Can we get the numbers right?


pharmacist workforce people growing numbers

Is it possible to get the right amount of pharmacists? Or are we permanently facing a crisis of oversupply? Michael Ortiz does the numbers

Ron Roland, a former CEO of a large pharmacy wholesale supplier (API), would regularly remind his staff that “proper planning prevented poor performance”.

Unfortunately for the pharmacist profession, a  lack of manpower planning by the leaders of  their professional associations, as well as the vested self-interests of some senior Pharmacy academics in graduating too many students, has created a potential pharmacist manpower “oversupply” disaster in Australia.

Australian Pharmacy Board statistics provide a useful picture of pharmacist numbers, age and gender distributions as well as how these numbers have changed over time (Table 1).  At the start of 2018 there were 28,000 pharmacists registered in Australia with a further 1700 provisional registrations who were undertaking their internship training (Table 1).

Around 62% of registered pharmacists are female and 67% are aged under 45 years.  Less than 5% of registered pharmacists are aged over 65 and still working as a pharmacist. The total number of registered pharmacists had increased by 18% over the 5 year period, while there was a 28% increase in female registrations over the five years since 2013.  There was a 2,700 increase in under 45 age group registrations (17%), there was a 28% increase in the 45 to 64 age group and a 5% decrease in the 65 plus age group (Table 1).

Workforce supply and demand modelling of pharmacist numbers described in the 2015 Pharmacy Workforce Planning Study [3], highlighted the impact of changes in pharmacy practice on pharmacist supply and demand.

The right estimate

The “best estimate” model predicted growth in pharmacist supply of 600 pharmacists per year with an oversupply of more than 10% by 2020 and with pharmacist demand continuing to fall beyond 2020. An “expanded professional services” model closed the gap between supply and demand for pharmacists, but did not return them to balance. Finally a “minimal change” model predicted an even greater oversupply of pharmacists exceeding 20% by 2025. This would be a manpower disaster to say the least.

Leaving this oversupply of pharmacy unchanged could have profound long term effects on the profession, resulting in lower wages, poor job satisfaction, increased unemployment and the loss of  large numbers highly qualified graduates from the profession. This is in addition to the wasted time and money spent educating students for jobs that don’t exist. It also wastes the time of their pharmacist preceptors and we register these pharmacists knowing that many of them may never find employment as a pharmacist.

One only has to look at the Australian Medical profession to see how their leadership is more effective in managing their manpower.  Their workforce planning projections [4] suggest that Australia’s demand for its 100,000 medical practitioners should align with supply. The “no change” scenario model predicted that the workforce would be in oversupply to 2017 before dropping to undersupply from the early 2020s. This leads to a gap betweenswitching from  an oversupply of 2,500 in 2025 moving to a shortfall of around 5,000 by 2030.  An “Economic constrained” model predicted that the medical workforce would change from a small undersupply relative to the starting point of 5,000 to a small oversupply of 5000. An “Economic constrained coupled with productivity gains” model predicted a small oversupply of the medical workforce and any gaps could be addressed through adjusting domestic supply, adjusting international supply or a combination of both. The medical profession uses two basic approaches to address an oversupply situation. They (1) reduce supply and/or (2) increase demand.

Table 1:  National Pharmacy Board Statistics                                                                                                                                                                                                                                                                                                    

Registered Pharmacists

Number in 2018

Number in 2013

5 year change

5 year change

General  register

28129

23820

4409

18%

Female

17579

13742

3737

28%

<45

18806

16099

2707

17%

45-64

7940

6213

1327

28%

65+

1382

1508

-126

-8%

Provisional registration

1710

1759

-58

-3%

Active work location

 

 

 

 

·       Community

 

13454

 

 

·       Hospital

 

3762

 

 

·       Other

 

4115

 

 

·       Not working in pharmacy

 

2404

 

 

Source: Australian Pharmacy Board online statistics [1, 2]

There are two essential steps required to return the oversupply market to equilibrium:

Step 1:  Pharmacist supply must be reduced by 3,000 over 5 years

Not surprisingly the pharmacy academics who conducted the Australian pharmacist manpower modelling seemed to have put changes to the supply side of the equation in the too hard basket. Their modelling suggests that demand can be improved by expanding pharmacists professional roles and the “do nothing” model resulted in disastrous oversupply exceeding 20% with no improvement in the 10 year model projections.

