A Brief History of the Pharmacist Job Market and Its Impact on Pharmacy School Enrollment

Since 2000 the pharmacist job market has been a roll coaster of extremes. First, there was a shortage of pharmacists and pharmacy schools. Then there was a surplus of pharmacists and pharmacy schools. Why is this industry so erratic? One could blame the explosion of new pharmacy schools. Another culprit is retail pharmacy working conditions. The ever-increasing student debt burden is also difficult to ignore. It is not one single cause. It is all these factors combined.

In 2000, the ACPE (Accreditation Council on Pharmaceutical Education) mandated that all future pharmacists earn a pharmacy doctorate (PharmD).¹ One year later the Pharmacy Manpower Project released a report predicting a pharmacist shortage.² The shortage was not as dire as the report led most people to believe. The report assumed the federal government would grant pharmacists provider status by 2020. The report estimated that provider status would create 417,000 pharmacist FTEs, but they projected a supply of only 260,000 FTEs.² Thus, the report claimed the U.S. would be short 157,000 full-time pharmacists. This means the “shortage” was contingent on pharmacist provider status. After this report, the U.S. saw a surge in new pharmacy schools and graduates.

Before the Manpower Project report, the U.S. had 80 pharmacy schools and by 2020 had 143.³ Pharmacy schools that existed before 2000 increased enrollment by almost 30% between 2000-2012.³ Eager applicants flooded the U.S., and the job market “demanded” more pharmacists. Opening new schools and increasing enrollment at existing institutions made logical sense. The universities would make money and prevent a looming pharmacist shortage. Yet, everything changed after the 2008 Financial Crisis.

I started pharmacy school in Fall 2009. My friends and I knew the job market was ice-cold, but we figured once we graduated the market would warm up. Our optimism faltered when we applied for internships in Spring 2010. Less than half of my pharmacy class received paid internships. One professor said that in the past most students received paid internships. My hometown pharmacist let me volunteer in her pharmacy. That summer I also worked day and night shifts at my family’s farm. I felt lucky to have a volunteer internship and a paying job.

Near my Spring 2013 graduation, companies were still slow to hire pharmacists. A few months before graduation we had a class meeting hosted by my pharmacy school. To start the day off, a school staff member got on the microphone. She asked everyone to raise their hands if they had a job offer from company A. No one raised their hand. She did this for companies B and C and still nothing. Finally, one of my classmates told her: “no one has heard anything yet.” She moved on to an unrelated topic. It was awkward and disheartening that my school did not understand this new reality. I was able to get a part-time, rural hospital job. I realized how fortunate I was when I talked to a PGY-1 resident without a job offer towards the end of her residency. Post-2008 graduates were taking any pharmacist positions they could find. A pharmacy recruiter told me that filling rural positions had never been this easy. People were desperate and companies knew it.

Retail pharmacies were busy pre-2008, but budget cuts worsened conditions. Less pharmacists and technicians meant more work for everyone. Going to the bathroom and eating lunch became luxuries. The COVID pandemic exacerbated the situation. Pharmacy chains told pharmacists to add COVID tests and vaccines to their already bloated workload. As a result, several pharmacists discourage students from applying to pharmacy school. A quick Reddit™ search shows why: wage stagnation, UTIs because they can’t go to the bathroom, decreased return on investment, demeaning customers, corporatization of pharmacy, constant performance metrics, etc.⁴

Pharmacy school tuition continues to rise each year. Meanwhile, pharmacist pay has not increased at a similar rate.³ The 2023 AACP Graduating Student Survey reported that 82.2% of respondents borrowed money to help pay for pharmacy school.⁵ Students borrowed a median of $158,000 among all institutions. The median amount borrowed at private schools was $200,000 and $130,000 at public schools.⁵ These debt numbers do not include the interest that a person will pay during loan repayment. According to the BLS, the 2023 median annual pharmacists’ wages were $131,290 for retail, $144,460 for hospital, and $150,110 for ambulatory care.⁶ Thus, many students will pay more than one year’s worth of salary in student loan payments. A PharmD degree’s return on investment is diminishing.

Many things need to change to help increase national pharmacy school enrollment. The ACPE needs to increase accreditation standards to help eliminate weak programs. Retail pharmacy chains need to improve working conditions. No one wants to work for a company where they must hide to eat a morsel of food. Pharmacist wages need to increase, and pharmacy school tuition needs to decrease. Pharmacy schools and companies need to accept this.

References

1. Oregon State University College of Pharmacy. History of the College. Oregon State University College of Pharmacy. Accessed September 2, 2024. https://pharmacy.oregonstate.edu/history-college#:~:text=This%20was%20to%20comply%20with,PharmD%20degree%20to%20become%20licensed.
2. Brown D. A looming joblessness crisis for new pharmacy graduates and the implications it holds for the academy. Am J Pharm Educ. 2013;77(5):90. doi: 10.5688/ajpe77590.
3. Brown D. Years of rampant expansion have imposed Darwinian survival-of-the-fittest conditions on US pharmacy schools. Am J Pharm Educ. 2020;84(10):ajpe8136. doi: 10.5688/ajpe8136. 
4. r/pharmacy subreddit. Why do so many people insist on telling you to not become a pharmacist. Reddit. 2023. Accessed September 2, 2024. https://www.reddit.com/r/pharmacy/comments/15ex5a0/why_do_so_many_people_insist_on_telling_you_to/
5. American Association of Colleges of Pharmacy Graduating Student Survey: 2023 National Summary Report. American Association of Colleges of Pharmacy Office of Institutional Research & Effectiveness. August 2023. Accessed September 2, 2024. https://www.aacp.org/sites/default/files/2023-08/2023-gss-national-summary-report.pdf
6. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Pharmacists Pay. Updated August 29, 2024. Accessed September 2, 2024. https://www.bls.gov/ooh/healthcare/pharmacists.htm#tab-5