03/16/2001
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Forget computer programming. The jobs and money are in dispensing drugs: Moody is a pharmacist.
"Salaries are probably the highest they've ever been," says Moody, 26.
The salaries and the perks are driven by one thing: The demand for pharmacists exceeds the supply.
"It's pretty bad," says David Davis, director of pharmacy at Port Huron Hospital, which has openings for three pharmacists. "It could take us 3 months to a year to fill those spots."
The demand for pharmacists comes as the number of prescriptions written has soared from 1.9 billion in 1992 to 3.1 billion last year -- and is expected to reach 4 billion in 2004. At the same time, the number of graduates from pharmacy schools has leveled off, and applications are up only slightly.
That combination worries some policy experts, who say the workplace shortage could mean patients get shortchanged, or worse, hurt.
For one thing, pharmacists have less time to counsel patients about their medications. Additionally, job stress and longer hours could result in "fatigue-related factors that increase the potential for medication error," says a report issued in December by the U.S. Department of Health and Human Services.
Yet few statistics exist on dispensing errors. Reporting is voluntary, and most states don't keep track.
"There's no data we're aware of that says the shortage is affecting or increasing the number of medication errors," says Paul Riches, legislative analyst for the California Board of Pharmacy. "Largely that's because there's no good data on that in general."
Overwork And Errors
Still, errors do occur. Last year, for example, a 5-year-old Virginia boy died after a pharmacy prepared a bed-wetting medication at five times the prescribed dosage. A technician, who was helping the pharmacist, apparently typed a wrong number into a computer. The pharmacist did not catch the error.
While not commenting on the specific Virginia case, pharmacists agree that overwork can be a problem.
"The more work you do, the more likely you are to make an error," says Tom Van Hassel, director of pharmacy at Yuma Regional Medical Center in Yuma, Ariz.
Despite the workload, Van Hassel says the main reason for errors remains the look-alike packaging and sound-alike names of many drugs, combined with the fragmented health system that often means patients' medical records are not available to pharmacists.
"We have to have some way of sharing information," says Van Hassel. "So that if you get a prescription filled at one pharmacy, it would show what you got last week at another pharmacy."
Solutions to the shortage range from increasing enrollment in pharmacy schools to decreasing the amount of routine paperwork required of pharmacists by insurers. Allowing pharmacies to hire more certified technicians, who in most states can fill prescriptions under a pharmacist's supervision, is supported by the pharmacy industry. California officials, for example, are considering new rules to allow one pharmacist to oversee two technicians. Currently the ratio is 1-to-1.
Changes in packaging could also help. For example, antibiotics that need to be taken in a specific dosage for 10 days could be packaged that way at the factory, says Phil Schneider of the National Chain Drug Store Association.
Insurers could help by standardizing their prescription benefit cards and including on them more of the information pharmacies need to process claims.
"It sounds simple, but every little thing you can do to make it more efficient reduces workload and adds to the time pharmacists can spend with patients," Schneider says.
The federal report on the pharmacist shortage says that dealing with insurers takes up an estimated 10% to 20% of a pharmacist's time.
"That's what we do all day -- jump through these hoops, get put on hold, fax this, dial that 800 number," says John Gelinas, owner of the Chimes Pharmacy in Berkeley, Calif. "All that for the $2 the insurer pays you that doesn't cover your costs anyway."
Perks For New Hires
Those hassles affect hiring.
As a selling point, hospitals trying to lure new grads point out that their pharmacists don't have to deal with insurers. They also have more opportunity to work with patients and doctors.
But hospitals are competing for pharmacists against retail pharmacies and mail-order houses, both of which generally pay more and offer perks to new workers, such as high-end leased cars.
"That's the disparity facing graduates," says Van Hassel at the Yuma hospital. "Do I want a job as a clinical pharmacist in a hospital or make the big bucks and work in retail?"
Most graduates choose jobs in retail pharmacies because the pay is better. "In retail, salaries start at about $75,000 for new graduates. Cars, signing bonuses and tuition reimbursement are also offered," says Robert Colmery Jr., vice president of Allied Consulting, a recruitment firm that helped place 252 pharmacists last year. Starting salaries at hospitals generally range from $67,000 to $72,000, Colmery says.
Pharmacists spend 4 years earning their degree, plus 2 or more years in college-level studies before pharmacy school. There are 82 colleges of pharmacy in the USA, which last year enrolled 34,481 students and graduated 7,260, says Susan Meyer, senior vice president of the American Association of Colleges of Pharmacy. Female graduates outnumber men almost 2-to-1.
"It's a great career for women," says Moody. Salaries are good, she says, and part-time work also is lucrative. After starting a family, many women pharmacists choose to work part-time.
For employers, that's posing some new challenges.
"We have two pharmacists now who work for us part time," says Davis at Port Huron. "I'm probably headed for a lot of part-time people."
When she graduated from the University of Texas at Austin, Moody says, she considered working for one of the large retail chains, which were offering various perks to new hires. But she opted to forgo the BMW and the big signing bonus to work for an independent pharmacy in Irvine, Texas.
The salary is comparable, she says, but the lure for her was being able to do medicine compounding, which means custom tailoring medications for people and pets. Plus the pharmacists at her store interact more with patients, doing cholesterol and bone-density testing.
"The independents have better working conditions," says Moody. "You get to do more things. It isn't just count-and-pour, lick-and-stick."
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