Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
I recognize that this question will probably result in hot debate. There are those who argue that there isn’t a shortage—rather, there is a lack of pharmacists willing to work in one segment or another. Then there are those in management positions who believe that there is a shortage because they’re having trouble hiring pharmacists. Rather than add to the debate, instead I want us to think about the factors at play in our health care system that are likely to have a significant impact on the pharmacy workforce and workplace conditions.
Rapid contraction in the number of traditional community pharmacies
Pharmacy closures are in the news every week, if not daily. Economic factors are driving many community pharmacies out of business. There will be some pharmacists from these closed locations who are at the end of their career and may retire; however, the rate of closures has been and continues to be significant.
We know that 2024 Medicare Part D reimbursements are below cost and early conversations indicate that 2025 Medicare contracts may be even worse. Given the continually changing product reimbursement rates and policies, there is a likelihood of additional pharmacy closures on the horizon and therefore, the number of pharmacists who find themselves looking for a job may substantially rise within the next 12–18 months.
How many? It’s anyone’s guess, but if there were 1,000 pharmacy closures (a conservative estimate) this would likely result in at least 2,500 to 4,000 pharmacists available to fill positions elsewhere.
Changes to the 340B program
Whether you are a hospital pharmacist, an ambulatory care pharmacist, a board-certified specialist in a health system, or a pharmacist in a community setting, the 340B program impacts you.
Hospitals and federally qualified health centers count on the 340B program to sustain their operations, and contract pharmacies also depend on the preferential pricing to sustain their business and ensure that patients can access affordable prescription medications. Academic pharmacists in clinic-based pharmacy practices are often supported, in part, by revenues from health-system 340B proceeds, including hundreds of board-certified specialists within those health systems.
However, the pharmaceutical industry believes that the program, originally intended to make pharmaceuticals more accessible to uninsured and underinsured patients, has been abused and has resulted in the industry subsidizing insured patients’ medications. Manufacturers want Congress to reign in the program and, at the very least, we will see impacts here which could result in lost pharmacist positions.
Routine payment for pharmacist care services
While the previous two scenarios impacting the workforce were negative factors, this one is very positive. California, and 13 other states, have adopted payment parity, meaning that pharmacists must be paid for their services at the same rate a physician would be paid for the same service. The back-end processes (e.g., credentialing, revenue cycle management, billing, etc.) are being negotiated.
I predict that within two years pharmacists in California and other states that have adopted similar legislation will be in high demand. Much of this demand will come from group medical practices that practice team-based care and are eager to integrate a pharmacist now that there is a pathway for equitable payment for pharmacist-delivered services. In addition, value-based payment (VBP) models such as accountable care or at-risk methods will continue to employ pharmacists. VBPs are growing, although at a slower rate than in the past. If these payment models advance quickly enough, they may provide enough service revenue to community-based pharmacies to offset losses from untenable drug reimbursement. The net effect of all of this could be thousands of new jobs for pharmacists in ambulatory care, community pharmacy, and telepharmacy practice.
Pharmacists in the pharmaceutical and regulatory industries
We are observing increasing numbers of pharmacists hired by pharmaceutical manufacturing companies for roles in the industry. These roles often include medical science liaisons, but also may include pharmacists in drug discovery and development, or in regulatory compliance. Even the cosmetics industry is actively recruiting pharmacists for the U.S. market, something that has been routine in Asian markets for decades.
These positions are highly desirable by pharmacists because of their opportunities for remote work, self-selected working hours, and travel.
The National Association of Boards of Pharmacy estimated that as much as 10% of 2023 graduates did not take the NAPLEX. While we don’t know why this is happening, anecdotal reports from deans of schools and colleges of pharmacy report that licensure as a pharmacist who provides patient care was unnecessary for a career path in the pharmaceutical industry. If this trend continues, with more pharmacists entering this segment of the profession and opting not to pursue licensure, then there will logically be fewer licensed pharmacists to fill positions in sectors where direct patient care is provided.
All of this is happening at a time when we are hitting the lowest graduation numbers from PharmD programs in over 20 years.
Is there a shortage of pharmacists? Let’s turn the discussion to these factors impacting our workforce and consider necessary systems and policy changes that fulfill the professional vision of pharmacists as an essential member of the health care team responsible for ensuring appropriate medication therapy outcomes. We must ensure that patients have access to the care services of a pharmacist wherever they interact with the health care system.
For every pharmacist. For all of pharmacy. ■