patient-centered activities provided by community pharmacists to optimize medication therapy and improve patient outcomes,” according to a study in Exploratory Research in Clinical and Social Pharmacy.² “Starting in the 1990s, the conceptualization of patient-centered care and pharmaceutical care practice have driven the innovation of new professional pharmacy services.”

The reality of contemporary community pharmacy practice is that pharmacists are fundamentally poor on time. Although there is immense clinical potential in services like vaccinations, point-of-care testing, and prescribing, daily workload pressures and conflicting administrative duties continue to choke service delivery in pharmacy practice.¹

READ MORE: Transforming Community Pharmacists Into Care Providers

A scoping review of implemented programs across the Organisation for Economic Co-operation and Development (OECD) member countries highlights that time constraints, specifically the hours needed for training, service provision, and documenting clinical interventions, are the most significant logistical barriers.

Workload and Staffing Bottlenecks

This struggle is further compounded by a widespread lack of support staff within community pharmacies, which leaves pharmacists torn between clinical consultations and traditional dispensing responsibilities. Industry experts argue that a successful transition to expanded practice models requires a structural redesign of the workplace.^1,3,4

In emerging primary care clinic setups, separating clinical and dispensing duties by utilizing dedicated staff is a best practice to ensure the safe and sustainable delivery of patient-centered care.⁴

Navigating the Remuneration Void

Even if workload challenges are addressed, the financial models backing these expanded roles have failed to keep pace with the evolving scope of practice. Pharmacists routinely report that the remuneration they receive for delivering advanced health services is inadequate, and they are often discouraged when corporate management fails to pass service-based funding down to the performing practitioners.^1,4

Historically, pharmacies have relied on rigid fee-for-service systems, which pay a flat rate per intervention but fail to cover the actual time and operational costs incurred. Compounding this, many patients are forced to pay out-of-pocket for clinical care when public funding is unavailable, which severely limits consumer participation.

Professional bodies, such as the Academy of Managed Care Pharmacy, strongly advocate for structured reimbursement models that compensate pharmacists for direct patient care services, recognizing them as collaborative medication experts. Pharmacists increasingly favor moving toward time- and practice-based government funding models linked with quality indicators rather than continuing to rely on dispensing-centered payment streams.^1,2

This shift is essential because the cost and duration of advanced clinical training, such as independent prescribing courses, are substantial, making financial sustainability a make-or-break factor for community pharmacies and individual practitioners.¹

Proving Value in the Broader Health Care Ecosystem

For expanded pharmacy services to secure long-term viability, community pharmacies must move beyond a retail identity and prove their clinical and economic value to health care payers and stakeholders. Robust evidence shows that pharmacist-led care interventions lead to optimized medication use, fewer drug-related problems, improved clinical outcomes, and an overall reduction in total health care costs.^2,3,5

However, demonstrating this impact systematically is hindered by a historic reliance on process outputs, such as dispensing data and the volume of services, rather than longitudinal patient outcomes like quality of life or reduced hospitalizations. Furthermore, there is currently no standardized set of key performance indicators (KPIs) to measure patient-level outcomes specifically for community pharmacy services.⁵

To overcome skepticism and general practitioner resistance, where other primary care professionals may view pharmacist services as encroaching on professional responsibilities, pharmacists must proactively build collaborative relationships, establish trust, and adopt outcome-based performance measures. Only through objective, data-driven validation of clinical improvement can the pharmacy profession successfully advocate for its integration and full recognition as a primary care destination.^1,2,4,5

“This review confirms that remuneration, workload pressures, confidence and collaboration between health professionals, support from staff and management, consumer relationships, organized procedures, and pharmacist training are important for professional service provision,” concluded the authors of the current study.¹ “Future research should investigate the newer remuneration structures and pharmacy services, their attempts to address implementation factors, and their impact on professional service practices and sustainability.”

READ MORE: Finance Strategies for Independent Pharmacies Facing Shrinking Margins

REFERENCES

1. Karia AM, Chen L, Norman R, et al. Barriers and facilitators affecting the implementation of community pharmacist–led professional services in Organisation for Economic Co-operation and Development member countries: a scoping review in the context of expanded scope. IJPP. 2025;34(4):344-357. doi:10.1093/ijpp/riaf120

2. Patient care services provided by a pharmacist. AMCP. March 2022. Accessed August 25, 2026. https://www.amcp.org/legislative-regulatory-position/patient-care-services-provided-pharmacist

3. Eldooma I, Maatoug M, Yousif M. Outcomes of pharmacist-led pharmaceutical care interventions within community pharmacies: narrative review. Integr Pharm Res Pract. 2023 May 15;12:113-126. doi: 10.2147/IPRP.S408340

4. Gysel SC, Tsuyuki RT. The pharmacist primary care clinic: the evolution of pharmacy practice? Can Pharm J (Ott). 2024 Feb 1;157(2):47-49. doi: 10.1177/17151635241229059

5. Reis L, Gregório J. Professional pharmacy services’ outcomes performance measurement: a narrative review. Explor Res Clin Soc Pharm. 2024;16:100533. doi:10.1016/j.rcsop.2024.100533