A Crisis Is a Really Terrible Thing to Waste

Abstract

Not since the Great Depression has the United States faced such a convergence of economic crises. As of September 2009, the unemployment rate in the United States was approximately 10% including discouraged workers (those who have given up actively looking for employment), with new unemployment claims reaching over 650,000 in the early months of 2009 – more than twice the number that is considered normal in a healthy economy.1-3 Additionally, home foreclosure rates increased 81% between 2007 and 2008 (225% between 2006 and 2008), the US median household income decreased by 3.6% between 2007 and 2008, and the poverty rate increased from 12.5% in 2007 to 13.2% in 2008.4,5 Along similar lines, the nation's gross domestic product experienced declines for 4 straight quarters, and state governments have reduced funding for higher education by approximately 5%, or $4 billion.6,7 As a result, colleges and schools of pharmacy have undergone significant budget cuts, with many resorting to quick fixes to meet their financial woes, such as increased student enrollment, tuition hikes, faculty and staff layoffs, and choosing not to fill vacant positions. Although it may be a reasonable supposition that increased pharmacy student enrollment and/or tuition will generate funds to support immediate financial needs, and in some schools increase profit margins, one should be mindful of the risks of this approach: these quick fixes are not “cures” and do not usually become long-term, beneficial solutions. Similar to pharmacy education, the pharmacy profession, which has so often taken pride in the booming job market for pharmacists, has not been immune to the effects of these challenging economic times. Although there remains a shortage of pharmacists in the workforce, this shortage has shifted, resulting in a reduction in demand and increased competition for pharmacists wanting positions in many areas.8 Reasons for this decline in demand include increased use of automation and technology, high pharmacist salaries, and expanded pharmacy technician responsibilities.8 The difficulty in filling pharmacist positions, particularly with mean pharmacist salaries at 6 figures, has contributed to the decline in demand, with health care organizations and retail pharmacies seeking alternate solutions to meet the needs of the public, such as regional prescription refill centers. Applying economic laws of supply and demand, if the demand for pharmacists significantly decreases or shifts while the supply increases due to excessive enrollment in colleges of pharmacy, it would not be inconceivable to see a decrease or at least some type of stabilization in pharmacists' salaries. This effect potentially will have “downstream” implications for the profession as well as pharmacy education, including fewer students matriculating and possibly more attrition in colleges of pharmacy. To safeguard its sustainability in this era of uncertainty, pharmacy education and the profession must face the current economic crisis directly and identify points of long-term opportunity rather than settling for quick fixes alone. As Stanford economist Paul Romer once stated “a crisis is a terrible thing to waste” – a sentiment echoed by both Secretary of State Hillary Clinton and White House Chief of Staff Rahm Emanuel.9-11 Merriam-Webster defines “crisis” as “an unstable or crucial time or state of affairs in which a decisive change is impending.”12 This definition implies that during times of uncertainty or instability, opportunities, ie, moments of “decisive change,” may arise. In times of crisis, opportunities emerge, and creativity, innovation, and entrepreneurship are inspired. For example, commonplace items in today's world, such as supermarkets, laundromats, the car radio, the chocolate chip cookie, the electric dry razor, and the boardgame Monopoly, were invented during the Great Depression.13 The polio epidemic of 1952/1953 spurred the production and licensure of the first polio vaccine in 1955.14 The tragic experiments on concentration camp prisoners conducted by Nazi doctors and scientists resulted in the development of the Nuremberg Code, a seminal document that delineated and advanced the rights of human subjects in scientific research, and provided the foundation for later legal regulations governing federally funded research.15 Mention of the word “crisis” generally evokes images of hardship, destruction, and/or turmoil. Yet the preceding examples provide evidence that crises may also serve as catalysts for positive events, significant learning moments, inventions, innovations, policies, or other changes that are beneficial to society. In other words, crises help birth progress. In times of prosperity, it is more difficult to engage interest in change and progress since prosperity is generally equated with stability, affluence, and thriving. There is no need to change or rock the boat. A crisis forces a shift in mindset: to retain or regain prosperity, change, progress, and identification of new opportunities become a necessity. There are at least 5 key principles that signify a time of crisis may be a time of opportunity: