UNIVERSITY
OF
CALIFORNIA

Healthforce
Center at ucsr

Pharmacist Workforce and Education in California

INTRODUCTION

Pharmacists are healthcare professionals who
work with patients, physicians and other
healthcare providers to ensure that patients
receive the safest, most effective and least
costly medications. They communicate
knowledge about drugs, dispense drugs and
manage patients whose chronic conditions
require drug therapy. This report presents an
overview of California's pharmacist workforce
and the pipeline of pharmacy (PharmD)
students.

SUMMARY

e California pharmacists make up a larger share
of the nation's pharmacists than those of any
other state.

e While the majority of the overall pharmacist
workforce in the United States is White, Asians
account for the largest percentage of
pharmacists in California.

e Women make up close to two-thirds of
pharmacists, both in California and nationwide.

e From 2012 to 2018, the number of California
PharmD graduates increased by 32%. This
increase was largely due to the opening of five
new schools of pharmacy.

e Although new pharmacists can begin
practicing general pharmacy following
graduation and licensure, new graduates are
increasingly choosing to complete residencies
after graduation.

e The Health Resources and Services
Administration predicts a national surplus of
full-time or equivalently employed pharmacists
of between 4.8% and 14.1% by 2030.

e Future demand for pharmacists will depend, in
part, on whether pharmacists achieve national
recognition as health care providers who can
bill insurers for their services.

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CURRENT SUPPLY

In July 2019, there were an estimated 47,085
licensed pharmacists in California.' California
has more pharmacists employed in the
profession than any other state in the United
States, accounting for approximately 10% of the
nation's 311,200 working pharmacists.?

Practice Settings

Pharmacists work in a variety of industry
settings. As shown in Table 1, the most
common industry settings for California
pharmacists are health and personal care
stores/retail pharmacies (38.2%), general
medical and surgical hospitals (25.1%),
physicians' offices (6.6%), grocery stores (5.5%)
and outpatient care centers (2.6%).3

Table 1. Top Industries Employing California
Pharmacists

 

 

 

 

 

 

 

 

 

 

 

Industry Share of
pharmacists

employed

Health and personal 38.2%

care stores

General medical and 25.1%

surgical hospitals

Physicians' offices 6.6%

Grocery stores 5.5%

Outpatient care 2.6%

centers

Insurance carriers 1.7%

Employment services 1.0%

Other industries 19.3%

 

 

Source: California Employment Development Department.
Occupation Profile: Pharmacists.

Demographic Characteristics

Nationally, nearly two-thirds of pharmacists are
White (64.5%), 22% Asian, 10.5% Black, and
2.7% Hispanic/Latino.* During the period from
2013 to 2017, 35.5% of California pharmacists
were White, 48.4% Asian, 2.5% Black, 5.1%
Hispanic, 0.03% American Indian/Alaska Native,
5.1% Filipino, 0.3% Native Hawaiian/Pacific

UNIVERSITYOFCALIFORNIA.EDU 01
Islander, 2.7% multiracial, and 0.3% of other
racial or ethnic background.®

Nationally, women make up 63.4% of
pharmacists.® Forecasts suggest that by 2025,
two out of three pharmacists in the United States
will be women.' During the period from 2013 to
2017, 61.6% of pharmacists in California were
women.®

The average age of California pharmacists was
42.9 years old during the period from 2013 to
2017. As seen in Figure 1, over half of
pharmacists were under the age of 45.

Figure 1. Age Distribution of California
Pharmacists

 

7.0%

¢ 33.7%
33.2%

26.1%
= Under 35 = 35-44 = 45-64 = 65 and older

 

 

 

Source: U.S. Census Bureau, 2013-2017 American
Communities Survey 5-Year Estimates

EDUCATION
Pharmacy Schools

In the United States, the Doctor of Pharmacy
(PharmD) degree is the professional degree
needed for licensure. Pharmacists are trained at
colleges and schools of pharmacy accredited by
the Accreditation Council for Pharmacy
Education (ACPE). Generally, these programs
require four years of graduate study, though
some schools offer accelerated three-year
programs. Some schools offer baccalaureate,
master's and Doctor of Philosophy (PhD)
programs in pharmacy in addition to PharmD
degrees. This report focuses only on PharmD
programs, because all new entrants to the
profession are required to obtain a PharmD
degree in order to obtain a license to practice.

