MO Pharmacist November 2022

Storm on the Horizon ALooming Lack of Access to Pharmacy Care Services by RUSSELL B. MELCHERT, STEVEN C. STONER, and MAQUAL R. GRAHAM

T he one certainty in healthcare and in the any degree of certainty is difficult-just ask your local meteorologists. But current tea leaves suggest that another storm is coming for patients and their access to care provided by pharmacy teams. Those of us on the inside of the pharmacy profession carried an “I told you so” expression on our faces when the nation looked on with amaze ment as pharmacists, student pharmacists, and pharmacy technicians partnered with the Federal Retail Pharmacy Program and provided some 43% of the 608 million COVID vaccinations given so far.1,2 These numbers do not include the many millions more vaccines provided by pharmacy personnel outside the walls of the traditional brick-and-mortar pharmacies. The outcomes are remarkable yet not surprising as phar macy teams are highly knowledgeable, skilled and accessible, withmost of our country’s population living within five miles of a pharmacy.1 In addition, pharmacists possess the resiliency and drive to optimize care despite professional challenges. Because of the pandemic, the public now knows exactly what we have known all along: that pharmacy teams are a great solution to closing gaps in care, not just in turbulent times such as a pandemic, but at all times. While access to pharmacies has been good, we must acknowledge significant problems with access to pharmacy care services that predated the pandemic. That is, while pharmacies have been accessible for many prior to the pandemic, pharmacy deserts have long existed throughout the country both in urban and rural areas.3,⁴ Since the pandemic began, many have observed the reduction in community pharmacy hours of operation or even closure due to staffing shortages of pharmacists and pharmacy technicians.⁵ There is no doubt that limited access has exac erbated the pharmacy desert problem as well as increased the workload and stress for all pharmacy personnel. Employers are now asking some schools of pharmacy for help in recruiting more pharmacists, student pharmacists, and pharmacy technicians. Those of us who have been in pharmacy academia for a while have observed pharmacist availability rise from famine to feast and now arguably back to famine. Key questions persist. How canwe increase access to pharmacy services for all patients? How canwe convince policymakers and payers of the value of pharmacy services for increasing access, improving medication use and outcomes, pharmacy profession is that change is inevitable. And of course, forecasting the future with

reducing overall costs, and improving patient satisfaction? Will there be enough pharmacists and pharmacy technicians tomeet current and future demands, especially as pharmacy practice continues to transform and more opportunities exist for pharmacies to get paid for clinical services? Proactively thinking, we have to ask ourselves, what does the future look like in terms of meeting these demands? Unfortunately, one forecast strongly suggests that these situations are going to get far worse in the immediate future. A very strong indicator of future availability of pharmacists is pharmacy school enrollment, and that indicator points to significant problems on the horizon. Data from the American Association of Colleges of Pharmacy show that from 1992 to 2002, the number of students beginning pharmacy programs in the United States rose from 8,664 to 9,128, representing a modest gain of 5%. Yet, from 2002 to 2012, this number rose to 14,011 near the peak high which occurred in 2013 at 14,276. While it may seem like a large number compared to a few decades ago, pharmacy schools enrolled only 11,135 new students into their programs in Fall 2021.This represents a substantial decline (21%) from the peak in 2013 and returns new enrollment num bers to 2006-2007 levels. While employers are currently experiencing problems recruiting and retaining pharmacists, they may not recognize the impending shortage of graduates nor realize their problem is likely to worsen. Official data is not yet available, but the number of graduates frompharmacy programs in spring 2022 most likely remained relatively constant given that the vast majority enrolled in 2018 and was among a nationwide cohort (13,546 new enrollees) near the peak high. In addition, on-time graduation rates are very high for pharmacy professional pro grams due to rigorous accreditation standards, and it is not uncommon to see on-time programcompletion rates exceed 90%. So, while 2022may have looked like recent past years, what does the future look like for new pharmacy graduates? The answer should be quite alarming to everyone in our nation who has ever looked to a pharmacist for information and appropriate use of drug therapy. If we assume that 90% of the new student enrollees nation wide graduate on time, thenwe would expect approximately 11,500, 10,500, and 10,000 newPharmD graduates in 2023, 2024, and 2025 respectively in the United States.This represents a 13%decline in graduates over the next three years alone, and a 33%decline from the pre-pandemic year of 2018. The national numbers are not yet available for those who matriculated into pharmacy programs inAugust of 2022, however we know that many pharmacy schools around the country experienced a further decline from last fall—for example, our entering class at UMKC is down 15% from the fall of 2021. With this in mind, national numbers of graduates may very well return to levels seen in the early 1990s within the next few years (i.e. approximately 9,000 graduates per year). Couple this information with data from the Bureau of Labor Statistics which currently projects an

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