A Crucial Endeavor
By Shane Garrettson
It is an irrefutable truth that pharmacists are the preeminent medical experts in the field and serve a critical function in healthcare management for patients all over the world. Pharmacists engage in optimization of pharmacotherapy, provide counsel to patients, administer vaccinations, and more. It is also universally understood that the profession of pharmacy is on the decline. The U.S. Bureau of Labor Statistics anticipates a decline in pharmacist jobs by 2% over the next decade while other healthcare jobs (Doctors, PA’s and NP’s) are expected to increase by 12%.1 This is despite the tremendous growth of pharmacy schools and pharmacy students in the nation. The number of pharmCAS enrolled pharmacy schools in the United States has more than tripled since 2003, with 142 universities now offering a PharmD.2 The number of applicants peaked in 2010-2011, however the number of accepted students has grown steadily with 13,139 new students enrolled in 2017.2
It is clear that the number of pharmacists continues to rise while the market oversaturates and seemingly parallel career choices offer more promising outcomes. This raises the question – why is there imbalance between the enrolled students and job prospects for pharmacists? One contributing factor could be the ballooning of pharmacy schools over the past few decades in response to feared pharmacist shortages.3 An aging population resulting in more complex case management as well as the expanding role and higher education requirement for a pharmacist appeared to guarantee an increased need for pharmacists in the near future. Pharmacy schools enthusiastically responded by continuing to expand, open new schools, and prune entry standards by removing testing requirements.4 As the labor pool of pharmacists grew, large chain pharmacies realized that pharmacists were becoming devalued by their own surplus. Chains like CVS and Walgreens began to exploit their pharmacists, imposing unattainable goals and increasing workload, endangering patients with errors from overworked pharmacists.5
The causes of the disparities are muddled and multivariate. It is difficult to pin down a single contributing factor to remedy that will benefit both pharmacists and their patients. It’s especially convoluted when culpability tends to vacillate between corporate pharmacy and pharmacy benefit managers, when the reality is there is no difference and they both profit from pharmacist suffering. Perhaps a more amenable question is – what can we as pharmacists and student pharmacists do to improve the situation?
Where advocacy comes in
This is where advocacy comes in. Students and pharmacists have a responsibility to advocate not only for themselves individually, but for their collective profession. Pharmacists can no longer be marginalized and exploited for profit. Chain pharmacies will continue to prey on pharmacists as long as this behavior is tolerated. Pharmacists are in danger of succumbing to complacency in this collapsing ecosystem for fear of reprisal from employers. Complacency begets exploitation. Exploitation endangers our patients. The patient is the ultimate casualty when pharmacists are taken advantage of. Becoming knowledgeable of policy changes and actively participating in legislative discourse are requirements to protect ourselves and our patients.
There is no perfect avenue or technique for advocacy. Promoting and becoming a champion of pharmacists can take many forms. An ideal ingress for students or others new to advocacy would be joining state pharmacist organizations and associations of pharmacists, as this is a simple and accessible method of staying up to date on policy and legislative changes. This can often be an avenue to more involved advocacy, like emailing or calling legislators. State senators and representatives from the house speak for not only the pharmacists in their state but their patients as well. Our duties as pharmacists include communicating issues to legislators when they arise. Legislators across the nation are beginning to recognize the influence and impact of pharmacists and are starting to listen to what we have to say. An expansive interactive map with links to each state’s legislative website can be found at this link. Most state websites allow enrollment in email updates on specific bills of interest.
Avenue for advocacy
We can no longer be reticent in our acceptance of the corporate stranglehold on this profession. A different avenue for advocacy could be communicating directly with members of state boards of pharmacy. These members are often pharmacists themselves and are very familiar with the intricacies of working behind the counter. In most states they have the ability to enact policies and levy fines against pharmacies and companies that violate policies or endanger patients. Board meetings are also open to the public, with their meeting agendas and minutes freely readable on their websites. Some offices allow visitors or enable their meetings to be viewed virtually.
Contact legislators, attend board meetings, and make your concerns known. Advocacy is the last bastion defending this profession from further stifling. Student pharmacists are in an ideal position to engage and establish rapport with legislators. We must act now to impact the environment we’ll be entering after graduation or residency. Take ownership of this responsibility and rapidly changing profession. Our patients need us. Continued inertia in the face of clear wrongdoing is undeclared complicity in the consequences. Prioritizing profits over patient safety is never an option. Advocacy starts now.
Shane Garrettson is a 2023 PharmD candidate at High Point University Fred Wilson School of Pharmacy in North Carolina. He can be reached at sgarrett@highpoint.edu.
References:
- S. Bureau of Labor Statistics. (2021, September 13). Pharmacists : Occupational outlook handbook. U.S. Bureau of Labor Statistics. Retrieved September 19, 2021, from https://www.bls.gov/ooh/healthcare/pharmacists.htm#tab-6.
- American Association of Colleges of Pharmacy. (2019). 2017-2018 PharmCAS Application Data Report. PharmCAS. Retrieved September 19, 2021, from https://www.pharmcas.org/.
- Pharmacy Times. (2021, March 5). The Pharmacy Job Crisis: Blame the Pharmacy School Bubble. Pharmacy Times. Retrieved September 19, 2021, from https://www.pharmacytimes.com/view/the-pharmacy-job-crisis-blame-the-pharmacy-school-bubble.
- Hall, J. L., Corelli, R. L., DeHart, R., Haney, J., Lebovitz, L., Philbrick, A. M., Ross, L. J., Sierra, C., & Jungnickel, P. (2021, March 1). Trends in pharmacy college admission test requirements and utilization across colleges and Schools of Pharmacy. American Journal of Pharmaceutical Education. Retrieved September 19, 2021, from https://www.ajpe.org/content/85/3/8179.
- Gabler, E. (2020, January 31). How chaos at chain pharmacies is putting patients at risk. The New York Times. Retrieved September 19, 2021, from https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html.