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There are 145 programs in the United States.
offering the PharmD degree. From Fall 2012 to
Fall 2018, the number of students enrolled in
PharmD programs as their first professional
degree increased by two percent, from 61,221 to
62,468. From Spring 2012 to Spring 2018, the
number of graduates from such programs
increased by 17.2%, from 12,692 to 14,876. "°

In the last five years, California has nearly
doubled its number of PharmD programs, from 8
to 14 programs. In Fall 2014, California Health
Sciences University College of Pharmacy
(Clovis), Keck Graduate Institute School of
Pharmacy and Health Sciences (Claremont) and
West Coast University School of Pharmacy (Los
Angeles) enrolled their first classes. Chapman
University School of Pharmacy (Irvine) enrolled
its first class in Fall 2015, Marshall B. Ketchum
University College of Pharmacy (Fullerton)
enrolled its first class in Fall 2016, and American
University of Health Sciences School of
Pharmacy (Signal Hill) enrolled its first class in
Fall 2019. UC Irvine has also expressed interest
in opening a new pharmacy school; however,
this proposal is currently under review and has
not yet been formally approved."

Except for the two programs offered by the
University of California (UC) at its San Francisco
and San Diego campuses, all pharmacy
programs in California are private. 12 While eight
of the state's private PharmD programs are
offered by traditional, not-for-profit universities,
four programs are offered by for-profit
universities (American University of Health
Sciences, California Northstate University,
California Health Sciences University and West
Coast University).

From Fall 2012 to Fall 2018, the total number of
students enrolled in California PharmD
programs increased by approximately 33%, from
3,718 to 4,947. From Spring 2012 to Spring
2018, the number of California PharmD
graduates increased by 32.7%, from 920 to
1,221 (Figure 2). The spike in the number of
graduates between 2017 and 2018 was likely
driven by the opening of four new schools that
graduated their first classes in Spring 2018.

UNIVERSITYOFCALIFORNIA.EDU 02
Graduates of California pharmacy schools in
Spring 2018 were 67.9% Asian, 23.3% White,
5.8% Hispanic, 2.8% Black, 0.2%
Hawaiian/Pacific Islander and 0.1% American
Indian/Alaska Native. '? The majority (92.6%) of
PharmD students enrolled at California schools
in 2018 were California residents, consistent
with prior years' trends. '4

Figure 2. Number of Graduates of California
PharmD programs, Spring 2012 to Spring
2018

1250 1221
1200
1150
1100
1050

1000 956 954 957 9

900
2012 2013 2014 2015 2016 2017 2018

    
    
 

Source: American Association of Colleges of Pharmacy
Profile of Pharmacy Students (Fall 2018).

Postgraduate Education and Training

Following graduation and licensure, new
PharmDs may enter practice as licensed
pharmacists. However, new PharmDs are
increasingly choosing to pursue postgraduate
education through research fellowships or
residency training. From 2014 to 2018, the
number of new U.S. PharmD graduates
matched to residency programs accredited by
the American Society of Health-System
Pharmacists (ASHP) grew 44.8%, from 2,640 to
3,822. During this time, the share of new U.S.
graduates matched to residencies grew from
19.1% to 24.4% of graduates. 15

Most general practice residencies (PGY1)
require one year for completion. These PGY1
residencies enhance pharmacists' knowledge of
treatment for a broad range of diseases.
Following the PGY1 year, residents can elect to
complete specialized training in postgraduate
year 2 (PGY2). These include specialty areas
such as ambulatory care, cardiology, infectious
diseases, oncology and specialty pharmacy. '®

