While much of the discussion concerning the health care work force in the era of reform revolves around physicians and nurses, another key member of the patient care team also faces strains. Pharmacists are in the unique position of working in an industry that is both contracting and poised for rapid growth, as millions of people become insured and increase the demand for prescription drugs.
Pharmacists in the Los Angeles area are experiencing what they hope is a temporary stagnancy in their industry, triggered both by consolidation and by the recession, as patients buy fewer drugs.
A 12.4% state unemployment rate translates not only to fewer jobs, but to lost or reduced health care benefits. Patients are seeing doctors less frequently and thus filling or refilling fewer prescriptions. Even employees with health insurance face higher deductibles and steep out-of-pocket expenses that discourage proactive self care.
“Families are feeling the effects of this economic climate across the board, feeling like they have to make difficult choices,” said Jon Roth, CEO of the California Pharmacists Association.
Filling Jobs and ‘Scripts’
The economic pinch makes it harder for pharmacists to find jobs.
“When I graduated in 2000, there was competition for my services,” said Eric Gupta, CPhA president and associate professor at Western University Health Sciences College of Pharmacy in Pomona. He recalls abundant, attractive job openings and signing bonuses for newly graduated pharmacists.
The major pharmaceutical job markets of Los Angeles and Orange counties are saturated, he said, due in part to mergers of large, community chains that need fewer employees. “At one time, you’d see competitors building in the same area, but there’s less of that now,” said Gupta.
California has eight colleges producing new pharmacists each year. There are rumors that two to six more may be in the planning stages.
Making the job market even tighter, many prescription benefit managers and third-party payors have moved to mail-order delivery systems to take advantage of lower prices.
Finally, said Gupta, many pharmacists who were set to retire or work part-time have stayed in the work force instead, creating a “log-jam” of filled jobs.
Gupta reports that Western’s recent pharmacy graduates have all obtained jobs, but more slowly than anticipated. “Some have had to wait three months, and instead of getting Los Angeles or Orange County, it’s been Lancaster or Bakersfield. It is, after all, a job.”
The ebb and flow of present and future economic conditions isn’t lost on the corporate pharmacy industry.
“We regularly review market conditions and adjust work hours upwards or downwards accordingly,” Mike DeAngelis, CVS/pharmacy director of public relations, said. The company operates more than 300 stores in Los Angeles and Orange counties.
Walgreens reported that it filled 778 million prescriptions in fiscal year 2010, an increase of 7.5%. In a prepared written statement, the company said it is poised to transform the role of its community pharmacists. “We are providing greater opportunities for our pharmacists to interact with patients by streamlining their workload, redesigning our pharmacy layout to promote more face-to-face conversations and expanding our scope of services,” the Walgreens statement said.
Reduced spending and declining consumer demand are not good for any industry, especially when sustained over a long period, said Neeraj Sood, an international programs expert in health policy and economics at the University of Southern California.
“The slowing economy affects employment in the pharmacy industry when fewer people fill prescriptions. There’s empirical support for this,” Sood said.
Health care reform proponents predict that when significant numbers of uninsured people become insured, they’ll spend more on their health, creating an increased demand for services and increased employment in the health care sector, Sood said.
In California, one in 10 people are employed in health care, but as the Los Angeles Times reported in late November, the sector has been stagnant, even as national health care employment has risen.
More Gates To Open
“The job isn’t just about knowing chemicals,” Gupta said, “but it’s more about being a gatekeeper.”
Health care reform will open more gates for pharmacy services, as 30 million people become insured. They will be taking medicines and they will need help with them.
A pharmacist is much more than the public’s often simplistic perception of “a glorified pill counter,” said Sood.
Research shows that greater compliance and adherence to prescription drugs is an effective way to improve health care quality while also reducing costs for patients with chronic illnesses.
“The pharmacist is the medication expert,” said Kukla Vera, spokesperson for USC School of Pharmacy. “Physicians recognize they can’t do it all. They don’t have time, and managing chronic disease is a lot of work that entails patient education. Additionally, how many people leave a physician’s office without complete instructions they need to make their medication regimen work for them?”
“They are highly educated doctors in their own sense, who play a front-line role,” said CPhA’s Jon Roth. He envisions pharmacists evolving to their “natural place.” As the delivery system fails to keep up with demand, pharmacists who complete a four-year graduate professional program will play increasingly important roles in the system, Roth predicted.
Gupta agreed. “We’ll finally be able to practice at the level to which we’re trained,” Gupta said. “We are not yet recognized as the providers we really are for chronic disease management. We give consultations, but we don’t want to diagnose.”
Side by Side
A July Wall Street Journal op-ed by USC Pharmacy School Dean R. Pete Vanderveen reinforced the concept that a single physician can’t be all things to all patients and functions best when complemented by a team of health care professionals.
Vanderveen writes that he wants to change federal CMS reimbursement codes to allow pharmacists to assume greater roles in patient care.
Gupta contends that pharmacists can help take some of the pressure and work load off physicians. For example, after a physician diagnoses a patient, the medication therapy manager — the pharmacist — could evaluate lab work, adjust medications and follow progress notes, Gupta suggested.
“We have data that shows pharmacists do a very good job of getting patients to goal,” he said. That goal, according to the American Pharmacists Association, is “to make sure that the medication is right for the patient and his or her health conditions and that the best possible outcomes from treatment are achieved.”
Health care reform has already identified specific incentives that aim to encourage health insurers and hospitals to institute quality improvement programs, Sood said, adding that pharmacists can participate in initiatives to improve medication management.
At safety-net clinics in Los Angeles, pharmacists work side-by-side with physicians to treat homeless, uninsured, chronically ill patients as part of the medical home team.
“In the medical home method of treating patients, studies show that when pharmacy is involved, the outcome is better,” said Vera.
Pharmacists predict that as health care reform progresses, Americans will likely see more involvement by pharmacy across the board, and they won’t object. In Gallup’s annual Honesty and Ethics Survey, pharmacists ranked third behind nurses and military officers.