THE CHANGING DEMOGRAPHICS IN PHARMACY, YES, MORE CHANGE!

1
THE CHANGING DEMOGRAPHICS IN PHARMACY,YES, MORE
CHANGE!

• Lynnae Mahaney MBA, RPh, FASHP
• New York State Council of Health-System
  Pharmacists
• May 2009

2
Disclosure

• I have no actual or potential conflict of
  interest in relation to this program.

3
OVERVIEW

• STATISTICS
• MULTIGENERATIONAL WORKFORCE
• WORKFORCE CRISIS
• LEADERSHIP CRISIS

4
PHARMACY WORKFORCE DEMOGRAPHIC STATISTICS
AGE AND GENDER TECHNICIAN DIVERSITY
5
Pharmacy Demographics

• 86 of licensed pharmacists actively practicing
• 230,000 total 200,000 FTE
• 30 in hospital, health-systems, LTC
• Increase in part-time workers
• 2000 23.4 of females, 11.6 of males
• 2004 26.8 of females, 15.4 of males

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Work Status of Licensed Pharmacists
7
ASHP SURVEY 2008
8
Proportion of Active Women Pharmacists in the
U.S. by Year
Source HRSA Study on Supply and Demand for
Pharmacists 2000
9
Pharmacy Technicians Statistics

• 284,000 Pharmacy Technicians in the U.S.
• 189,000 Active, PTCB certified Jan 2007
• 310,873 PTCB certified June 2008
• Sources PTCB National Statistics
  https//www.ptcb.org/AM/Template.cfm?SectionNatio
  nal_StatisticsTemplate/CM/HTMLDisplay.cfmConten
  tID2432
• Paul, R. Technician numbers on the rise
  nationwide, Drug Topics, March 10, 2007.

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Pharmacy Technician CertificationPTCB Certified
Pharmacy Technicians 16

• PHARMACY TECHNICIAN CERTIFICATION BOARD (PTCB)
  STATISTICS
• EXAM DATE WHO SAT FORPTCE WHO
  PASSED PTCE PASSED
• 1995-2000 Exams 91,741
  73,705 80
• 2001 Exams 31,107 24,269 78
• 2002 Exams 33,794 26,917 80
• 2003 Exams 39,710 32,232 81
• 2004 Exams 41,245 32,114 78
• 2005 Exams 45,991 35,838 78
• 2006 Exams 49,689 32,319 65
• 2007 Exams 45,045 31,490 70
• 2008 Feb-Mar 7,547 5,165 68
• 2008 Apr-Jun 14,291 10,155 71
• TOTAL 400,160 304,204 76
• TOTAL WHO PASSED PTCE 304,204
• TOTAL WHO COMPLETED TRANSFER PROCESS
  6,670
• TOTAL OF CERTIFIED PHARMACY TECHNICIANS (CPhTs)
  310,874

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Age Distribution of Pharmacists

• Card A 55
• Card B 45-54
• Card C lt45

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Age Distribution of Pharmacists

• 17 55
• 24 45-54
• 59 lt45

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FTE by Gender and Age - 2004
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Gender Statistics

• Not actively working primary reason
• Men retirement 10.9
• Women not working 4.3
• Pharmacists practicing in hospitals
• Women 30.7 vs. men 22.3

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Diversity Statistics

• Female gt65 pharmacy students
• Asian Americans 23.4 of Pharm.D degrees
• Underrepresented minorities 11.8 of Pharm.D.
  degrees
• Applicants gt 68 had 3 or more years of
  postsecondary education

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Workforce Diversity

• Racial and ethnic minorities comprise 1/3 US
  population  
• African Americans, Asians, and Hispanics will
  outnumber Whites in the 21st Century

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MULTIGENERATIONAL WORKFORCE

• For the first time in history, four
• generations are present in the workforce.

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ALSO KNOWN AS

• THE GENERATIONAL TSUNAMI

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Traditionalist

• Black and white TV
• stretch a buck nine ways to Sunday
• Ballroom dancing
• Push mower not motorized

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Traditional 1930 1945

• The "silent generation
• Value loyalty, sacrifice, discipline
• Respect authority, rules, and hierarchy
• Delayed reward
• Duty before pleasure

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Pharmacist -Traditionalists(over 62 yrs)

• 17 of the nations Pharmacist workforce
• CARD A

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Baby Boomers

• Elvis before sequins
• Typewriter
• Worlds first trip to the moon
• Woodstock, hippie
• Generation Gap

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Baby Boomers 1946 1964

• Loyal
• Live to work largest group of workaholics in
  history
• Driven by personal success
• Spenders
• Excellent Mentors, experienced
• Politically active
• Want or need to work longer

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Pharmacist - Baby Boomers (44-62 yr olds)

