Human Resources
Neil Johnson

Human Resource 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 Canada.

Staffing

In 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.

Average budgeted 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%).

Salaries

The salaries 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.

Respondents 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.

Seventy-seven 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%.

By contrast, 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 2%.

Management vacancy 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%).

The average 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

Human resource 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.

Recruitment and Retention

Recruitment 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.

Unions

Respondents 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.

Summary

This year’s 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.