 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
Authorizing Safety Net Public Health Programs
Subcommittee on Health
Ms. Adele Pietrantoni
Summary
of Major Points 1.
There is an acute shortage of
pharmacists in the United States today. In
December of 2000, the Health Resources and Services Administration (HRSA)
released a report entitled "The Pharmacist Workforce: A Study of the Supply
and Demand for Pharmacists." The
report identified and quantified the degree of the current shortage. 2.
The shortage is largely due
to increased demand for pharmacists and their services, demand evident in the
dramatic growth in the number of prescriptions prepared daily-growth that is
sure to continue-and the significant expansion of the pharmacist's role in
patient care. 3.
HR 2173, the Pharmacy
Education Aid Act, is an important step in addressing the pharmacist shortage,
and does so in a way that will provide relief to every setting where
pharmacists practice and help patients. 4. HR 2173 would provide financial aid to students, helping students who would otherwise not be able to pursue such a career. The bill would help schools and colleges recruit new students to study pharmacy, while the concurrent emphasis on training in rural and underserved areas will help retain these graduates as practicing pharmacists in those settings. Testimony
of the American Pharmaceutical Association Good morning. Mr. Chairman and Members of the Committee, thank you for the opportunity to present the views of pharmacist caregivers in hospitals, long term care facilities, community pharmacies and other practice settings across the country. I am Adele Pietrantoni; I am a pharmacist, immediate past president and current Chair of the Massachusetts Pharmacists Association and am currently a trustee for the American Pharmaceutical Association (APhA), the national professional society of pharmacists. I am here to speak about the acute shortage of pharmacists in the United States today. In December of 2000, in response to Congressional concern about the imbalance between the demand for and the supply of practicing pharmacists, the Health Resources and Services Administration (HRSA) released a report entitled "The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists." The report identified and quantified the degree of the current shortage. A shortage of pharmacists is a serious problem, as pharmacists are a valuable resource for ensuring the safety, efficacy, and cost effectiveness of medication therapy for the millions of Americans who rely on medications to cure disease, resolve symptoms and maintain health. While nurses provide the most public face in the healthcare system and laboratory technicians perform vital functions to support the system, pharmacists are the patient's last line of defense to ensure the appropriate use of medications. Pharmacists work with patients to ensure that medications work-and to minimize the situations where this valuable technology causes harm. How
did this shortage emerge? The
shortage stems from a hyper-demand for medications and medication therapy
management services, and thus pharmacists. This demand is evident in the dramatic growth in the number
of prescriptions prepared daily-growth that is sure to continue-and the
significant expansion of the pharmacist's role in patient care.
As the population ages, the shortage of pharmacists and other health care
professionals will continue. Congress
can play a valuable role in helping address this serious issue. The
Facts First, let me review a few statistics: According to the HRSA study, the number of prescriptions dispensed in ambulatory settings increased by 44% between 1990 and 1999. The number of pharmacists per 100,000 people, a standard measurement, rose 5% in that period,[1] and a study published recently in the Journal of the American Pharmaceutical Association estimates that this level of growth will remain the same over the next ten years.[2] This disconnect between the demand and supply of pharmacists has yielded an increase in open positions. According to the National Association of Chain Drug Stores, the estimated number of full and part-time unfilled pharmacist positions in chain drug stores grew by 159% from 1998 to 2000.[3] And the shortage is not limited to the community setting. A recent American Hospital Association survey of 715 rural and urban hospitals found that 21% of hospital pharmacist positions are unfilled.[4] At
a local level, we have seen a slight decline in the number of pharmacists
licensed in Massachusetts from June 2000 to June 2001, while the number of
