The shortage of available pharmacists that has plagued hospitals, home-health agencies, community clinics, and retail pharmacies here for years hasnt run its course yet, but steps are being taken to ease the pain.


Larry Bettesworth, director of Sacred Heart Medical Centers pharmacy department, says that while Sacred Heart, like many hospitals nationwide, has struggled to fill positions, its challenge is nothing compared with the recruitment problems faced by hospitals in nearby rural communities.


To help combat those recruiting difficulties, Sacred Heart plans this summer to begin a pilot program with Othello Community Hospital, in Othello, Wash., to test a new prescription-dispensing system.


Through the program, which will use Inland Northwest Health Services TeleHealth communications system, a physician will prescribe a medication for a patient at the Othello hospital, Bettesworth says. A nurse in Othello will enter that prescription into a computer system thats linked with the INHS system here, then send that order electronically to a pharmacist at Sacred Heart, and fax a copy of the prescription. The pharmacist here will verify the prescription, will check the patients medical history to ensure that he or she isnt allergic to the drug or isnt taking another medication that might interact with the prescribed drug, then will OK the prescription for dispensing. That approval will be sent electronically to an automated, computerized drug-dispensing device at the Othello hospital, where a nurse will retrieve the dispensed drug dosage from the device for the patient, Bettesworth says.


The hospital in Chewelah already has said its interested in participating in the program if it succeeds, Bettesworth says. Im sure theres at least another five or six rural hospitals that probably would be interested.


Meanwhile, Washington State University has asked the Legislature to increase enrollment in its College of Pharmacy to 90 students a year from 75. While the ability to school more pharmacists would help somewhat with the shortage, its still a longer-term solution since the enrollment increase, if approved, wouldnt go into effect until fall 2002, says Dennis Clifton, a professor at WSUs College of Pharmacy here. Then, it would take another four years for those students to graduate and enter the work force, he says.


Employers paying premium


In the meantime, all sectors of the health-care industry here are scrambling to find pharmacistsand many employers are paying a premium.


David A. Sclar, chairman of WSUs department of pharmacy practice, says pharmacists salaries have increased an average of at least 5 percent a year over the last five years, which is well ahead of the pace of inflation.


Clifton says that nearly all of the students who will be graduating from WSUs pharmacy program this May already have secured jobs, and most of them can expect to earn between $50,000 and $75,000 a year when they start. Also, a number of employers are offering graduates sign-on bonuses.


Its unclear how many pharmacy positions currently are open in the Spokane-area, but the most recent Sunday classified section of The Spokesman-Review daily newspaper advertised at least 17 pharmacy-related positions. Holy Family Hospital, in Spokane, and Whitman Hospital & Medical Center, in Colfax, each ran one of the classified ads, as did Group Health Cooperative, Tidymans LLC, Costco Wholesale Corp., Merck-Medco Rx Services, and Albertsons Inc.


Theres definitely a sizable shortage, says Mike Racine, Tidymans vice president of sales and marketing. Were certainly looking for good pharmacists.


Tidymans currently has two pharmacy manager positions open and two part-time pharmacists positions open, says Racine. One of the pharmacy manager positions, which is for Tidymans store on Cedar, has been vacant for two months, but Racine says he expects to fill all four of Tidymans vacant positions within the next two weeks. All of the applicants hes interviewing, however, currently are employed elsewhere here, which means that if four of them accept the new positions that will create other vacancies in the Spokane market.


Tidymans is offering its pharmacy managers a $5,000 sign-on bonus and an hourly salary of up to $36.50 an hour, or $1,460 for a 40-hour week.


Safeway Inc., which currently is advertising for pharmacists in Spokane and elsewhere in Washington on hotjobs.com, the job recruitment Web site, says its offering employees a $5,000 sign-on bonus, a relocation plan, a stock-option plan, annual bonus plans, family-assistance programs, and enrollment in a company-funded pension plan, among other benefits.


Sacred Hearts Bettesworth says the hospitals pharmacy department, which employs about 35 pharmacists and 35 pharmacy technicians who are licensed and have completed a six-month to 12-month program, currently has three pharmacists positions vacant. To help it recruit workers, the hospitals human resources department is considering helping new pharmacists pay off school-related debt, he says.


WSUs Clifton says that some companies even are approaching students while theyre still in school and offering to pay part of their tuition if they agree to come work for a certain amount of time once they graduate.


Multifaceted causes


The cause of the shortage is multifaceted, Bettesworth says. He says that the nations aging population is contributing to the shortage because as people are getting older theyre needing more prescription drugs, which means theres an increased need for pharmacists to fill those prescriptions.


Pharmaceuticals also are becoming more complex, which means that pharmacists must spend more time helping patients to ensure that theyre taking their medications properly and are using their medical devices correctly, WSUs Sclar says.


Also, pharmacy colleges have changed their curricula from a 5-year bachelors of science in pharmacy to a 6-year doctorate of pharmacy, which has created a significant short-term decrease in the number of pharmacists who are graduating, Bettesworth says. He says that as colleges across the U.S. have been switching from 5-year to 6-year programs, that has meant one year of transition when each college graduates relatively few or no students.


Another wrinkle in the shortage is that between 50 percent and 60 percent of students who are graduating from pharmacy colleges are women.


Dont get me wrong, these women are excellent practitioners, Bettesworth says. But, many also would like to have families, and they want to take three months or longer for maternity leave. I have three pharmacists on maternity leave right now, and it creates a short-term shortage in the midst of a longer-term shortage. Some employees also prefer to work fewer hours once they return from maternity leave, he says.


Meanwhile, during the last five years, pharmacists roles also have been changing. Bettesworth says that pharmacists employed by hospitals no longer are involved just in dispensing medications in hospital pharmacies, but also take part in clinical activities, such as working on the patient floor with physicians, nurses, and patients to help monitor drug therapies. They also manage anticoagulation and cholesterol clinics to help outpatients monitor blood-thinning or cholesterol medications.


It used to be that physicians and nurses would regularly check a patients cholesterol levels and perform routine blood tests to help manage their drug therapies, but doctors offices are becoming inundated now, and the monitoring of drug therapy is a natural progression for the pharmacist, Bettesworth says.


We still need pharmacists for traditional, drug-dispensing services, but they also are needed to handle these expanded services, he says.


To help free up some time for pharmacists, hospitals such as Sacred Heart have been moving toward more automated systems and relying more on pharmacy technicians to set up medications and count pills for the pharmacists. Pharmacy techs previously had spent their time typing prescription labels primarily, Bettesworth says.


Within the last two years, Sacred Heart also has installed automated drug-dispensing devices and automated mixing machines that prepare total parenteral nutrition (TPN) liquid diets given intravenously to patients who cant eat solid foods.


Bettesworth says that he expects retail pharmacies also to begin adding more automated systems to help weather the shortage.


In my estimation, its going to be 10 years at the very least before theres going to be any resolution to this shortage problem, Bettesworth says.