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Pharmacists, Pharmacy and Idaho

Providers of Health Care Today and Tomorrow

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College of PharmacyIdaho State University

• First College on the ISU campus - 1920• First College in the North West• Early adopter of the 4 year program – 1922• 7th College in the US to adopt Pharm.D. as the

only degree available.• Most successful and one of two remaining

non-traditional programs

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College of Pharmacy

• Admitted 60 students in 2008• Admitted 70 students in 2009 – 2011• Potential to grow to 100 students with current

facilities.

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College of Pharmacy

• Pocatello, Meridian, Coeur d’Alene • Meridian and the new facility• Member of the Division of Health Sciences

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Idaho’s College of Pharmacy

• State wide recruiting• Equal preference for all residents• Preceptors located across Idaho

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Pharmacies in Idaho Counties

BLS 10 Year Occupation ProjectionUS (Idaho)US 2008 - 2018

Occupation 2008 2018 10 Year Growth

Pharmacist 243,000 296,00017%

(29%)

All Occupations 150,931,700 166,205,000

10%(16%)

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*Fourth highest ranking “hot-job” per Idaho Department of Labor. Criteria: number of jobs, fastest growing, highest pay

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Conclusions: BLS Occupation Projections

• US - pharmacist employment expected to grow much faster than total employment, 2008-2018

• Idaho 2008-2018– Total Idaho employment to grow much faster than US– Idaho pharmacist employment growth nearly double

growth of total Idaho employment– Idaho pharmacist employment to grow much faster

than both US pharmacist and total US employment

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Conclusions: BLS Occupation Projections

• Factors likely to reduce demand for pharmacists – BLS expects mail-order and online pharmacies to grow

much faster than community pharmacies – BLS expects greater automation of drug dispensing– BLS expects greater employment of technicians/aides

Why hasn’t more automation been deployed? Impact of more national involvement in healthcare?Role of electronic medical records?

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Conclusions: BLS Occupation Projections

• Factors likely to increase demand for pharmacists– Aging of the population– Continued expansion of the potential for new drugs to

treat diseases– Continued expansion of the role of pharmacists in

primary and preventive care– New opportunities in disease management, research,

informatics– New opportunities for pharmacists in managed care and

elsewhere to analyze trends and patterns in medication use and in pharmacoeconomics

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Conclusions: BLS Occupation Projections

• Notice that the BLS identified factors increasing demand for pharmacists also deepen pharmacy job content, adding to pharmacist responsibilities

• Pharmacy professional societies pushed for the PharmD and are pushing for more pharmacist responsibilities

• George Halvorson, Chairman, CEO Kaiser Health Plan

“….clinical pharmacists are the most underutilized member of the healthcare team.” (6 April 2009)

Will more national involvement in healthcare lead to job deepening & more clinical responsibilities for pharmacists?

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Impact of Current Recession

• Recession appears to be impacting pharmacy, ie, some slowdown, but that impact appears to be limited so far.

• Consistent with notion that healthcare is one of the least impacted sectors during economic downturns

• However, pharmacy & healthcare in general are not totally immune to recessions, particularly severe downturns.

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Impact of Current Recession

• Anecdotal Reports: Idaho– ISU COP placed all May 2010 graduates– Rite-Aide store closed Pocatello Spring 2010– Less part-time hours

• Anecdotal Reports: USA– Chains slowing expansion plans– Hospitals hiring less– Private school rumors

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US Prescription Spending

15

0

2

4

6

8

10

12

14

16

18

20

1980 1985 1990 1995 2000 2005

Source: CMS, Office of the Actuary, National Health Statistics Group, 2009

Calendar Years

Perc

ent

Share of NHE

Rx Growth

5%

Retail Prescription Drug Expenditure Growth and Share of National Health Expenditures

2009 5%

2009 10%

0.0%2.0%4.0%6.0%8.0%

10.0%

US Prescription (scripts) Growth, 1998-2009

Source: NACDS Chain Industry Profile, annual issues, based on IMS data.

IMS reports 2% prescription growth in 2009.

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Effects of Price and Quantity on Retail Prescription Sales Growth

Since 1993 about three-fourths of total growth of prescription drug spending has been real growth, meaning growth in utilization/quantity of drugs actually sold and consumed. Through 2019 prescription drug spending is expected to grow at about 5-6% annually.

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Pharmacist Shortage

• Short Run Demand: Pharmacist Shortage

• Supply Response to Pharmacist Shortage

• Pharmacist Demographics

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Pharmacist Shortage

• National pharmacist shortage recognized 1998-99

• Major national report completed in 2000*

• The current shortage may have been exacerbated by the switch to the longer 4-year PharmD degree

Note: there were earlier pharmacist shortages, e.g. 1991

*Health Resources and Services Administration. The pharmacist workforce: A study of supply and demand for pharmacists. Rockville, Md.: US Department Of Health & Human Services, 2000.

