The Future of Pharmacy Jobs -- Will It Be Feast or Famine?
Darrell Hulisz, PharmD, Daniel L. Brown, PharmD
April 15, 2014
Editor's Note:
Chances are, if you ask most laypeople about the job outlook for
pharmacists, they would say it is outstanding. For many years, pharmacy
graduates have enjoyed near-full employment in the geographic areas of
their choice. According to the Bureau of Labor Statistics, employment
of pharmacists is projected to grow 14% from 2012 to 2022.[1] However,
if you ask pharmacy students, recent graduates, and many practicing
pharmacists, they are likely to express increasing concern about
employment opportunities.

Daniel L. Brown, PharmD, Professor in the Lloyd L. Gregory School of
Pharmacy and Director of Faculty Development at Palm Beach Atlantic
University, is considered a national thought leader in the field of
pharmacy workforce. Dr. Brown published a thought-proving article
last year in the American Journal of Pharmaceutical Education[2]
and addressed what he called a "looming joblessness crisis for new
pharmacy graduates." Darrell Hulisz, PharmD, Associate Professor,
Case Western Reserve University School of Medicine, and member of the
Ask the Pharmacists panel for Medscape, spoke with Dr. Brown regarding
this important topic, which should be of great interest to all pharmacy
professionals.

New Pharmacy Schools: Why So Many Expanded Programs?
Dr. Hulisz: What were the most important factors that led to the rapid
increase in the number of newer pharmacy schools?
Dr. Brown: The pharmacist job market in the 1990s and up to about 2007
was characterized by a significant shortfall of pharmacists, fueled
largely by a marked increase of community pharmacy positions in chain
stores, supermarkets, and mass merchandisers. This made jobs plentiful
and caused salaries to rise above 6 figures, understandably making
pharmacists a very hot commodity. The lure of a guaranteed job with a
high salary attracted many people to pharmacy, and the growing number
of applicants created opportunities for new schools of pharmacy to be
established and for existing schools to expand.
It is not surprising that many academic institutions found starting
a school of pharmacy to be a lucrative enterprise, and many existing
schools saw opportunities to build new facilities or secure additional
resources by expanding enrollment. Essentially, the financial incentives
for academic growth have been considerable.
Dr. Hulisz: Why did the rapid expansion of new pharmacy schools seem to
go largely unnoticed for so many years?
Dr. Brown: At first it was a good thing -- perhaps up to about 2010 --
and allowed the profession to meet legitimate manpower needs. And because
pharmacy has a strong accrediting body, which does an excellent job
of ensuring that high quality standards are met by all new and existing
programs, there was no need for concern about academic expansion weakening
the quality of pharmacy education.
However, the rate of growth turned out to be much greater than anyone
could have anticipated 10 years ago. A profession that produced a fairly
stable graduating cohort of 6000-8000 new pharmacists per year from 1974
to 2003 is suddenly poised to graduate over 14,000 this year. Such growth
is totally unprecedented in pharmacy.
To some extent, the magnitude of growth snuck up on people, though the
tightening job market has been increasingly apparent to graduates and
recruiters of graduates going back to 2007 or 2008. It is ironic that
academic growth tends to mask itself by creating many new faculty jobs
for pharmacists. Roughly 50 new schools have created a couple thousand
jobs for pharmacists as faculty members over the past 13 years. Some
in our profession overlooked the growth because they were counting on
an expansion of pharmacist patient-care roles to offset the increasing
number of graduates, with the hope that they would be assimilated into an
ever-expanding workforce as new responsibility for pharmacists generated
new pharmacist positions.
I don't dispute such potential, but I also feel that academic growth
has far exceeded the need, and a more reasonable growth rate would have
better served the profession.
Dr. Hulisz: In your article, you noted that there were 80 colleges
of pharmacy in 2000 and 127 accredited colleges by 2012. What is the
current number of pharmacy schools, including those having candidate or
precandidate status?
Dr. Brown: The figure of 127 accounted for accredited pharmacy programs
within the 50 states. Only 1 new program was established in 2013: the
University of North Texas. There could be as many as 3 more in 2014,
bringing the total to 131. California Health Sciences University has been
granted precandidate status by the Accreditation Council for Pharmacy
Education (ACPE). Two other schools in Southern California are hoping
to receive precandidate status in time to open in the fall of 2014.