• 24 of the nations Pharmacist workforce
• CARD B

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Generation Xers

• Prince and 1999
• Road trips in the station wagon
• Know who shot JR
• Know rotary phone
• Term papers on word processor

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Generation X 1965 1980

• Latchkey kids, watched parents overworked/lose
  jobs, distrustful
• Best academic training and internatl. experience
  in history
• Demand work life balance,work to live
• Technology experts
• Need positive reinforcement and communication
• Desire stimulation and growth in work

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Pharmacist - Generation Xers (28-45 yr olds)

• 59 of the nations Pharmacists lt45
• CARD C

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Millennials

• Term paper typed on computer
• Always had answering machine and voicemail
• Always had cable TV with remote control
• Popcorn in the microwave only

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Millennials /Gen Y 1981

• grew up in groups
• volunteers, joiners
• close to family, trusting, value relationships
• technology experts lived entire lives with
  information technology
• excellent multi-taskers
• after BBs next dominant generation to influence
  health care

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Pharmacist - Millennials(18-27 yr olds)

• 59 of nations Pharmacists lt45
• CARDs C and D

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Tomorrows Pharmacist
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Generational Commonalities

• Common life experiences more clearly define each
  generation group
• Trad environment of scarcity, value austerity
• Boomers spawned social phenomena (hippie,
  feminism, divorce)
• X, Y less social impact due to recent emergence

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From AARP report The Business Case for Workers
Age 50 (http//research.arp.org).
RETIREMENT

• Cohort of workers gt55 will grow significantly
  and opt for second and third careers or downsize
  work roles rather than fully retire.
• This report makes a great case for keeping people
  longer in the work place.

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RETIREMENT

• Many cannot afford to retire early
  children/stocks
• 2007 survey, nearly 1/3 over-65 workforce will
  delay retirement
• AARP 2006 survey, 70 Americans want to work as
  long as able
• Copeland, Craig. Employment status of workers
  ages 55 or older. Employee Benefit Research
  Institute, Notes, Vol 28, No. 8. August 2007, p.
  2.

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WORK-LIFE BALANCE

• Not a gender or generation issue today.
• Boomers
• Sandwich generation
• Personal health issues
• Approaching retirement
• Generation X
• Dual working couples
• Single parents
• Outside interests
• Household responsibilities
• Community involvement
• Generation Y
• Community involvement
• Volunteers

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GLOBAL CHANGES

• Overall healthcare environment is changing -
  permanently.
• The Baby Boomers - dominant generation to
  influence health care.
• Baby boomers retirement, beginning 2011, will be
  overwhelming and will dramatically affect the
  health care system.

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HEALTHCARE CHANGES

• 50 of US population has at least one chronic
  condition
• 36 over 65yo have 3 or more
• By 2025, 25 will have multiple chronic
  conditions
• Increase in cancer, cardiovascular disease, and
  type II diabetes (due to obesity)
• Medicare to consume more of the national budget
  and give the federal government more direct
  control over health care dollars.
• MC were 3 GDP in 2006, 8.8 in 2030
• Baby boomers will unify and become more
  responsible elders about the expense of
  end-of-life care.
• Wye River Group on Healthcare 2008

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Global Demographic Statistics(WSJ Demographic
Bomb Ticks On 6/6/06)

• 2005 16.7 US population 60 years and older
• 2050 26.4 US population 60 years and older
• US is relatively young.as compared to Japan,
  Germany, and China.
• By 2040, these nations face even more peril.

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• Population of the Oldest Old
• age 85 or older
• Will grow 377 by 2050

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IMPENDING WORKFORCE CRISIS

• 76m Boomers will retire in the next 15 years
• 46 of current workforce
• 45m Gen Xers available to replace
• 29 of current workforce
• 14m skilled worker shortage predicted by 2020
• 80 of Pharmacy directors and 77 of middle
  managers plan to resign in the next 10 years

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Healthcare Worker Shortage

• 5.3m new Healthcare Workers needed by 2010 
• Pharmacist shortage will be 157,000 by 2020

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Pharmacy Workforce Changes

• Multigenerational work place
• Desire for balance of values to the workforce
• Increasing the demand for alternatives to
  traditional work norms
• Increasing ethnic diversity
• Job satisfaction does not change across the
  generations and indicates pharmacists are
  generally satisfied

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WHAT CAN WE DO ?

• Teach four generations to work together as a team
• Flexible work schedules
• Restructure work
• Invest in the 50 worker
• Facilitate pharmacist re-entry

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Tips for Bridging the Gap (Mayoclinic.com)
For the Older working with Younger

• Challenge them with important work that matters
  and reward them for success. Dont micromanage
  and give them space.
• Ask for their opinion so they feel part of a
  team. Try to avoid the strict chain of command
  style of management.
• Provide frequent feedback they are used to quick
  and direct criticisms and compliments.
• Use e-mail and avoid frequent meetings on menial
  topics.

