Steven Pak was 17 when he committed to six years of pharmacy school in 2010. His family had struggled financially during his childhood, and his mother, an immigrant from South Korea, had heard about the career’s upsides: prestige, a professional degree, and a six-figure salary, all before his 25th birthday. Though he had originally wanted to study acting, Pak agreed that pharmacy was the more responsible choice. He was admitted to the PharmD program at St. John’s University, and began his degree there the following year.
Pak’s mother was not alone in urging her child to pursue this career: All across America, teenagers were making similar calculations. A predicted shortage of pharmacists over the last decade, combined with an expected expansion of the pharmacist’s role in medical care, made it a lucrative career path. Even as the economy struggled in the mid-aughts, pharmacy graduates easily found big salaries, 9-to-5 jobs, and the respect that came along with handling medications. Nicholas Popovich, a professor at the University of Illinois at Chicago College of Pharmacy, tells me that, “Some signing bonuses even involved a car, that type of thing.”
Now, the profession is on the verge of a crisis: The number of pharmacy jobs has dried up but the number of pharmacy students keeps growing. It’s difficult to find a cushy, full-time job and metropolitan job markets are saturated. PharmD candidates are graduating with hundreds of thousands of dollars of debt, and each year, there are more and more of them in a six-year-long pipeline. When Pak graduates in 2016 with a PharmD degree, he’ll have up to $150,000 in loans.
The pharmacy boom began in 2000. That year, a report from the Department of Health and Human Services suggested that 98 percent of Americans lived in an area adversely affected by a pharmacist shortage. Almost 6,000 pharmacist jobs stood empty, and the shortage was only predicted to grow worse. The following year, a group now known as the Pharmacy Workforce Center predicted a shortfall of 157,000 pharmacists nationally within two decades as demand and responsibilities increased while the number of pharmacists stood still. As Baby Boomers aged, the thought went, pharmacists would be able to fill some roles traditionally held by doctors, and would be able to counsel them on how to take the medications prescribed to them.
Quickly, the free market kicked in. Over the last 20-odd years, the number of pharmacy schools in the United States has almost doubled. There were just 72 such schools in 1987; today, there are more than 130.
At first, graduates found work easily. No matter where in the country a young pharmacist wanted to settle, the number of jobs available far exceeded the number of people qualified to fill them. Slowly, the numbers began to even out, and 2009 marked a turning point: The number of jobs available was roughly on par with the number of pharmacists searching for work. The days of signing bonuses and vast job choices were over.
Purdue University, whose pharmacy school is ranked as one of the best in the nation, makes employment information about its graduates publicly available. By and large, the numbers are impressive—from salaries to unemployment statistics. But some statistics have changed. In 2008, graduates got up to eight offers; in 2009, up to 12. These days, the range is from one to three offers per graduate. In 2008, only one student was still seeking work when the university surveyed the graduating class; by 2012, that number had grown to eight students, and by 2013, to 12. (The average graduating class has about 150 students.)
According to the Aggregate Demand Index (ADI), which measures pharmacist job outlooks, employers in the Northeast began reporting more job candidates than slots in December 2011. Quickly, everywhere from Hawaii to Utah became a tough market. Now, only about ten states have decent employment prospects, with enough openings for every job seeker. In the rest of the country, pharmacists are seeing either a surplus of candidates, or a rough balance of supply and demand.
This would not be a problem if there were not so many new pharmacists in the pipeline. Students who entered six-year programs in 2009 will only graduate next spring. Now, young people who committed early on to a long, expensive program worry about finding a stable, well paying job upon completion. By the time the last of these students graduate, jobs will be even harder to find. And with every passing year, the graduating classes get larger as the field gets worse.
"My estimate [is] 20 percent unemployment of new grads by 2018," Daniel Brown, a pharmacy professor at Palm Beach Atlantic University, told the Pittsburgh Post-Gazette in 2013. "The job market is [stagnant], but we're still pumping out graduates every year.”
The tough market is complicated by the fact that the field didn’t quite expand as expected. Pharmacy was supposed to go from a profession of pill-dispensers to that of people-people: In 2000, the standard bachelor’s degree that was until then all that was required to practice pharmacy was phased out, replaced by a four year professional degree. Instead of a five-year BPharm, aspiring pharmacists were shuffled into six-year programs (of two undergraduate years and four years of professional-level education) and many others into four-year programs that supplement a bachelor’s degree.
