Updates on the Human Resource Issues
CPhA, APES, AFPC, CSHP
Pharmaceutical Association, Janet Cooper
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.
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
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.
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.
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.
des pharmaciens des établissements de santé du Québec
- Manon Lambert
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.
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.
of Faculties of Pharmacy in Canada, Jim Blackburn
From the Faculty
perspective, there are three issues to examine related to pharmacist
· 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
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.
1999 admissions for 2003 graduation 888
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
Area Admissions/ 100,000 pop'n Faculty Plans for future numbers
British Columbia 3.48 University of B.C. Stable with 140 graduates
Alberta 3.71 University of Alberta Have 110 graduates, considering
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
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.
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.
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.
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.
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.