Addressing the Shortage of Pharmacy Faculty and Clinicians
Addressing the Shortage of Pharmacy Faculty and Clinicians
Federal capitation payments during the 1970s helped stimulate growth in student and faculty numbers. Although capitation was discontinued in the early 1980s, the intended effect of increasing resources to expand clinical education was achieved. With the approaching end of the first decade of the 21st century, many of the faculty who began careers during the capitation period will retire, creating opportunities for midcareer, minority, and female faculty. The transition period will be short and with the continued increases in class size and the number of accredited or planned pharmacy schools, the competition for clinical and basic science faculty and senior academic leadership will be intense. As a temporary solution to the shortage of faculty members, colleges of pharmacy will seek new partnerships with health care systems to provide teaching resources for clerkship rotations. However, it cannot be assumed that health systems will have the capacity to absorb additional students, nor can it be expected that health systems will have the financial resources to provide relief time or hire additional clinical specialists to support advanced clerkship education. Strategies such as paying for clerkship rotations are not universally accepted within academia and do not provide sufficient revenue to the health system to offset the costs of training and mentoring. The career paths for health-system-based clinical specialists and clinical faculty often intertwine, so academia and health-system pharmacy do share some responsibility for identifying the factors that affect the supply and demand for pharmacists. To address this need, the ASHP Board of Directors on September 23, 2005 commissioned the Task Force on Pharmacy's Changing Demographics to study trends for hospital and health-system pharmacy. The Task Force is studying ways in which hospital and health-system pharmacy practice can capitalize on the evolving demography of the profession to improve its contributions to patient care.
The work force shortage that has affected health-system pharmacy since the late 1990s is not an isolated problem within the profession. The "graying" of pharmacy faculty and turnover for higher-paying job opportunities have contributed to a "workforce crisis in academic pharmacy." In describing how academia must respond to promote an academic career among doctor of pharmacy (Pharm.D.) students, Carter noted that increasing pharmacist salaries make pharmacy practice careers more attractive than academic pharmacy. Options to resolve the faculty work force crisis are predicated on the success of recruiting larger numbers of Pharm.D. graduates into postgraduate education and training programs. So far, the results appear to be mixed. The increasing number of postgraduate year 1 and postgraduate year 2 residency program graduates offers hope for recruiting pharmacy practice faculty, but, as Leslie has noted, the number of Pharm.D. students pursuing graduate education continues to decline.
The role of pharmacy faculty at research-intensive universities has traditionally focused on scholarship, research, and teaching. Successful pursuit of an academic career has depended on the receipt of tenure. Tenured faculty have the academic freedom to pursue and express ideas, regardless of how unpopular in mainstream thinking. This system of award and recognition has positively affected individual faculty productivity and careers, but the overall result for academia has been senior faculty who are primarily Caucasian, over age 50 years, and male.
Female and minority faculty have been disadvantaged from achieving senior faculty ranks because fewer pursued academic careers; those who did choose academia had to overcome barriers, including the possible perception that accomplishments were attributed to gender or affirmative action. Since the awarding of tenure and promotion is based on consistent achievement in research and scholarship, the negative consequences of family leave on the research programs of female faculty have contributed to the gender disparity seen between senior and junior faculty members.
The affirmation of the Pharm.D. degree as the sole entry-level degree paralleled the expansion of clinical pharmacy services in health systems, creating a demand for advanced trained clinical practice faculty. An increasing number of these faculty are female, reflecting the demographic changes in admission and graduation rates. The focus of the traditional tenure-based career ladder has broadened for pharmacy practice faculty from research to a tripartite role of scholarship, teaching, and practice, with an emphasis on practice and teaching. To remain competitive in an increasingly clinically focused profession, many colleges of pharmacy have partnered with health-system pharmacy departments to share faculty positions, or place faculty on "clinical tracks" or the nontenure track, which allows career recognition through promotion without the awarding of tenure. The continued growth of nontenure-track positions in the junior ranks may be a function of the increasing number of nonresearch-intensive schools, larger class sizes, financial pressures that limit startup packages for tenure-track positions, or declining interest in tenure from female graduates of colleges of pharmacy.
