Planning and Evaluation in Health Workforce Development: Projection for the Pharmacy Workforce in Taiwan Yu-Hung Changa,b, Ming Neng Shiuc, Chao A. Hsiunga
a Institute of Population Health Sciences, National Health Research Institutes, Taiwan b Department of Public Health, China Medical University, Taiwan
c Ministry of Health and Welfare, Executive Yuan, Taiwan
Author to whom correspondence and requests for reprints should be sent: Professor Chao A. Hsiung,
Institute of Population Health Sciences, National Health Research Institutes, Taiwan, 35 Keyan Road, Zhunan, Miaoli County, Taiwan 350
Tel: +886 37 246166 Fax: +886 37 586261 Email: hsiung@nhri.org.tw
Running title: Projection for Pharmacy Workforce in Taiwan
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Shortage of Pharmacy Workforce
Shortages and imbalances of human resources for health (HRH) are a major crisis in numerous countries across all health professions.1 For tackling the workforce crisis, solid information, reliable research, and firm knowledge are required to form effective policies and actions. In the 2006 World Health Report, a “worker-lifespan approach” was suggested to strengthen policy strategies in preparing the workforce, enhancing performance, and managing attrition and migration.2 An integrated view of each stage of a professional career is necessary in the management and development of human resources of the health professions.
Being a major HRH, the pharmacy workforce has experienced a shortage and distributional imbalance in developing and developed countries.3 In Taiwan, the pharmacy workforce, including pharmacists and pharmaceutical assistants, has experienced significant growth over the past two decades. The ratio of current pharmacy workforce to population increased from 8.8 per 10,000 in 1990 to 14.0 per 10,000 in 2010, which is higher than that of most Organization for Economic Co-operation and Development (OECD) countries.3,4 However, the present proportion in the total supply of the pharmacy workforce does not necessarily meet an adequate workforce in the future because an aging workforce and aging population can cause 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
fluctuations in workforce supply and demand.
Task Force for Projection of Pharmacy Workforce
For evidence-informed decision making, a cooperative framework between
policymakers and researchers is necessary to form a policy or action in HRH. Since 2010, the National Health Research Institutes and the Bureau of Medical Affairs, Department of Health, has been coupled to conduct a series of studies to forecast the health workforce for various health professions. The pharmacy workforce was targeted for the first year. This study is composed of two parts: First, a task force, including stakeholders, such as government representatives, faculties from the pharmacology departments in universities, clinical and managerial pharmacists working in hospitals, and representatives of the pharmacist association, was organized to outline a plan and discuss the following issues: clarify the main purpose; detail policy and practice environment, frame the scope of the research, confirm the
approach, offer access to databases, provide the required parameters, and contribute to interpreting and reviewing the results. The second part formed a projection team, mainly composed of NHRI’s researchers to be in charge of data collection, analysis, and presenting and interpreting the results. The task force and projection team
regularly interacted with each other. The main purpose of the projection is to forecast
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whether shortages or excesses will exist in the pharmacy workforce in the coming decade: 2011-2020. On the supply side, the inventory model was introduced, and entrant and attrition flows of the workforce were estimated using the official registration data of medical practitioners.5 Sensitivity analysis for six scenarios was provided to assess the effects of new entrants, attrition, or returner flows on the results. As far as demand is concerned, clinical pharmacists (CPs) and non-clinical pharmacists (NCPs) were considered separately. The demand for CPs was estimated by forecasting the future volume of pharmaceutical care based on the National Health Insurance Research Database (NHID) and the official population projections. The demand for NCPs was modeled on the time trend of national medical expenditures spent on OTC drugs in drug stores.
Supply, Demands, and Their Determinants of Pharmaceutical Works
The projection indicated that the supply of pharmaceutical workers will be 35,635 by 2020. The demand for CPs and NCPs was 28,246 and 8,075, totaling 36,321.
Sensitivity analysis was used to examine the effectiveness of workforce development strategies in managing entrants, retention, and attrition of the workforce. The attrition rate is the predominant factor for determining supply: a 1% decrease in attrition flow will lead to a 0.45% increase in supply by 2020 (equivalent to 161 pharmacists), 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81
followed by a returning workforce (0.32% increase, or 115 pharmacists), outstripping new entrants (0.26% increase, or 94 pharmacists). Supply is exceeding demand until 2018; a 0.2% to 2.8% shortage, comparing supply and demand, will occur by 2020. How to control attrition might be the most crucial and urgent issue in the development of the pharmacy workforce in the coming decade.
A demographic transition of the pharmacy workforce will occur in the next decade. More than 13% of the workforce will be supplied by pharmacists aged 65 years and older in 2020 compared that of 6% in 2010. According to the registration data between 2001 and 2010, pharmacists aged 50 years and over tend to practice in community pharmacies (36.9%) and retailer, academic, or industrial (30.3%), and younger pharmacists tend to work more in hospitals (28.9%) and community
pharmacies (28.0%). The increasing supply of female pharmacists, especially among the workforce aged less than 40 years, will contribute 60.6% of the younger
workforce by 2020. Female health care professionals were thought to have lower labor force participation during their childbearing years because of their traditional familial roles.6 The supply projection, however, suggested lower attrition rates for female pharmacists than men among the workforce aged less than 50 years.
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Limitation
The demand projection was developed based on current utilizations and practice patterns, which may not consider the potential changes of pharmacists’ roles in the future. Because the population is aging and older adults tend to use multiple drugs,7 pharmacists may be required to offer patient counseling, disease management, and adverse effect assessment for older adults with multiple chronic conditions.8 Beside clinical service, hospital-based health professionals are responsible for teaching and research,9 which raises additional demand for hospital pharmacists. A growth in research positions in the industrial or academic sector involved in clinical or translational research may also occur to develop new treatment or biotechnology.10 These two causes, which were not fully captured in the projection, might offer more opportunities in the pharmacy profession in the future.
This workforce projection, bridging the gap between policy making and research evidences, provided the understanding of and the insight into future scenarios. It also calls for actions to reduce attrition and to augment retention of pharmaceutical workers. This requires collaborative efforts and knowledge inputs of policy makers, researchers and stakeholders to review policy options and to develop evidence-based workforce strategies. The present projection reflects what occurred in the past onto 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119
the long-term future. Its assumptions should be regularly reviewed, and the outcomes should be repeatedly updated by the national plans for the pharmaceutical human resources. 7 120 121 122 123 13
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now_fod_list_no=11622&class_no=440&level_no=3. Accessed January 30, 2013.
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