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Tips for Bridging the Gap (Mayoclinic.com)
For the Younger working with Older

• Show respect and acknowledge your lack of
  experience and need to learn.
• Avoid using solely e-mail and voicemail
  communications many baby boomers prefer face to
  face communications.
• Learn about the department/company history, what
  has gone wrong and what has worked BEFORE trying
  to actively change something.
• Play the game of seniors in the office even if
  you are turned off by traditional workplace
  politics.

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Tips for Bridging the Gap (Mayoclinic.com)
For All Generations

• Avoid stereotyping.
• Realize that no generational characteristics
  apply to everyone, and
• Remember everyones personality is unique.

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WHAT CAN WE DO?Flexible Scheduling

• Demand for greater work-life balance Gen X , Y
• Role reversals
• Boomer needs

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Flexible Work Schedules

• Develop multiple schedules/hour/days of the week
• Engage staff in work schedule development to meet
  organizational and staff needs
• Obtain regular feedback on schedules and activity
  preference
• Develop attractive incentives for undesirable
  work shifts
• ASHP Task Force on
  Pharmacys Changing Demographics

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Flexible Schedules create perceptions

• Viewed as unfair, favoritism
• Workers not seen as valuable contributors
• Part time staff viewed as competent and informed
• Pharmacy managers lack understanding of the
  differences among generations in attitudes toward
  work

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Potential negative implications of alternative
work schedules

• Scheduling challenges
• Resentment from full-time staff about flexible
  schedules for certain workers
• Difficulty filling part-time vacancies
• Challenges training part-time workers
• Part-time workers lacking connection to overall
  health system because of limited work hours
• Lack of availability of part-time workers with
  desired skill set

ASHP Task Force on Pharmacys Changing
Demographics
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Positive implications of alternative work
schedules

• A pool of extra staff to cover time off
• More uncompensated hours from a larger number of
  workers
• More flexibility in covering schedules with
  several part-time workers
• Management does not have to provide benefits for
  some part-time workers
• Access to qualified pharmacists that would not
  otherwise be available for full-time work
• Flexible hours can be used as a recruitment tool
• Flexible scheduling allows for re-entry into the
  profession

ASHP Task Force on Pharmacys Changing
Demographics
52
WHAT CAN WE DORestructure the Work

• Phase out purely distributive roles and replace
  with more integrated roles
• Find responsibilities that can be share
• Leverage technology to increase schedule
  flexibility
• Dispensing and cart fill robotics
• Work that can be done from home, long distance
• e.g. VA computer system enables work from home
  very well
• ASHP Task Force on
  Pharmacys Changing Demographics

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ASHP Position on Pharmacy Technicians

• Evolving role of technicians is key to advancing
  what pharmacists do
• Developing well-qualified pharmacy technician
  workforce, with defined skills and competencies,
  is essential to the success of this role
• Support uniform training ASHP-accredited
• Support certification through PTCB
• Support registration through state boards

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A well-qualified pharmacy technician workforce is
critical to our future

• Growing complexity of medication use
• Continued focus on medication safety, quality
• Increased public visibility, accountability
• Described in the ASHP Long-Range Vision for the
  Pharmacy Workforce in Hospitals and
  Health-Systems
• Supports goals described in the JCPP Future
  Vision for Pharmacy Practice 2015
• Objective within the ASHP 2015 Initiative

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Definitions

• Registration is the process of making a list or
  being enrolled in an existing list registration
  should be used to help safeguard the public
  through interstate and intrastate tracking of the
  technician work force and preventing individuals
  with documented problems from serving as pharmacy
  technicians.
• Certification is the process by which a
  nongovernmental agency or association grants
  recognition to an individual who has met certain
  predetermined qualifications specified by that
  agency or association.
• Licensure is the process by which an agency of
  government grants permission to an individual to
  engage in a given occupation upon finding that
  the applicant has attained the minimal degree of
  competency necessary to ensure that the public
  health, safety and welfare will be reasonably
  well protected.

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Accredited Training Program Statistics

• 112 programs in 32 states (TX 24, CA 23)
• 6,400 graduates in 2006 (5,000 78 are related
  to chains)
• lt 10of all technicians completed an accredited
  program

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Status of State Regulation of Pharmacy
Technicians(NABP Survey of Pharmacy Law-2007)

• Regulations on REGISTRATION
• 34 states require registration
• 5 states require licensure
• 11 states have no registration or licensure
  requirements
• Regulations on CERTIFICATION
• PTCB Recognition in 30 states as one option for
  registration or for expanded tech
  responsibilities
• - MT only state that requires PTCB
• 310,873 CPhTs Nationwide
• Regulations on TRAINING
• 29 states require education and training
  (non-accredited)
• (ND and NV specifically recognize ASHP
  accreditation in some form)

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ASHP Pharmacy Technician Initiative

• What Advocacy partnership with goal of
  developing an educated, trained, certified and
  registered pharmacy technician workforce.
• Who ASHP and individual state affiliates.
• How Joint advocacy to promote a qualified
  technician workforce, with strategies and tactics
  unique to each state.
• When Seeking affiliate sign-on starting January
  1, 2008.

