The demand for prescription drugs is growing as fast as the supply of pharmacists to dispense them is shrinking.

[Guest guest]

A Bitter Pill to Swallow

The demand for prescription drugs is growing as fast as the supply of

pharmacists to dispense them is shrinking.

By   Braslavsky WebMD Medical News

July 16, 2001 -- 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. "

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, 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.

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 , MBA,

PhD.

" The estimates are that there were approximately 2,500 unfilled

positions when the class of 1998 graduated, " says , 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 Affect 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. "

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 , 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 . " 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 . 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

. " 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 . 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 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. "

Medically Reviewed

By Dr. Dominique Walton