Finding a Path Through Times of Change

Abstract

The statement, Looming Joblessness Crisis for New Pharmacy Graduates and Its Implications for the Academy, addresses a topic of wide discussion and increasing concern. (1) Brown, who is recognized for work in this area, describes the unprecedented growth in pharmacy graduates observed since 2000 and concludes that looming joblessness is an inescapable outcome. (2) The data, analysis, and reasoning presented are reminiscent of equally compelling data and analyses presented in 2000 that led to the conclusion that there was an acute of pharmacists in the United States that would persist for 5 to 10 years. (3) But things did not turn out that way. The pharmacist shortage slowly lessened from 2000 to 2005; and since 2006, a steady downturn in available pharmacist jobs as measured by the Aggregate Demand Index as well as many anecdotal sources, has been observed. (4) A similar phenomenon was observed in nursing where the of the early 2000s disappeared more or less concurrent with the Great Recession of 2008. (5) The widely accepted physician surplus, on the other hand, gave way to a primary care physician over the same period. (6) From these dramatic and rather rapid workforce swings in 3 major health professions, pharmacy educators are forced to acknowledge that projections, even when based on the most solid evidence available, are not inescapable outcomes. How then should research, projections, and data trends be used? This response addresses that question and examines some of the assumptions underlying the reasoning presented in Brown's statement and offers alternative scenarios. The authors must challenge Brown's assertion that the pharmacy academy was somehow negligent in allowing unprecedented growth to occur. The Accreditation Council for Pharmacy Education (ACPE) has been similarly targeted. This position disregards the reality that market conditions govern the educational enterprise in the United States. Attempts to block new colleges or schools or college or school expansion could be subject to restraint of trade or antitrust lawsuits based on the Sherman Anti-Trust Act of 1890. (7) While pharmacy education expansion is a key issue for the pharmacy academy, the elephant in the room over the last 6 to 7 years has been the weak US economy. Interpreting any phenomenon involving workforce issues requires attention to the core driver of jobs in all sectors: the economy. A 2013 study confirmed an earlier analysis showing that unemployment rates, a surrogate for the state of the economy, were the strongest driver of the unmet demand for pharmacists from 2001 to 2010. (8) The study also identified graduate numbers, prescription growth rates, and Medicare Part D as less strong but significant drivers of unmet demand. While pharmacy stakeholders can anticipate that the improving economy will improve pharmacist job prospects, these other factors--including growth in the number of pharmacy graduates--may play a stronger role in the future. The authors suggest, therefore, that passively waiting for the economy to bring back a strong demand for pharmacist services is probably not the wisest course. The federal report addressing the 2000 pharmacist used the Federal Register to invite comments about the impact of the pharmacist shortage. (3) It is interesting to review the broad range of respondents, which included individual pharmacists, hospitals, universities, individual pharmacies and pharmacy corporations, professional associations, the Federal Bureau of Prisons, the National Consumers League, corporations producing medications and medical supplies, and others. Faced with the overwhelming national consensus to combat the shortage, colleges and schools of pharmacy--both public and private--took action to expand class size, open new campuses, and open new colleges and schools. Thus began 10+ years of unprecedented expansion. As reasoned in Brown's statement, expansion per se is not harmful. …