ADI Meaning

1.0 Supply surplus: demand is much less than the pharmacist supply available

2.0 Moderate supply surplus: demand is less than the pharmacist supply available

3.0 Balance between demand & supply

4.0 Moderate demand shortage, some difficulty filling open positions

5.0 High demand shortage: difficult to fill open positions

Aggregate Demand Index (ADI)

ADI survey utilizes a 5-point scale where 3.0 indicates a balance in demand/supply, higher values a shortage and lower values a surplus

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Aggregate Demand Index: Moderate Shortage

4.05 4.213.83

4.074.003.79

3.5 3.44

1

1.5

2

2.5

3

3.5

4

4.5

5

Idaho U.S.

Jan-07

Jan-08

Jan-09

Jan-10

Source: Aggregate Demand Index. http://www.pharmacymanpower.com/index.html (accessed 5-20-10)

ADI survey utilizes a 5-point scale where 3.0 indicates a balance in demand/supply and 4.0 indicates a moderate shortage, some difficulty filling open positions.

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State/Region Rating Meaning

United States 3.3 Some shortage

Mountain Region 2.9 Balance

Idaho 3.0 Balance

ADI: Shortage/Surplus Ratings June 2010

Source: Aggregate Demand Index. http://www.pharmacymanpower.com/index.html (accessed 9-20-10) 22

ADI: Shortage/Surplus Ratings by States Bordering Idaho

State January 2010

June2010

USA 3.4 3.3

Mountain Region 2.9 2.9

Idaho 3.5 3.0

Montana 3.4 2.7

Nevada 2.6 2.5

Oregon 3.2 3.4

Utah 3.1 3.2

Washington 3.7 3.6

Wyoming 2.7 3.0Source: Aggregate Demand Index. http://www.pharmacymanpower.com/index.html (accessed 9-20-10) 23

ISU College of Pharmacy Graduating PharmD Student Survey 2010: Distribution of Employment

Type Percent

Retail 58%

Hospital 10%

Resident/Other 32%

Source: ISU College of Pharmacy Graduating PharmD Student Survey

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Supply of New Pharmacists

• New graduates

• First year enrollment

• Projections based on first year enrollment and existing attrition rates

• Number of Colleges/schools of pharmacy

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Number  of  U.S.  Pharmacy  School Graduates: 1960‐2008

11000

10000

9000

8000

7000

6000

5000

4000

3000

2000

1000 0

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Source: Data from AACP website, www.aacp.org

Source: The National Pharmacist Workforce Study, March 2009

02000400060008000

1000012000 United States

TotalMaleFemale

Source: AACP Profile of Pharmacy Students, Fall academic data issued each Spring of following year.

Supply of New Pharmacists, 2001-2009

In the 2001-2009 period the supply of new pharmacists increased 57% over the entire eight year period.

11,000

7,000

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02000400060008000

100001200014000

First Year Professional Enrollment, 2000-2009

Source: AACP Profile of Pharmacy Students, Fall academic data issued each May of following year

12,705United States

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US Pharmacy Schools/Colleges 2000-2010

Fall of Each Year

Total Institutions

Total GrowthNumber

Total Growth5 years

2000 82

2005 92 10 12%

2010 120* 28 30%

Source: AACP Profile of Pharmacy Students & Academic Pharmacy’s Vital Statistics, Fall academic data issued each Spring of following year

*Includes 4 institutions anticipating inaugural class Fall 2010

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Workforce Summary• Review of available data indicates

– Some easing of pharmacist shortage in nation & Idaho.

– Significant growth in pharmacist supply

7,000 graduates 2001, 11,500+ by 2012• Caveats

– Important to review data but….

– Future role of automation/technology

– Future impact of changing healthcare system

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Pharmacy’s Future

• Pharmacy’s evolution• Legislative changes• Professional changes• Roles• ISU College of Pharmacy

Evolution of Pharmacy• Pharmacy is much more than dispensing pills

– Although….3.6 BILLION Rx’s filled in US in 2009 – 12 Rx’s for every US citizen

• Pharmacists play integral role in health care delivery– Most visited health professional

• Medication mis-adventures result in $70 billion+ in excess expenditures– Pharmacy’s role

• Medication Therapy Management• Health care quality

Legislative Changes

• Practice evolution– Medicare Part D– Legislation in Idaho

• Pharmaceutical care rule• Telepharmacy• E-prescribing• Limited prescribing by pharmacists

– Immunizations, fluoride• Registration of non-dispensing outlets that provide

pharmaceutical care only• Practitioner status

Residency Requirements

• Several major pharmacy organizations endorse the requirement of a residency for entry into clinical pharmacy practice– Many residency types – cardiology, psychiatric,

oncology, ambulatory care, primary care, managed care, pediatrics, infectious disease, etc.

• Federal funding for residencies• An even more qualified professional

Health Care Reform and Pharmacy• Changing role of pharmacist

– Collaborative care delivery– Medical home– Underserved populations – 340B pharmacies – Rural issues

• Care delivery extension– Immunizations– Protocol-driven patient management

Role of the College• Present

– Teaching – state-wide– Practice – state-wide, VA– Service – Meridian compounding lab– Research

• College-State Collaborations – top DUR program in nation• Basic science programs• Boise VA• Clinical trials – ACCORD, ALLHAT, AIM-HIGH• Care delivery - ECHIP• Quality - TLC

• Future– Division of Health Science focus on rural care delivery– Telepharmacy?

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QUESTIONS?