Pharmacy Education: Who's in Charge?

by Scott A. Meyers, Executive Vice President
July 16, 2010

This month’s column may cause a bit of controversy, but most of us have been thinking it so I might as well say it. The pharmacy profession oversees its own educational process. Pharmacy leaders guide ACPE for both the professional degree program and the continuing pharmacy education component that plays such an important role after the initial professional degree is granted. Pharmacy leaders guide our colleges of pharmacy as deans, faculty and staff. Pharmacy leaders guide the national pharmacy organizations that develop and implement practice policy that impacts healthcare nationwide. Pharmacists play key roles in the continuing pharmacy education programs created by state and national pharmacy associations, medical education companies and many of the above mentioned colleges of pharmacy. But does the pharmacy profession have a plan for, or even control of, the educational expansion that is currently underway?

To my knowledge, no recent national manpower study has publicly acknowledged that the “pharmacist shortage” is over, but I’m hearing stories everyday that indicate it is. As of March 2010, the Pharmacy Manpower Project still claims that there is a “moderate demand” in 21 states, a balanced demand in 28 states and a “moderate surplus” in two. There may be shortages in very remote regions of Illinois and many other states, but there are now plenty of applicants for every open position in the larger metropolitan areas across the country! If that’s the case, what can or should we do about this issue?

I’d like to ask some questions (and don’t necessarily look for the answers) that need to be asked publicly to begin some real dialogue:

Are there too many colleges of pharmacy? And consequently, who and what are driving the current expansion in numbers and size of colleges of pharmacy? Is it the currently high pharmacist wages? Is it the high number of applicants to colleges of pharmacy created by the high wages? Probably both, and the high wages were created by the shortage of pharmacists that faced the nation around the turn of the millennium. The number of colleges of pharmacy has increased from 80 in the 1990’s to nearly 120 (counting colleges in the application through candidate status) today! The output of graduates has nearly doubled in that same time period indicating that existing colleges of pharmacy have also increased class sizes to meet the needs of the end of the previous century.

My concern is that some Universities might be establishing colleges of pharmacy strictly as a revenue source because the demand for seats in the classroom was so high! The problem is that the demand is now diminishing, but the frenzy to open schools has not. If pharmacists continue to receive wages in the $90-100K range then perhaps a college loan debt of potentially more than $120K is tolerable (not necessarily acceptable). But if wages begin to drop as they did with physical and occupational therapists in the recent past, then how will pharmacist making $60-75K per year ever erase a college loan debt of that size? That wage forecast comes from someone much smarter and seasoned than me!

And speaking of wages, I have to ask “Are pharmacists paid too much?” Or perhaps more appropriately, “Are pharmacists paid too much for what they may be currently doing?” The answer to the second question may be easier to tackle. Should someone who merely makes sure that the medication dispensed is the medication that was ordered, receive $45 to $50 per hour? Probably not. But if the pharmacist is ensuring that it is the best medication in the proper form and dose for that specific patient, their other existing conditions and medications, and in addition, the pharmacist is educating the patient or their caregiver on the proper way to use that medication, then the wage is a good value.

So if we have an abundance of graduates and currently licensed pharmacists, the next question that comes to mind is, “Why are there still shortages in rural and inner city sites?” This question is a tougher one to answer, but I have a couple of thoughts. One, does it take a specific kind of person to work in a small town or inner city pharmacy or hospital? Or is it that there are many professionals who lack the willingness to go where the need is? I think it could be both! Small towns and the inner city have trouble recruiting.

Small towns struggle with the perception of isolation and limited financial incentives. I say the perception of isolation because small towns can’t offer the big city perks of professional sports, the arts, the theater and a wide variety of fine dining options. But while almost every part of Illinois is within 90 minutes of all of that in either Chicago, Madison, St. Louis, Louisville, the Quad Cities, Evansville, and even Indianapolis, what most pharmacists don’t realize is that the small town makes it much easier to get to know the doctors and other prescribers in the community. The financial component comes from smaller prescription volumes in the community pharmacies and smaller bed capacities in the hospitals. The hospital will struggle to compete with the city institutions, but those who look a little further find that the cost of living in the rural settings will also be less.

Inner city sites deal with higher crime and cultural issues that sometimes scare away potential job seekers. Personal safety is always a reasonable concern and knowing how to protect yourself and your property as well as possible is valuable. But the larger issue that scares off potential job seekers, but really shouldn’t, is cultural difference. I know I would face a significant challenge if I practiced pharmacy in a largely ethno-specific neighborhood for which I was unfamiliar. But that actually happened to me in a way immediately after my own graduation in 1976. My first job was on the southwest side of Rockford in a community pharmacy. The neighborhood was solidly African-American and I grew up in a town of only 1000 white non-immigrants my entire life. The store’s staff was almost entirely African-American including all the pharmacy technicians. The two pharmacists, one clerk and the janitor were white. I truly enjoyed working for and with the patients that patronized the store. The pharmacy technicians helped this poor, pasty-looking white boy understand the needs of the patients and the community that surrounded the store and the patients themselves adapted and embraced a relationship that didn’t exist in many of Rockford’s retail outlets. Now, I may have fared as well in a largely Hispanic, Vietnamese, or Arabic neighborhood and I’m sure I would have given it a great try if they existed in Rockford at the time.

With the economy under stress and many of the babyboomers whose retirement was imminent a couple of years ago, now working for what could be another decade, we face a potential pharmacist surplus that could have a lasting impact on the profession. It seems to me that the pharmacy profession had better create a plan to address this and do it quickly. I certainly don’t have the answers, but I believe the current course could have an extremely negative impact on pharmacy and on health care. Pharmacists play a key role on the health care team and could play an even more important role with health care reform. The profession needs to take control of Pharmacy Education to ensure that we are there in the long run!

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