National Pharmacy Board data in 2018 showed that there are 28,000 registered pharmacists and around 1.700 new graduates each year (Table 1) with “best estimate” model predicting an oversupply of around 3,000 pharmacists. If there is no change in the Pharmacy manpower strategy, then Pharmacist oversupply numbers will continue to increase by around 600 pharmacists per year over the next 5 years.  If this growth continues unabated, then the oversupply of pharmacists could balloon out to 6,000 (20%) in 5 years [3]. The obvious place to start to address a manpower oversupply is to reduce the number of students studying pharmacy. Unfortunately, the pharmacy profession has little control over the number of students accepted to study pharmacy.

Where the profession does has some control is over the number graduates who receive a 12 month internship required as part of their pre-registration.  Manpower model data suggests that pharmacist numbers are growing by 600 per year, so unless internships in community and hospital pharmacies need are reduced by 600 per year for 5 years, the oversupply of pharmacists will continue to increase. Any reduction in the number internships would be unpopular with students.

A much more difficult change to supply would come from reducing student intake.  Currently there are two pathways (1) four year under graduate and (2) two year Masters pharmacy degrees offered by around 20 academic institutions all around Australia.

In the absence of any data demonstrating large differences in the quality of the graduates of these two different pathways, (from a simple cost perspective), the profession should consider advocating moving to a two year post graduate course costing half that of a four year under graduate course (no HECS payment deferral is available for post graduate degrees).  In terms of wasted education dollars, a two year post graduate student failing to find employment as a pharmacist is much less wasteful of educational resources than a four year trained graduate.   Maybe it is time that the highly paid pharmacy academics are held accountable for wasting students and taxpayer funds by training too many pharmacy students for jobs that simply don’t exist. Furthermore, how can they justify a four year pharmacy undergraduate course over a two year post graduate course, if they deliver a similar product that takes twice as long to complete and at double the cost..

It is obvious to most, that the proliferation of new Pharmacy schools in Australia has generated a dramatic growth in the number in pharmacy graduates (around 1,700 provisional registrations needing an internship a year) and that this is what has caused the current pharmacist oversupply disaster.

If these pharmacy schools fail to acknowledge the harm that they have caused to the profession, through their contribution to the pharmacist oversupply and more importantly if they fail to take immediate remedial action to drastically reduce student intakes, then the profession should react by reducing their financial and in kind support to these pharmacy schools, until such time as they reduce their student intakes.  There is little point donating money and/or time to a pharmacy school, if in doing so, you are harming the profession by increasing the oversupply of pharmacists.  That is, as many as half of the new pharmacy graduates each year could join a growing pool of oversupply pharmacists, who will not be able to find employment as pharmacists in the short term. This will also harm the employment prospects of practicing pharmacists whose bargaining power is diminished in an oversaturated employment market. 

One only needs to look at recently graduated high school teachers to see the negative impact of a manpower oversupply in the relatively fixed employment market. Many teachers have been waiting up to ten years to find a permanent job within a reasonable distance from their home. Job satisfaction is poor and large numbers of graduates give up looking for work as a teacher.

Step 2:  Pharmacist demand must be increased by 3,000 over 5 years

The other way to reduce oversupply is to increase demand for pharmacist services and this was supported by the manpower “expanded professional services” model [3].  There are three possible areas where pharmacist demand could be increased:

  1. Increased non dispensing related professional services reimbursed by the MBS and provided by accredited pharmacists in community pharmacies
  2. Increased medication related activities by hospital pharmacists taking on nurse drug administration roles in hospitals and Aged Care facilities.
  3. Embedding non dispensing pharmacists in GP practices to improve medication use by patients [5].

A target of 600 new pharmacist positions per year in Australia over the next 5 years would bring pharmacist supply back in line with pharmacist demand, provided that there is little or no growth in pharmacist supply (ie. reduced pharmacy student intake or reduced internships). These new employment opportunities should be designed to be value for money as well as improve health outcomes (through the better use of medicines).

