shortages currently affect a number of medical professions. Over
the past few years, these shortages have come to affect pharmacy,
and particularly hospital pharmacy, in a dramatic fashion. The scope
of this problem is believed to be wide-spread and its impact has
caused reductions in patient oriented pharmacy services. This year’s
Annual Report represents one of the few comprehensive measurements
of the human resource shortage affecting hospital pharmacy across
the current pharmacy labour market, noting the distinction between
budgeted and actual staffing is important. Due to the dynamic nature
of pharmacy staffing in this environment, several metrics utilized
in this report rely on budgeted staffing as opposed to actual filled
positions. As a result, reported figures show increases in staffing
at a time when many institutions are reporting significant shortages
of skilled workers.
staffing, paid hours per patient day and changes in staff are reported
in Table F-1. Overall, reported pharmacy staff paid hours per acute
care patient day (excluding residents) increased from 0.68 in the
1999/2000 Annual Report to 0.74 in this year’s report. Comparisons
at the provincial level showed that the reported paid hours per
acute care patient day increased in each province except Alberta.
Paid hours per acute patient day increased for hospitals of all
bed sizes (Table F-2) except those between 100-200 beds, which decreased
from 0.66 to 0.64. Increases were reported for teaching and non-teaching
hospitals and for all types of medication delivery systems.
Half of the
respondents (62/123) reported an increase in staff positions, 41%
(51/123) indicated no net change, and 6% (7/123) reported a decrease
in positions. Increases were reported by 46% (33/71) of non-teaching
hospital and 56% (29/52) of teaching hospital respondents. These
results were similar to those reported in the 1999/2000 Annual Report.
Staffing increases were cited as being due to program changes by
52% (32/62) of respondents with increases, due to increased workload
by 50% (31/62) and due to revenue opportunities by 3% (2/62). The
percentage make up of the budgeted pharmacy department staff remains
consistent with the proportions reported previously.
Pharmacists spent approximately 39% of their time in clinical activities
(Table F-3); however the time spent in distribution activities reportedly
decreased from 49% in the 1999/2000 Annual Report to 46% in this
Report. This decrease in drug distribution time was offset by small
increases in other non-patient care activities and pharmacy research.
Interestingly, pharmacists in non-teaching hospitals spent 5.5%
of their time in teaching activities, which is very similar to that
reported in teaching hospitals (6.9%).
reported in Table F-4 are reflective of those paid up to March 31,
2002. Salaries continue to be dynamic given the current labour shortages,
so these figures may not be comparable to current salary figures.
Clearly the trend in many areas of health care in Canada is toward
a marked increase in compensation to health care workers. The average
expenditure per full time equivalent pharmacy staff position increased
to $49,298 from $44,286 reported in the 1999/2000 Annual Report.
This increase is well above the increase in cost of living for the
period; however this could, in part, be due to changes in the mix
of respondents from various provinces.
reported that salaries for pharmacists increased substantially over
the 1999/2000 Annual Report. Increases in average maximum salaries
for assistant directors, coordinators, pharmacists (BSc) and pharmacists
(MSc/PharmD) increased by between 12.2% and 16.2%. Average maximum
reported salaries for technicians increased by 9.9% and the increases
were loosely correlated with the complexity of the distribution
system employed. Ranges for the salaries of directors are reported
in Table F-5. Respondents indicated that 56% of directors earned
over $80,000 per year compared to 19% as reported in the 1999/2000
Annual Report. Directors of larger facilities tended to be compensated
at higher levels and salaries were reported to increase across all
jurisdictions and size of hospitals. The substantial reported increase
in salaries for professional staff is reflective of the current
shortage of pharmacists in Canada.
respondents noted the starting salary of a pharmacist (BSc) with
no experience to be different than the bottom level of the salary
scale. This was reported to be an average of $2,419 per year above
the lowest salary level. The teaching hospital average was $3,072
and the average for hospitals with 100-200 beds was $5,672. There
was a large variance in the responses with some hospitals reporting
starting salaries below the lowest salary level. By contrast the
average difference for pharmacy technicians was reported as $69
per year (n=90). Clearly, respondents are using increased salaries
for less experienced pharmacists in an effort to recruit new graduates
to hospital practice.
Human Resource Shortages
This Annual Report quantifies vacant hours and positions in all
job categories. The results are presented in Tables F-9 and F-10.
