Let pharmacists not become worthless
The value of pharmacists will depend on what users of their services think they are worth. For that reason it is essential that pharmacists do not sell themselves cheaply.
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The oversupply of pharmacists has recently become a hot topic that has overtaken other important issues in UK pharmacy practice. I have read several articles and letters in The Pharmaceutical Journal proffering solutions to the pharmacist supply problem. I remember my first economics lesson, in the first year of secondary school education, on the effect of supply and demand on prices of commodities, and how these three variables can be adjusted to bring about a stable and sustainable market. Is there anything we can learn from economics that will help us find a workable solution to the present challenge of the oversupply of pharmacists? I believe there is, even though some critics might want to complicate things by arguing that the problem has gone beyond the simple logic of supply and demand.
Flooding the market
Having grown up in a country where the leaders thought the mismanagement of public funds could be tackled by flooding the global market with its huge reserve of crude oil, I could not avoid learning a new acronym at a young age: “OPEC”, which was often mentioned as the reason the country was struggling to pay off its colossal debt to international creditors. OPEC, the Organisation of the Petroleum Exporting Countries, helped to set quotas for crude oil export from member countries. The demand of the developed nations for petroleum meant it strongly influenced the price of crude oil, preventing this price from dropping to zero as a result of the oversaturation of the market.
Many, including myself, have always wondered why we needed a restricting organisation like OPEC. We wonder why OPEC does not allow individual nations to the flood the market with crude oil if they wish to do so under a free market policy. Something similar has been recently suggested by some commentators regarding the supply of pharmacists in the UK. But it is naive to think that such a suggestion will not eventually hurt both the producing and the consuming markets because, when it comes to, for example, the stability of the oil market (similar to medicines, cocoa, etc), the destinies of both consumers and producers are intertwined. Although OPEC members own the petroleum resources, their members often lack the technological know-how to drill and refine crude oil into finished products, and so they depend heavily on shareholder-financed companies such as BP, Shell, Agip and Mobile, to make the finished petroleum products available to end users. Some nations have tried to beat the system by flooding the market with extra, unallocated crude oil through the back door. When caught, they have been sanctioned or even suspended from membership of OPEC.
So what can pharmacy learn from OPEC, in addition to the economic principles of supply and demand, to ensure that the value of pharmacists does not drop to zero? As we read in Fayaz Ahmedali’s letter (PJ, 21/28 December 2013, p633), pharmacists are “a dime a dozen” in Canada, and some preregistration trainees are working for no salary. What Mr Ahmedali did not know, however, is that the same thing has been happening for a long time in the US. So it should not surprise anyone if this happens one day in the UK. Interestingly, while organisations such as the Pharmacists’ Defence Association (PDA) have been calling for stricter control of pharmacy student numbers in the UK to match the number of preregistration places available, at the same time the PDA has come to the same realisation as I have (PJ 2012;289:627 and 2013;290:301), which is that a greater demand for pharmacists needs to be created to keep the UK pharmacy system dynamic.
I have suggested that adopting the undergraduate clinical pharmacy PharmD programme, as run in the US and France, or running a dual pharmacy degree programme (eg, MPharm or PharmD with a master of public health or master of business administration degree), could help enhance demand for pharmacists in the UK (PJ 2006;277:100 and 2011;286:618).
The PDA has partly enhanced demand for pharmacists by negotiating an innovative arrangement in Scotland to allow individual pharmacists to provide pharmaceutical care services without the need to own pharmacies. This could save lives, enable pharmacists to practise what they have learnt in pharmacy schools, save money for the Government by reducing overhead costs and middlemen, and help to stabilise or even enhance the worth and morale of pharmacists.
Recently, there have been several calls by UK medical bodies for individual pharmacists to work closely with doctors to help reduce the public’s demand for GPs and accident and emergency services. However, there has never been enough clinical specialist pharmacists, leaving a huge gap in the pharmacy market, and many UK pharmacy schools may be unaware of this. The situation is worsened by the fact that many UK pharmacy schools are in departments and faculties affiliated to science and engineering, rather than in medical colleges. Again, it is probably more cost-effective to integrate clinical pharmacy training within the undergraduate pharmacy degree (PJ 2011;286:524) rather than relying only on the present hospital postgraduate clinical pharmacy diploma programmes, which are often limited in intake.
Many UK universities will always want to have pharmacy programmes under their roof, as well as the ability to accommodate as many pharmacy students as possible; after all, there is huge demand from students in China, India, Malaysia and many other countries around the world. Foreign students, unlike their British counterparts, do not have to take student loans which might never be repaid due to poor remuneration or joblessness. Although many of these overseas students will eventually go back to their host nations, others may also stay behind in the UK, owing to changes in their circumstances (eg, jobs, marriage). It is employers of pharmacists that will benefit most from such eventualities.
Risky and unworthy
Returning to my economic principle of supply and demand, pharmacist remuneration will soon equal or even go below that paid to technicians. The gap between the training of both professional groups is often far apart, in terms of rigour and duration. Everyone will eventually become a loser, as many pharmacists, as well as technicians, may soon end up unemployed. Becoming a pharmacist may soon be earmarked as unworthy, as risky or even as a not-too-good return on investment. This has happened in many groups such as librarians, professional typists, travel agents, switchboard operators, on-air disc jockeys, etc.
To avoid this happening to pharmacists, we must act swiftly by adapting, reinventing the profession, and restudying our first economics lessons on supply and demand, as well as the impact these have on prices. The value that end-users place on pharmacists will depend on how much they think pharmacists are worth. Let us not help them further by making ourselves available more cheaply than is necessary.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065343
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