These targets will be challenging but are achievable if they are endorsed and supported financially by the Federal Government with MBS funding.  That is:

  • 1000 more pharmacists jobs over 5 years dedicated to professional services with MBS funding, more than half should be in non capital cities and rural areas (where there is a well documented undersupply of medical practitioners).
  • 1000 more pharmacists jobs over 5 years in Australian hospitals and Aged Care facilities dedicated to medication administration, thus freeing up already scarce nursing resources that can be better spent on neglected patient care activities. (That is, substituting “oversupply pharmacist” labour for “undersupply” nurse labour, in particular where the quality of the pharmacist service is likely to be no worse than or better than the current nursing service.)
  • 1000 more pharmacists jobs over 5 years embedded in general practices with MBS funding for their services and least half of the pharmacists are to be located in non capital cities and rural areas currently underserviced by medical practitioners.

The profession of pharmacy has little choice.  It must decrease supply and increase demand for pharmacists in order to address the dramatic oversupply of pharmacists in Australia.  If the profession fails to act, then this will spell disaster for many young employee pharmacists resulting in: lower wages, poor job satisfaction, increased unemployment and the waste of millions of education dollars and the loss of a large numbers highly qualified University graduates to other industries or occupations.

In conclusion, it is time for the pharmacy profession’s leadership to get their heads out of the sand and to take up the challenge of returning the pharmacist market to equilibrium by balancing pharmacist supply with pharmacist demand. It is also time for Pharmacy schools to put their hands up and acknowledge that they were responsible for the increase in the number of pharmacy graduates that has caused the disastrous oversupply of pharmacists and that they will act immediately to reduce the number of new students.

If pharmacist leadership lacks the courage to make these hard decisions or senior pharmacy academics fail to act to reduce the number of pharmacy graduates, then they need to step aside so we can find new leaders who will make these hard decisions even if they are unpopular.

Michael S Ortiz BPharm, MSc, PhD, runs Zitro Consulting Services and is Associate Professor in health economics at the University of NSW

References

  1. Pharmacist Registration Board online statistics 2013 pharmacyboard.gov.au/About/Statistics.aspx
  2. Pharmacist Registration Board online statistics 2018 pharmacyboard.gov.au/About/Statistics.aspx
  3. Ridout L. The Pharmacy Workforce Planning Study Human Capital Alliance 2015 http://6cpa.com.au/wp-content/uploads/Pharmacy-Workforce-Planning-Executive-Summary.pdf
  4. AUSTRALIA’S FUTURE HEALTH WORKFORCE – DOCTORS August 2014 https://www.health.gov.au/internet/main/publishing.nsf/Content/F3F2910B39DF55FDCA257D94007862F9/$File/AFHW%20-%20Doctors%20report.pdf
  5. Polasek TM, Rowland A, Wiese MD & Sorich MJ Pharmacists in Australian general practice: an opportunity for expertise in precision medicine Ther Adv Drug Saf 2015, Vol. 6(5) 186 –188

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11 Comments

  1. Susan Elsass
    14/09/2018

    Whoever wrote this article has not spoken to the pharmacy recruitment agencies. What oversupply? The situation is dire. Pharmacists are either leaving the profession or else using pharmacy as an undergraduate degree. Never in my 30 years in pharmacy recruitment has the situation been as bad as now. Not only is it difficult to get pharmacists to relocate permanently to rural areas (this has always been a challenge) but even trying to source a pharmacist to fill a day in a capital city is proving to be more of a challenge than previously. This is having a desired impact for the locums that remain because they can virtually name their price and owners will have to pay it if they want a day off.

    • Michael Post
      14/09/2018

      I would be happy to locum rural and regional occasionally. I am not happy to locum anywhere for 42 dollars an hour . I note many jobs are disjointed whereby hours are less than 7.5 on some or most days and locums are asked to work 3-4 odd days of the week only. This may suit a retiree but not a young pharmacist in accumulation phase.
      There is plenty of money in community pharmacy yet it does not flow to the employee pharmacists – Anthony White and Terry White Chemmart are always happy to share their substantial earnings .

      As long as the Guild maintain an effective stranglehold on community pharmacy influence in education and political spheres the pharmacy graduates will keep rolling out in numbers. Work is and will be unsecure , casualised and wages low- all contributors to poor health outcomes for the very people tasked with improving health outcomes.

