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

Association between increased number of US pharmacy graduates and pharmacist counts by state from 2000-2009

OBJECTIVE

To determine whether growth in the number of pharmacy graduates and newly accredited schools from 2000 to 2009 were larger in states with fewer pharmacists per population age ≥ 65 years.

METHODS

States were aggregated into quartiles based on rank-ordered ratios of in-state pharmacists per 100,000 population aged ≥ 65 years. Quartiles were then compared with respect to the number of new graduates.

RESULTS

The mean cumulative number of graduates was highest in the first quartile of states (those with the greatest need for pharmacists) and lowest in the fourth quartile of states. States with the greatest need for pharmacists had the lowest positive growth in number of pharmacists per population ≥ 65 years. The majority of new schools in 2009 were located in states with relatively low numbers of pharmacists.

CONCLUSION

The growth in new pharmacy graduates created by expansion in schools as well as in graduates per school helped states meet demand between 2000 and 2009. However, tremendous variation remains in the number of graduates as well as the number of pharmacists across states. The quartile framework is useful for assessing the number of new pharmacy graduates based on pharmacists per population ratios. Based on current dynamics in the supply and demand of pharmacists, frequent monitoring is recommended.

An examination of pharmacists' labor supply and wages

BACKGROUND

For the last decade, there has been a shortage of pharmacists for most of the United States. This shortage is in part because of demand-side phenomena (eg, increasing prescription drug use, increases in the complexity of drug regimens, and an aging population). However, there also may be supply-side causes. Although the number of pharmacy school graduates has increased, most graduates are women, many of whom may choose to work part-time. Because of the change in sex composition of the workforce, some researchers conclude that pharmacist shortages will be even more critical in the future.

OBJECTIVES

The goals of this article are to model pharmacists' decisions to work, estimate pharmacists' wages, and identify influences on the number of hours worked by pharmacists in the United States.

METHODS

Pharmacist labor supply is examined using a static, 3-step, empirical labor supply model that estimates the decision to work, hourly wages, and number of hours worked for U.S. pharmacists.

RESULTS

Pharmacists have high starting wages but flat wage trajectories. Although many pharmacists are working part-time, this is true for women and men. Income effects do not dominate substitution effects, even at the high level of compensation found here.

CONCLUSIONS

Results indicate that previous predictions brought about by the changing sex composition of the pharmacist labor force might not come to pass, and additional pharmacists may be attracted to the profession by higher wages and flexible schedules.

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.

New pharmacist supply projections: Lower separation rates and increased graduates boost supply estimates

OBJECTIVE

To revise the 2000 Bureau of Health Professions Pharmacist Supply Model based on new data.

DESIGN

Stock-flow model.

SETTING

United States.

PARTICIPANTS

A 2004 estimate of active pharmacists reported by the Bureau of Labor Statistics was used to derive the base count for the 2007 supply model.

INTERVENTIONS

Starting with a 2004 base of active pharmacists, new graduates are added to the supply annually and losses resulting from death and retirement are subtracted.

MAIN OUTCOME MEASURES

Age- and gender-based pharmacist supply estimates, 2004-2020.

RESULTS

Increased U.S. pharmacist supply estimates (236,227 in 2007 to 304,986 in 2020) indicate that pharmacists will remain the third largest professional health group behind nurses and physicians. Increases were driven by longer persistence in the workforce (59%), increased numbers of U.S. graduates (35%), and increases from international pharmacy graduates (IPGs) achieving U.S. licensure (6%). Since more pharmacists are expected to be working part time the full-time equivalent (FTE) supply will be reduced by about 15%. The mean age of pharmacists was projected to decline from 47 to 43 by 2020. Because of unequal distribution across age groups, large pharmacist cohorts approaching retirement age will result in fewer pharmacists available to replace them. The ratio of pharmacists to the over-65 population is expected to decrease after 2011 and continue to fall beyond 2020; this is likely a reflection of baby boomers passing through older age cohorts.

CONCLUSION

The revised estimated active U.S. pharmacist head count in 2006 is 232,597, with equivalent FTEs totaling approximately 198,000. The substantial increase over the 2000 pharmacist supply model estimates is primarily attributable to pharmacists remaining in the workforce longer and educational expansion. U.S. licensed IPGs account for less than 6% of overall increases. The pharmacist work-force is projected to become younger on average by about 4 years by 2020. Coincident demands for more physicians and nurses over the same period and shortages in all three professions stipulate that active steps be taken, including continued monitoring of work trends among pharmacists and other health professionals.

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.

Update on the pharmacist shortage: National and state data through 2003

PURPOSE

Aggregate Demand Index (ADI) survey results were used to describe the severity of the pharmacist shortage at the national and state levels and by practice site and impact on the U.S. population.

METHODS

Time-series analysis was used to characterize national and state trends in the ADI from September 1999 through September 2003. The time trends for the distribution of ratings and the demand index by practice site were also examined. Historical data about retail prescriptions filled and related growth rates were compiled and compared. ADI survey results were also compared with data from other surveys.

RESULTS

Over time, ADI data demonstrated a continuing national pharmacist shortage, as the ability to fill pharmacist vacancies was rated at least moderately difficult. A very slight downward trend in severity (slope = -0.008) was observed. Other survey series had similar findings. States with the most severe shortage levels tended to have large populations, while those with the lowest levels tended to have smaller populations. More states improved than worsened the severity of their shortage, with 30 states maintaining the same ADI rating. Although there was a high correlation between the retail prescription growth rate and the ADI (r = 0.84), there was a much greater decrease in prescription growth (73%) than ADI levels (6.5%).

CONCLUSION

There was a sustained unmet demand for pharmacists throughout the United States from September 1999 through September 2003. More states moved toward having an adequate supply of pharmacists than toward having a more severe shortage of pharmacists, but the national ADI suggests that the system remains stressed.