However, the number of programs is not an ideal measure of academic
growth. The majority of academic growth in pharmacy since 2000 has
been the result of the expansion of existing programs rather than the
establishment of new schools.
Just looking at the number of accredited programs does not reflect the
full picture. The total number of graduates is a more reliable measure
of academic growth.
Dr. Hulisz: In your opinion, should some pharmacy schools consider
decreasing student enrollment into the professional division?
Dr. Brown: No, not at this point. It might come to pass eventually through
natural supply and demand market forces, but that probably won't happen
until the next decade. For now, I would like to see new growth abate for
at least a few years, as a result of individual institutions voluntarily
choosing to refrain from either establishing new programs or expanding
existing programs. Furthermore, I am not in favor of ACPE or any other
agency being given the power to prevent a new program from opening or
expanding, apart from a failure to meet accreditation standards.
My purpose in raising awareness of this issue is simply to encourage
institutions that might be considering a start-up or expansion to factor
in all the facts before making a decision. In addition to the financial
feasibility of their plans, they should give thought to the magnitude
of loans that students are likely to accrue while completing a PharmD
program and the probability of graduates being able to secure suitable
employment in the job market they are likely to encounter upon graduation.
Much attention is paid to the large number of applicants to pharmacy
schools and to robust job projections for the future -- such as those in
the latest Bureau of Labor Statistics report issued in January 2014, which
are frequently used to justify new or expanded programs. However, the
ever-increasing supply side of the equation seems to be generally ignored.
I would like to hear leaders within pharmacy organizations at least admit
to the possibility that academia might have already grown sufficiently
to meet the demands of the near future, and that continued growth might
not be necessary at this time.
What is wrong with encouraging a full examination of all evidence
before making a decision? Why not engage in open discussions about
the possibility that the rate of academic growth since 2000 might have
overshot the mark, and it needs to be curtailed for a while?
Such feedback might be helpful in dissuading institutions currently
contemplating the start-up or expansion of a PharmD program that is
not really necessary. I foresee a day when ACPE will require schools to
report the employment rate of their graduating cohorts 6 or 12 months out
from graduation, just as they report North American Pharmacist Licensure
Examination (NAPLEX) pass rates today.
Job Outlook for Grads
Dr. Hulisz: Do we have surplus of PharmD graduates at the present time?
Dr. Brown: I think we have been hovering around an equilibrium point for
a few years. It is a gradual process and it varies from state to state,
but as the job market in more states begins to level off, it is becoming
more of a national phenomenon.
What concerns me is that the growth or supply side of the manpower
equation shows no signs of reaching a plateau. There are currently 17
new schools that have yet to graduate their first class, and there are
also newly expanded programs whose larger graduation rates have not yet
taken effect. With new programs still on the drawing board and hoping
to open within the next 2 or 3 years, a pervasive pharmacist surplus is
a very real possibility.
Dr. Hulisz: Has momentum shifted yet? In 2014, has major academic
expansion either plateaued or possibly even declined?
Dr. Brown: The answer is a definitive "somewhat." The last year in
which academia did not have at least 1 new school open was 2004. From
2005 through 2012, at least 4 new schools opened every year. To put the
magnitude of growth in perspective, the 2001 Pharmacy Manpower Project
Conference projected that about 3 new PharmD programs would open every
10 years.[3] Back then, no one could have imagined that a minimum of 4
new schools would open every year for 8 consecutive years. It is a good
sign that only 1 school opened last year, but there could be 3 more this
year pending ACPE approval, so the growth phase has slowed -- but it is
by no means over.
The expansion of existing schools has not stopped, either. My hope is
that the growth of the academy will finally plateau within 2-3 years
and then hold steady for a period of time, as the pharmacist marketplace
becomes better defined. It is important to keep in mind that the impact
of a new school is not felt in the job market until 3 or 4 years after
the program starts, and then it takes a few years thereafter for the
market to equilibrate to the expanded number of graduates.
With that in mind, it is reasonable to anticipate that the pharmacist
job market will be affected by continuing academic growth for at least
another 8 years.
Dr. Hulisz: In your article, you cite the Pharmacy Workforce Center
and their statistic of aggregate demand index (ADI) as being at an
equilibrium point: close to 3 in 2010. You also cite regional differences
in 2012. Where is the ADI today, and in which direction do you see
it heading?