      • Bryan Soh
        19/09/2018

        Try breaking this down to many employers, they just cannot/will not see things from anyone else’s point of view other than theirs. From the comments of many owners, it seems like employee pharmacists owe it to themselves to go rural or address their work related issues, without many of them once ever considering on how to make a more enticing deal. Thanks PGA!!! Keep perpetuating the status quo and there won’t be any pharmacists left to hire!!

    • Paul Sapardanis
      14/09/2018

      Years of low wages have now killed the profession. As many new graduates come many more leave and even with new opportunities on the horizon it unfortunately maybe too late. As a pharmacist with 20 years of experience it has always been difficult to attract pharmacists to regional and rural areas so it still baffles me why these owners do not take on working partners or have plans on how to attract pharmacists here

    • Red Pill
      14/09/2018

      We came, we saw, we ran

    • United we stand
      14/09/2018

      In a profession where majority are female and under 45, the number of people willing to travel afar or away from home for variable amounts of time is limited to say the least.

      For the same pay, most end up getting a cushy office job in an administrative role with the added benefit of having the option to work from home.

      Unnfortunately, I have a feeling such an inciteful and well thought out article will be archived and forgotten about without a single after thought.

  2. Bruce ANNABEL
    14/09/2018

    Interesting contribution but down at the real world of pharmacy I’m seeing shortages re-appearing in the cities and provincial areas are far worse. What damage has the low wage rates and pressures applied by many pressures done to the profession and the supply side!
    Given the extra professional pharmacist opportunities coming available plus growing remunerated services the industry needs to maintain and build more patient oriented pharmacists particularly in community setting.

    • Michael Ortiz
      18/09/2018

      Hello Bruce
      It is always nice to read your insightful comments
      Workforce modelling suggested that there may only be modest improvements in demand, based on expanding current professional services.
      There needs to be some more fundamental changes to generate greater demand for pharmacists – 1. MBS funding of non dispensing professional services, 2. Increased involvement of pharmacists in drug administration in aged care facilities and hospitals 3. Embedding pharmacists in GP practices to improve medication use.

  3. Anthony Tassone
    16/09/2018

    Based on data from the Department of Jobs and Small business of the Australian government, there is a documented shortage according to their data and modelling of pharmacists (or at least recruitment difficulty) in every state and territory of Australia except for Western Australia.

    Below is a link to the occupational skills shortage page for ‘Hospital/retail pharmacists’on the Department of Jobs and Small business website:

    https://docs.jobs.gov.au/collections/hospitalretail-pharmacist-occupational-reports

    A report is available for each state and territory for pharmacists.

    Whilst the data from the department reports ‘no shortage’ for pharmacists in Western Australia, I have heard anecdotally numerous times from colleagues there of difficulty in recruiting pharmacists.

    Also from the Department’s own data, there is a ‘metropolitan shortage’ reported for NSW.

    The suggestion by the author of this article that there is an óversupply’ of pharmacists is not consistent with any of the feedback I have received from community pharmacy proprietors, employee pharmacists, recruitment agencies, Department of Jobs or any other source.

    Anthony Tassone
    President, Pharmacy Guild of Australia (Victoria Branch)

    • Michael Ortiz
      18/09/2018

      Hello Anthony
      The current employment data makes interesting reading
      More than 10 applicants for each job in the city? with only around 2 deemed suitable?
      That doesn’t sound like a shortage to me,
      however there is a shortage of pharmacists in rural areas
      What is happening to all of the university graduates? and the 1700 with provisional registration doing internships?
      Are we wasting taxpayer funds training pharmacist for jobs that don’t exist.
      Oversupply has driven down wages that so many of the graduates have left the profession.
      So why are so few pharmacists aged over 65 years still practicing?
      What has happened is that pharmacists are abandoning the profession so supply has fallen and you end up with the geographic maldistribution you described..

      • United we stand
        19/09/2018

        Like I said a year ago when the penalty rates were cut. If you’re still a practising pharmacist by January 2019, then you deserve the wages they are paying you. Get retrained and get out. (Like many others who have done so)

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