The Current and Future State of the Pharmacy Workforce Hannah K. Vanderpool, Pharm.D., M.A. Vice President, Office of Member RelaFons Disclosure Statement I do not have (nor does any immediate family member have) a vested interest in or affiliafon with any corporate organizafon offering financial support or grant monies for this confnuing educafon acfvity. I am an employee of ASHP which is a member of the NaFonal Workforce Center. ASHP is one of the five pharmacy organizafons that governs PTCB. 1
Learning ObjecFves To describe the current state of the pharmacy workforce To compare the factors that determine supply versus demand To forecast the availability of residency posifons in the future To analyze potenfal implicafons for NMSHP and ASHP Technician ObjecFves To describe the current state of the pharmacy technician workforce To jusffy how pharmacy technicians support the improvement of medicafon use and opfmize medicafon- related outcomes To idenffy how changing roles of pharmacy technicians influence workforce demand Na)onal Pharmacist Workforce Survey 2014 2
Pharmacy Workforce Center, Inc. American AssociaFon of Colleges of Pharmacy (AACP) American College of Clinical Pharmacy (ACCP) American Pharmacists AssociaFon (APhA) American Society of Health- System Pharmacists (ASHP) Board of Pharmacy SpecialFes (BPS) Bureau of Health Professions (BHPr) NaFonal Alliance of State Pharmacy AssociaFons (NASPA) NaFonal AssociaFon of Boards of Pharmacy (NABP) NaFonal AssociaFon of Chain Drug Stores (NACDS) FoundaFon NaFonal Community Pharmacists AssociaFon (NCPA) Pharmacy Technician CerFficaFon Board (PTCB) True or False There are more licensed pharmacists with a Pharm.D. degree than a B.S. Pharm degree True False 3
Highest Degree Earned by Licensed Pharmacists 2014 52 38 10 2009 66 22 12 2004 71 19 10 2000 74 14 12 0% 20% 40% 60% 80% 100% BS Pharmacy PharmD Other (MS/MBA/PhD) True or False The race/ethnicity of licensed pharmacists is primarily Asian. True False 4
Race/Ethnicity of Licensed Pharmacists 2014 85% 9% 2% 2% 2009 87% 8% 2% 2% 2004 88% 7% 2% 3% 2000 88% 7% 2% 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% White Asian Black Hispanic American Indian Other True or False The percent of ac<vely prac<cing pharmacists that are female is over 50%. True False 5
Percent of AcFvely PracFcing Pharmacists that are Female: 1990-2014 60.0% 57.1% 50.0% 44.8% 45.9% 46.4% 40.0% 31.3% 30.0% 20.0% 10.0% 0.0% 1990 2000 2004 2009 2014 Mean Full- Time Equivalent (FTE) ContribuFons by Age & Gender 1.2 1.1 1 1.03 1.03 0.98 1.04 1.01 1.00 0.99 1.00 0.96 0.98 0.88 0.8 0.9 0.9 0.85 0.87 0.62 0.61 0.6 0.69 Males 0.44 Females 0.4 0.2 2009 Females: 0.82 Males: 0.92 2014 Females: 0.93 Males: 0.95 0 <30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 >70 6
PracFce Sedngs of Licensed Pharmacists PracFce Sedngs Community: Independent, Chain, Mass Merchandiser, Supermarket Hospital: InpaFent or outpafent hospital sedngs Other PaFent Care Sedngs: long term care, nuclear, clinic- based, central fill, home health/infusion, and specialty pharmacies Other Non- PaFent Care Sedngs: pharmacy benefit administrafon, academic, government administrafon, pharmaceufcal industry, consulfng, professional associafons, and other organizafons that were not licensed as a pharmacy 7
PracFce Sedng shies: 2009 vs. 2014 60% 50% 40% 30% 54% 44% 30% 27% 2009 2014 20% 10% 16% 10% 9% 10% 0% Community Hospital Other, Pa)ent Care SeQng Other, Non- Pa)ent Care SeQng RaFngs of Workload as High or Excessively High* by Work Sedng: 2004, 2009 & 2014 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 63% Indep Chain MM Super Hosp OPC Other Overall 2004 2009 2014 * High is a summated score of five items (1 = strongly disagree to 5 = strongly agree) > midpoint (15) 8
