Association Updates on the Human Resource Issues
CPhA, APES, AFPC, CSHP

Canadian Pharmaceutical Association, Janet Cooper

The Pharmacy Human Resources HRDC study "A Situational Analysis of Human Resource Issues in the Pharmacy Profession in Canada" is on the CPhA web site www.cdnpharm.ca. The study reviewed published articles and reports, public data and internet sites. They also had 23 key informant interviews asking questions about labour markets for pharmacists and technicians, evolving roles, training and practice patterns. This is a limitation of the report since it was based on available information only and no new information.

The report indicated the pharmacist occupation is in transition and where we are going is not precisely clear. Despite the increasing demand for pharmacist services in both community and hospital, patients don't seem to be suffering although some pharmacies have reduced their hours or closed. In terms of the pharmacist shortage, there is approximately a 10% vacancy rate, both in community and hospital settings. This is both a Canadian and a global issue. The root causes of this shortage may include expanded grocery and department store pharmacies, increased hours of service, rising prescription volumes due to the aging population, greater demand for information from consumers and increased availability and complexity of drug therapies.

On the flip side, it has been suggested there is not a shortage, but that pharmacists are performing tasks they don't need to. If technicians assume these functions, pharmacists could focus on what they are trained to do and there would not be a shortage. However, if pharmacists get involved in primary care reform, there may be a very significant rise in demand for their services.

The report concluded there are gaps in information. A comprehensive objective analysis of current and future human resource issues in pharmacy practice is not available. The next step would be an Occupational sector study with HRDC looking at both pharmacists and technicians. The Millcroft group also suggested that the scope of technicians and the use of "assistants" when it is more appropriate be considered in this study. The purpose of the study would be to answer questions about the extent and nature of the shortage, the causes of it, and what can and should be done to address the problem. The steering committee for the sector study is being established. A proposal for HRDC will be developed with a 50:50 funding model (HRDC:Pharmacy) for an 18-24 month study that will cost $400,000-500,000. Pharmacy contributions can be both cash and in-kind contributions.

Other CPhA initiatives include working with a Health Sector Studies Communications Secretariat committee looking at several sector studies on nursing, medicine, pharmacy, oral health, social work and home care. There is also a rural and remote practices survey to look at recruitment and retention factors, and pharmacy will be part of this study.

L'Association des pharmaciens des établissements de santé du Québec - Manon Lambert

In Quebec in 1999 the health minister created a task force on the pharmacist shortage. Many organizations were involved including APES, the employers' association, and the Faculties of Pharmacy. The health minister was already convinced there was a shortage and the study was to look at the impact of this shortage on the profession. The study found a 10% vacancy rate in hospitals, and a 3-6% vacancy in retail pharmacy (although the data was less clear). If the current trend continues, there is a forecasted 25% vacancy rate in 15 years time.

The problem affects all categories of hospitals in all geographic locations. About half of the vacant positions are permanent full-time positions with the average time to fill a position being 8 months. The report should be published in July and will have an action plan with two measures related to recruitment and retention. The capacity to attract new pharmacists to the Masters program, a requirement for hospital pharmacy practice, is one measure. The report indicated a need to increase pharmacist salaries, and to provide more tuition scholarships. Retail pharmacists are very aggressive in marketing themselves to pharmacy students early in their school career. The retention measures are more difficult since they rest with the health minister and he was not prepared to discuss salaries in the context of this report.

Association of Faculties of Pharmacy in Canada, Jim Blackburn

From the Faculty perspective, there are three issues to examine related to pharmacist manpower:
· How many graduates does Canada need in the future?
· How can faculties work with hospitals to get students interested in hospital practice early on in their education?
· Education is a collaboration between universities and practitioners which also means it requires collaboration between the Education and Health Ministries in each province.

How Many Graduates are Needed?
From a planning point of view, immediate action by Faculties still has a 4-5 year time line. For example, any admission changes made for the September 2001 entry of students will not affect graduating numbers until May 2005. Medium and long term perspectives have 10 year plus time lines. The total numbers of Canadian graduates has varied over the last 2 decades and is outlined in the following chart. Universities have recently put pressure on faculties to increase enrollments since Pharmacy is a significant program for revenue generation for the university. As a result, there will likely be 1100 students 7 years from now.