Sixty percent (72/120) of respondents reported having pharmacist
position vacancies at March 31, 2002, which was somewhat less than
the rate reported in 1999/2000 (69%). The average percent of vacant
paid hours for pharmacists reported was 10.3 (range 0-58.2%) with
a vacancy rate at March 31, 2002 of 9.7% (range 0–51%). Overall,
respondents reported a total of 228 pharmacist position vacancies
across Canada on March 31, 2002. The absolute number of reported
vacancies will clearly underestimate the true pharmacist human resource
gap across Canada, given the response rate to this survey. New Brunswick/PEI
respondents reported the highest hourly vacancy rate at 13.1%, and
highest positional vacancy rate at 16.6%.
only 15% (18/119) of respondents reported having technician vacancies
at March 31, 2002. The reported vacancy rate for technicians (based
on both vacant hours and positions) was reported to be less than
rates were reported as 8.7% (paid hours) and 7.6% (positions). The
greatest position vacancy rates were reported in Manitoba (19.4%)
and Ontario (13.1%).
of reported durations of pharmacist vacancies was calculated as
210 days, which has increased significantly from the previous Annual
Report (122 days). This average was 180 days in non-teaching hospitals
(134 days in 1999/2000), and 257 days in teaching hospitals (110
days in 1999/2000). Vacancy duration was longest in hospitals over
500 beds (258 days) and shortest in hospitals between 100 and 200
beds (121 days). Average management vacancy durations were reported
as 53 days. The longer vacancy periods in large teaching hospitals
may be in part due to the greater degree of specialized training
required in some of these patient care areas. In addition, in some
jurisdictions, urban hospitals have experienced a migration of skilled
health care staff away from the downtown core to hospitals in suburban
communities. Health care workers may be seeking an enhanced and
more affordable quality of work and personal life.
Impact on Patient Care Services
shortages can ultimately lead to reductions in service. Sixty percent
of respondents (Table F-7) noted that services have been curtailed
in the past year due to staff shortages. In hospitals over 500 beds,
this figure was 82% and in teaching hospitals it was 75%. Of those
respondents who noted that services had been curtailed, 80% (50/74)
responded that direct patient care / clinical services had been
curtailed, 59% (44/74) delayed the implementation of an approved
program and 49% (36/74) reduced teaching services. Given the need
for pharmacists, it is worth noting the reduction in teaching services
amongst the respondents. This reduction clearly could have a significant
impact on the ability of Faculties of Pharmacy to graduate greater
numbers of skilled pharmacists.
and retention strategies should be a standard component of a department’s
human resources strategy. Specific strategies employed by the respondents
of this Annual Report are listed in Table F-8. Interestingly, given
the critical labour shortage, 17% (21/123) of respondents indicated
that they used no specific recruitment and retention incentives.
This was highest in Quebec (44% - 13/36), in non-teaching hospitals
(25% - 18/71) and in hospitals between 100-200 beds (24% - 7/29).
The most common incentives included paid educational leave (49%),
conference opportunities (44%), moving expense allowance (41%),
start salaries above usual salary steps (33%) and flexible work
hours (28%). Other less traditional measures were employed relatively
infrequently. The frequency of use of these incentives did not change
from the 1999/2000 Annual Report. Respondents appear to use relatively
traditional strategies to retain and recruit human capital and,
in addition, pharmacy respondents did not appear to be increasing
their efforts to employ incentives as part of their human resource
plans. The influence of labour unions/associations in hospitals
can limit a hospital’s ability to design creative retention
and recruitment incentives.
to the 1999/2000 survey indicated that pharmacists belonged to a
union in 67% (77/115) of hospitals, while respondents this year
indicated a unionization rate of 59% (72/123). The change is likely
due in part to a higher proportion of responses from Ontario hospitals,
which continue to have the lowest unionization rate amongst pharmacists
(34% - 13/38). Unionization rates for various groups are represented
in F-6. Respondents reported that management staff were unionized
in 24% (29/123) of hospitals and pharmacy technicians were represented
by a union in 79% (97/123) of hospitals.
Annual Report illustrates the growing problem of human resource
shortages in Canadian hospital pharmacy. These shortages of skilled
pharmacists are giving rise to significant increases in compensation
and a more focused effort on the part of employers to implement
strategies to retain and recruit skilled professionals. Based on
trends from previous reports, this skill shortage is likely to continue
to grow, further compromising the ability of hospital pharmacies
to deliver comprehensive quality patient oriented pharmacy services.