100% 80% 60% Pharmacists with High Job SaFsfacFon by PracFce Sedng: 2000, 2004, & 2014 68% 40% 20% 0% Indep Chain MM Super Hosp OPC ONPC Overall 2000 2004 2014 The pracfce sedng with the highest job safsfacfon rafng is: A) Independent B) Chain C) Hospital D) Other 9
ProporFon of U.S. Pharmacists by Segment in Descending Size (2009 data in lighter tone and 2014 data in darker tone) 45% 40% 41% 40% 35% 30% 25% 25% 22% 20% 16% 18% 12% 13% 15% 10% 5% 6% 7% 0% Medication Provider Medication Provider who also Provides Patient Care Other Activity Pharmacist Patient Care Provider who also Provides Medication Patient Care Provider ProporFons of Community Pharmacists in U.S. Pharmacist Segments in 2009 and 2014 70% 60% 50% 60% 61% 2009 2014 40% 30% 32% 29% 20% 10% 0% Medica)on Providers 6% 3% 5% Medica)on Other Ac)vity Providers Pharmacists who also Provide Pa)ent Care Pa)ent Care Providers who also Provide Medica)on 4% 0% 0% Pa)ent Care Providers 10
ProporFons of Hospital Sedng Pharmacists in U.S. Pharmacist Segments in 2009 and 2014 35% 30% 25% 20% 15% 23% 23% 24% 20% 17% 14% 23% 31% 13% 12% 2009 2014 10% 5% 0% Medica)on Providers Medica)on Other Ac)vity Providers Pharmacists who also Provide Pa)ent Care Pa)ent Care Providers who also Provide Medica)on Pa)ent Care Providers ProporFon with Residency Training for U.S. Pharmacist Segments in 2009 and 2014 40% 35% 30% 25% 20% 15% 10% 5% 0% 6% 3% 4% 5% Medica)on Providers 19% 27% Medica)on Other Ac)vity Providers Pharmacists who also Provide Pa)ent Care 30% 25% 26% Pa)ent Care Providers who also Provide Medica)on 34% Pa)ent Care Providers 2009 2014 11
Workforce Supply vs. Demand How many pharmacists are there? The Department of Labor, Bureau of Labor Sta)s)cs (BLS), reports that in 2012 there were 286,400 pharmacists BLS projects 14% growth by 2022, or 327,800 pharmacists They project employment figures, not supply and demand Bureau of Labor Sta)s)cs, U.S. Department of Labor, Occupa&onal Outlook Handbook, 2014-15 Edi&on, Pharmacists, on the Internet at h _p://www.bls.gov/ooh/healthcare/pharmacists.htm (visited April 24, 2015). 12
NaFonal Center for Health Workforce Analysis Health Workforce ProjecFon: Pharmacists Released December 2014 Uses HRSA Health Workforce SimulaFon Model Accounts for changes in supply (new entrants, refrement, hours worked panerns) Accounts for changes in demand (ACA Rx coverage, populafon demographics, demand for prescripfon medicafons) Does not account for future growth in pafent care services/roles of pharmacists, provider status, changes in part D coverage h_p://bhpr.hrsa.gov/healthworkforce/supplydemand/pharmacy/ NaFonal Center for Health Workforce Analysis Health Workforce ProjecFon: Pharmacists Released December 2014 Uses HRSA Health Workforce SimulaFon Model Accounts for changes in supply (new entrants, refrement, hours worked panerns) Accounts for changes in demand (ACA Rx coverage, populafon demographics, demand for prescripfon medicafons) Does not account for future growth in pafent care services/roles of pharmacists, provider status, changes in part D coverage h_p://bhpr.hrsa.gov/healthworkforce/supplydemand/ pharmacy/ 13
EsFmated Supply and Demand for Pharmacists 2012-2025 Source: HRSA Na)onal Center for Healthcare Workforce Analysis Hospital Pharmacist Vacancy Rates ASHP Surveys show peak pharmacist shortage in 2000, with decline in vacancy rates Percent Vacancies 9 8 7 6 5 4 3 2 1 0 8.9 7.2 6.3 6.3 5.7 5.7 5.9 3.7 2.8 2.7 2.4 2.1 2.2 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: 2012 ASHP Na)onal Survey of Hospitals 14
16000 14000 12000 10000 8000 6000 4000 2000 Supply of Pharmacists: Graduates from US Pharmacy Schools: 1960-2014 0 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 Source: AACP 29 A lot of press on possible surplus of pharmacists 15