This new degree program expanded the pharmacist’s repertoire: More than just being well trained in different drugs and side effects, this new batch of pharmacists focused heavily on client interaction. The new degree was meant to enable pharmacists to take on some client counseling roles—what is referred to today, in pharmacist shorthand, as “provider status.” These ideas were taken into account when calculating the 157,000 shortfall: If pharmacists were able to counsel patients about their drugs in order to maximize patient outcomes, they might be able to bill for their services and spend more time on each patient, which would in turn create more demand.
This, however, didn’t work out as planned. The expansion of pharmacist roles and responsibilities has to be approved on a state-by-state or federal basis, and such initiatives to hand over nurse and physician roles to pharmacists have not gained much traction. (Providers, no doubt, are reluctant to abandon their share of the market, though pharmacy organizations don’t want to assign blame.) Yet without provider status, pharmacists can’t get reimbursed for the counseling and advisory services they provide to clients.
Some individual states have made advances in recognizing pharmacists as healthcare providers, and through Obamacare, pharmacists will be included as members of care teams through Accountable Care Organizations for Medicare Part D recipients. They will provide medication therapy management services, and will be reimbursed for their time. But still, the expansion is not yet what had once been predicted.
Many of those enrolling in six-year programs do so as teenagers. They choose the field while still in high school, and many come from families where a salary like the one promised to pharmacists—$100,000 a year, and up—is an unbelievable accomplishment. The debt they will incur pales in comparison to the promised salary, and often, the outlook they set out with does not hold true.
That was the case for Diana Gritsenko, a warm and outgoing student going into the final year of a six-year program. She began considering pharmacy at a career path at a friend’s suggestion days before the application deadline, and it “just clicked.” She submitted her sole application to St. John’s. “It was the most frantic career researching I’ve ever done,” she recalls.
“I really like talking to people, and I like being around people. I like being really helpful,” Gritsenko tells me. She had planned to study biology, but the programs she looked at before her pharmacy epiphany were focused on lab work. Pharmacy would allow her to focus on people. And, the older pharmacists she consulted assured her that work was easy to find.
But Gritsenko entered pharmacy school just as supply was beginning to meet demand. She will graduate with about $120,000 of debt, which she tries to minimize by working part-time on top of a full 40-hour workweek of pharmacy school rotations. “And whatever money I need for living expenses, I’ll add a little extra to the private loan,” she says.
Now that she’s in school, Gritsenko sees that job prospects are not as plentiful as she had hoped. Many of her friends have had trouble finding full-time work. “You know, the ideal job to have when you graduate is a full time job, with benefits, preferably nine to five but with some evening shifts, the occasional weekend,” she says. “In most cases, though, a lot of my friends had to have a bunch of part time jobs, or per diem jobs.” Yet another friend is graduating with close to $300,000 in debt.
Many careers have their moment in the spotlight, but few have as much institutional support for expansion as pharmacy has. Daniel Brown has suggested that institutions came to see pharmacy as a sort of “golden goose”—a never-ending supply of eager students, willing to take on loads of debt for a seemingly never-ending supply of jobs. (For context, a 2013 survey of pharmacy graduates found that the average debt load at graduation was $133,694, going up to $152,901 for private schools.)
The key is being able to pay off those loans. Though Brown doesn’t dispute that an increase to about 10,000 graduates annually was warranted, the number is instead expected to top 14,000 a year shortly, with no end in sight. With each year, thousands more pharmacists than needed are entering the workforce, driving up competition for jobs. Before long, jobs will not only be hard to come by—for many young pharmacists, they may not exist. “The math is not complicated, which suggests that it may have been overlooked due to the lure of economic gain,” he wrote in a 2013 article:
The health needs of aging baby boomers and the Affordable Care Act could serve as mitigating factors to increase the demand side of the pharmacy manpower equation, though it is likely to be a matter of “too little too late.” Even if the job market is able to accommodate up to 12,000 graduates a year for the next several years, that still translates into at least 3,000 graduates each year who will not find suitable employment—20% of the cohort of new graduates! Despite the overall unemployment rate for the profession remaining relatively low, the joblessness rate among new graduates could be staggeringly high.
Those hardest hit would be young people just out of college, with mountains of debt. None of them expected 4 in 5 odds of employment upon graduation. By the time first-year unemployment rates reach that 20 percent number, six additional years of pharmacy graduates will have already begun studying for their degrees.
