ASHINGTON,
Aug. 25 As demand for prescription drugs rises, pharmacies in the United
States face a shortage of trained professionals, increasing the risk of
improper medication, pharmacists and health care experts say.
About 6,500, or 6 percent, of the pharmacist jobs at chain pharmacies are
unfilled, says Phillip L. Schneider, a vice president at the National
Association of Chain Drug Stores. That is an increase of almost 4,000 since
February 1998. In hospitals, about 21 percent, or 12,600, of the pharmacist
jobs are unfilled, according to a survey in June by the American Hospital
Association.
To fill the vacancies, pharmacies are offering higher salaries. From March
to September last year, the average starting salary for a hospital pharmacist
with little or no experience jumped to $60,740 from $56,000, an increase of
8.5 percent, according to the Department of Health and Human Services.
Despite the rising salaries, pharmacists say they expect the shortage to
get worse in the next few years. The main concern is that errors will increase
as pharmacists become increasingly overworked.
"The pharmacist shortage is a prescription for increasing medication
errors," said Mary Anne Koda- Kimble, dean of the School of Pharmacy at
the University of California in San Francisco.
Another concern is that the shortage may cause pharmacies to pull out of
some areas, particularly rural areas. Some have already begun cutting hours
and eliminating weekend service.
Medication errors cost the health care system more than $177 billion last year,
up from $77 billion in 1995, according to the Journal of the American
Pharmaceutical Association. And the Health and Human Services Department says
that errors also cause more than 7,000 deaths a year.
But, said Carmen Catizone, the executive director of the National
Association of Boards of Pharmacy, which represents state pharmacy boards and
works to strengthen safety standards, it is very difficult to determine how
many of the errors are caused by pharmacists.
"When medication errors occur in pharmacies," Mr. Catizone,
said, "because of the liability, we don't get the information."
He said that despite persistent lobbying efforts by his organization, only
one state, North Carolina, had passed a law requiring pharmacies to report
medication errors.
The shortage of pharmacists also hinders their ability to catch errors
made by others. "The pharmacist often represents the last safety
net," Dr. Koda-Kimble said.
The shortage has been caused largely by increasing demand for prescription
drugs in the last decade or so as the population has aged and health care
plans offering prescription drug coverage have expanded.
In 1990, 2 billion prescriptions were filled in the United States. By last
year, the number had jumped to 3.15 billion, Mr. Schneider said.
As the demand for pharmacists rose in the 1990's, pharmacy school
enrollments dropped every year beginning in 1994, said Will Lang, a spokesman
for the American Association of Colleges of Pharmacy. Many licensed
pharmacists were also lured away to jobs produced during the decade's
economic expansion.
The number of pharmacists has risen slightly, to about 196,000 today from
almost 181,000 in 1995, according to the Department of Health and Human
Services. But the growth has not been nearly enough.
The increased demand for drugs has meant more administrative work for
pharmacists, who on average spend as much as 20 percent of their making sure
prescriptions are covered by health plans and explaining limitations to
patients.
"Pharmacists need to be able to spend less time explaining insurance
plans and more time explaining medication," said Susan Winckler, a
policy director at the American Pharmaceutical Association.
Congress has taken notice of the pharmacist shortage. Legislation has been
introduced in the House to help broaden enrollment at the 83 pharmacy
schools. But some say that much more must be done.
"Major systematic changes will be needed," Dr. Koda-Kimble said,
or "the pharmacist shortage is likely to become more acute."