ASHP Policy PosiFon 1108 QUALITY OF PHARMACY EDUCATION AND EXPANSION OF COLLEGES OF PHARMACY Source: Council on EducaFon and Workforce Development To support the AccreditaFon Council for Pharmacy EducaFon s confnuing role of promulgafng accreditafon standards and guidelines and engaging in sound accreditafon processes to ensure quality in the educafon provided by colleges of pharmacy; further, To acknowledge that, in addifon to a robust curriculum, access to quality experienfal educafonal sites and the availability of qualified faculty (including preceptors and specialty- trained clinical faculty) are essenfal determinants of the ability to expand enrollment in exisfng or addifonal colleges of pharmacy; further, To oppose expansion of enrollment in exisfng or new colleges of pharmacy unless well- designed projecfons demonstrate that such enrollment increases are necessary to maintain a viable pharmacist workforce. Factors influencing the supply The number of pharmacy graduates State of the economy Impact on the number of pharmacists re)ring Impact on part )me to full )me shib The gender mix (slowly growing) The number of internafonal pharmacy graduates (minimal) 16
Factors influencing the demand The demand by employers State of the economy Prescrip)on volume NEW roles of pharmacists Changing role of pharmacists Changing role of pharmacy technicians Impact of automa)on and technology Pharmacy Technicians 17
When considering all pharmacy prac<ce loca<ons, there are more pharmacists than pharmacy technicians in the U.S. True False Pharmacy Technicians According to the U.S. Bureau of Labor StaFsFcs, there are currently 396,540 pharmacy support personnel (355,300 pharmacy technicians + 41,240 pharmacy aides) (2012) - 53% work in retail pharmacy sedngs 17% work in hospitals/health systems 12% work in general merchandise stores 7% work in grocery stores 3% work in ambulatory health care services BLS projects a 20% growth by the year 2020 Training, cerfficafon requirements, and registrafon by states vary greatly 70% or more of hospital technicians are trained on the job 18
ASHP PosiFon on Pharmacy Technicians Well- qualified, competent pharmacy technicians are integral to the safe provision of medicafons in all sedngs. To achieve this, ASHP: Supports uniform training ASHP/ACPE- accredited Support cer)fica)on through PTCB Support licensure through state boards (Ideally should be completed in this sequence) Status of State RegulaFon of Pharmacy Technicians RegulaFons on TRAINING 38 states require educafon and training (in some form) RegulaFons on CERTIFICATION All 50 states recognize and accept PTCB for pharmacy technician cerfficafon There are 23 states which require PTCB A total of 6 states recognize PTCB and no other exam for cerfficafon RegulaFons on REGISTRATION 36 states require registrafon 10 states require licensure 9 states have no registrafon or licensure requirements: RegulaFons on TECH- CHECK- TECH 15 states allow tech check tech Source: NABP Survey of Pharmacy Law - 2015 19
AcFviFes of Pharmacy Technicians % Hospitals with technicians performing acfvity Tradi)onal func)ons Non- tradi)onal func)ons Restocking floor stock and/or ADCs Replenishing unit dose carts Purchasing Packaging ac)vi)es Compounding sterile preps Billing Quality Assurance act/unit inspec)ons Compounding chemotherapy preps Controlled substance system mgmt IT system management Technician supervising other technicians Tech- check- tech Medica)on reconcilia)on (obtaining list) Order entry (for pharmacist verifica)on) Medica)on assistance program mgmt Facilita)ng Transi)ons of Care Screening of medical records for MRPs Dispensing with remote video supervision Source: 2012 ASHP Na)onal Survey of Hospitals 98% 94% 95% 91% 85% 81% 76% 62% 61% 38% 28% 18% 18% 11% 11% 8% 6% 6% 0% 20% 40% 60% 80% 100% 39 Non- tradifonal acfvifes of Pharmacy Technicians % Hospitals with technicians performing acfvity IT system management 42% 38% Areas of growth Areas of decline Technician supervising other technicians Order entry (for pharmacist verifica)on) Prepara)on of clinical monitoring informa)on Screening of medical records for MRPs Tech- check- tech Medica)on reconcilia)on (obtaining list) Medica)on assistance program mgmt Facilita)ng Transi)ons of Care Dispensing with remote video supervision 29% 28% 25% 11% 9% 5% 10% 6% 15% 18% 12% 18% 8% 11% 5% 8% 2% 6% KEY: 2011: Blue 2014: Orange Source: 2012 ASHP Na)onal Survey of Hospitals 0% 20% 40% 60% 80% 100% 40 20
Pharmacy Technician AllocaFon of Time - CURRENT Nontraditional activities, 8% Administrative, 8% Other, 0% Traditional drug preparation and distribution, 79% Order processing, 5% Non- tradifonal acfvifes: IniFaFng medicafon reconciliafon IV/PO switch programs Dispensing via remote video supervision Criteria based screening of medical records PreparaFon of clinical monitoring informafon Managing pharmacy informafon systems Managing medicafon assistance programs Tech check tech Source: 2012 ASHP Na)onal Survey of Hospitals Pharmacy Technician AllocaFon of Time - FUTURE Administrative, 9% Nontraditional activities, 18% Other, 0% Order processing, 6% Traditional drug preparation and distribution, 66% Non- tradifonal acfvifes: IniFaFng medicafon reconciliafon IV/PO switch programs Dispensing via remote video supervision Criteria based screening of medical records PreparaFon of clinical monitoring informafon Managing pharmacy informafon systems Managing medicafon assistance programs Tech check tech Source: 2012 ASHP Na)onal Survey of Hospitals 21
ASHP/ACPE- Accredited Pharmacy Technician Training Programs 300 250 270 200 150 100 50 0-50 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Number and Type of ASHP/ACPE- Accredited Pharmacy Technician Programs (current total = 258) Health System & Hospitals, 5 programs 2% University 6 programs 2% Chain Drug Stores 3 programs 1% Military School 1 program 1% Community College 83 programs 32% Technical College 160 programs 62% 22
Availability of Pharmacy Residency PosiFons 2000 1800 ASHP Accredited Pharmacy Residency Program Growth (1980-2015) as of 1/5/15 Hospital Pharmacy Practice PGY1 Clinical Specialized PGY2 1,861 1600 1400 1200 1000 800 600 400 200 0 23
5000 ASHP Residency Matching Program 2007-2015 PGY1 4500 4000 3706 3933 4142 4358 3500 3000 2500 2000 1500 1900 1612 1343 2508 2092 1873 1769 1651 1487 2915 1951 1801 3277 2173 2027 2413 2268 2694 2495 2862 2640 3081 2811 # applicants # posi)ons # matched 91% fill for all PGY1 1000 500 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 1200 1000 ASHP Residency Matching Program 2007-2015 PGY2 917 1002 906 800 777 792 794 677 692 706 585 601 600 541 483 514 505 384 439 438 400 330 380 369 334 286 297 297 239 267 260 230 195 200 144 179 114 81 88 41 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 # applicants (includes early commits) # posi)ons (includes early commits) # total match (early commit+match) # early comit 88% fill for PGY2 24
Shortage of PGY1 posifons - based on match parfcipants and available PGY1 posifons 1800 1600 1400 1200 1104 1293 1239 1491 1373 1000 964 800 600 635 400 200 288 323 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 ImplicaFons and Discussion 25
ImplicaFons Good implicafons: Workload, job safsfacfon, proporfon of pafent care dufes is posifve for our members Challenges: Ongoing monitoring of supply vs. demand, advancing the roles of pharmacists What can ASHP and NMSHP Do? ProacFvely monitor workforce trends Communicate implicafons with members IdenFfy and move forward acfons that support the ASHP strategic plan related to workforce trends Advocate with stakeholders to advance pharmacy pracfce 26
QuesFons/Discussion? 27