What is the right balance between supply and demand for pharmacists and how do we ensure an adequate number with the requisite skills and experience for the existing and emerging roles, asks John Jackson
The pharmacy profession currently has no ability to predict with any degree of accuracy what the balance should or will be at any given time in the future.
An Australian pharmacist workforce strategy would help address this limitation and increase the likelihood that the nation maintains the right pharmacist workforce capacity and capability.
Australia had a dramatic shortage of pharmacists between 1995 and 2005 and employers were frequently unable to recruit the workforce that they needed. The shortage was resolved largely as a result of an increase in the number of graduates from the six existing pharmacy schools augmented by graduates from 12 new schools which were established between 1997 and 2011. The number of graduates jumped from approximately 400 per annum in the mid-1990s to the current level of approximately 1,700 per annum.
While there are still shortages reported in some specific areas of practice such as rural and remote locations, the overall pharmacist workforce has moved into balance and possibly over supply. A reduction in over-award payments in community pharmacy and reports of registered pharmacists being amongst the lowest paid of all health graduates support the claims of oversupply, particularly in the major cities.
Under or oversupply are not solely the result of the number of graduates from pharmacy schools. Supply is also influenced by net positive migration of pharmacists, loss of workforce capacity due to retirement, changes in participation rates particularly associated with increased feminisation of the workforce and decisions by pharmacists to change their career and leave the profession for good. On the other side of the balance, demand can be influenced by an increase in population with a growing percentage of older people with chronic conditions treated with prescription medicines. It will also increase as a result of an expansions in pharmacists’ scope of practice but it may contract with the adoption of new pharmacy business models and through technology enabled efficiencies.
It is not only existing pharmacists and employers who have an interest in the current and future workforce balance. With a program of study and internship to become a pharmacists lasting up to 5 years, university course fees approaching $40,000 plus other study-related and living costs, prospective pharmacy students also have an interest in the likely workforce balance and their chance of obtaining employment upon registration. Student indebtedness combined with low salaries has led to concern regarding the ‘return on investment’ of a pharmacy education, which mirrors concern in the United States.
A number of workforce studies were conducted between 2000 and 2010, mostly providing snapshot reports. Where projections were made, the basis of the calculation of future supply was more robust than the calculation of demand.
View from the summit
As there is a need for more detailed understanding and analysis of current and future workforce issues, a Workforce Summit was co-convened in mid-2015 by Project Pharmacist of the Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, in association with the Australian Pharmacy Liaison Forum [APLF now Australian Pharmacy Leaders Forum][see Box 1].
The Summit involved delegates from the major pharmacy organisations [i.e. the members of the APLF] and health workforce demographers from the Australian Institute of Health and Welfare, Australian Health Practitioner Regulation Agency and the Workforce Section of the Commonwealth Department of Health. The intent of this initial Summit was to consider how to achieve maximum utilisation of the existing pharmacist workforce.
The member organisation of the APLF were surveyed in advance of the Summit to determine whether they believed an oversupply of pharmacists exists and to identify workforce issues and relevant workforce data that may be available. Of the eight organisations responding to the survey, six indicated that they believed there was an oversupply of pharmacists although four of the responses were qualified, stating that the oversupply was either localised or minor. One organisation referred to an undersupply in rural areas and three indicated a mal-distribution. Little data was provided which validated or quantified these perspectives.
The numerous issues submitted by the organisations were able to be consolidated under twelve broad workforce topics as shown in Table 1
Table 1. Workforce topics reported by the pharmacy organisations.
Supply of pharmacists
The number of graduates
The quality of the graduates
Internship processes, capacity and quality
Retention of pharmacists in the profession
Demand for pharmacist
Existing opportunities that remain unrealised
Potential opportunities not yet established
Restraints and barriers to change
Functions pharmacists are able to perform
Conditions of employment
Participation in employment
Composition of the workforce
Distribution of pharmacists and jobs
The Summit participants prioritised the topics and resolved the five most important to be:
- Making use of the potential opportunities created for pharmacists by demographic driven demand, emerging professional roles and development of new services.
- Resolving restraints and barriers to demand for pharmacists in health care. The restraints include uncertainty regarding the future, levels of remuneration, limited career development prospects and a lack of acknowledgement of expertise as part of the healthcare team.
- Addressing workplace factors and workloads to enhance the functions pharmacists are able to perform, improve their career paths and the utilisation of their expertise.
- Sustaining the quality of graduates with a balanced supply of appropriately educated pharmacists for future evolving roles.
- Internship and factors relating to the availability of adequate numbers of appropriate sites with suitably trained preceptors able to provide necessary supervision, mentoring and guidance.