prescriptions dispensed continues to rise.[5] As noted, the shortage affects every setting where pharmacists practice. Approximately 60% of pharmacists work in community pharmacies.[6] These are the pharmacists who most patients encounter and rely on most often, so the community setting is where most Americans see the effects of the shortage through longer waits, less time with the pharmacist, and service that is as good as it can be under trying circumstances. And similar to the community setting, drug therapy in hospitals has become an integral part of treating disease, and often the drug regimens are potentially toxic and must be very closely monitored. The monitoring of these hospital-based medications is extremely demanding and time consuming, but absolutely vital. Shortages of other health professionals compound the challenges hospitals face. Additionally the federal services, including the military, Veteran's Affairs, and the Public Health service, are important settings where pharmacists practice. As the lowest paying of pharmacist employers, the federal government has been hit hard by the shortage. Federal pharmacist vacancy rates are estimated as high as 18%, while the Public Health Service pharmacist vacancy rate more than doubled from 5% in 1996 to 11% in 2000.[7] The result of these vacancies have been cutbacks in services as well as the hiring of pharmacist consultants who are significantly more expensive than uniformed or civilian pharmacists. A recent article in Stars and Stripes outlined the shortage problem, stating that for current pharmacy students, "working for a lower-paying VA medical center may be off the post-graduation radar."[8] The
Expanded Role of the Pharmacist As illustrated by those statistics, the pharmacist shortage affects every state and every setting in which pharmacists work, from community pharmacies to hospitals, from long term care facilities to health maintenance organizations. The numbers, however, do not tell the whole story. The pharmacist shortage is not simply a result of the greater volume of prescriptions, but also the expanded role of the pharmacist in today's healthcare system. The role of the pharmacist has shifted from making medications for patients to working with patients to make medications work. An asthma inhaler is not effective if the patient hasn't received sufficient training to use it correctly. Pharmacists work with patients to explain medication therapy and monitor for side effects, working in a collaborative fashion with physicians to implement, monitor, and maintain drug therapy. The myth of the pharmacist simply dispensing pills is just that, a myth. Pharmacists today are best viewed as the clinical managers of medication therapy, specialists overseeing one aspect of patient care in a similar manner to a pathologist or radiologist. Just as a radiologist working in collaboration with a generalist is responsible for interpreting X-rays and MRIs in the process of diagnosis and treatment, a pharmacist is likewise responsible for implementing and monitoring drug therapies in that same process. These clinical responsibilities are essential for both patients and the profession. Such activities integrate pharmacists into the patients' overall care and allow pharmacists to provide critical advice and counseling regarding drug regimens that are complex and require rigorous compliance. However, these activities take time in what is already a very busy day, and demand expertise that cannot be addressed by automation or technicians. Other pressures come to bear as drug therapy becomes more widespread. Pharmacists often have to manage multiple, sometimes complicated third party payer situations and health plan specific programs. Pharmacists work to manage clinically appropriate, cost-effective therapy within those programs. Adoption of a Medicare pharmacy benefit will increase the number of patients requiring assistance with third party payment systems-thus increasing the workload. A study conducted by Arthur Andersen in 1999 found that "one-fifth of pharmacy personnel time, including pharmacists, is spent on activities directly related to 3rd party issues."[9] This includes data entry, determination of eligibility status, assistance with prior authorization requirements, and response to insurance-related inquiries. Some of these tasks can-and are-delegated to personnel such as technicians, but this also diverts that personnel from medication preparation activities. Also, patients come to pharmacies today having learned about drugs through enticing but brief direct-to-consumer ads, and often rely on the pharmacist for the details of what the drugs are for and whether they are appropriate. Providing this information has become a critical, objective counterbalance, but these activities stretch the pharmacist even further. Ultimately, while we are proud to provide these services which ensure safety, efficacy, and cost containment, there simply aren't enough of us to do it. Demand has outstripped supply, and the need for licensed pharmacists is considerable. Consequences
