The Aggregate Demand Index: measuring the balance between pharmacist supply and demand, 1999-2001

Wage Premiums as a Means to Evaluate the Labor Market for Pharmacy Technicians in the United States: 1997-2018

Pharmacy technicians are integral members of the health care team, assisting pharmacists and other health professionals in assuring safe and effective medication use. To date, evaluation of the labor market for pharmacy technicians has been limited, and relatively little has been evaluated regarding trends in wages. The objective of this research is to use US Bureau of Labor Statistics (US BLS) data to evaluate changes in pharmacy technician wages in the United States from 1997 to 2018 relative to changes in the US consumer price index (CPI). Median hourly wages for pharmacy technicians were collected from US BLS data from 1997 to 2018. Median hourly wages were compared to expected hourly wages, with the difference, a wage premium, indicative of imbalances in the supply and demand of labor. Both positive and negative wage premiums were observed, with most positive wage premiums occurring prior to 2007 and most negative wage premiums observed after 2008. Differences in wage premiums were also observed between technicians working in various practice settings. Given the median length of employment of pharmacy technicians, it is likely that the majority of technicians working in US pharmacies have not experienced increases in their wages relative to what would be expected by changes in the CPI. This has occurred at a time when pharmacies and pharmacists are asking more of their pharmacy technicians. Researchers and pharmacy managers must continue to evaluate the pharmacy technician labor market to assure that technician wage and compensation levels attract an adequate supply of sufficiently skilled workers.

Illuminating the MPH Health Educator Workforce: Results and Implications of an Employer Survey

The public health workforce has been studied, but not health educators specifically. The development of a Master of Public Health (MPH) in community health education inspired research to illuminate the San Francisco MPHhealth educator labor market. Atime-series survey of an employer panelwas conducted between 1995 and 1999 regarding the number of MPH health educators on staff, hiring projections, and importance of selected competencies. In the San Francisco Bay Area, there were 4 MPH health educators per 100, 000 persons in 1999. The majority worked in local health departments and community-based organizations. Although hiring was largely replacement in the late 1990s, employers anticipated an increase in hiring from 2000 to 2004. Employers reported that educational preparationw as adequate, although preparationin specific competencies, such as bilingual competence, was lacking. These results suggest a favorable labor market for MPH health educators in the San Francisco Bay Area.

Trends in the Numbers of US Colleges of Pharmacy and Their Graduates, 1900 to 2014

Objective. To describe the cumulative and contemporary numbers of colleges and schools of pharmacy between 1900 and 2014 based on membership in the American Association of Colleges of Pharmacy or its predecessor, the American Conference of Pharmaceutical Faculties, as well as the mean number of graduates among member schools each year. Methods. A review of published literature for numbers of schools and graduates was conducted and descriptive statistics were calculated. Results. The cumulative number of schools rose from 21 to 152 between those years. The peak contemporary number was 130 in 2014. Including satellite campuses with parallel curricula brings the contemporary total to 172. The smallest number of graduates per member school per year occurred in 1945 and 1946, with peaks in 1951, 1977, and 2013 (∼110 per school per year in the latter two peaks). Conclusions. The number of US pharmacy schools progressively rose between 1900 and 2014, with the fastest rate of growth occurring in 2014. The mean number of graduates per school per year rose or fell with influences such as the Great Depression, World War II, and the GI Bill.

Factors affecting the unmet demand for pharmacists: state-level analysis

OBJECTIVE

To describe the relationship between state-level Aggregate Demand Index (ADI) data and market factors reflecting both supply and demand: unemployment rates, pharmacy graduates, community pharmacy prescription growth rates, and Medicare Part D.

DESIGN

Cross-sectional time series analysis using state-level data.

SETTING

U.S. labor market for pharmacists, from 2001 to 2010.

INTERVENTION

Model ADI data for states (dependent variable) against five independent variables: previous year ADI, unemployment rates, pharmacy graduates, prescription growth rates, and Medicare Part D.

MAIN OUTCOME MEASURES

Significance and predictive ability of the model, sign of the variables studied, and R2.

RESULTS

In the two-way (state and time) fixed-effects model, all variables were significant and R2 was 0.79. Contributions to state-level ADIs were, in rank order, previous year ADI, unemployment rates, pharmacy graduates, and prescription growth rates. The model predicted 2010 ADI values for 44 of 51 states within ±10%. The model depicts the independent contributions of each variable for the short (∼1 year) and longer term. Although the nature of ADI data precludes quantitative predictions about the pharmacist job market, the model results show marketplace directions (up or down) and comparative impacts.