Year #Graduates
1980 695
1985 632
1990 826
1995 785
2000 780
1999 admissions for 2003 graduation 888

David Hill undertook a study of the admissions to schools of pharmacy, by province, in the last 10 years. The indicator he used was the number of placements per 100,000 population. The average was 2.9 however, as illustrated in the table below there was significant variation with Ontario at 1.21 at the low end and Saskatchewan at 7.78.

Geographic Area Admissions/ 100,000 pop'n Faculty Plans for future numbers of graduates
British Columbia 3.48 University of B.C. Stable with 140 graduates
Alberta 3.71 University of Alberta Have 110 graduates, considering the future
Saskatchewan 7.78 University of Saskatchewan Stable with 80 graduates
Manitoba 4.54 University of Manitoba Have 52 graduates, but will begin constructing a new building
Ontario 1.21 University of Toronto Going from 140 to 240 when new building is finished
Quebec 3.54 Universite de Laval Going from 110 to 130 graduates
Quebec 3.54 Universite de Montreal Going from 130 to 165 this year and to 200 next year
Nova Scotia/ NB/ PEI 3.60 Dalhousie University Going from 66 to 90 this fall
Newfoundland 7.40 Memorial University Reducing from 42 to 36 graduates

With these increasing enrollments in Faculties of Pharmacy, there is a need to consider the human resource issues for teaching staff, particularly with upcoming retirements and insufficient graduates pursuing academia as a career.

Over the last few years across Canada, there has been a gradual decrease in the number of applicants to pharmacy faculties. Because faculties were over-subscribed previously, there were never any real recruitment campaigns and faculties are now faced with student recruitment as a priority issue. Dalhousie had a fairly aggressive recruitment program last year including TV ads. They were able to double the number of applicants to their program.

How do we get Students Interested in Hospital Pharmacy?
The faculty suggestion is that all first year students should do a one month placement in hospital practice. However with the shortages in the system, this will result in additional stress. As part of the BSc program there needs to be greater exposure to direct patient care. Hospitals also need to get graduates interested in residency programs where they will get patient exposure and clinical experience. The impact of student placements can be reduced with job shadowing, ratios of 1:2 for preceptor:students, and by reducing the paperwork and administrative burden for preceptors.

Collective agreements need to consider the education component and the extra efforts of preceptorship, but progress is slow. In Alberta, they are considering financial recognition for preceptor time, e.g. $1 per preceptor hour for nursing preceptors. In B.C. there is currently a disagreement between the Ministries of Education and Health as to who is responsible for paying for preceptorship.

Education also needs to be responsive to the needs of the market. Pharmacy students should learn about technology and medication safety, however it is difficult to move away from the scientific foundation of pharmacy. These topics are covered in residency programs that have a more practical focus.

Education as Collaboration between Faculties and Practitioners:
We need to determine what it costs hospitals to provide student placements and develop a process to negotiate with Ministries of Health. Somehow, education has to return to hospital funding as a priority for all health care professions. For the future, there is a specific need to consider that 1100 pharmacy students will mean an additional 300 placements in hospitals.

Canadian Society of Hospital Pharmacists, Linda Polloway

CSHP has not put out a position statement on the pharmacist shortage. However, CSHP does support the increased use of technicians and automation and an increased clinical role for pharmacists. There is a task force that will be publishing a statement on the use of technicians. At the CPhA conference in May, there was a forum for discussion of issues across organizations including the scope of practice of the technician. The Canadian Council on Accreditation of Pharmacy Programs, is looking at certifying pharmacy technician programs. Alberta and Ontario are certifying their Pharmacy Technicians. CSHP has looked at the relationship between automation and safety, but this is dormant at the moment.

In terms of improving the hospital environment as a work site, CSHP will be surveying members and may look at a job satisfaction survey for hospital pharmacists as part of this. In terms of enhancing job satisfaction for the practitioner, CSHP is looking at the pharmacist as a prescriber. At the joint officers meeting with the Association of Faculties of Pharmacy in Canada there was discussion on how to get students interested in hospital practice early in their career. CSHP could possibly look at the IOM report and provide summary points to members, as well as the six action steps in the second report.