The Future of Pharmacy Jobs -- Will It Be Feast or Famine?

Darrell Hulisz, PharmD; Daniel L. Brown, PharmD

Disclosures

April 15, 2014

In This Article

Pharmacist Roles

Dr. Hulisz: You note that direct patient care jobs for pharmacists outside of acute care facilities have been slow to develop. Why is this?

Dr. Brown: I wish I could answer that question definitively, but I can only provide my best guess. First, I should mention that the impact of the medication therapy management provisions of Medicare Part D has not been as dramatic as originally anticipated. It has been slow-going. Billing for such services and integrating medication therapy management practices into the workflow of community pharmacies have proven to be daunting logistical challenges. Aside from Medicare Part D, it is the development or lack thereof of direct ambulatory care roles that is more central to the issue.

I was the Director of Ambulatory Care at the University of Illinois Medical Center in 1990. At that time, I thought direct pharmacist involvement in primary care and ambulatory care was about to take off, but it didn't.

In 2001, the conference hosted by the Pharmacy Manpower Project that I spoke of earlier predicted a major expansion of primary care jobs over the next 20 years.[3] Their projections were reasonable at the time, but the growth of such ambulatory care jobs hasn't materialized to any great extent.

Over the past couple of decades, the prevalence of pharmacists working in an ambulatory care environment has been somewhat localized to 3 specific areas: first, the Veterans Administration and Public Health Service; second, sites that have accepted a faculty practitioner funded by academia; and third, closed health maintenance organization systems, such as Kaiser Permanente.

The fact of the matter is that new patient care positions for pharmacists in outpatient care have failed to expand in a manner comparable to the consistent expansion of inpatient clinical positions during the 1980s and 1990s. I suspect that this disparity has a lot to do with differences in reimbursement for services.

It was relatively easy to justify the cost of pharmacist activities on the inpatient side, whether on the basis of a cost or a revenue model. As a result, clinical pharmacy services in hospitals were easily assimilated into inpatient pharmacy operations.

Reimbursement for outpatient clinical pharmacy services is an entirely different matter. Even as pharmacists gain provider status and prescribing authority, the rate-limiting step to job growth is going to be reimbursement for services rendered and the ability to readily assimilate new patient care functions into existing pharmacy operations.

In other words, the system needs to undergo fundamental change for pharmacy to develop clinically on the outpatient side as it did on the inpatient side. It appears that such change might be forthcoming, but the scope and rate of change remain uncertain.

Dr. Hulisz: Do you see the Affordable Care Act as serving to increase or decrease demand for pharmacists, and why?

Dr. Brown: At this point in time, the Affordable Care Act is fraught with unknown variables. I hesitate to conjecture on the impact it might have on the profession of pharmacy. Some expect great opportunities for pharmacists to find new niches in the patient-centered medical home model. I just don't know.

However, the one aspect of the legislation that seems most likely to affect pharmacy practice is Medicaid expansion. I would expect that community pharmacies will see more Medicaid prescriptions in coming years and, perhaps, greater opportunities to engage in preventative services, such as health screenings and immunizations.

We also might see a greater emphasis on establishing routine medication therapy management services. Other than that, we will have to wait and see how the law unfolds, which provisions remain untouched, which are fully funded, and which are modified or eliminated.

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