of the Shortage The pharmacist shortage has had serious impacts on both pharmacists themselves and the services they are able to provide. Obviously, the pressure of keeping up with demand has been hard for pharmacists personally. Longer hours and less flexibility translate into stressful conditions and decreased job satisfaction. This impact is of particular concern because it prompts pharmacists to leave the profession or seek less stressful work environments. Along with a negative impact on the pharmacists themselves, consumers suffer when pharmacists' services are limited. The shortage is forcing some pharmacies to cut back on services, and these cuts are particularly noticeable in medically underserved areas as well as in the federal services, where vacancies are more widespread. More importantly, the current work environment increases the potential for medication error. As pharmacists, we are dedicated first and foremost to the safety of our patients, but it is inevitable-as it is in any professional situation-that when we are fatigued and under pressure, the potential for mistakes increases. Additionally, as pharmacists are drawn to higher paying jobs in industry and other sectors not involved with direct patient care, there is a real danger that faculty vacancies at schools and colleges of pharmacy will increase, restricting the capability of these institutions to increase class size and increase the supply of pharmacists. This shift away from academic institutions hinders the primary long term solution to the problem. H.R. 2173 - The Pharmacy Education Aid Act The recent introduction of HR 2173, the Pharmacy Education Aid Act, is an important step in addressing the pharmacist shortage, and does so in a way that will provide relief to every setting where pharmacists practice and help patients. By providing financial aid to students, HR 2173 will trigger an immediate incentive for students who otherwise may not be able to afford this education to pursue pharmacy as a career. The bill will help schools and colleges recruit new students to study pharmacy, while the concurrent emphasis on training in rural and underserved areas will help retain these graduates as practicing pharmacists in those settings. In many of those settings, pharmacists may be the only available health care professional. Maintaining access to those professionals is essential. By extending that aid to schools and faculty in the form of loan forgiveness and expanding existing physical facilities, HR 2173 will enhance the long-term ability of schools to expand while maintaining adequate faculty staffing. In this sense, the bill mirrors private sector efforts of some large chain pharmacies that are currently offering to pay tuition for pharmacists willing to work for them after graduation. Additionally, the bill will ensure that pharmacist services are available to everyone by requiring participating schools to establish clinical rotations in under-served areas. HR 2173 will provide further resources to rural and under-served areas by mandating the inclusion of pharmacists and pharmacist services in the National Health Service Corps, which provides primary health services in health professional shortage areas. This measure will provide immediate assistance to those areas with especially critical needs. The Pharmacy Education Aid Act is significant in that it addresses the fundamental problem we face - an insufficient supply to meet the demand for pharmacists. While increasing use of automation and pharmacy technicians and other changes within healthcare management systems will certainly help deal with the increasing volume of prescriptions prepared every day, the future of comprehensive drug therapy requires trained pharmacists able to provide patients with valuable clinical services. Pharmacy schools represent the only supply of these professionals, and thus must be one focus of our efforts to address the pharmacist shortage. On
the Right Track We are extremely pleased to be here talking about this issue, and to be able to voice our support for the Pharmacy Education Aid Act. The pharmacist shortage is not a temporary problem, but does not have to be a long term one. Recognizing the problem is a significant step toward the solution. Both the public and private sector have begun to take the necessary initial action to ensure that we have enough pharmacists to manage drug therapies that already have a significant impact on the health of millions of Americans, and hold so much promise for the future. We look forward to working toward this end, and strongly encourage your continuing efforts. Thank you for listening to the views of the nation's pharmacists. [1] "The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists," Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions; December 2000, p. 4. [2] Gershon SK, Cultice JM, Knapp KK. "How Many Pharmacists Are in Our Future? The Bureau of Health Professions Projects Supply to 2020," JAmPharm, Vol. 40, No. 6, p. 760. [3] NACDS member surveys, 1998-2000. [4] AHA Special Workforce Survey - June 5, 2001. [5] Massachusetts Board of Registration in Pharmacy. [6] "The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists", pg 14. [7] Ibid., p. 30 [8] Fillmore, Randolph. "Does the Nationwide Pharmacist Shortage Threaten VA Patients' Health", The Stars and Stripes. May 21-June 3, 2001: p. 9. [9] Arthur Andersen LLP. (1999) Pharmacy Activity Cost & Productivity Study, p. 2.
|
|||||||||||
|