CONCLUSION

The model demonstrated that unemployment rates, pharmacy graduates, prescription growth rates, and Medicare Part D contributed significantly to state-level ADIs between 2001 and 2010. The relationships uncovered should be monitored and reexamined as new data emerge in order to anticipate the directions of the pharmacist job market.

The pharmacist Aggregate Demand Index to explain changing pharmacist demand over a ten-year period

OBJECTIVES

To describe Aggregate Demand Index (ADI) trends from 1999-2010; to compare ADI time trends to concurrent data for US unemployment levels, US entry-level pharmacy graduates, and US retail prescription growth rate; and to determine which variables were significant predictors of ADI.

METHODS

Annual ADI data (dependent variable) were analyzed against annual unemployment rates, annual number of pharmacy graduates, and annual prescription growth rate (independent variables).

RESULTS

ADI data trended toward lower demand levels for pharmacists since late 2006, paralleling the US economic downturn. National ADI data were most highly correlated with unemployment (p < 0.001), then graduates (p < 0.006), then prescription growth rate (p < 0.093). A hierarchical model with the 3 variables was significant (p = 0.019), but only unemployment was a significant ADI predictor. Unemployment and ADI also were significantly related at the regional, division, and state levels.

CONCLUSIONS

The ADI is strongly linked to US unemployment rates. The relationship suggests that an improving economy might coincide with increased pharmacist demand. Predictable increases in future graduates and other factors support revisiting the modeling process as new data accumulate.

Examination of state-level changes in the pharmacist labor market using Census data

OBJECTIVE

To examine long-term changes in the U.S. pharmacist labor market across states.

DESIGN

Retrospective cohort study.

SETTING

The United States as a whole and individual states in 1990 and 2000.

PARTICIPANTS

Pharmacists and pharmacy school graduates from Census data and previous research, respectively.

INTERVENTION

Retrospective analysis of 5% Public Use Microdata Samples data on pharmacists from the 1990 and 2000 U.S. Census surveys, information on migration among states between 1995 and 2000, and previous research on pharmacy school graduates.

MAIN OUTCOME MEASURES

Changes in pharmacist counts and wages, as well as migration of pharmacists across states and pharmacy school graduates by state.

RESULTS

From 1990 to 2000, the ratio of pharmacists to 100,000 population increased from 70 to 76, but 13 states experienced declines in this datum, and overall changes in pharmacist counts varied considerably among states. The average wage, expressed in 2000 U.S. dollars, for pharmacists increased from $26.58 per hour to $33.80 per hour (17%), while the average wages of non-pharmacist college graduates increased from $26.37 to only $28.76 (9%). Wage changes varied across states.

CONCLUSION

According to the Census, the number of pharmacists per 100,000 population varied substantially across states. This variance in supply across states is not converging or easily explained. Overall, the shortage had a clear impact on the pharmacist labor market, yet this effect was not consistent across states.

Predicting the impact of Medicare Part D implementation on the pharmacy workforce

BACKGROUND

There is currently a shortage of pharmacist manpower, and it is expected to continue into the near future. It is also likely that the implementation of Medicare Part D will further aggravate the shortage by increasing demand, but it is not clear how much impact it will have.

OBJECTIVE

The purpose of this study was to estimate the impact that the new Medicare drug benefit program will have on pharmacy workforce demand.

METHODS

Analysis was conducted using forecasting techniques, which combines traditional statistical theory with both quantitative and qualitative methods. The Aggregated Demand Index (ADI) was designated as the dependent variable. A number of independent variables were selected for their potential to affect the workforce, demand for prescriptions or clinical services, and patient population. Data for the identified variables were collected from a variety of sources. Supply and demand data were analyzed at a national level.

RESULTS

Both historical and univariate forecasts indicated that the demand for pharmacists will continue to exceed the supply of pharmacists. The ADI ratio of pharmacist demand-to-supply has recently leveled off which means that demand and supply are in an equilibrium that falls to the demand side. Consequently, the Medicare Modernization Act (MMA) is not predicted to produce a dramatic increase in prescription volume, which would change the current demand for pharmacists. Multivariate forecasting models were not robust primarily due to the lack of precise predictor variables.

CONCLUSIONS

Despite the reliance on preliminary univariate forecasts and imprecise predictor variables, it appears that the increased use of prescriptions due to the MMA Part D will have minimal impact on pharmacist demand.