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Additionally, there are specialized one- to two-
year residency tracks in community pharmacy,
managed care, community and health
administration, drug information, health system
administration, investigational drug services,
medication systems and operations,
pharmacotherapy and pharmacy informatics. In
the 2019 match cycle, the most common
programs were general pharmacy PGY1
(87.6%), community pharmacy (7.2%), and
managed care (2%).17

Some states, including California, have
designated pharmacists as reimbursable health
providers. In 2013, California passed Senate Bill
(SB) 493, which expanded pharmacists' scope
of practice and authorized reimbursement for
services that supplement their traditional role in
dispensing medications. The expanded scope of
practice included the creation of the "advanced
practice pharmacist" (APh) license. APhs work
in collaborative practice agreements with
physicians. They can perform patient
assessments, refer patients to other healthcare
providers and collaborate with other providers to
evaluate and manage diseases and health
conditions. 18 To become an APh, a pharmacist
must be licensed and meet two of the following
three criteria: (1) certification in a relevant area
of practice (e.g., ambulatory care, oncology
pharmacy, psychiatric pharmacy, etc.), (2)
completion of a postgraduate residency
program, and (3) provision of clinical services to
patients for at least one year and no fewer than
1,500 hours under a collaborative practice
agreement or protocol with a phsyician, APh,
pharmacist practicing collaborative drug therapy
management or health system; this experience
must have been earned within 10 years of the
time of application for APh licensure. '? 2° As of
July 2019, there are 550 APhs in California
(1.2% of all pharmacists in the state).2'

FUTURE SUPPLY AND DEMAND

The U.S. Bureau of Labor Statistics (BLS)
estimates that there will be little or no change in
employment of pharmacists through 2028. While
job opportunities in health and personal stores
are expected to decrease due to increasing
sales via mail order and online pharmacies, the
BLS projects that demand will increase for

UNIVERSITYOFCALIFORNIA.EDU 03
pharmacists in healthcare settings such as
hospitals and clinics.22 By contrast, a 2018
report by the Health Resources and Services
Administration (HRSA) predicts a national
surplus of full-time or equivalently employed
(FTE) pharmacists of 4.8% to 14.1% by 2030.
HRSA's analysis also projects that the number
of new pharmacists entering the profession from
2016 to 2030 will exceed the number leaving the
profession.23

According to the California Employment
Development Department (EDD), the number of
pharmacist jobs in the state is expected to grow
8.2% between 2016 and 2026 (by approximately
2,400 jobs).24 Although the number of California
PharmD program enrollments and graduates
has increased during the last decade, the lack of
available data on the age distribution and
interstate mobility of California's pharmacists
makes it difficult to conclude whether there will
be enough new pharmacists to replace retiring
pharmacists or those leaving the state. At the
time of this writing, there are no publicly
available analyses about whether California's
pharmacist supply will be sufficient to meet
future demand.

Given that California's population is aging, and
that older patients are on average sicker and
more reliant on prescription drugs than those
from younger age groups, demand for
prescription drugs will likely increase and could
increase demand for pharmacists. The move
towards greater integration of care could also
increase demand for pharmacists in care
management.

However, new pharmacy workforce models
could mitigate or reduce demand for
pharmacists. For instance, pharmacy
technicians, whose job growth is expected to
outpace that projected for pharmacists (14.4%,
or approximately 5,100 jobs), may be able to
take on additional lower-skill tasks in
pharmacies."° Additionally, automated
dispensing and refill systems and mail order
filling of prescriptions may reduce demand in the
community pharmacy setting. Moreover, if
HRSA's projection of a national surplus by 2030
is correct, California may be able to recruit
pharmacists trained in other states if pharmacy

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schools in California do not produce a sufficient
number of graduates to replace retiring
pharmacists.