(Editor's Note: The ADI is a data element derived by the Pharmacy
Workforce Center [PWC] from monthly impressions of the pharmacist job
market provided by a nationwide group of participants. The index consists
of a 5-point scale, where 5 = high demand, difficulty filling openings; 4
= moderate demand, some difficulty filling openings; 3 = demand in balance
with supply; 2 = demand is less than the supply of pharmacists available;
and 1 = demand is much less than the supply of pharmacists available.[4])
Dr. Brown: The latest ADI data from January 2014[4] show that 2 regions
of the country, New England and Middle Atlantic, are already below 3. I'm
not inclined to venture a prediction on the future of the ADI any more
than I would attempt to predict the 2014 NCAA basketball champion. I
would point out, however, that the growth rate of pharmacy graduates
can be projected into the intermediate future with a high level of
certainty. It involves no skill in prognostication. We know for a fact
that pharmacy is headed for an annual graduation rate of at least 15,000
graduates within a few years.
In contrast, the number of jobs that will be available for those graduates
is an area of great uncertainty. I hope there will be enough new jobs to
sustain the equilibrium, but such optimistic job projections are based on
assumptions that might not come to pass. Therefore, on the basis of the
differing probabilities between the supply side and the demand side of
the manpower equation, it seems quite possible that the ADI will trend
downward at least into the next decade.
One should also consider that the ADI, as a measure of job market
conditions, relies on feedback from employers on the basis of their
experiences in hiring pharmacists. The methodology is well suited to
a pharmacist shortage environment, such as existed when the ADI was
created. However, as the marketplace moves closer to pharmacist surplus
conditions, the perspective of job seekers might be more telling than
that of the people doing the hiring. I think our profession needs to do
a better job of soliciting feedback from the new graduates who are out
there trying to find a job.
Pharmacist Roles
Dr. Hulisz: You note that direct patient care jobs for pharmacists
outside of acute care facilities have been slow to develop. Why is this?
Dr. Brown: I wish I could answer that question definitively, but I can
only provide my best guess. First, I should mention that the impact of the
medication therapy management provisions of Medicare Part D has not been
as dramatic as originally anticipated. It has been slow-going. Billing for
such services and integrating medication therapy management practices into
the workflow of community pharmacies have proven to be daunting logistical
challenges. Aside from Medicare Part D, it is the development or lack
thereof of direct ambulatory care roles that is more central to the issue.
I was the Director of Ambulatory Care at the University of Illinois
Medical Center in 1990. At that time, I thought direct pharmacist
involvement in primary care and ambulatory care was about to take off,
but it didn't.
In 2001, the conference hosted by the Pharmacy Manpower Project that I
spoke of earlier predicted a major expansion of primary care jobs over
the next 20 years.[3] Their projections were reasonable at the time,
but the growth of such ambulatory care jobs hasn't materialized to any
great extent.
Over the past couple of decades, the prevalence of pharmacists working
in an ambulatory care environment has been somewhat localized to 3
specific areas: first, the Veterans Administration and Public Health
Service; second, sites that have accepted a faculty practitioner funded
by academia; and third, closed health maintenance organization systems,
such as Kaiser Permanente.
The fact of the matter is that new patient care positions for pharmacists
in outpatient care have failed to expand in a manner comparable to the
consistent expansion of inpatient clinical positions during the 1980s
and 1990s. I suspect that this disparity has a lot to do with differences
in reimbursement for services.
It was relatively easy to justify the cost of pharmacist activities on
the inpatient side, whether on the basis of a cost or a revenue model. As
a result, clinical pharmacy services in hospitals were easily assimilated
into inpatient pharmacy operations.
Reimbursement for outpatient clinical pharmacy services is an entirely
different matter. Even as pharmacists gain provider status and
prescribing authority, the rate-limiting step to job growth is going
to be reimbursement for services rendered and the ability to readily
assimilate new patient care functions into existing pharmacy operations.
In other words, the system needs to undergo fundamental change for
pharmacy to develop clinically on the outpatient side as it did on the
inpatient side. It appears that such change might be forthcoming, but
the scope and rate of change remain uncertain.
Dr. Hulisz: Do you see the Affordable Care Act as serving to increase
or decrease demand for pharmacists, and why?