Although the mission of each organization differs, the Joint Commission on Accreditation of Healthcare Organizations and the Accreditation Council for Pharmacy Education share a vision to improve the quality and safety of patient care by focusing on performance measurement of the medication-use system. The ASHP Health-System Pharmacy 2015 Initiative envisions a future practice of pharmacy where medication use is safe, evidence based, and effective. Bond et al. defined the core clinical pharmacy services that significantly affect patient mortality and morbidity and postulated that core services can be implemented with projected work force growth. The increasing demands for advanced clinical pharmacy services in health systems will challenge the profession to train more clinical specialists, formulate new models of clinical specialist staffing that extend beyond daytime hours, and recognize that the changing demographics of the profession may require innovative approaches to recruitment, retention, and training of faculty and clinical specialists.
The traditional approach of engaging pharmacy students enrolled in advanced clerkship courses in discussions about becoming practice faculty or clinical specialists may be a case of "too little, too late." Due to the expanded job market for pharmacists and the willingness of other practice sectors to pay wages beyond those offered by most colleges or health systems, promising students must be identified much earlier in their academic careers and mentored through their academic program. Colleges of pharmacy have done a very good job of assisting students who plan to enter the traditional job market, but more must be done to encourage students to enter residency training programs and pursue faculty or clinical specialist careers. Potential strategies include shadowing programs in early practice that focus on the patient care role of the pharmacy practice faculty, designing a track within advanced clerkships that provide exposure to the residency experience, and structuring an elective clerkship to introduce the student to the college teaching experience.
How will pharmacy leadership respond to the changing demographics of the workplace? The most immediate need is to formulate creative hiring strategies that encourage women and minorities to seek positions as advanced-trained practitioners. Examples of job strategies for either faculty or clinical specialists that might allow for expanded services while maintaining flexibility in scheduling, work assignments, and career planning include
The effects of pharmacy's changing demographics extend beyond the feminization of the profession. The health professions are increasingly attractive as a career choice because of the need for health care workers to support an aging population, greater flexibility in job placement, and high income for part-time hours. Pharmacy leadership must accept as fact the changes that are occurring and embrace the diversity and practice challenges that will shape pharmacy for the future.
Federal capitation payments during the 1970s helped stimulate growth in student and faculty numbers. Although capitation was discontinued in the early 1980s, the intended effect of increasing resources to expand clinical education was achieved. With the approaching end of the first decade of the 21st century, many of the faculty who began careers during the capitation period will retire, creating opportunities for midcareer, minority, and female faculty. The transition period will be short and with the continued increases in class size and the number of accredited or planned pharmacy schools, the competition for clinical and basic science faculty and senior academic leadership will be intense. As a temporary solution to the shortage of faculty members, colleges of pharmacy will seek new partnerships with health care systems to provide teaching resources for clerkship rotations. However, it cannot be assumed that health systems will have the capacity to absorb additional students, nor can it be expected that health systems will have the financial resources to provide relief time or hire additional clinical specialists to support advanced clerkship education. Strategies such as paying for clerkship rotations are not universally accepted within academia and do not provide sufficient revenue to the health system to offset the costs of training and mentoring. The career paths for health-system-based clinical specialists and clinical faculty often intertwine, so academia and health-system pharmacy do share some responsibility for identifying the factors that affect the supply and demand for pharmacists. To address this need, the ASHP Board of Directors on September 23, 2005 commissioned the Task Force on Pharmacy's Changing Demographics to study trends for hospital and health-system pharmacy. The Task Force is studying ways in which hospital and health-system pharmacy practice can capitalize on the evolving demography of the profession to improve its contributions to patient care.
The work force shortage that has affected health-system pharmacy since the late 1990s is not an isolated problem within the profession. The "graying" of pharmacy faculty and turnover for higher-paying job opportunities have contributed to a "workforce crisis in academic pharmacy." In describing how academia must respond to promote an academic career among doctor of pharmacy (Pharm.D.) students, Carter noted that increasing pharmacist salaries make pharmacy practice careers more attractive than academic pharmacy. Options to resolve the faculty work force crisis are predicated on the success of recruiting larger numbers of Pharm.D. graduates into postgraduate education and training programs. So far, the results appear to be mixed. The increasing number of postgraduate year 1 and postgraduate year 2 residency program graduates offers hope for recruiting pharmacy practice faculty, but, as Leslie has noted, the number of Pharm.D. students pursuing graduate education continues to decline.
The role of pharmacy faculty at research-intensive universities has traditionally focused on scholarship, research, and teaching. Successful pursuit of an academic career has depended on the receipt of tenure. Tenured faculty have the academic freedom to pursue and express ideas, regardless of how unpopular in mainstream thinking. This system of award and recognition has positively affected individual faculty productivity and careers, but the overall result for academia has been senior faculty who are primarily Caucasian, over age 50 years, and male.