What makes the situation in pharmacy slightly more sinister than a comparable crisis in law is that students commit to many of these six-year programs straight out of high school. (About half of graduating pharmacists each year are aged 25 or under.) Not only do they have little understanding of what such a debt load may mean for them, but they also tend to rely more heavily on the suggestions of parents and friends. And, even if they made the decision to pursue pharmacy through their own research, the rapid growth in the number of pharmacists means many are gambling on a job market six years into the future. Further, while a law degree can be useful in a wide range of professions, including business and consulting, pharmacy degrees have relatively narrow purposes: PharmDs are equipped to oversee the dispensation of medication and counsel patients on how to take it and its effects.
Gritsenko messaged me again a week after our interview: “Thought I should let you know that NYS is planning on opening three more pharmacy schools," adding "that would bump New York’s total number of pharmacy schools up to ten” with a sad-face emoticon at the end. With her friends already unable to find full-time positions, the three new schools and hundreds of new pharmacists could worsen the situation even more. “Some of us students are thinking of starting a petition but that's going to take time and not sure if they'll really do anything with [it].”
In New York, where she lives and hopes to work, there is already a surplus of graduates, based on data employers are reporting to the Pharmacy Manpower Project. Overall, the state has just a moderate surplus, but jobs in New York City are far more competitive than those upstate.
Popovich, for his part, also worries about the quality of pharmacists. The proliferation of new schools has also created a new demand for pharmacy faculty members. Though Popovich, a professor of more than 30 years, praises the curricula he’s seen at many of these new schools, the fact remains that there were only so many faculty members circulating when the boom hit. Schools now have to draw from the pharmaceutical industry and from recent graduates. Paradoxically, the demand for new faculty positions has helped mask some of the surplus graduates. They have been put to work teaching at the more than 60 new schools.
And there’s little incentive for schools to slow down this expansion. PharmD students are cash cows, taking on hundreds of thousands of dollars in debt and often committing to a longer course of study. (At St. John’s University, for instance, the last two years count as professional education, and many students pay entirely out-of-pocket.) Though for-profit institutions are not as prevalent in pharmacy as other fields like law, more have been cropping up in recent years. Setting up a pharmacy school does not require the same large-scale investment in equipment as setting up medical or dental schools, but it brings in the same type of eager students.
Some of the new, for-profit institutions offer a five-year first professional degree that covers both undergraduate and graduate training, or a three-year professional degree. These programs help them stay competitive by allowing students to save a year’s tuition on their education, but raise quality concerns. “I think for a doctorate degree, that’s too short,” Popovich says of these programs. While pharmacy programs used to be five-year bachelors degrees, they grew longer as they added provider status to the curricula. Typically, students in six-year programs now devote a whole year not to taking classes but to being out in the field, working alongside pharmacists and getting first-hand experience in pharmacy’s many areas.
Those skills were at the core of the projected growth for pharmacists 15 years ago, but today, only about half of states reimburse pharmacists for some medical services. Many more states and services would be covered if they were recognized as providers federally, through changing the Social Security Act. A bill currently pending in the House of Representatives, HR4190, seeks to expand the role of pharmacists on a national level. Sponsored by Kentucky’s Brett Guthrie, the resolution will amend Medicare benefits legislation in order to allow pharmacists to provide (and be reimbursed for) services provided to patients in specially defined medically underserved communities.
It’s not clear when, or if, that bill will pass. Lucinda Maine, head of the pharmacy membership organization American Association of Colleges of Pharmacy, acknowledges that it was introduced quite late in the 113th Congress, with little chance of passing before the next time around. Even if it does pass, the language of the bill means it will affect a narrow part of the population—by and large, pharmacists still won’t be able to fully deploy the skills their new degree grants.
As for Pak, his interests have developed somewhat from when he first applied to pharmacy programs as a teenager. When the professional years hit and he began questioning his choice to pursue a PharmD, he had invested too much time and money to drop out. Eventually, he found a home for his interests in research, and his eyes light up when he talks about it. (He was recently accepted into a research position at Memorial Sloan-Kettering.)
But the PharmD degree is so narrow that most of the research that falls under its purview is clinical trials. In order to pursue the kind of research he is most interested in, Pak will likely have to pursue further education and get a PhD.