Dr. Brown: At this point in time, the Affordable Care Act is fraught
with unknown variables. I hesitate to conjecture on the impact it might
have on the profession of pharmacy. Some expect great opportunities
for pharmacists to find new niches in the patient-centered medical home
model. I just don't know.
However, the one aspect of the legislation that seems most likely to
affect pharmacy practice is Medicaid expansion. I would expect that
community pharmacies will see more Medicaid prescriptions in coming years
and, perhaps, greater opportunities to engage in preventative services,
such as health screenings and immunizations.
We also might see a greater emphasis on establishing routine medication
therapy management services. Other than that, we will have to wait and
see how the law unfolds, which provisions remain untouched, which are
fully funded, and which are modified or eliminated.
Final Thoughts, and Advice for Future Pharmacists
Dr. Hulisz: US News & World Report [5] ranked the career of pharmacist
as #5 of 100 careers overall and #3 among the best healthcare jobs. Among
the reasons cited was solid employment growth. Do you agree?
Dr. Brown: I am a pharmacist, so I am biased -- but yes, I agree. Pharmacy
is and always has been a rewarding profession that provides valuable
healthcare services and unmatched access to care. The role of pharmacists
will continue to develop and expand, as it should.
A tightening job market due to the growth of pharmacy schools changes
neither the importance of pharmacy nor the public's need for pharmacy
services. It might become more challenging to find the right job amid
increasing competition from a growing applicant pool, but those who
prepare themselves well and are willing to be flexible should have no
trouble securing employment. When they do, I expect that they will find
pharmacy to be a richly rewarding vocation.
I consider myself blessed to have spent 3-plus decades in this field. On
the other hand, those who are attracted to pharmacy primarily because
they anticipate an easy-to-find, high-paying job might want to reconsider.
Dr. Hulisz: What advice would you give to a current pharmacy student?
Dr. Brown: Be optimistic, and have faith that you have chosen the right
profession. It is a profession that will serve you well if you take care
of business. By that I mean, fully dedicate yourself to making the most
of your pharmacy education, and prepare yourself for the future in ways
that maximize your marketability.
Study diligently for the sake of learning, not just to pass exams. When
engaged in a real-life training experience, treat it as a 24/7
interview. Impress everyone at the training site with your work ethic,
your commitment to excellence, your service-oriented mentality, your
compassion for all people, your emotional maturity, and your ability
to work well with others. In short, put your best foot forward at all
times. People tend to notice a positive attitude, a willingness to work
hard, and a trustworthy character. If they witness such attributes in you,
they will want you to be a member of their team.
Also, get involved in supporting, promoting, and developing your
profession. Be an advocate for pharmacy issues, and prepare yourself
to be a pioneer of progressive new roles and services. Become the kind
of pharmacist who feels compelled to blaze a trail where one does not
already exist.
If you follow this advice, grounded in a sense of humble gratitude for
the talents and opportunities that have been afforded to you, employers
will eagerly seek to hire you. Issues pertaining to employment will
become inconsequential.
There is a well-worn biblical expression which suggests that we tend
to reap what we sow. That principle supersedes the dynamics of the job
market. Pharmacy students who sow a great education are destined to reap
the rewards of a great career.
References
 US Department of Labor. Bureau of Labor
 Statistics. Occupational outlook handbook: pharmacists. 2014-2015
 edition. http://www.bls.gov/ooh/healthcare/pharmacists.htm Accessed
 March 19, 2014.
 Brown DL. A looming joblessness crisis for new pharmacy graduates and
 the implications it holds for the academy. Am J Pharm Educ. 2013;77:90.
 Knapp DA. Professionally determined need for
 pharmacy services in 2020. Am J Pharm Educ. 2002;66:421-429.
 http://www.aacp.org/resources/research/pharmacymanpower/Documents/2020NeedForServices.pdf
 Accessed April 7, 2014.
 Pharmacy Manpower Project. Aggregate demand
 index. http://www.pharmacymanpower.com/ Accessed April 2, 2014.
 US News & World Report. Money. Careers. Best jobs
 2014. http://money.usnews.com/careers/best-jobs/rankings Accessed April
 2, 2014.

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Cite this article: The Future of Pharmacy Jobs -- Will It Be Feast or
Famine? Medscape. Apr 15, 2014.