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What can we do?Invest in the 50 Worker

• They represent a solid and sound investment
  proposition.
• Promote Mentoring From the AARP report
  Mentoring can invigorate middle and older
  workers, creating challenges, conveying critical
  knowledge and sharing institutional history.

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What Can We Do?Re-entry Programs

• Severe problem existing in all health
  professions.
• How do we ensure competency prior to return to
  work?
• It is not a question of expense for the re-entry
  program, we NEED pharmacists.

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Why do Pharmacists Leave the Workforce?

• Caretaking issues
• Personal illness
• Dissatisfaction
• Pursue alternative careers

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The National Task Force on Re-entry into Clinical
Practice identified several barriers to funding
of re-entry programs

• Limited public information regarding programs
• Resource-intensive
• Lack of standardized curricula and no officially
  recognized national accreditation
• Key factors for success include
• Absolute commitment from the highest level of the
  organization
• Excellent examples exist from successful business
  re-entry programs.

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Pharmacist Re-entry

• Develop innovative programs to recruit community
  Pharmacists to transition to Health-system
  positions
• Develop competitive recruitment packages

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THE FACTS? True or FalseCard A or B

• Women and both sexes of Generation X bring a
  desire for balance of values to the workforce
• Generational differences are increasing the
  demand for alternatives to traditional work norms
• Job satisfaction does not change across the
  generations and indicates pharmacists are
  generally satisfied

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THE LEADERSHIP CRISIS

• Part-time pharmacists CAN move into leadership
  roles.

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THE FACTS? True or FalseCard A or B

• Many Pharmacy leaders are reaching retirement and
  will be leaving in the next 5 to 10 years, e.g.
  VA.
• In a survey of 290 current pharmacy
  practitioners, only 30 wanted a leadership or
  managerial position during their career.
• Male or female want leadership responsibilities,
  but are not willing to work the long hours as
  their bosses.
• There is an ample supply of senior mentors.

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Women are still under-represented in leadership
positions

• In academia - higher administrative position and
  tenured faculty
• In the corporate sector executive leadership and
  board membership
• In leadership positions in the healthcare
  industry
• There are a lack of nontraditional role models
  and job structures for leaders and managers.

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Can we reconcile the impending crisis of a
leadership shortage and the increasing number of
women in the profession with the lack of
alternative ways to be a manager or leader in
health-systems?Yes or NoCard A or B
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Reconciliation

• Develop leadership skills in all Pharmacy staff
  members
• Combine clinical and management functions into
  the responsibilities of specific positions
• Recognize and reward staff with the goal of
  fostering interest in leadership
• Educate students, residents, and staff about
  importance of their leadership role in daily
  practice
•   
• 
  ASHP Task Force on Pharmacys Changing
  Demographics
•                                            

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FACT OR MYTH

• There is nothing we can do within an organization
  to affect the change in the demographics.

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TRUE!

• BUT WE CAN AFFECT WHAT WE DO ABOUT THE
  CHANGING DEMOGRAPHICS!

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From the ASHP Task Force on Pharmacys Changing
Demographics Final Report

• The profession of pharmacy needs to respond
  quickly to these demographic changes and create a
  workplace that engages and retains a diverse
  multigenerational workforce that can make many
  unique contributions to improve patient care.
• Educate leaders and pharmacy directors about
  generational differences and the need for greater
  options in the workplace.

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Alternative methods must be developed to
cultivate leaders and opportunities in
nontraditional programs.

• Consider alternatives to current norms so that
  diverse ways of working are recognized and
  rewarded and that people have opportunities to
  fully contribute to the success of the
  organization
• Formal mentoring programs that address the
  business imperatives for leadership, skilled
  workforce, diverse workforce

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Alternative methods must be developed to
cultivate leaders and opportunities in
nontraditional programs.

• Leadership track programs for talented and
  committed workers
• Create formal off ramp and on ramp programs
  that make it possible to leave and re-enter an
  organization

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THANK YOU!

• Lynnae Mahaney MBA, RPh, FASHP
• Chief, Pharmacy Services
• Wm. S. Middleton Memorial Veterans Hospital
• Madison, WI
• 608-256-1901 x11028
• Lynnae.Mahaney_at_va.gov