© The Author(s) 2023
Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/17151635231189226
“We are run off our feet here and there’s no one out there to hire to help us.”
“Why do they keep opening new pharmacy schools and increasing numbers at the old schools—don’t they know they’re flooding the market?”
“There are so many amazing and important new opportunities—we wanted to do a blood pressure screening clinic for our community as part of World Hypertension Day but there’s literally no one available to do this.”
“Great—on top of vaccines, med reviews and everything else, now I’m supposed to be doing common ailments too? Forget it, that’s too much—I’ve gotta retire.”
Every pharmacist in Canada has observed, reflected upon and likely commented about the state of our profession and the nature of our workplaces. Most pharmacists recognize that the work of pharmacy is essential, but the places where this work occurs can be frenzied, disorganized and stressful. The pharmacy profession is the third-largest health workforce in Canada (behind nurses and physicians)1 yet, unlike other professions, has had relatively little attention in terms of workforce planning. With the accelerated implementation of full scope of practice activities across Canada, the lingering effects of the extraordinary stress associated with our response to the COVID-19 pandemic and a large cohort of pharmacists nearing (or exceeding) normal retirement age, the workforce issues facing the profession are more acute than ever.2
A particular source of recent pressure has been the general state of primary care across Canada.3 As pharmacists and patients know, accessibility to primary care services from coast to coast to coast has been increasingly problematic,4 and this has emerged as a major political issue—and headache—for governments of all persuasions. In many jurisdictions, recent announcements regarding expanding the scope of practice for pharmacists have been a direct (arguably somewhat panicked) political response to citizens’ complaints about lack of access to family physicians. Allowing pharmacists to prescribe for common ailments, undertake independent therapeutic substitutions or use their own professional judgement to assess suitability of renewal, modification or adaptation of prescriptions is likely less a reflection of politicians’ esteem or regard for pharmacists’ knowledge and skills and more likely a convenient and expedient solution to a vexing problem.
Pharmacy is more central to primary care service delivery now than ever before.5 Although this may provide us with a surge of pride as pharmacists, it is also accompanied by unprecedented levels of occupational stress, staff burnout and plummeting morale across the pharmacy workforce.6 In large part, this is due to what appears to be a haphazard system of implementation of rapid practice change. To many pharmacists, it appears as though schools have not adequately prepared graduates for the reality of primary care practice, workplaces have not adequately planned for rapid changes and the profession as a whole seems to be reactive rather than proactive in supporting individual pharmacists and technicians.
Health human resources (HHR) planning is a system of activities that allows professions, organizations and workplaces to balance the flow of workers, prevent situations of worker shortage or surplus and ensure there is the appropriate mix of skills and abilities to support goals and objectives.7 Whether undertaken formally, informally or not at all, every organization needs to consider ways of aligning their needs with available workers in the most strategic and productive manner. At the most visible level, HHR planning would inform decisions around the location and number of pharmacy schools, inform immigration policies with respect to prioritization of international pharmacy graduates and drive implementation of changes to create an entirely new regulated professional group (regulated pharmacy technicians). At a less visible level, HHR planning would inform decisions related to staffing levels in workplaces or the ratio of pharmacists to technicians working on any given shift. HHR planning might also be used to justify employer practices related to quotas or minimum performance expectations for staff members. Yet, pharmacy has no system-wide HHR planning. At best, we have some unconnected silos of haphazard and reactive responses, such as by individual corporations.
Although there are many different forms of HHR planning in pharmacy that occur at the practice, organizational, employer, association and government/regulatory levels, these have been historically disconnected and somewhat unaligned in the past. It is believed (although it is not certain) that across diverse arms of the profession an abundance of HHR planning data exist and that the lack of coordination of these data sets means we have an incomplete picture of the pharmacy work-force. In part, this lack of coordination reflects the competitive nature of for-profit community practice and an understandable unwillingness to openly share corporate/business data that could be of competitive importance. This also reflects various technological and system articulation problems, where data from one source cannot be easily imported or meshed with data from other sources. It also reflects the general structure of Canadian health care in which 10 provinces, 3 territories, multiple health authorities and diverse private sector employers all overlap in unmapped ways.
Compared with other more centralized professions (such as nursing), HHR planning in pharmacy has not been as well integrated, resourced or emphasized. Although the nursing profession is enormous (in terms of numbers), diverse (in terms of roles and activities) and equally affected by scope-ofpractice questions, there may be useful lessons to learn from that profession for pharmacy. Perhaps because many nurses work within unionized settings, data collection, organization and access make workforce planning and projection somewhat more possible in nursing than in pharmacy. The success of the nursing profession in advocating for change, building public awareness for the needs of its workforce and supporting practice evolution on the profession’s own terms provides a useful example for pharmacy to consider.
Over the next year, we are pleased to be publishing a special series of articles in CPJ that will focus on HHR planning in pharmacy. This series will introduce pharmacists to the rationale for and value of HHR planning as well as the methods used and the outcomes that can be realized through a coordinated approach to workforce planning. It is hoped that these articles will spur profession-wide conversations around the state of the pharmacy workforce and the ways in which data and evidence can be used to support more proactive planning that engages all parts of the profession in planning for its own future. Although there has been unprecedented change in pharmacy over the last few years—and at times this may have felt overwhelming and chaotic—we have opportunities (indeed, a responsibility) to be more systematic, evidence-based and informed in our planning decisions in the future.