Although the overall national supply of
pharmacists appears adequate, the skills mix of
pharmacists in the western United States does
not appear to be aligned with demand. The most
recent Pharmacist Demand Indicator (PDI)
published by the American Association of
Colleges of Pharmacy's Pharmacy Workforce
Center reports that in 2018, employers in the
Western region of the United States, which
includes California, perceived a shortage of
specialized pharmacists (for instance,
pharmacists with qualifications in medication
therapy management, anticoagulation, oncology,
informatics, etc.).26

The perceived shortage of specialized or skilled
pharmacists coincides with the growing
recognition that pharmacists can play crucial
roles as members of interprofessional care
teams and in settings that focus on public health
issues. The aforementioned SB 493 explicitly
declares pharmacists as health care providers
who have the authority to provide health care
services beyond their traditional role in
dispensing prescription medications. SB 493
further authorizes pharmacists to furnish self-
administered hormonal contraceptives and
nicotine replacement products, order and
interpret tests for monitoring and managing the
efficacy and toxicity of drug therapies, and
independently inititate and administer routine
vaccinations. 2"

In 2017, the state passed SB 401, which
authorizes the creation of remote dispensing site
pharmacies in medically underserved areas,
operated and overseen by a supervising
pharmacy through telepharmacy technology. 28
In 2019, the state also passed SB 159, which
authorizes pharmacists to furnish pre- and post-
exposure prophylactic drugs for HIV/AIDS after
completing a training program.?° The extent to
which pharmacists provide these additional
services will likely depend on the availability of
reimbursement.

Ultimately, California's ability to meet its future
demand for pharmacists will depend on the

UNIVERSITYOFCALIFORNIA.EDU 04
demographic composition of the workforce,
evolving pharmacy delivery and workforce
models (including changing roles for pharmacy
technicians), national designation of pharmacists

 

1 California State Board of Pharmacy. (2019, July
2). License Type Totals. Retrieved from
https://www.pharmacy.ca.gov/about/license tota
Lshtml

2 U.S. Bureau of Labor Statistics. (2019).
Occupational Employment and Wages, May 2019.
Retrieved from
https://www.bls.gov/oes/current/oes291051.ht
m

3 California Employment Development
Department. Occupation Profile: Pharmacists.
Retrieved October 3, 2019 from
https://www.labormarketinfo.edd.ca.gov/cgi/dat
abrowsing/occExplorerQSDetails.asp?soccode=29
1051

+U.S. Bureau of Labor Statistics. (2020, January
22). Employed persons by detailed occupation,
sex, race, and Hispanic or Latino ethnicity.
Retrieved March 12, 2020, from
https://www.bls.gov/cps/cpsaat11.htm

5 U.S. Census Bureau. (2018). Public Use Microdata
Sample, 2013-2017 American Community Survey
5-year estimates.

6 U.S. Bureau of Labor Statistics. (2019, January
18). Employed persons by detailed occupation,
sex, race, and Hispanic or Latino ethnicity.
Retrieved October 3, 2019, from
https://www.bls.gov/cps/cpsaat11.htm

7 University of California. (2014). An Era of Growth
and Change: A Closer Look at Pharmacy Education
and Practice. An Era of Growth and Change: A
Closer Look at Pharmacy Education and Practice.
University of California. Retrieved from

https: //www.ucop.edu/uc-

health/ files /pharmacy-an-era-of-growth-and-

change.pdf
8 U.S. Census Bureau (2018). Public Use Microdata

Sample, 2013-2017 American Community Survey
5-year estimates.

9 Accreditation Council for Pharmacy Education.
(2018, July 11). Programs By State. Retrieved
October 4, 2019, from https://www.acpe-
accredit.org/accredited-programs-by-state/

10 American Association of Colleges of Pharmacy.
(n.d.). Profile of Pharmacy Students. Retrieved
from

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as providers and the extent to which the
healthcare system utilizes pharmacists beyond
their traditional roles.

https://www.aacp.org/research/institutional-
research/student-applications-enrollments-and-
degrees-conferred

11 UCI News. (2018, October 30). Jan Hirsch named
founding dean of planned School of Pharmacy &
Pharmaceutical Sciences. Retrieved from
https://news.uci.edu/2018/10/30/jan-hirsch-

named-founding-dean-of-planned-school-of-
pharmacy-pharmaceutical-sciences/

12 Accreditation Council for Pharmacy Education.
(2018, July 11). Programs By State. Retrieved

October 4, 2019, from https://www.acpe-
accredit.org/accredited-programs-by-state/

13 American Association of Colleges of Pharmacy.
(n.d.). Fall 2018 Degrees Conferred - Profile of
Pharmacy Students. American Association of
Colleges of Pharmacy. Retrieved from
https://www.aacp.org/sites /default/files/2019-

05/fall-2018-profile-of-pharmacy-students-

degrees-conferred.pdf
14 American Association of Colleges of Pharmacy.

