A Bitter Pill to Swallow

Rx for Disaster?

July 16, 2001 -- Sandra Allen was a young pharmacist, with five years' experience under her belt, when she made her first mistake: Instead of giving a customer the correct dose for his medication, she misread the prescription and gave him 10 times the proper amount. The man ended up in the emergency room and had to undergo detox treatment to clear the medication from his system.

"The following week he came into the pharmacy and told me what happened," the now-retired pharmacist from Wisconsin tells WebMD. "I apologized profusely and asked him if there was anything I could do. He told me the trip to the emergency room cost $60; I happened to have enough cash in my pocket, so I gave it to him."

Sandra Allen and her customer were lucky in that no one was seriously harmed. And she learned a valuable lesson.

"After that, no matter how busy I was or how many people were waiting, I would take the time to really carefully check my work," she says, adding that it isn't always easy with all the tasks a pharmacist is expected to do, from counseling customers, to counting pills, to troubleshooting insurance problems, to manning counters and drive-through windows.

During her 27 years on the job, Allen says, she often had to stay late to complete her work, and hardly ever got a chance to take a bathroom break, let alone a lunch break.

Allen is not alone, and life for today's pharmacist is not expected to get any easier or less stressful. Despite record-high starting salaries for the industry, there is a growing shortage of qualified people to fill the available jobs.

"I would not call it a grossly severe set of circumstances just yet, but we are very much headed in that direction," says Kenneth Roberts, MBA, PhD.

"The estimates are that there were approximately 2,500 unfilled positions when the class of 1998 graduated," says Roberts, professor and dean of the College of Pharmacy at the University of Kentucky. "When the graduates of the class of 2000 had taken their position, there were approximately 7,500 unfilled."

"It is pretty universal, it is pretty national in scope, and is not here-today-gone-tomorrow," says Lucinda Maine, senior vice president for policy, planning, and communications at the American Pharmaceutical Association. "It will impact the profession for the foreseeable future."

The Effect on You

Aside from having to wait longer to get a prescription filled, fewer pharmacists means more overworked pharmacists, which can lead to errors. The National Institute of Medicine last year estimated that errors are made on about 4% of the nation's prescriptions -- a total of 120 million mistakes a year.

Other research suggests the rate of prescription errors increases after a pharmacist fills more than 24 prescriptions an hour. The National Pharmacist Association recommends pharmacists fill no more than 15 prescriptions an hour, but that rate is routinely exceeded, with some pharmacists filling as many as 29 an hour.

Topping the prescription-pad list of reasons for the shortage of pharmacists, experts say, is an increased demand for medications.

"I am going to stop saying 'shortage' and begin referring to it as an excessive demand," says Maine. "That really is what is happening here: an increased demand for processing prescriptions."

Roberts agrees.

"The demand has really gone gangbuster," he says. "In 1992 there were approximately two billion prescriptions dispensed on an outpatient basis; by 1999 it had risen to three billion and is expected to increase to four billion by 2005. I must tell you, we have not seen an increase even approaching that in terms of infrastructure for pharmaceutical distribution."

The Ever-Increasing Demand

Why the boom? The baby boom chiefly, says Roberts, as members of that needy, numerous generation are reaching the age of peak consumption of health services.

Coupled with that, more medications are out there to treat diseases -- including chronic ailments requiring multiple drugs, like AIDS, and conditions like erectile dysfunction that, before Viagra, really had no treatment. The final factor is the explosion of direct-to-consumer advertising that prompts well-informed patients to walk into their doctor's office and demand a prescription.

And of course, people are living longer. "What's keeping them alive?" asks Roberts. "It's longer living through chemicals."

On the other side of the equation is the nationwide shift from a five-year bachelor's degree in pharmacy to the six-year doctor of pharmacy degree. This means some may skip an advanced degree in pharmacy in favor of, say, a business or law degree.

The new PharmD degree requirement has another unintended consequence.

"Our graduates are very well educated and are finding many more career opportunities," says Roberts. Careers exist not only as a pharmacist at a hospital, large chain, or independent store, but also at pharmaceutical companies, in managed care organizations, and insurance companies. Oftentimes these new opportunities mean better money, less stress, and more job satisfaction.

In addition to the growing number of prescriptions waiting to be filled, and the fact that the number of trained pharmacists isn't growing at the same explosive rate, there is another issue. More Americans are taking complex drug regimens requiring counseling and checking for interactions and contraindications. Additionally, more Americans are taking herbal medicines, which can also interfere with prescription medications.

"Our [new] curriculum places greater emphasis in patient care," says Roberts. "Unfortunately, this high demand is working counter to pharmacists being able to spend quality time with patients and help them understand why they have to take medication, understand how to use it, and appreciate side effects."

Possible Rx for a Growing Problem

"Unfortunately, we can't snap our finger and respond to this instantly," says Roberts. The first step, he says, is improving educational opportunities. "It needs to start in education facilities so that we have capacity to produce more graduates."

With that goal in mind, nine pharmaceutical organizations, including the American Pharmaceutical Association, have asked the federal government for help turning out more pharmacists, specifically federal funds to modernize and expand schools.

But Roberts says more than a decade can go by before an existing program (or a new program) collects the funds for any expansion and modernization project, realizes the projects, enrolls, and finally graduates a fresh crop of pharmacists.

New programs are also being created. Maine notes that in addition to the 82 schools with current enrollment, an estimated 4-10 new programs are slated to open in the next couple of years, which should annually add 400-1,000 new graduates to the existing pool of 8,000 graduates. She acknowledges these are small increases but at least is a move in the right direction.

Maine also says the profession has to make itself more efficient by using adequately trained technicians who can do everything the pharmacists do except the final check, to take on more of the drug distribution responsibilities. These technicians, for example, could also handle some of the calls to insurance and managed care companies, a task that eats up an estimated 20%-25% of a pharmacist's time.

Taking advantage of technological advances, such as robotics, is another step that could ease the crunch, says Maine. So-called robo-druggists are already in use at some hospitals and mail-order companies, she notes.

Another possible solution is to encourage, and make it worthwhile for, mothers to come back to work after taking a few years off to raise their children. This is especially important, says Maine, since a large percentage of pharmacists are women.

"I don't know that we have identified all of the answers," says Maine. "There may be some out-of-the-box ways we haven't thought about yet."