Female and minority faculty have been disadvantaged from achieving senior faculty ranks because fewer pursued academic careers; those who did choose academia had to overcome barriers, including the possible perception that accomplishments were attributed to gender or affirmative action. Since the awarding of tenure and promotion is based on consistent achievement in research and scholarship, the negative consequences of family leave on the research programs of female faculty have contributed to the gender disparity seen between senior and junior faculty members.
The affirmation of the Pharm.D. degree as the sole entry-level degree paralleled the expansion of clinical pharmacy services in health systems, creating a demand for advanced trained clinical practice faculty. An increasing number of these faculty are female, reflecting the demographic changes in admission and graduation rates. The focus of the traditional tenure-based career ladder has broadened for pharmacy practice faculty from research to a tripartite role of scholarship, teaching, and practice, with an emphasis on practice and teaching. To remain competitive in an increasingly clinically focused profession, many colleges of pharmacy have partnered with health-system pharmacy departments to share faculty positions, or place faculty on "clinical tracks" or the nontenure track, which allows career recognition through promotion without the awarding of tenure. The continued growth of nontenure-track positions in the junior ranks may be a function of the increasing number of nonresearch-intensive schools, larger class sizes, financial pressures that limit startup packages for tenure-track positions, or declining interest in tenure from female graduates of colleges of pharmacy.
Although the mission of each organization differs, the Joint Commission on Accreditation of Healthcare Organizations and the Accreditation Council for Pharmacy Education share a vision to improve the quality and safety of patient care by focusing on performance measurement of the medication-use system. The ASHP Health-System Pharmacy 2015 Initiative envisions a future practice of pharmacy where medication use is safe, evidence based, and effective. Bond et al. defined the core clinical pharmacy services that significantly affect patient mortality and morbidity and postulated that core services can be implemented with projected work force growth. The increasing demands for advanced clinical pharmacy services in health systems will challenge the profession to train more clinical specialists, formulate new models of clinical specialist staffing that extend beyond daytime hours, and recognize that the changing demographics of the profession may require innovative approaches to recruitment, retention, and training of faculty and clinical specialists.
The traditional approach of engaging pharmacy students enrolled in advanced clerkship courses in discussions about becoming practice faculty or clinical specialists may be a case of "too little, too late." Due to the expanded job market for pharmacists and the willingness of other practice sectors to pay wages beyond those offered by most colleges or health systems, promising students must be identified much earlier in their academic careers and mentored through their academic program. Colleges of pharmacy have done a very good job of assisting students who plan to enter the traditional job market, but more must be done to encourage students to enter residency training programs and pursue faculty or clinical specialist careers. Potential strategies include shadowing programs in early practice that focus on the patient care role of the pharmacy practice faculty, designing a track within advanced clerkships that provide exposure to the residency experience, and structuring an elective clerkship to introduce the student to the college teaching experience.
How will pharmacy leadership respond to the changing demographics of the workplace? The most immediate need is to formulate creative hiring strategies that encourage women and minorities to seek positions as advanced-trained practitioners. Examples of job strategies for either faculty or clinical specialists that might allow for expanded services while maintaining flexibility in scheduling, work assignments, and career planning include
Developing practice teams that share responsibility for a practice and the scheduling of coverage,
Rotating service blocks, which allows for relief time for projects or research,
Mentoring by more senior practitioners, especially if those practitioners are women or minorities,
Establishing an administrative-training position and scheduling young practitioners with an interest in advancement,
Borrowing against future vacancies to hire two practitioners who would initially share a job or serve in any of the aforementioned capacities,
Negotiating for release time with a college of pharmacy or department of pharmacy in a health system for a summer research or practice experience,
Creating nine-month per year nontenure-track positions for faculty to assist with the care of school-age children or family members,
Recommending young practitioners for high-visibility and high-impact institutional committees,
Mentoring by department heads who would set performance goals, provide insight into planning a career around family responsibilities, and teach how to manage a work–life balance, and
Creating return-to-work or job reentry programs that immerse the returning worker into a structured learning-renewal experience.
The effects of pharmacy's changing demographics extend beyond the feminization of the profession. The health professions are increasingly attractive as a career choice because of the need for health care workers to support an aging population, greater flexibility in job placement, and high income for part-time hours. Pharmacy leadership must accept as fact the changes that are occurring and embrace the diversity and practice challenges that will shape pharmacy for the future.
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