Survey of certified pharmacy technicians in the United States: a quality-of-worklife study

OBJECTIVE

To describe a nationwide random sample of Certified Pharmacy Technicians (CPhTs) by various demographic and work-related characteristics, identify various worklife attitudes, and determine whether these attitudes differed by practice setting and personal characteristics of the respondents.

DESIGN

Cross-sectional descriptive design.

SETTING

A random sample of 3,200 CPhTs provided by the Pharmacy Technician Certification Board.

INTERVENTIONS

Survey mailed in January 2004.

MAIN OUTCOME MEASURES

Responses to previously validated instruments measuring quality-of-worklife attitudes, rankings of factors as probable causes of medication preparation errors, and topics for continuing education (CE) programming.

RESULTS

The typical respondent was a white woman, 39 years of age, who was earning dollar 12.87 per hour. CPhTs exhibited modest levels of job satisfaction and career commitment and relatively low career turnover intention. They perceived modestly high levels of support from supervisors and coworkers, but less support from their employers. Quality-of-worklife attitudes were associated significantly with practice setting, rate of pay, and age, but not with gender and racial/ethnic background.

CONCLUSION

In view of CPhTs' continuingly important role in the delivery of pharmacy care, employers of CPhTs may want to consider rewarding experienced CPhTs who have demonstrated competency and loyalty to the organization. Career ladders for CPhTs may be a viable option.

Medication Management Model as Experiential Education Tool for Students of Pharmacy

A visiting nurse association (VNA) and a college of Pharmacy sought cost-effective models by which consultant pharmacy services could be offered at a rural branch office to improve medication management for high-risk patients. Through a collaborative relationship with the Albany College of Pharmacy, the Eddy VNA used the structure and support of the Partners In Care Foundation (The Model) Medication Management Model to simultaneously provide patient services and train Doctor of Pharmacy candidates. The Model brings the pharmacist into the homecare team to provide pharmaceutical care and can provide the framework by which pharmacist preceptors and interns can effectively provide services to high-risk patients identified through the agency's CQI process. Results from program implementation with 100 Medicaid waiver patients indicate positive staff response and an overall 43% acceptance rate with prescribers and suggest that this is a cost-effective medication management service with implications for adaptation by other HHAs.

Analysis of Pharmacist and Pharmacist-Extender Workforce in 1998–2000: Assessing Predictors and Differences Across States

OBJECTIVE

To examine the impact of supply and demand factors on filled positions for pharmacists and pharmacist extenders (pharmacist technicians and aides) and assess differences across states through analysis of state-level pharmacist labor market data.

DESIGN

Cross-sectional analysis.

SETTING

United States.

PARTICIPANTS

Not applicable.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

State-level counts of filled pharmacist and pharmacist-extender positions, wages, and various available demographic, health, policy, and other factors related to the pharmacist labor market.

RESULTS

Across states, the total population and the number of community pharmacy prescriptions were very accurate predictors (R2 = 0.99) of the number of pharmacist and pharmacist-extender positions, and all other variables were insignificant after these two variables were controlled for. Pharmacists and pharmacist-extenders were positively correlated, and the ratio of the two was not related to observable policy-related variables. Outlying states, in terms of simple pharmacist-to-population ratios, were difficult to categorize.

CONCLUSION

Future changes in prescriptions are likely to affect the pharmacist and pharmacist-extender labor markets. Across states, pharmacists and extenders relate as complements rather than substitutes. The number of pharmacist graduates and state-level regulations regarding technician-to-pharmacist ratios appears to have a small effect on filled positions across states.

The Feasibility of Implementing an Evidence-Based Core Set of Clinical Pharmacy Services in 2020: Manpower, Marketplace Factors, and Pharmacy Leadership