The objective of this initial Summit was to identify areas of concern and while no specific actions were resolved, the following were discussed. Firstly, the collaborative process used in the conduct of the Summit should be maintained as a way to address the identified issues. Next, in recognition of the limited amount of workforce data available, the profession should maintain engagement with the workforce demographers to ensure that currently collected workforce data are collated and analysed in a timely manner and that gaps in available data are identified along with means to resolve them.
As most of the current data relates to workforce supply, a range of scenarios of future practice should be developed as a basis for projecting both supply and demand over a period of 5 – 10 years. Furthermore, to overcome the limitations of snap shot studies, the benefits of a longitudinal study of the pharmacist workforce should be assessed.
Finally, the all-of-profession focus on this important issue should be maintained with the ultimate objective being the development of a pharmacist workforce plan and implementation strategy to minimise the risk of future over or under supply.
Project Pharmacist is a program within the Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, established to facilitate enhanced and sustainable roles for pharmacists in primary care. The capacity and capability of the pharmacist workforce have been identified as major barriers to the implementation of patient-focussed models of practice in this setting and consequently are a focus of the program.
Australian Pharmacy Leaders Forum [APLF] was established in 2008 as an independent group of representatives from all key pharmacy organisations who work together on issues of national importance that relate to the pharmacy profession and to the general public. Members of the APLF include the Australian Association of Consultant Pharmacy, the Australian Pharmacy Council, the Council of Pharmacy Schools (Australia and New Zealand), the National Australian Pharmacy Students’ Association, the Pharmaceutical Society of Australia, the Society of Hospital Pharmacists of Australia, Professional Pharmacists Australia, the Australian College of Pharmacy, Pharmaceutical Defence Limited and the Pharmacy Guild of Australia. The Pharmacy Board of Australia is an observer organisation to the APLF.
John Jackson is Director of Project Pharmacist at the Monash University Faculty of Pharmacy and Pharmaceutical Science
- O’Leary K. Allinson Y. Kirsa S. Jackson J. Burges N., Snapshot of Hospital Pharmacy Workforce in Australia. J Pharm Pract Res 2002; 32: 72-76
- Aust Institute Health and Welfare (AIHW), 2003. Pharmacy labour force to 2001. AIHW National Labour Force Series cat.no. 25. Canberra
- Chapman C. Pharmacy Student Numbers. Australian Pharmacists. 2001: 20 (6) 357.
- Marriott J. Nation R. Roller L. Costello M. Galbraith K. Stewart P. Charman W., Pharmacy Education in the Context of Australian Practice, Am J Pharm Educ. 2008 Dec 15; 72(6): 131
- Pharmacy Board of Australia Registration Data, December 2015. Available at: file:///C:/Users/jacksonj/Downloads/Pharmacy-Board—Registrant-Data-Table—December-2015%20(3).PDF
- Kardachi G. Adequate Remuneration. Australian Pharmacist, July 2013: 1
- GradStats – Employment and salary outcomes of recent higher education graduates 2015. Available at: http://www.graduatecareers.com.au/wp-content/uploads/2015/12/GCA_GradStats_2015_FINAL.pdf Accessed: 10th May 2016
- Cain J, Campbell T, Cogdon H, Hancock K, Kuan M, Locjman R and Evans R. Pharmacy Student debt and Return on Investment of a Pharmacy education. Am J Pharm educ. 2014 Feb 12; 78(1): 5.
- Health Workforce Australia 2014. Australia’s Health Workforce Series – Pharmacists in Focus. Available at: http://pandora.nla.gov.au/pan/133228/20150419-0017/www.hwa.gov.au/sites/default/files/HWA_Australia-Health-Workforce-Series_Pharmacists%20in%20focus_vF_LR.pdf Accessed: 5th May 2016
- Health Care Intelligence. 2003. A study of the demand and supply of pharmacists, 2000-2010, Executive Summary. Available at: http://www.uq.edu.au/pharmacy/PACE/EOI%20Document%20Annexure%20E%20-%20Exec%20Sum%20-%20Supply%20&%20Demand%20Study.pdf Accessed: 5th May 2016
- Human Capital Alliance. National Pharmacy Workforce Planning Study 2008-2010. Available at: https://www.guild.org.au/docs/default-source/public-documents/services-and-programs/research-and-development/News-and-Events/final-reports.pdf?sfvrsn=0 Accessed on: 5th May 2016
- Jackson J. Ramzan I. Tassone A. Emerson L. Kelly B. Turner S. Sriwardene K., The Australian Pharmacist Workforce Summit: issues affecting sustainable and rewarding careers for pharmacists. Australian Pharmacist, April 2006: 62-66