(n.d.). Profile of Pharmacy Students. Retrieved
from
https://www.aacp.org/research/institutional-

research/student-applications-enrollments-and-

degrees-conferred
15 American Society of Health-System Pharmacists.

(2019, September 17). ASHP Match Statistics.
Retrieved from
https://natmatch.com/ashprmp/stats.html

16 American Society of Health-system Pharmacists.
(n.d.). Glossary of Terms. Retrieved from
https://www.ashp.org/Professional-

Development/Residency-Information/Student-
Residency-Guide/Glossary-of-Terms

17 American Society of Health-system Pharmacists.
(2019). Summary of Programs and Positions
Offered and Filled in the 2019 Match - Combined
Phase I and Phase II. Retrieved from
https://natmatch.com/ashprmp/stats/2019sum
mpos.pdf

18 SB 493. Sess. 2013-2014. (Cal 2013). Retrieved
from

https:/ /leginfo.legislature.ca.gov/faces/billTextCli
ent.xhtml?bill id=201320140SB493

UNIVERSITYOFCALIFORNIA.EDU 05
 

19 California BPC § 1730.1 Retrieved from

https: //govt.westlaw.com/calregs/Document/I15
0913B5AA2040C4AA3410597054F09E

20 California BPC § 4210. Retrieved from

https: //codes.findlaw.com/ca/business-and-

professions-code/bpc-sect-4210.html
21 California State Board of Pharmacy. (2019, July

2). License Type Totals. Retrieved from
https://www.pharmacy.ca.gov/about/license tota
Lshtml

22 U.S. Bureau of Labor Statistics. (2019,
September 4). Pharmacists : Occupational Outlook
Handbook. Retrieved from
https://www.bls.gov/ooh/healthcare/pharmacist
s.htm#tab-1

23 Health Resources & Services Administration,
National Center for Health Workforce Analysis.
(2018). Allied Health Workforce Projections, 2016-
2030: Pharmacists. Retrieved from
https://bhw.hrsa.gov/sites/default/files /bhw/nc
hwa/projections /pharmacists-2016-2030.pdf

24 Employment Development Department, State of
California. (n.d.). Detailed Guide for Pharmacists in
California. Retrieved from
https://www.labormarketinfo.edd.ca.gov/OccGui

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des/Detail.aspx?Soccode=291051&Geography=06
01000000.

25 Employment Development Department, State of
California. (n.d.). Detailed Guide for Pharmacy
Technicians in California. Retrieved from

https://labormarketinfo.edd.ca.gov/OccGuides/D

etail.aspx?Soccode=292052&Geography=0601000
000

26 American Association of Colleges of Pharmacy,
Pharmacy Workforce Center. (2018). Pharmacist
Demand Indicator (PDI) Summary Report, Fourth
Quarter (December) 2018. Retrieved from
https://pharmacymanpower.com/archive/Summ
aryReport201804.pdf

27 SB 493. Sess. 2013-2014. (Cal 2013). Retrieved
from
https://leginfo.legislature.ca.gov/faces/billTextCli
ent.xhtml?bill id=201320140SB493

28 AB 401. Sess. 2013-2014. (Cal 2013). Retrieved
from
https://leginfo.legislature.ca.gov/faces/billTextCli
ent.xhtml?bill id=201720180AB401

29 SB 159. Sess. 2019-2020. (Cal 2019). Retrieved
from
https://leginfo.legislature.ca.gov/faces/billTextCli
ent.xhtml?bill id=201920200SB159

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