Development of a national plan to implement a core set of clinical pharmacy services in United States hospitals by 2020 requires assertive leadership from pharmacy organizations and state boards of pharmacy, and a commitment from the profession. Factors that may affect the development are grouped into three areas: manpower, marketplace variables, and pharmacy leadership. Although the number of pharmacy school graduates (7000) was about the same in 1990 and 2000, a greater number of pharmacy schools and high student enrollment, coupled with the Accreditation Council for Pharmacy Education's acceptance of foreign-trained pharmacists, suggest that the number of pharmacists will increase substantially in the near future. We estimate that the net increase in pharmacists (new pharmacy graduates less pharmacists who retire or die) in the United States will be 139,929 from 2000-2020, for a total of 335,040 pharmacists (71% increase). The number of pharmacy technicians increased substantially (66%), from 150,000 in 1996 to 250,000 in 2002. The number of residents in programs accredited by the American Society of Health-System Pharmacists increased 148%, from 435 in 1990 to 1080 in 2002. We conservatively project an increase of 33,000 pharmacists who complete residencies from 2000-2020. The pharmacy marketplace has changed dramatically over the last 12 years, with 10,754 independent community pharmacies closing (2.46 pharmacies/day) and 8459 chain outlets opening (1.93 chains/day). In recent years, mail-order pharmacies have expanded faster than other retail outlets and now process over 18% of U.S. prescriptions. Increased use of robotic systems (some can process 5000 prescriptions/hr) and technicians will diminish the demand for dispensing pharmacists. In addition, up to 10% of U.S. retail prescriptions may be filled outside the country's borders. These data indicate that there will be a sufficient supply of pharmacists and technicians in the future. Thus, it is feasible, based on manpower, marketplace factors, and pharmacy leadership, to implement a core set of clinical pharmacy services for patients in U.S. hospitals by 2020.

Disequilibrium and Human Capital in Pharmacy Labor Markets: Evidence From Four States

OBJECTIVES

To estimate the association between pharmacists' stocks of human capital (work experience and education), practice setting, demographics, and wage rates in the overall labor market and to estimate the association between these same variables and wage rates within six distinct pharmacy employment sectors. Wage estimation is used as a proxy measure of demand for pharmacists' services.

DESIGN

Descriptive survey analysis.

SETTING

Illinois, Minnesota, Ohio, and Wisconsin.

PARTICIPANTS

Licensed pharmacists working 30 or more hours per week.

INTERVENTION

Analysis of data collected with cross-sectional mail surveys conducted in four states.

MAIN OUTCOME MEASURES

Hourly wage rates for all pharmacists working 30 or more hours per week and hourly wage rates for pharmacists employed in large chain, independent, mass-merchandiser, hospital, health maintenance organization (HMO), and other settings.

RESULTS

A total of 2,235 responses were received, for an adjusted response rate of 53.1%. Application of exclusion criteria left 1,450 responses from full-time pharmacists to analyze. Results from estimations of wages in the pooled sample and for pharmacists in the hospital setting suggest that advanced training and years of experience are associated positively with higher hourly wages. Years of experience were also associated positively with higher wages in independent and other settings, while neither advanced education nor experience was related to wages in large chain, mass-merchandiser, or HMO settings.

CONCLUSION

Overall, the market for full-time pharmacists' labor is competitive, and employers pay wage premiums to those with larger stocks of human capital, especially advanced education and more years of pharmacy practice experience. The evidence supports the hypothesis that demand is exceeding supply in select employment sectors.

Pharmacy school graduates by state and region: 1990-1999

OBJECTIVE

To describe the distribution of pharmacy schools and graduates (first professional degree) at the state, divisional, and regional levels during the 10-year period from 1990 through 1999, as well as enrollment patterns by residential status.

DESIGN

Yearly school-level graduate counts from 1990 through 1999 were obtained from the American Association of Colleges of Pharmacy and analyzed at the state, division, region, and national levels. Comparisons were made before and after adjusting for state population. In-state enrollment patterns for 1998 were examined.

SETTING

United States.

MAIN OUTCOME MEASURES

At various geographic levels, the distribution of schools and new graduates adjusted to population; cumulative production of graduates; percentage of in-state enrollment.

RESULTS

Over the 10-year study period, 73,541 new pharmacists graduated from U.S. pharmacy schools, about 9,500 more than graduated in the 1980s. The number of schools varied across states (range, 0-5), as did cumulative graduate counts (range, 0-7,303), with high-producing states including those with four and five schools. Nationally, 28 new pharmacists graduated per year per 1 million population. Several populous states, including California, Florida, Illinois, and Texas, produced pharmacists at a rate substantially below the national average when computed as graduates per year per million population. The West region had the lowest annual graduate count adjusted for population. In-state enrollment was consistently high, with nearly 80% of individuals graduating from schools in their state of residence.

CONCLUSION

The number of pharmacy schools and graduates increased during the 1990s, a period of substantial educational and workforce change in pharmacy. Numbers of schools and graduates varied significantly across states. The West region and several populous states had graduate counts less than one-half the national average. With the current national pharmacist shortage, greater attention should be directed to the development of strategies to address imbalances between supply and demand within individual states.